White armor

Chapter 410 Nothing Happened Because Not Enough Surgery Was Performed

"What's wrong, Xiao Zeng?" Wang Guohua asked.

"Director Guohua, the patient's PETCO2 has suddenly risen to 58mmHg. It's okay. Just do your job and give him two breaths of pure oxygen."

Is that true?
Wang Guohua's hand gradually stopped.

He tried to recall every detail from the moment the patient lay on the operating table.

From anesthesia to surgery, they went through it quickly, but Wang Guohua didn't find any problems. Everything was very standard. At least with his technical level, he didn't find anything that was not taken care of.

The patient's preoperative lung function test was also normal, so it should not be caused by geriatric disease.

So why?
Wang Guohua looked at the anesthesiologist, who had already switched to pure oxygen inhalation and manual assisted ventilation to speed up the excretion of CO2.

A few minutes later, the anesthesiologist drew an arterial blood gas analysis.

pH7.174, PaCO286mmHg, PaO2144mmHg, K+4.03mmol/L, HCO-330.9mmol/L, BE0.21mmol/L, Lac1.2mmol/L.

The operating room is really different now than before. Indicators like blood gas analysis can produce results in just a few minutes. Wang Guohua was worried and sighed in his heart.

When I was young, the anesthesiologists I worked for didn’t have such good conditions.

At that time, general anesthesia did not even have a ventilator, and the anesthesiologist had to hold the ball throughout the whole process, which was a very strenuous job.

After performing an operation, the anesthesiologist was so tired that he had cramps.

"Director Guohua, why don't we suspend the operation? The patient's carbon dioxide partial pressure is still high."

Wang Guohua did not say no, but followed the advice of anesthesia doctor Zeng to stop pneumoperitoneum.

"Xiao Zeng, what's going on?"

"I don't know. It may be a transient reaction. I have never seen a similar situation before," the anesthesiologist replied.

Wang Guohua was silent.

He had some experience with anesthesia because he had seen it so many times, but when it came to the deeper content, Wang Guohua was a little confused and began to grope in the dark.

Wait a moment.

Wang Guohua is quick to accept advice.

It's a major operation anyway, so a pause of ten or twenty minutes in the middle doesn't matter.

"Xiao Zeng, have you ever encountered similar situations before?" Wang Guohua asked.

"Well, I haven't encountered that." The anesthesiologist replied.

"How long do we have to wait?"

The anesthesiologist didn't say anything, but just lowered his head silently.

Wang Guohua also knew that this kind of thing depended on the situation, and no one could be absolutely sure of the exact minute or second.

The atmosphere in the operating room was a bit depressing, and Wang Guohua started chatting.

We can't just not talk to each other face to face, so we can chat while waiting to avoid being too nervous during the operation and causing technical errors.

After all, Wang Guohua is an old hand, and he has mastered the art of judging the scale in this regard.

"Xiao Zeng, how are you now?"

"It's okay, as long as I don't do too heavy work. The director also takes good care of me and doesn't arrange night shift emergency rescue for me." The anesthesiologist smiled.

When he was a child, he was walking on the roadside and encountered a truck carrying steel pipes from a mining area. The truck braked suddenly, and a steel pipe flew out and hit Dr. Zeng's stomach, rupturing his liver.

The operation was performed by Wang Guohua at that time. One third of the liver was removed. The mining area also organized people to donate blood.

After all, the mining area is a state-owned enterprise, so it is much easier and more open to deal with such things than with private individuals.

After paying all medical expenses, blood transfusion fees, nutrition and other expenses, the leader gave two suggestions - one was to wait for Dr. Zeng to grow up and work in an office directly in the mining area, and the other was to give him a sum of money.

Dr. Zeng's family had high expectations for him, so he chose the latter.

When Wang Guohua learned about this, he felt a little resentful.

But I didn't expect that one day when I was performing laparoscopic-assisted transanal total mesorectal excision under general anesthesia, I would mention my former "patient".

This can also be considered a kind of fate.

"Yes, emergency department is really exhausting. You anesthesiologists may look relaxed, but you are actually exhausted. Several anesthesiologists have died from exhaustion in recent years. You better be careful."

"Alas, I'm on a pirate ship." The anesthesiologist sighed, "The last time I performed surgery, the anesthesiologist was there with me all the time, Director Guohua, you know. I was young at that time and was deceived. Who knew that being an anesthesiologist is so tiring."

Wang Guohua smiled.

Tired, that is for responsible doctors. For doctors who are lazy, it is not that tiring.

This job is a matter of conscience.

After 10 minutes of small talk, the anesthesiologist said, "Director Guohua, the carbon dioxide partial pressure has dropped. Please continue to breathe."

Wang Guohua's originally nervous mood suddenly relaxed a lot. He breathed a sigh of relief in his heart, but he didn't show it.

When performing surgery, especially difficult surgery, you need a steady hand.

I was panicking, and everyone from top to bottom was panicking. Even small operations that seemed simple at ordinary times became difficult.

"I said it's okay." Wang Guohua's voice was as loud as a bell, and he glanced at the people from the medical department sitting in the corner of the operating room.

Wang Guohua knew that he was here to watch him perform the operation, but since he said nothing and did nothing, he couldn't just chase him away.

Besides, they came here under the banner of promoting general surgery, so it would be inconvenient for me to chase them away.

"dududu~~~"

“Beep, beep, beep~~~”

Suddenly the alarm sounds became more and more crazy.

"What's going on!" Wang Guohua was horrified, his voice was heavy and buzzing in the operating room.

But his voice could not drown out the alarm of the monitor, which was sharp and loud, striking people's hearts.

The anesthesiologist didn't say anything. He picked up a tube of medicine with one hand, pressed his thumb on it to break it apart, and with his other hand held the syringe and began to concentrate on drawing the medicine.

The monitored arterial pressure dropped to 78/47 mmHg and the central venous pressure rose to 31 cmH2O.

Wang Guohua's head buzzed when he saw it.

Bleeding?
As soon as the thought came to his mind, Wang Guohua denied it.

This is not the case with hemorrhagic shock; it must be some other problem.

Unless it hits a large artery such as the abdominal aorta, the blood pressure will drop gradually. There is no reason for it to drop off a cliff.

But what was going on? Wang Guohua was a little confused.

He boasted that he was extremely skilled in laparoscopic surgery and could perform various surgeries smoothly, including those with severe adhesions.

That's why Wang Guohua dared to perform such a difficult operation.

But Wang Guohua had never seen such a situation before. What was going on? !

The carbon dioxide partial pressure was a bit high before, but after waiting for 10 minutes, it returned to normal, and the anesthesiologist also confirmed this.

How come the arterial blood pressure drops so suddenly when you pump air into it?

"Xiao Zeng, what did you give?" Wang Guohua pretended to be calm and asked the anesthesiologist.

“Ephedrine.”

However, the anesthesiologist opened the three-way valve and injected 12 mg of ephedrine, but there was no obvious change in blood pressure and heart rate.

"Director Guohua, I will perform cardiopulmonary resuscitation." The anesthesiologist said in a deep voice.

He opened the sterile sheet covering his chest, used the standard CPR hand position, stepped on a footstool, and immediately performed cardiopulmonary resuscitation.

"Adrenaline, 1mg!" Wang Guohua shouted loudly.

The nurse immediately injected 1 mg of epinephrine intravenously through the central venous catheter.

Wang Guohua was only rescuing the patient based on instinct; he had no idea what the cause of the illness was.

If you don’t know the cause, you can only treat the symptoms.

Epinephrine, new triple, renal triple, hormones, these drugs are all useful, but Wang Guohua is not sure to what extent. He just hopes that the patient can be stronger.

It is a bit absurd to pin hopes on the patient's horoscope at this time, but... who else can Wang Guohua rely on?

But the reality is completely opposite to what Wang Guohua hoped.

In less than a minute, ventricular fibrillation appeared on the electrocardiogram.

It seems that the patient's fortune is average.

"Prepare the defibrillator!" The anesthesiologist's voice was shaking and he was extremely nervous.

"How much energy?" the nurse asked as she prepared.

"Asynchronous defibrillation, bidirectional wave 200J!" A familiar voice came.

The airtight door of the operating room opened a crack, and Luo Hao, wearing a mask, walked in sideways.

"Luo..."

"Keep doing chest compressions. I'll do it."

Luo Hao completely ignored Wang Guohua. After saying something to the anesthesiologist, he held the defibrillator in both hands, applied coupling agent and rubbed them against each other. Luo Hao winked at the anesthesiologist.

The anesthesiologist took his hand away.

"Bang~~~"

The patient's body trembled.

Another figure pushed the anesthesiologist down and said, "Brother Zeng, you push the medicine and I'll do the compression."

It’s Chen Yong!
When the anesthesiologist saw Luo Hao and Chen Yong come in, he almost cried.

A strong sense of security lingers in my heart.

"Bang~"

After the second defibrillation, the ventricular fibrillation disappeared. Chen Yong didn't say much. As Luo Hao took away the defibrillator, he began to press.

"Nicardipine 1mg, IV push."

"Epinephrine, 1mg, IV."

"Dexamethasone, 10 mg, IV push."

Luo Hao kept giving medical instructions, and the anesthesiologist pushed the medicine into the tube as quickly as possible.

Fortunately, Wang Guohua was well prepared before the operation. He even monitored the central venous pressure and administered the medicine very quickly.

"Position: adjust to left-lying position."

"Ice cap, do you have one? Put it on the patient quickly. Run! Faster!"

"Nicardipine 1mg, IV push!"

Luo Hao stood in front of the patient, holding the defibrillator in both hands, observing the various numbers on the ventilator and monitor, and constantly giving medical instructions.

7 minutes passed in the blink of an eye.

The patient finally recovered his spontaneous heart rate.

But this is only temporary, and the patient may have problems again at any time.

"Take a blood test and give me 5ml of 250% sodium bicarbonate."

"50ml syringe."

Luo Hao stretched out his hand, but his hand fell empty.

Oh, this is not Union Hospital, Luo Hao felt a little regretful. Turning around, he took a pair of No. 8 sterile gloves, tore them open and put them on.

The anesthesiologist just tore open the outer packaging of the 50ml syringe and handed it to Luo Hao.

After connecting the central venous catheter, Luo Hao paused for a moment, then pulled the catheter out 1 cm.

What is he doing?
Wang Guohua was wearing sterile clothes, his gloves were covered in blood, and he stared at Luo Hao in a daze.

The dark red blood was drawn out, along with a large number of bubbles.

bubble?

bubble!

Wang Guohua suddenly thought that the patient’s financial situation might be caused by carbon dioxide.

But he had performed thousands of laparoscopic surgeries, and had never experienced the accident of air embolism caused by pneumoperitoneum as mentioned in the paper.

After all, it is a rare situation, so how can you say that you will always encounter it?

If air embolism were a common occurrence during laparoscopic surgery, the procedure would have been discontinued long ago.

What a damn bad luck, Wang Guohua thought to himself.

It must be Lin Yuming who came from the Medical Department to "supervise" his staff, but where are Luo Hao and Chen Yong? Why did they appear together? !

Could it be that Lin Yuming guessed that something would happen today?
While Wang Guohua was in a daze, Luo Hao had already drawn out about 50ml of blood foam with a 150ml syringe.

"Recorded, approximately 150 ml of blood containing a large number of bubbles was withdrawn through the central venous catheter, of which approximately 100 ml was gas."

There was silence in the operating room.

"Brother Zeng?" Luo Hao tilted his head.

"Ah? Is this an air embolism?" asked the anesthesiologist.

"Well, it's air embolism caused by establishing pneumoperitoneum. Remember what I just said." Luo Hao's tone was no longer as anxious as it was during the previous rescue, and became much gentler.

"Oh oh oh." The anesthesiologist quickly took notes.

Wang Guohua's face looked extremely ugly.

He thought Luo Hao was targeting him.

"Director Guohua, don't worry, it's just a normal complication." Luo Hao looked at Wang Guohua and explained gently, "I checked the electronic medical record, and it's written in the preoperative instructions. The patient is fine, observe for 30 minutes, and then go for surgery."

Although Luo Hao's tone was gentle, it was full of the authority of a senior doctor, especially the last sentence about switching to surgery, which was not a question, nor was it discussed with Wang Guohua, but rather... a notification.

"Xiao Luo..." Wang Guohua felt a little embarrassed and wanted to say something, but he didn't know where to start for a moment.

"It's okay, Director Guohua. Similar situations will occur if you do too many surgeries." Luo Hao smiled, "Observe for half an hour. If there is no problem, go and explain to the patient's family. The hospital will not worry about this."

“……”Wang Guohua was silent.

But behind Luo Hao was Lin Yuming.

"Luo Hao, please contact your medical department. I will send a letter for an emergency consultation during the operation. Are there any other procedures required?" Lin Yuming asked.

"That's enough. There are no other formalities. I'll contact Director Feng, and you can connect with Director Feng."

"President Lin." Wang Guohua stepped forward subconsciously.

"Director Guohua, air embolism is fatal." Lin Yuming complained.

"But fortunately, Director Guohua made careful preparations and prepared a central venous catheter. Otherwise, it would have taken another two minutes to insert the tube and draw out the air," Luo Hao added.

The father and son, one plays the good guy and the other plays the bad guy, both are so skilled and I don't know how much time they have spent on this.

Wang Guohua had long known the working styles of Lin Yuming and Luo Hao. What he cared about was not the good cop and the bad cop, but what Luo Hao said - delay for two minutes.

Just two minutes?
Wang Guohua was a little confused.

"Luo Hao, are you really okay? Are you sure?" Lin Yuming asked.

"Well, we couldn't draw out the air later, about 100ml. Now the vital signs are stable, observe for half an hour, and then we can operate." Luo Hao said easily, "Don't worry, you can see that the patient's vital signs are stable now."

“How about observing for a while longer?” Lin Yuming was still feeling a lingering fear.

Lin Yuming almost had a heart attack when he first received the call from the clerk.

It has been a long time since the mine had an experience of a patient dying on the operating table, and Lin Yuming still thinks like the old medical director, that human life is the most important.

They are on different wavelengths from those hospital leaders who have never worked in clinical practice.

"Director Lin." Luo Hao smiled. In front of others, he and Lin Yuming spoke more formally. "Normally, air embolism caused by pneumoperitoneum will cause bleeding. According to Director Guohua's surgical procedure, I estimate that it may be venous bleeding.

Although it is only a vein, if the bleeding lasts for a long time, it will cause more troubles.”

Lin Yuming nodded. He left the professional matters to Luo Hao. He just asked a few questions. These words were mostly spoken to Wang Guohua.

Wang Guohua was silent.

Looking at the mess on the ground, I felt inexplicably sad.

I had carefully prepared an operation, hoping to create a new surgical procedure for the Donglian Mine, but I didn't expect it to end up in such a mess.

"Brother Ni, this is the operating doctor." Luo Hao then greeted the operating doctor.

Doctor Ni was so frightened that he was still in a trance. When he heard Luo Hao talking to him, he forced a smile and narrowed his eyes.

"Xiao Luo, your rescue skills are really high. Air embolism, that's air embolism." Doctor Ni exclaimed.

"Haha, what a coincidence."

"I remember that when you were a clerk, you occasionally came to the operating room and helped deal with an orthopedic accident."

"It's just a coincidence." Luo Hao said it was a coincidence for the second time.

Really?
Neither Dr. Ni nor Wang Guohua thinks so.

Once was a coincidence, twice or something?
Facts have proved that this was because Luo Hao's level was high, just like the rescue of air embolism today.

Otherwise there is no way to explain it.

Dr. Ni was silent and looked at Wang Guohua. He had something to say, but now Wang Guohua's voice was the only one in the department.

"Director Guohua, take a rest." Luo Hao turned around and moved the big white stool nicknamed "White Dragon Horse" to Wang Guohua, just like an ordinary doctor who was trying to flatter.

"It's a small problem. Similar situations will be fine once they are over. We have gained experience this time, so we will have experience if we encounter them again in the future."

"Again?" Wang Guohua smiled bitterly. Fear was already forming in his heart and he absolutely did not want to get involved.

Do what you can, and if you can't, let the patient go to a higher-level hospital. He is over 60 years old, why make him so nervous?

If the patient dies on the operating table, wouldn't that be asking for trouble?

"Oh, nothing went wrong because I didn't do enough surgeries. As long as the number of surgeries is large enough, something will go wrong. It's unavoidable anywhere, not even my Union Hospital."

Chen Yong looked up and then turned his head away.

"Hey, I'm not used to it. My 912 doesn't work either." Luo Hao changed his words, but it still felt awkward.

"You went to 912?" Wang Guohua was stunned.

"Not yet. We have to wait for the bamboo project to be completed, which will take three or four years."

3 or 4 years may sound like a long time, but in fact it’s just a blink of an eye.

As for what level of doctor Luo Hao would be, Wang Guohua didn't even dare to think about it.

A full professor at Peking Union Medical College did not return to Peking Union Medical College but went to 912. The conditions offered were not good, so what fool would go there?

Luo Hao asked Wang Guohua to sit down, and he returned to the patient's head, staring at the various values ​​without blinking.

Fortunately, Wang Guohua had all kinds of supervision in place before the operation and was extremely well prepared. For this kind of operation, he even monitored the central venous pressure, which was a bit excessive.

But it made rescue easier.

It seems that Wang Guohua's level is average, but his luck is really good, Luo Hao thought to himself.

"Xiao Luo, are you already a professor at the First Hospital of Medical University?" asked Dr. Ni.

Luo Hao nodded.

Dr. Ni was envious, but seeing that Luo Hao didn't say anything, he didn't continue asking.

At this time last year, Luo Hao was still working as a clerk in the mine headquarters, but this year he has become an expert. It looks like he will have to go on stage to stop bleeding and perform surgery soon.

I don't know what Ronaldinho's level is.

"Xiao Luo, you can come up later." Wang Guohua asked the question that was in Dr. Ni's mind.

"Okay, I'll go up and take a look." Luo Hao said with a smile.

"What do you think is the problem?"

"100ml of air was extracted. It should not be an artery. It should be a vein, and a venous plexus. It bled during the stripping. It is temporarily considered to be the venous plexus near the prostate."

Doctor Ni lowered his head and didn't dare to say a word.

The anal examination was done by Director Wang Guohua. The prostatic venous plexus ruptured and bled, so Luo Hao's meaning was self-evident.

Is it true or just nitpicking?
Dr. Ni didn't know, but he didn't want to get involved.

Wang Guohua's face turned ugly, but he didn't say anything.

I have just seen the rescue of the patient with air embolism. If Lin Yuming hadn't planted a "nail" next to me, I am afraid that what I would be thinking about now is how to explain to the patient's family.

The best way is to "pretend" that the patient is not dead yet, press all the way, and go to the ICU for more than an hour to rescue him, giving the patient's family time to accept it.

The appearance of Luo Hao changed all this.

The patient's vital signs were stable. Although the operation was suspended, it was just a technical problem. It wouldn't be a big deal if it was delayed by an hour.

Wang Guohua was daydreaming, and Luo Hao continued to comfort him, "Director Guohua, it's okay. It takes time to start something. There will always be discrepancies between imagination and reality. They are definitely not the same."

The operating room was quiet, making Luo Hao's words seem a little awkward.

"Yes." Chen Yong's voice came, "I found something really ridiculous when I went to England."

"Oh? What's the matter?" Luo Hao skillfully picked up Chen Yong's words.

"There was a magician who wanted to commit suicide, so he bought a Locke 17 and shot himself eight times in the head, but he wasn't dead yet."

"Ah?!" Wang Guohua was stunned.

Chen Yong distorted the style of the painting beyond recognition, jumping directly from surgery to suicide. He is still a magician, and still Locke 17.

Wang Guohua didn't know what model of gun the Locke 17 was, but it was nonsense to say that 8 shots couldn't kill a person.

"It was then that I realized that putting a gun to the temple in China was nonsense. If you look at the movies made by the Americans, they all shoot themselves to death; or put a gun to the jaw."

"Yes, according to the trajectory of the bullet, it would hit the brain stem directly, and the death would be painless. If it was the temple... the gun's power was smaller, it might not kill him."

"Yes, yes, yes. Two years ago, our hospital received a patient whose head was pierced by rebar. Dean Lin was the director of the Medical Department at the time and he came to oversee the rescue. Xiao Luo, you were there too," Dr. Ni added.

"Yes, I followed up with the patient after he was discharged from the hospital. His quality of life was guaranteed and he had no problem taking care of himself," said Luo Hao.

Wang Guohua was a little confused and had not yet recovered from the shadow of the rescue for air embolism.

"912 used to send people to the United States every year to learn how to treat gunshot wounds, especially complicated ones. China really has no experience in this. So don't worry, Director Guohua, just do it."

Luo Hao brought the topic back to the topic and comforted Wang Guohua.

Isn't he trying to deceive himself? Wang Guohua was stunned.

"If you have any complicated problems in the future, you can tell me. I will come back to see my mother and uncle during the weekend opening." Luo Hao smiled, "If you don't want the expert consultation fee, I won't go. I will just stand below and watch."

"!!!"

Wang Guohua was speechless.

(End of this chapter)