Chinese medicine: When you do things to the extreme

Chapter 228 Decisiveness and Affirmation (Subscription Request)
Huang Yaqin can be said to have no figure and looks careless, but she is still quite famous in the field of surgery.

Zhou Yanqing could hear all the legends about Lin Yuxuan from her mouth. She should really be the 'Holy Body of Hepatobiliary Surgery'.

Huang Yaqin checked the time, looked at Zhou Yanqing thoughtfully, and then said, "Doctor Zhou, let's go see the patient."

"Teacher Huang, what is the condition of that patient with multiple injuries?" Zhou Yanqing asked quickly!
"He was injured in a car accident. He has multiple injuries all over his body. There are puncture objects in his chest and abdomen. Both upper limbs are partially amputated. I have called the trauma surgery department for a consultation. The chief doctors of thoracic surgery, gastrointestinal surgery, and hepatobiliary surgery have also arrived."

"You are the only one missing." Huang Yaqin said.

"Call me Sister Qin from now on. I'm not used to hearing you call me teacher all the time."

"If it really doesn't work, you can just call me Brother Qin." Huang Yaqin walked quickly, in a hurry.

"Then just call me Sister Qin."

"How is your blood pressure after you came here?" Zhou Yanqing asked again.

"Let's talk about it when we get to the bedside. The chief resident of our department is still on the counter. I have to go over to check out the situation." Huang Yaqin put her hands in her pockets and quickly moved into the gap between the crowd and went into the first rescue area.

Zhou Yanqing also followed in.

Inside, a group of white coats surrounded a bed, and a professor of emergency surgery was giving orders: "The consultation staff, please step back. The patient's blood pressure is unstable and there is a possibility of cardiac arrest at any time."

“ECMO ready at any time!”

"Professor Su Feng is coming from the ICU." Another doctor in a white coat replied.

Artificial membrane lung, also known as ECMO (extracorporeal membrane oxygenation), is an artificial heart-lung machine, mainly used for patients with severe heart and lung failure. It reduces the patient's cardiopulmonary burden by providing continuous extracorporeal oxygenation and circulatory support.

"The emergency CT film has been extracted." Next door, another consulting doctor refreshed the imaging data and quickly replied.

Hearing this, most people moved over.

At the same time, Yan Huanyu from the trauma surgery department was working hard to perform emergency hemostasis and rescue of the large blood vessels at the bedside.

If the patient's limbs are severed, arteries are damaged, and bleeding does not stop, no amount of effort will be needed to maintain his vital signs.

He hunched his body and shook his hands quickly. Suddenly, a column of blood spurted out, rising into the sky, and blood rain sprayed everywhere.

Basically, the people near the bed had no time to dodge and were splashed to varying degrees.

A few drops fell on Zhou Yanqing's mask and the corners of his eyes.

"Call Professor Liang!" Yan Huanyu's voice sounded a little frightened and scared!
But he did not step back. He tried hard to block the opening in the muscle tissue with his right hand, while picking up the hemostat with his right hand to find a blood vessel to clamp it.

His mask was already scarlet, and the arms and back of his white coat were mottled with red spots.

Upon seeing this, Zhou Yanqing simply moved sideways to avoid the position of the emergency nurse next to him. Then, with his right hand, which he had just put on the right glove, he grabbed the hemostatic forceps on the operating panel and reached towards the wound.

Zhou Yanqing's hemostatic forceps and Yan Huanyu's hemostatic forceps reached the patient's wound almost at the same time, but Zhou Yanqing's hemostatic forceps were higher and the angle of inclination was more tricky.

After two "click, click" sounds.

Zhou Yanqing said: "Brother Yan, try to get your right hand out of the way!"

Yan Huanyu quickly turned his head and saw that it was Zhou Yanqing. He did not answer but carefully opened the palm of his left hand.

As soon as the palm was opened, the spray of blood disappeared, replaced by a trickle of bleeding!

This is just the opening of the small arteries and veins.

Zhou Yanqing quickly picked up the hemostatic forceps again, not even caring about the principles of sterility, and worked with both hands at the same time.

After seven or eight seconds of clicking, four hemostatic forceps were used to mechanically clamp the blood vessels of each bleeding point with precision!

[Hemostasis (Expert 5/15)] is still very effective.

Even though one of the core basic skills of trauma surgery is hemostasis, Yan Huanyu's level is still not as good as Zhou Yanqing's.

Yan Huanyu carefully released his left hand, breathed a sigh of relief, and turned his head to a white coat who was still looking for a phone number and said, "Don't call Professor Liang for now!"

"There are still two wounds that have not been opened." The man in the white coat hesitated slightly.

Yan Huanyu's tone before was a little panicked.

"We should be able to do it." Yan Huanyu looked at Zhou Yanqing, and then affirmed: "We can do it."

Within orthopedics, hand surgery and trauma surgery are two sub-specialties. In the hospital's surgical system, hand surgery and trauma surgery are both orthopedics. Broken bones are related to tendons!
Helping each other is a matter of course.

Zhou Yanqing did not shirk his responsibility. He turned around and washed his hands again. After disinfecting them, he quickly put on sterile surgical gloves again.

Then he came to the bedside and said politely, "Brother Yan, please open the wound and I will help you stop the bleeding."

"Okay!" Yan Huanyu no longer was polite or cared about his face.

When facing a life-threatening emergency, face is never an issue; the first thing to do is to rescue the patient.

The method used on site was packing hemostasis, which was to stuff gauze and sterile cotton pads in all at once, then apply pressure bandage, and then tie the proximal end of the patient's limbs. It was simple and violent.

But after arriving at the emergency room, if even so, the vital signs cannot be stabilized, it means that the bleeding is not stopped completely, and a more precise bleeding must be stopped to restore the patient's blood volume and blood pressure.

"Take it away!" Zhou Yanqing saw Yan Huanyu did not dare to continue after opening the bandage again, so he gave the order decisively.

Maybe it was because of Zhou Yanqing's previous help, or maybe it was because he had heard of Zhou Yanqing's name, so Yan Huanyu did not hesitate too much.

He simply lifted up a corner of the sterile gauze ball.

In an instant, you can see that the blood at the proximal end of the brachial artery is vibrating, making a slight hissing sound.

However, before the sound lasted for a second, Zhou Yanqing accurately "locked the neck" of the proximal end!
The bleeding stopped immediately!

"Keep driving!" Zhou Yanqing didn't look back because someone handed him a pair of hemostatic forceps.

Yan Huanyu then completely loosened all the gauze balls and released the oppression!
There are very few arterial branches in the upper limbs, at least the large arteries have few branches. With this common sense of anatomy, Yan Huanyu is not afraid of blood spurting out again!
However, the stumps of the brachial vein and other veins were still bubbling with red blood.

But it didn't last long, just a few seconds, and Zhou Yanqing solved it all.

Zhou Yanqing even used the remaining hemostatic forceps to search the wound and found that the nerve was broken!

Then, Yan Huanyu packed it with gauze again!

"Measure the blood pressure!" Yan Huanyu ordered a nurse.

The nurse immediately pressed the blood pressure measurement button, and the inflatable bag on the left upper arm started working immediately!
This patient suffered multiple injuries to his limbs, including wounds on both lower limbs and right upper arm, while his left upper limb was intact.

Now, they have resolved the bleeding in two places. With the rapid blood transfusion and fluid replacement, the blood pressure should have recovered to a certain extent!
Although the last point needs to be dealt with, before that, we need to give everyone some confidence.

Professor Tong from the emergency surgery department cleared away all the white coats around, leaving enough space for Zhou Yanqing and Yan Huanyu.

No applause, no praise, no complaints!
Emergency rescue work is like walking a tightrope at the door of the underworld. Any unnecessary words may reverse the outcome!

Qualified emergency doctors and doctors involved in emergency cases will not say a single word more.

In this case, even if Yan Huanyu failed to stop the bleeding and the patient died, Yan Huanyu had done his best. Some injuries cannot be healed by the two hands of a white coat, never!
More than forty seconds later!
The blood pressure measurement results on the monitor came out: 80/53 mmHg!

It's not very high, but it's two millimeters of mercury higher than the previous high pressure.

"It should be more stable, but the amount is not large. There should be other bleeding points."

"Hurry up and find and stop the bleeding, and send him to the operating room quickly!" Professor Tong, a professor of emergency surgery, was giving orders very calmly at this moment!

First, make the purpose of emergency rescue clear!
Yan Huanyu gained confidence this time, and went to his left lower limb again, tilting his head and saying, "I took it away!"

"Okay, leave it to me." Zhou Yanqing's voice was decisive and crisp.

Yan Huanyu opened it, but the patient's luck seemed both good and bad.

There was no arterial damage in the left lower limb, and the depth of the injury only reached the middle layer of the gastrocnemius muscle and did not go deeper.

That is, he had no arterial damage.

This is good luck!
However, either the arteries in his lower limbs were damaged or the arteries in other parts of his body were damaged, and there was no way to stop the bleeding and provide treatment immediately. This was where he was unlucky.

Orthopedics is only responsible for the limbs, and the two of them have no way of getting involved in stopping bleeding in other parts of the body.

"There is no active bleeding in the left lower limb, and the active bleeding in the right lower limb and right upper limb has stopped. The patient's blood pressure is still unstable. It is considered to be active blood loss in the abdomen and chest!"

"It is recommended that general surgery and thoracic surgery handle the case first. After stabilizing the blood pressure, we will perform hemi-limb replantation or debridement." After Yan Huanyu stood up, he calmly stepped back a distance.

In emergency rescue, save lives first, then treat the disease.

After the orthopedics department has completed the hemostasis, there is of course no need to continue to intervene immediately.

When stopping bleeding, the priority is naturally to stop bleeding in the limb arteries, which are very easy to handle.

The chief resident of the gastrointestinal surgery department, Yue Li Zhong, had already arrived at the bedside. He had been standing by the patient's abdomen, but he did not dare to open the hemostatic gauze that was stuffing the abdomen rashly.

I’m afraid that once I open it, I won’t be able to close it again.

At this moment, Yan Huanyu's words made him feel even more pressured!
The orthopedic bleeding has been treated, but the patient's vital signs have not stabilized and his heartbeat is still accelerating, proving that there is definitely a problem with the abdominal artery.

But how many problems are there?

Yue Li Zhong wasn't sure.

Yan Huanyu did not give him an answer, but turned to the side and reported to Professor Tong of the emergency surgery department: "We have completed the hemostasis of trauma surgery, the emergency treatment has been completed, and the remaining operations are semi-elective operations."

"Once the patient's vital signs are stable, we can start the operation at any time."

There is no point in performing surgery now. Even if the trauma surgeon performs the lower limb surgery very well, if the patient is dead, all the surgeries are in vain.

The orthopedic thing is over.

After that, the two rushed to the imaging examination department.

Yue Lizhong from the General Surgery Department asked: "Could it be bleeding from the broken bone?"

He really didn't want to open the hole in his abdomen.

We can only hope that there are other reasons and this patient can be rescued relatively "peacefully and simply".

"The hematoma of a fracture is localized. By the time the patient arrived at the hospital from the accident site, the hematoma had already been localized to the extreme. Even if there was vascular damage, it was balanced with the blood pressure, and it was impossible for the patient to lose more blood!"

Zhou Yanqing also heard what Yue Lizhong said. However, when he came to the computer and looked at Liao Huatong, the chief resident of the hepatobiliary surgery department, scrolling through the CT interface, he tilted his head and said, "Renal artery injury, inferior mesenteric artery injury, bilateral ureteral artery injury, intestinal rupture!"

"Open up the abdomen quickly!"

After Zhou Yanqing finished speaking, a girl next to the chief resident of the hepatobiliary surgery department spoke up: "How do you know so many blood vessels are damaged?"

"Instead of hemothorax in the chest?"

She is the chief resident of vascular surgery. All the things Zhou Yanqing just listed point to her, which makes her a little nervous.

"It was checked by CT scan. This is just a suggestion I made."

"It's a suggestion to Professor Tong. I'm just a resident and I only have the right to make suggestions." Zhou Yanqing did not refute or argue, but retreated to advance.

Arguing cannot solve the problem, and arguing and blaming others cannot solve the problem even more.

If you like it, listen to it. If you don’t like it, forget it!
The orthopedic problem has been solved, and the remaining problem will be dealt with in ten hours. The patient’s life is not in danger.

But Zhou Yanqing was not sure about other aspects.

Professor Tong hesitated for only three seconds before picking up the phone and dialing: "Professor Yang, could you please come to rescue District 1?"

"This is an emergency, we'll talk after you get there!"

After hearing what Zhou Yanqing said, Huang Yaqin, who was standing behind Du Shibin, the chief resident of the hepatobiliary surgery department, spoke up: "Send him to the operating room immediately and prepare for laparotomy!"

"These blood vessels that Doctor Zhou mentioned are indeed damaged!"

"Brother Qin?" Xiang Miao, the resident chief of vascular surgery, knew Huang Yaqin.

"Open the abdomen and explore, immediately!" Huang Yaqin didn't bother to talk to the other party and spoke in an imperative tone.

If Zhou Yanqing hadn't pointed it out, it would have been very difficult for her to find the local vascular damage from the entire wound surface, and she didn't figure it out, after all, she was a hepatobiliary surgeon.

The blood vessels in the liver, gallbladder and digestive systems are what we are best at examining, and there is no damage to them.

After Zhou Yanqing's guidance, she looked in the direction of the blood vessels pointed out and indeed found a clue.

The level of film reading is part of the diagnostic ability.

Clearly distinguish between high and low.

Whether your level is good enough can be revealed during an emergency.

If the diagnosis cannot be made clear, rescue is nonsense.

Diagnosis is more important than treatment. All medical students learn how to diagnose first during their medical career, and then go on to learn how to treat in depth.

"Transfer to the operating room!"

"Be prepared for EMCO at all times!" Professor Tong seemed to have extreme trust in Huang Yaqin and no longer had any hesitation.

At this time, Professor Yang from the vascular surgery department, whom Professor Tong had called, had not arrived yet.

After Professor Tong gave the order, everyone started pushing the bed towards the operating room!

Rescue is like fighting a war, and military orders are as heavy as mountains.

(End of this chapter)