When I'm on the night shift, all the department heads can't sleep.

The monitor's alarm light is flashing rapidly.

My heart rate soared to 165 beats per minute, while my blood pressure dropped to 36/18 mmHg.

"The lower abdominal muscles are tense, and percussion of the entire abdomen produces a fixed dullness, with the abdominal wall rapidly distending and tightening."

Liang Shumin pressed on the injured person's lower abdomen.

"Intra-abdominal pressure is rising rapidly, and blood pressure is dropping!"

Zhao Feng's scalpel suddenly stopped. He immediately moved away from the incision and quickly approached the abdomen: "The abdominal wall is bulging so quickly, could it be a rupture of abdominal organs or a tear in the mesentery?"

Lin Ye strode forward, his gaze fixed on the injured man's side: "There's no rebound tenderness in the entire abdomen upon palpation. Examine the subcutaneous tissue in the lumbar and costal region!"

He pressed the heels of his hands against the iliac crests on both sides, squeezing inwards. He immediately felt a distinct, abnormal movement of the bones and heard a rough crepitus sound. Patches of purplish-blue bruising were faintly visible under the skin of the injured man's lower back.

"The pelvic compression separation test is strongly positive, the pelvic ring is completely severed, and the right iliac bone is displaced." Lin Ye quickly made the judgment. "The mechanical torsion not only tore the femoral vessels, but the powerful shearing force also directly tore the pelvic ring apart. The presacral venous plexus and internal iliac vessels were torn, causing an acute retroperitoneal high-pressure hematoma."

The pelvic cavity expands rapidly, and once it loses the constraint of the skeleton, the retroperitoneal space can swallow thousands of milliliters of blood in a short period of time.

Guo Shusen stood to the side, his expression filled with anxiety: "Massive retroperitoneal hemorrhage... The county hospital doesn't have the facilities for interventional embolization, so selective angiography can't be performed. If we open an exploratory laparotomy at this point, the intra-abdominal pressure will drop sharply, and the bleeding will be unstoppable. The patient will die on the spot!"

"Absolutely no cesarean section."

Lin Ye and Zhao Feng spoke almost in unison.

Lin Ye put down the examination equipment in his hand and turned to the circulating nurse: "Bring me two of the thickest and sturdiest sterile cotton sheets!"

The two nurses took out a flat, pure cotton sheet from the sterile cabinet as instructed.

"Most retroperitoneal hematomas originate from low-pressure venous plexuses and cancellous bone oozing, and are only kept in place by the integrity of the peritoneal wall to maintain limited mechanical packing," Lin Ye quickly explained to Zhao Feng. "The most crucial thing now is to push the stretched pelvic ring back in, rebuild the rigid structure of the pelvis, and compress the bleeding space to the minimum."

"Pelvic support belt fixation." Zhao Feng immediately understood. "The center of the sheet must be strictly aligned with the plane of the greater trochanters on both sides. It must not be tied around the waist or iliac wings, otherwise the torque will be incorrect and will actually stretch the pubic symphysis further."

Lin Ye lifted the injured man's buttocks with both hands, and smoothly passed the thick bed sheet, which was folded to a width of 20 centimeters, through it, pulling the edges flat and aligning it precisely with the level of the greater trochanter of the femur and the pubic symphysis on both sides.

"Dr. Zhao, catch the other side and pull it taut across your legs!"

Zhao Feng caught the edge of the opposite side of the bed sheet and, together with Lin Ye, steadily exerted force outwards.

The two individuals continuously apply opposing, uniform pulling forces to bring the externally rotated and separated iliac wings on both sides of the pelvis together and close them, compressing the geometric volume of the pelvic cavity.

Lin Ye took two large cloth clamps and firmly clamped them together at the point where the sheets overlapped on the front, maintaining continuous pressure and fixation on the pelvic ring.

As the pelvic ring is mechanically closed, the expansion of the retroperitoneal space is physically suppressed, and the swollen hematoma gradually forms an effective self-compression hemostasis effect by relying on the taut peritoneal wall.

The downward trend in blood pressure on the monitor finally stopped, and gradually stabilized at 52/32 mmHg.

"The progressive retroperitoneal hemorrhage has been initially controlled." Liang Shumin breathed a sigh of relief. "The circulatory indicators have stabilized for the time being."

"But both bags of red blood cells have been completely transfused." The nurse pointed to the empty bags on the IV stand. "There's only one bag of balanced salts left in the pressure bag. The blood bank just called; the hospital's stock of type O red blood cells has completely run out!"

Excessive crystalloid resuscitation following massive blood loss can dilute clotting factors, leading to a triad of hypothermia, acidosis, and coagulation dysfunction.

The operating room door was suddenly pushed open, and Vice President Yan Mingcheng strode to the door:

"Captain Lin, the emergency blood donation announcement has been broadcast. All eligible medical staff off duty are currently having their blood drawn in the laboratory. The injured person's family members have also had their blood drawn. The first batch of 400 ml of fresh whole blood will be delivered immediately!"

Lin Ye nodded towards the door: "Thank you, Dean Yan."

He turned to Zhao Feng beside him: "Dr. Zhao, the pelvis is temporarily stable. You will be the lead surgeon for the vascular anastomosis, and I will assist you."

"Okay, let's hurry." Zhao Feng nodded. "The wounded soldier has a severe retroperitoneal hematoma, so we absolutely cannot perform systemic heparinization, otherwise the fracture wound will bleed extensively. We will only perform local intravascular heparinized saline irrigation."

"Agreed, local heparinization for thrombolysis," Lin Ye responded.

The two quickly took their positions.

Zhao Feng made a longitudinal incision on the inner side of the injured man's healthy left thigh and dissected a full and bulging great saphenous vein along the anatomical layers. After ligating the collateral branches, he removed an eight-centimeter section, attached a flat-tipped needle, and injected heparinized saline to fill the lumen, confirming that there was no leakage from the branches or axial torsion.

At the same time, Lin Ye, in the first-assist position, helped to expose the surgical field, using toothless oval forceps and deep retractors to open the wound on the right leg, alternately rinsing and suctioning away deep impurities, revealing a clear surgical field.

Zhao Feng then used fine scissors to trim the contused openings at both ends of the femoral artery into a smooth 45-degree bevel, increasing the cross-sectional area of ​​the anastomosis to prevent postoperative stenosis.

Lin Ye used miniature forceps to grasp one end of the great saphenous vein: "Dr. Zhao, pay attention to the direction of the venous valves, invert it."

"Understood." Zhao Feng smoothly adjusted the direction of the blood vessel. "The venous valves are unidirectional to prevent backflow, and the arterial bypass must be inverted so that the distal end is opposite the proximal end, allowing blood to flow smoothly."

Zhao Feng held a micro needle holder and clamped the 6-0 polypropylene vascular suture.

With steady hands, Lin Ye used two micro forceps to precisely pull the outer membrane of the severed blood vessel ends, providing a stable fulcrum for the anastomosis.

Insert the needle, penetrate the inner membrane, exit the needle and tie a knot, then perform full-thickness eversion and continuous locking suture.

The stitch spacing and edge distance are strictly controlled within one millimeter.

Lin Ye followed up by cutting the sutures as needed, and gently rinsed the affected area with heparinized saline solution to keep the tissue moist and prevent microthrombus formation.

The soft autologous vein gradually and tightly adheres to the severed end of the femoral artery.

"Fresh whole blood has arrived!" The circulating nurse took the blood bag with the filtration device and quickly connected it to the intraosseous cavity pressurization tubing.

Warm blood is rapidly propelled into the venous system.

"Distal anastomosis complete." Zhao Feng tied the last surgical knot and cut the sutures.

The countdown to the edge of the forest's field of vision is coming to an end:

【00:01:15】

"Prepare to open the blood flow." Lin Ye placed his fingers on the handle of the clamp.

"The tourniquet has been loosened." Zhao Fengxuan loosened the tourniquet near the proximal end of his thigh.

Lin Ye loosened the Satinsky non-traumatic vascular clamp.

High-pressure arterial blood surged into the transplanted autologous great saphenous vein segment, and the deep blue vessel wall instantly swelled and expanded, exhibiting a regular and powerful rhythmic pulsation.

Apart from a few needle pricks with bleeding, no active damage was observed at the anastomosis site.

A moment later, the extremities of the wounded man's right foot, which had been icy cold, gradually turned from pale white to light red, and the skin temperature noticeably rose.

Lin Ye pressed his fingers on the first interosseous space on the dorsum of the injured man's right foot, and felt a clear and regular pulse of the dorsalis pedis artery under his fingertips.

He then reached out and pressed on the muscles on the back of his calf. The fascial spaces were soft and there were no signs of acute compartment syndrome.

The countdown numbers at the edge of my vision flickered once, then went out completely.

The vital signs on the monitor are steadily improving.

Heart rate: 98 beats/min;

Blood pressure: 92/60 mmHg;

Blood oxygen saturation: 99%.

Guo Shusen stared at the regular green lines on the screen, his expression one of shock, and then lowered his head to put away the transfer slip in his pocket.

Zhao Feng stepped back half a step and took off his gloves: "The blood vessels are clear, the lower limb has been saved."

Just as the team was preparing to clean the surgical field, the red internal telephone on the operating room wall suddenly rang urgently.

Guo Shusen quickly stepped forward to answer the call.

The urgent voice of the county traffic police brigade came through the receiver:

"Emergency room? A long-distance bus has overturned at Erdaowan on the Cangshan Eighteen Bends. The vehicle has fallen into a deep ditch, and there are more than 20 injured people at the scene! The first batch of seriously injured are being rushed to the county hospital by police cars and other vehicles along the route. Be prepared to receive them immediately!"