The Godfather of Surgery

The blood of type AB blood from the last 8 units of the blood bank is being sent to Sanbo Hospital. In the follow-up, emergency procedures are activated, and family members and volunteers are called to donate blood on the spot. It also takes a certain amount of time. At present, only these 8 units can be used for rescue.

This is the driver, and there is a student next door. Both of them are seriously injured. Director Han said that both of you need to take a look.

Dr. Lu briefly introduced the condition. Whether these two patients can be saved can only be seen by Yang Ping. Others do not have such a fast speed.

At the gate at the end of the corridor of the emergency operating room, two police officers stood. The female driver was suspected of drunk driving and rushed into the crowd without any braking action. She ran into the crowd for the first time until she was blocked by an obstacle, and she reversed the car and then went crazy. Accelerating, hitting another group of people for the second time, and choosing a place with a lot of people to rush, has been suspected of committing a crime.

After learning about the situation, Yang Ping quickly browsed the CT pictures on the screen. The abdominal cavity and pelvis were in a mess, and many large blood vessels should be ruptured. If temporary conservative treatment, relying on blood transfusion to resist shock, the blood volume balance could not be maintained, even if the pelvic outer tube was temporarily installed. The fixation frame maintains the volume of the pelvis, but it still cannot maintain the balance of the volume. The pelvis is now full of bleeding points.

If you ask the interventional department to do interventional embolization, there is no way to embolize so many places, and it is too late.

The fastest and most effective method is to intervene in the aortic balloon occlusion technique.

The femoral artery is punctured from one side, and the balloon is sent into the abdominal aorta, and then it is expanded in the abdominal aorta to block the abdominal aorta. All the bleeding below this plane can be almost blocked, which greatly reduces the bleeding.

The balloon can even be sent to a higher position to control bleeding, cooperate with blood transfusion and rehydration, temporarily stabilize blood pressure, and buy time for surgery.

This operation can be completed in a minute or two.

The plan quickly took shape in his mind, and Yang Ping immediately ordered:

Prepare for REBOA!

REBOA, Resuscitative Balloon Aortic Occlusion!

Dr. Lu, who followed, heard Yang Ping's order and immediately took out the resuscitation aortic balloon occlusion kit from the locker in the operating room.

These are common in emergency operating rooms, but no one can use this technology as skillfully as Yang Ping.

At this time, Director Ouyang and Lao Jin had already rushed over. Yang Ping handed the wounded over to them, and took Song Zimo and others to see the student next door.

Do REBOA first!

Yang Ping explained, and immediately came to the No. 2 operating room next door.

The emergency department now has 6 operating rooms, all of which are multi-functional operating rooms integrating inspection and surgery.

Hemorrhagic shock, comminuted pelvic fractures, comminuted sacral vertebral fractures, bilateral femoral shaft fractures, multiple rib fractures, hemopneumothorax, mediastinal hematoma, ruptured lung, severely comminuted pelvis, unmaintained blood pressure—

The emergency doctor in charge of the patient reported the condition to Yang Ping.

This female student, a high school student, and the driver just now are the most injured.

Dr. Lu came over again. He is the doctor in charge of first aid at the scene, and he has to report the condition to Yang Ping at any time.

The pictures on the screen swept across, and Yang Ping immediately made a judgment that the patient's condition was very similar to the one just now, and both were on the verge of life and death.

REBOA!

Xiaowu didn't wait for the emergency doctor to start, he took out the REBOA kit directly from the cabinet, opened it, Yang Ping and Song Zimo had already put on gloves, and Song Zimo was an assistant.

Puncture, insert a cannula, and deliver a deflated aortic occlusion balloon from the cannula.

In Yang Ping's mind, based on the patient's height, CT scan images, the proportion of the images, and the amount of bleeding in each part, he could quickly determine the precise anatomical position of each segment of the injured aorta and the height at which the balloon needs to be delivered.

The action is fast, the balloon is sent to the appropriate position, and it is opened immediately. The opened balloon instantly blocks the lumen of the aorta, just like tap water closes the main gate, and most of the bleeding is controlled in time.

However, this only temporarily blocked the bleeding. If the injured person is to survive, blood needs to be supplemented to maintain the perfusion of the vital organs of the body. Sufficient blood is required for oxygen delivery.

In this window period, we should seize the time for surgery to achieve real long-term hemostasis, so that the injured can have hope of surviving.

This kind of surgery is nothing more than to compete with bleeding time.

If the hemostasis and blood transfusion are completed before the organ collapses due to massive blood loss, everything can be reversed; if the hemostasis and blood transfusion is not completed before the organ collapse, once the ischemia and hypoxia of important organs crosses the critical point, it will immediately cause an avalanche and cause failure. will be powerless.

Continue the blood transfusion! Brush your hands on the stage, I'll go to the next door and see, I'll be over soon.

Next door, Dr. Jin and Director Ouyang are puncturing and inserting the aortic balloon, but because the position judgment is not accurate enough, they are sent up bit by bit, and the balloon is being accurately expanded.

Lower! Up, up again!

Yang Ping simply went up by himself and sent the balloon up about fifteen centimeters before expanding the balloon.

You make this one, and I want to go to the next door.

Yang Ping came here just to help insert the balloon and complete the emergency hemostasis.

When Yang Ping returned to the operating room No. 2, Song Zimo had finished the disinfection and laying out the sheets and was ready to open the chest. They all had full surgical authority and did not need the assistance of thoracic surgery at all.

The director of thoracic surgery stood at the door, just glanced at it, and saw that Yang Ping and Song Zimo were performing the operation. He didn't say anything and changed the goal of the consultation.

With these two buddies here, what kind of thoracic surgeon is needed.

After the chest is processed, the pelvis and bilateral femoral shafts will be done later. The pelvis needs to be reconstructed with plates, and the bilateral femurs need to be interlocking intramedullary nails—

The emergency operating room has a full set of spare orthopedic instruments, from the spine, pelvis to the limbs, full of several large boxes, which came in handy at this time, and soon, several metal boxes wrapped in sterile sheets were pushed over.

Right-Angle Vascular Clamps!

Yang Ping took the vascular clamp and found that it was a curved clamp, and immediately reminded the instrument nurse.

Where's Su Yixuan, call Su Yixuan!

This kind of time-rushing surgery can decide life and death in one second.

Yang Ping needs the best assistant and the best equipment nurse to make the operation the fastest.

At this time, there is no need to worry about other people's face, and simple and direct communication methods are the most effective.

coming!

Familiar voice, tall and straight posture, at the door of the surgery, Su Yixuan has walked in with her hands raised, and she has finished brushing her hands.

So timely!

Seeing this scene, the equipment nurse on the stage had to silently give up her seat and wait for dispatch.

Immediately afterwards, Zhou Can, an itinerant nurse, and Fatty Liang, an anesthesiologist, took over the place of the original itinerant nurse and anesthesiologist.

There is not enough muscle relaxation, and the abdominal muscles are too tight. I will use a pararectus abdominis approach later. Yang Ping told Fatty Liang in advance.

Fatty Liang made an OK gesture and immediately increased the dosage of the muscle relaxant to relax the injured person's muscles and facilitate retraction and exposure.

Not enough blood! Why hasn't it come yet?

Fatty Liang glanced at the data on the monitor.

The blood that has been sent has been transfused. The last 8 units have just arrived at the blood bank. The emergency nurses have already gone to collect them and have not returned.

There are only 8 units of suspended red blood cells in stock now! The wounded next door is also AB type, and only 4 units can be allocated to us. We must wait for the follow-up!

Zhou Can quickly grasped the situation, and she has been urging the nurse who was taking blood.

Depend on! 4 units, Yang Ping cursed in his heart.

Not enough, far from enough, 8 units are not enough, let alone 4 units.

8 and 4, although the difference is only a 4, but sometimes hovering near the critical value, push it, it will live, almost, it will be gone.

Bring all 8 units, all! Yang Ping ordered Zhou Can, and went into surgery again.

Fatty Liang quickly estimated the accumulated bleeding, the blood that is being lost, and the blood that needs to be replenished.

4 units is definitely not enough, but 8 units can push the injured away from the critical line. He understands why Yang Ping insists on 8 units. This is a critical point of life.

8 units! Quick!

Since the chief knife gave the order, the order in charge of promoting blood was handed over to Liang Fatzi and Zhou Can.

The nurse who took the blood returned to the operating room No. 2. The eight bags of suspended red blood cells were piled up on the cart. Zhou Can pulled the entire cart over.

The nurse who took the blood was very embarrassed: President Sun said that it is evenly distributed, with 4 units on each side.

That is, only 4 units are given to this side, and 4 units are to be sent to the No. 1 operating room next door.

However, if the 8 units of red blood cells are used separately, two severely injured, one will not even think about living. If they are used intensively, the student still has hope.

Let's put it all here, if there is any problem, Director Han will communicate with Director Sun! Fatty Liang grabbed the handle of the cart tightly.

Fatty Liang didn't dare to delay, he intercepted the blood of 4 units, and immediately reported to Director Han.

Director Han was nearby and appeared in the operating room soon after.

How's it going? he asked.

Yang Ping immersed himself in the operation: I'm pulling it back, it's impossible without blood, 8 units are reluctant, and 4 units can rest their hands now.

I know the situation. Ouyang and A Jin are supporting each other next door. Save one is one.

Director Han circled around the operating table, but couldn't see anything.

The two were just chatting like this.

Maybe the nurse who just took the blood also reported to his head nurse and the director of the emergency department, and President Sun ran to the No. 2 operating room.

Old Han, you are confused, with only these 8 units of blood, wouldn't the average score be enough?

Dean Sun anxiously persuaded Director Han.

He is an old fritter in the officialdom and has his own considerations. Now the two wounded are both AB type, and both are seriously injured. If they are distributed equally, there will be no leakage from ethics and procedures. As for whether they can be rescued or not, it is another matter.

But once these 8 units of blood are separated and used by one person, who will they be concentrated on?

No matter who it is focused on, no one knows, and nothing happens; once someone pursues it and the guidelines go online, it will be a big trouble.

If it is given to students, some people say that although this female driver is suspected of committing a crime while drunk driving, she is also a life. Why should students be given priority? Where is the humanitarianism.

If it is given to the female driver, the student is innocent. It's fine. If she was hit by the drunk driver and seriously injured, why should she share the life-saving blood equally with her?

It must be divided equally! The family members of the driver and the family members of the students are all outside. There are also a lot of reporters. The commissioner of the municipal government is also outside, supervising the rescue. The family members of the female driver also invited a professor from the Southern Metropolis Affiliated One. We're rushing over to support the rescue! We can't have any problems with the procedure. Dean Sun's tone was still persuasive.

Overtones, as long as the program is correct and no faults can be picked, it will be fine. As for whether these two can be saved, it depends on the fortune.

These days, doctors are tired and drink a bottle of glucose, and some people go online.

Director Han said slowly: Critical first! According to the unanimous assessment of several of our experts, this wounded is the most critical and needs the most blood from these 8 units. Those people outside are not doctors. Are they coming to the stage to perform surgery?

You? Old Han, what should I say about you?

Dean Sun was angry in his heart, Dean Xia went out for a meeting, he is now the first person in charge, and he has to take responsibility.

Director Zhao next to him said: Well, Dean Sun actually means the same thing. Now this student needs this blood most from the perspective of his condition. The limited resources are given to those who need it the most. There is still blood in the back. The blood station is trying to find a way. Well, just wait a minute, it's just 8 units of blood, what a big deal.

Dean Sun had no choice but to acquiesce.

I'll take a look next door, you guys are busy. Director Han turned around and went out again.

Fatty Liang stared at the bags of blood, for fear of being snatched away in the blink of an eye.

This is something that can't be helped, sometimes, a choice must be made.

For example, in the graded treatment of emergency patients, red patients are given priority, which is also a medical choice.

Because red patients have unstable vital signs and will die without rescue, yellow patients can wait, and green patients are fine.

Sometimes, two lives are placed in front, and only one can be saved. Who is to be saved, choose one of the two!

Very cruel, but also must choose!