godfather of surgery

Chapter 141 Demon Lung
Director Kong looked anxiously at the elevator entrance, and as soon as Yang Ping came out, he immediately went up to meet him.

"Doctor Yang, I'm sorry to call you over this weekend!" Director Kong showed a look of embarrassment.

Yang Ping said modestly: "Director Kong is serious, Xiao Yang is always on call, what can I do for you?"

In an emergency, Director Kong was unambiguous and straightforward: "Mr. Ning suddenly suffered from respiratory failure in the morning, and his blood oxygen has been unable to rise, hovering around 70. Director Jiang from the ICU has seen it and decided to use ECMO. They punctured the blood in the emergency ward. The tube was connected to ECMO after the tube was placed. Although the blood oxygen went up a little, it was still low, only 78. They thought that the tumor squeezed and invaded the right external iliac artery and vein, resulting in narrowing of the lumen, and the flow rate of blood was not good. The unit time The amount of blood drawn out for oxygenation is too small to meet the demand, Miss Ning offered to ask you to come."

ECMO, nicknamed the magic lung, is an improved artificial heart-lung machine, also known as extracorporeal membrane oxygenation, which can replace the function of the human lung or heart to a certain extent and within a certain period of time.

It draws the blood of the human body from the veins, oxygenates it through the machine, turns it into oxygen-rich blood, and returns it to the body through the veins or arteries.

If it is infused back into the human body through a vein, it can replace the function of the lungs; if it is infused back into the human body through an artery, it can replace both the functions of the heart and lungs. The magic lung is called the last straw for life-saving by doctors!
But the price of this kind of machine is very expensive, so the use fee is also very expensive, and it cannot be covered by medical insurance.It costs [-] yuan to start it up, and [-] to [-] yuan a day for the follow-up, which is a sky-high price for ordinary people, but for Mr. Ning, it doesn't need to be considered at all.

As the two walked towards the ward, Director Kong introduced the situation to Yang Ping, and when they got to the emergency ward, the situation was also introduced at random.

The emergency ward of the Overseas Chinese Building is equivalent to a small ICU. All kinds of emergency equipment are available, including expensive magic lungs. Moreover, these equipment are not purchased by the hospital itself, and many of them are donated by patients who live here or have lived here.

Inside, Director Jiang of the ICU and his assistants were placing tubes, but they had already stopped, probably waiting for Yang Ping.Next to it, there are chief physicians or deputy chief physicians of vascular surgery, general surgery, tumor surgery, and color ultrasound room.

"I can't go in any more, back it up a little, or the blood vessel will break if you go in again!" the deputy chief physician of the vascular surgery reminded Director Jiang.

"Keep down! Look clearly!" Director Jiang commanded the doctors in the ultrasound room.

The probe of the color ultrasound doctor was lowered a little, and the blood vessels on the ultrasound image became clearer.

Mr. Ning was lying on the bed, his face was withered and yellow, his mind was a little unclear, and his body was covered with a blue sterile sheet. Director Jiang had just completed the catheterization of both femoral veins. The catheterization of the left femoral vein went smoothly, but there was a Narrow, the catheter dare not go deep.Now the right side is the tube that takes the blood out and the left side is the tube that goes in the blood.

Because of the stenosis of the right external iliac vein, the drawn blood did not achieve the expected flow.If it is reversed, the right side is used as the input pipe, and the left side is used as the output pipe, the result will not make any difference.Even if enough blood is drawn out from the left side for oxygenation, the flow rate of the blood sent back is too slow, and it still cannot achieve the expected purpose.

"Doctor Yang, I'm going to trouble you again!" Miss Ning said.

She was always by her side, squatting beside the bed, holding her father's hand, and smiling: "Dad, don't be afraid, Dr. Yang is here, he has a solution."

Mr. Ning seemed to understand clearly when he heard what his daughter said, but he couldn't speak, so he nodded with difficulty.

In fact, Yang Ping was also very helpless as to what to do for a patient with systemic failure at the advanced stage of liver cancer.

Doctors treat patients, just like the epitaph of Dr. Trudeau in New York, USA: sometimes heals, often helps, and always comforts.

Mr. Ning stretched out a trembling hand with difficulty, and Yang Ping held his hand tightly, cold and thin.

His lips were trembling, trying to say something, Yang Ping's ear was close to his mouth, and he heard a few indistinct words.

"Help--me--delay for a few more days--" Mr. Ning seemed to have exhausted all his strength after saying these words.

Yang Ping nodded heavily, and clenched his hand tightly to show that he heard what he said.Trust, how precious this kind of trust is, you can entrust your life to yourself with just a few conversations on the operating table.

"Sure, I will do my best to help you fight for it!" Yang Ping put down his hand.

Mr. Ning used to be hospitalized in the attached hospital. For his condition, all the top oncologists in the attached industry were invited here, and even overseas experts were invited for consultation. Unfortunately, he was already at an advanced stage, his body was exhausted, and the tumor had metastasized in multiple places. Lost the chance of surgery, tumor resection, liver transplantation, lung transplantation can not be done.So after liver cancer interventional treatment, lenvatinib was used as targeted therapy. Later, the drug became resistant and changed to regorafenib, and then a famous old Chinese doctor from the Provincial Hospital of Traditional Chinese Medicine was invited to do the traditional Chinese medicine treatment.

Because the inpatient conditions in Sanbo's Overseas Chinese Building can be said to be the best VIP ward in G City, he transferred to Sanbo and planned to spend the last journey of his life in Sanbo's Overseas Chinese Building.

"The bilateral subclavian and internal and external jugular vascular regions were seriously invaded by tumors, so I dared not puncture and place tubes, so I wanted to put two tubes in the bilateral femoral veins. The tumor pushed the external iliac vein away, causing it to squeeze, and the tube couldn’t get in. Pushing it up forcibly may break the blood vessel and cause massive bleeding. Can’t go up, you see blood oxygen is only 80, this won’t work—”

Director Jiang didn't care about face at this time, he was a real person, and at the moment of life and death, he would listen to whoever had a way, no matter if he was a young doctor or a great professor.

He is familiar with Yang Ping. He also heard about the nerve root blockade last time. Needless to say, the five-stage replantation, the treasure that Director Han holds in his hand is not at the right level, and he is not qualified to stand at this time. At this.

"You have worked hard, let me see!"

There is a reading light in the emergency ward, and the film has already been hung up. Yang Ping went to watch the film on the reading light. Indeed, as Director Jiang said, the bilateral subclavian and internal and external jugular veins cannot be punctured, and only the bilateral femoral veins can be punctured. , The right femoral artery and vein have been invaded and squeezed by the tumor, and the lumen is flattened. If the puncture is forced, once the blood vessel is broken, it will cause massive bleeding.

In Mr. Ning's situation, if there was a massive abdominal hemorrhage, his whole body would collapse immediately, and multiple organs would fail, and the magic lung would not be able to save him.

But now if only the catheter of the magic lung is left at the current position, there is a narrow opening on it, the blood flow drawn out is too little, and the oxygenated blood per unit time is too little, which cannot meet the needs of important organs at all. To open, you must be able to pass to open it.

No wonder the last time he had a physical examination, the temperature of his right lower extremity was lower than that of his left lower extremity, especially the peripheral circulation was particularly poor.

Facing the film reading light, Yang Ping used the knowledge gained from systematic anatomical training and combined with Mr. Ning's CT scan to start composing pictures in his brain, superimposing sections one by one, and slowly, a three-dimensional anatomical map appeared in his brain.

This time it was still very difficult, and the combination was unsuccessful several times, but it was a little easier than last time, which shows that there has been progress.

According to the blood flow rate of the human body, Yang Ping simulated the blood flow in his mind, added the dynamic image of the blood flow, and a dynamic three-dimensional anatomical image appeared in his mind, which was quite clear.

It seems that the composition of the brain is very important to the improvement of medical skills. The system uses anatomy to spare no effort to train itself with this ability, which is to lay a strong foundation for the improvement of medical skills in the future. Yang Ping understands the intention of the system.

To successfully puncture the catheter, the catheter of the magic lung must be constructed. Yang Ping kept the image in his brain, and turned to Director Jiang: "Director Jiang, do you still have the catheter of the magic lung? Let me take a look?"

"Xiao Li, show Dr. Yang a tube." Director Jiang ordered a doctor in the ICU next to him.

The cost of a pipe is very expensive, tens of thousands, but this is not the time to worry about it, and there is no need to worry about it.

Xiao Li opened the sterile packaged tube, and Yang Ping observed the complete catheter, copied such a catheter in his brain, and then used the graphics constructed in his brain to perform a simulated puncture and catheter placement, so that Yang Ping knew exactly what it was .

"Okay!" Yang Ping told Xiao Li to put away the catheter.

"I'll try!"

Yang Ping put on sterile gloves and a disposable sterile gown, and stood beside the bed.

(End of this chapter)