godfather of surgery

Chapter 604 Orthopedics is lifesaving

The helicopter landed on the roof of Sanbo Hospital, and the emergency department sent Qin Xiaowei to the ICU, where he was quickly connected to an artificial liver.

Qin Xiaowei suffered from organ failure caused by heat stroke. The results of various examinations indicated an imbalance of water and electrolytes, as well as severe liver failure. The enzyme levels of glutamic acid and aspartate aminotransferase soared to more than 1, indicating that there was a large amount of necrosis in liver cells. Therefore, it condition is very dangerous.

The cause of the disease should be high-intensity exercise under the hot sun for a long time.

Heat stroke is a type of heat stroke and the most dangerous type of heat stroke.

In layman's terms, heat stroke means that various reasons lead to problems with the body's heat dissipation. If the heat cannot be dissipated, it will accumulate in the body and cause a rise in body temperature, which will bring a series of problems.

Just as a mobile phone cannot dissipate heat, it will malfunction or catch fire and explode. The same is true for people. If the heat accumulation cannot be dissipated, there will also be "failures" or "shutdowns".

According to the severity of the condition, heatstroke is divided into three types: premonitory heatstroke, mild heatstroke and severe heatstroke.

Severe heat stroke can be divided into heat cramps, heat exhaustion and heat stroke. Heat stroke is the most serious type of heat stroke. If not rescued in time, the mortality rate is 80.00%.

The on-site first aid for heat stroke is to cool down. Move the patient to a cool and ventilated place. If there is an air-conditioned environment, it is better, and then quickly physically cool down. Untie the clothes to promote heat dissipation. The most convenient way to cool down is to pour cold water on the patient. Ice water is better , cooling faster.

In addition to on-site cooling treatment, the goal of follow-up hospital treatment is to treat complications, save lives, prevent organ damage, and save organ functions.

Qin Xiaowei had been treated to cool down at the scene, and was rushed to the hospital by helicopter, and there was still hope of being rescued.

Yang Ping received a call from Dr. An and came to the ICU, followed by Xu Zhiliang. He came from an emergency department, and he might be able to help in the ICU.

Qin Xiaowei Cup was placed next to Li Jun, and he has been intubated with a ventilator to assist his breathing, and the artificial liver has started to work to replace his almost non-functional liver.

"The most important thing is liver failure. He is currently in a deep coma, and his heart function is not bad. If severe heart failure occurs, we will also give him ECMO." Dr. An said while checking the parameters of various instruments.

Everyone was worried that Tan Xiaowei would fall while climbing with his bare hands, but he never expected that he would suffer from heat stroke after climbing up.

"He had symptoms of heat stroke when he was supposed to climb, but he was in good physical condition, so he gritted his teeth and insisted on climbing the last leg." Xu Zhiliang noticed something was wrong when he watched his climbing video.

But if he couldn't persist at that time, he might not even have the chance to enter the ICU now.

Qin Xiaowei has no family members, his contract unit pays his medical expenses, and Dr. An has to go out to explain his illness to the contract unit.

Yang Ping couldn't help Qin Xiaowei for the time being, so he bid farewell to the ICU doctor and returned to the department.

-

Harlaching Orthopedic Hospital.

The little duke has completed various examinations. He is panting heavily while sitting in a wheelchair. For him, this is already normal. During this period of time, his condition has worsened, and his heart seems to be about to strike at any time. He reported his state to the family doctor, the doctor It is recommended to conduct a comprehensive inspection in advance.

I was supposed to go to Göttingen Hospital for an examination in a few days, and now I am coming to Harlaching for an examination, just to check carefully to what extent the heart has deteriorated.

"Do you need oxygen?"

Seeing that the little duke's face was not looking well and his breathing rhythm was disordered, the nurse helped him to lie on the bed.

The little duke nodded. He usually inhales oxygen frequently, and sometimes he would bring a bottle of oxygen during class.

The nurse connected him with a nasal cannula to inhale oxygen, and the doctor began to auscultate the heart, and the beating of the heart sound became weaker, and the situation was not good.

This is the VIP emergency ward. There will be doctors and nurses guarding the little duke 24 hours a day, and the ward is equipped with some first aid equipment. Although the equipment is not as complete as the ICU ward, it is sufficient to cope with most changes in the condition.

It is not once or twice that the little duke was admitted to the hospital because of heart failure. The doctor is like a paper painter, trying his best to make this precarious heart last until now.

So every time he comes to Harlaching, he must be admitted to the emergency room of the VIP ward in order to receive the most complete care.

In the conference room of the Harlaching Orthopedic Hospital, the orthopedic experts have not yet left, and they are immersed in learning the technique of spinal external fixation collectively.

It was announced that all the inspections of the little duke had been completed and discussions could begin.

Everyone looked up, the screen lit up, and various data were laid out on it.

The state of the heart worsened, and the color Doppler ultrasound showed that the contraction was weaker, and the rhythm of the electrocardiogram was also unstable.

The main force sitting here is a big orthopedic doctor, but their knowledge is relatively comprehensive, but no matter how comprehensive they are, it is impossible to compare with professional cardiologists.

Therefore, for other specialties, other experts are needed to help.

Norton, a cardiologist at the Charité Hospital who was connected to the line, frowned when he saw the data of the little duke: "His heart has deteriorated, so he needs to be more vigilant. His heart will collapse completely at any time. I'll come over."

The cardiologist saw some signs. There was a little fluid in the corners around the heart on the chest X-ray, and the thickness of the heart wall increased slightly compared with the last time, indicating that the heart was swollen. In a small space, compression and swelling would interact with each other. influence, forming a vicious circle.

"Before I came, increase the amount of diuretics. I don't know if there is any progress in surgery? The squeeze on the heart must be resolved, otherwise there will always be a day of useless medical treatment." Dr. Norton can only treat from the internal medicine, However, the bony oppression of the Little Duke's heart can only rely on surgical correction, and hardware problems must start from the hardware.

In a sense, the little duke's orthopedic surgery was actually a life-saving surgery. Unfortunately, no one dared to perform the surgery on him because it was too difficult.

"We have a new surgery that can correct deformities of the spine and thorax, but the process takes three to six months," said Professor William, speaking on behalf of orthopedic surgeons.

Norton shook his head: "Judging from the current examination results, the process is too long. Theoretically, he needs to be corrected now, and the deformity should be corrected immediately so that the heart can gain ample space. In this way, it may be possible to rely on a heart transplant to solve the problem."

"If the deformity is not resolved, no one can complete the heart transplant. There is a serious shortage of surgical space and field of view, and the biggest problem is that the donor heart cannot be put in at all." Konstantin, a cardiac surgeon at Charité Hospital, is also on the line In the movie, as a heart transplant expert, he has been paying attention to the little duke's illness, hoping to use a heart transplant to save the congenitally deficient heart, but until the spinal deformity is resolved, he is helpless.

"Constantin, it's best for you to come too. We'll discuss it face to face. The little duke's condition is not optimistic. The doctor just reported that his left ventricular ejection fraction is decreasing and B-type natriuretic peptide is increasing." Professor William I feel that the little duke has surprises at any time.

"Okay, I'm going to come over right away and walk with Norton." Constantin felt that the orthopedic problem had not been resolved, and he could only be a bystander.

---

"Gotenberg!" the doctor

Call the little duke by name.

He didn't have the strength to answer, as if he couldn't breathe, his face was pale, his body was cold, his blood pressure dropped to shock blood pressure, his lungs were full of moist rales, and his heart sound was weak.

The doctor auscultated his heart and lungs and checked his pupils. He thought that as usual, he would get better after a short rest, but now the situation is getting worse.

Cardiac diuretic increased dose, no response!
ECMO!

The doctor realized the great danger and made a decisive decision. The nurse immediately got busy and brought various instruments.

The doctor was calm when he was in danger. He began to puncture and insert the tube for the little Duke in the ward, and connected ECMO to stabilize his vital signs.

Well-trained doctors are often able to discover the clues from the subtleties, and then act decisively. The opportunity for rescue is fleeting, and any muddle-headedness will lead to regret.

"Immediately report to the medical team leader and start the rescue process." The doctor in charge directed the subordinate doctors while rescuing.

Various puncture tubes, connection of various pipelines, and machine parameter settings are very proficient.

The orthopedic experts and experts from other departments of the hospital were notified and were on their way. After the sound of dense leather shoes stomping on the ground, the door of the emergency room of the VIP ward opened, and everyone rushed into the ward and gathered around the bed.

Due to severe heart failure, the little duke's heart could no longer maintain the most basic circulation needs, and finally collapsed.

Orthopedics bigwigs are powerless, which is beyond their professional scope.

They had just approved the technique of external fixation of the spine, and they waited with great anticipation for August to come back to perform the operation on the little duke, but this happened suddenly.

However, they are also used to this kind of situation. The little duke is often admitted to the hospital for emergency treatment because of a cold that aggravates his heart failure, so the orthopedic surgery seems so urgent.

Norton and Konstantin from Charité Hospital took a special plane to Harlaching Orthopedic Hospital.

Cardiologists said that there was nothing they could do. The heart was squeezed in a small gap, and only surgical intervention could solve the problem. For hardware problems, it was difficult to obtain results through software operations.

But he can be sure that this time the situation is worse than before.

Konstantin stood in front of the reading light, his pen tip wandered over the video, and then solemnly said:

"His heart muscle is already fatigued because of the squeeze of the narrow space. If the narrow space can be opened to allow the heart to beat freely, it may last for a while. If the stenosis cannot be opened, ECMO can only be used to maintain life for a short time, and then Waiting for heart replacement, but such a deformed gap-like space, there is no way to complete heart replacement.”

This set of rhetoric has not been changed for many years. As a cardiac surgeon, Constantine’s disease involves spinal deformity. His knowledge structure cannot push him to imagine novel surgical procedures to resolve this crisis. His strategy is to rely on ECMO. Maintain cardiopulmonary function and gain buffer time to think about countermeasures.

Soon, the old prince with a cane, accompanied by the butler, stood on the edge of the bed, looking at his dying son, with tears streaming down his face, not sure if he could get through this time safely.

His good friend August is not here at this time, and he seems to have lost his support.

"Poor boy, Auguste has just found a doctor who can treat his spine." The old prince took out his handkerchief and wiped his tears.

"Yes, sir, we are also looking forward to the new technology to solve his problem, but the accident came first. The new technology will take at least three months to correct the problem, but Gothenburg's current state can't wait so long." Professor William expressed regret. Technology definitely doesn't work.

"Where's Marcus?"

Professor Lloyd thought of this confident young man, he might be able to come up with a brilliant idea.

"He's calling August!"

Marcus was seen hiding in a corner on the phone.

-

"professor-"

August ran to catch up with Yang Ping, calling out to the professor, and at the last moment when the elevator closed, he pressed the switch.

"Don't get excited, Doctor Ao, what's the matter?" Song Zimo steadied August.

"The little duke is dying, and his heart failure has worsened suddenly, and he is now maintained by ECMO." Dr. Ao gasped.

What are the days these days, why are the ears full of ECMO.

"No hurry, just speak slowly." Yang Ping and Song Zimo got out of the elevator and walked back to the office.

August followed behind and told Yang Ping about the little duke's condition in detail.

"Do you have any medical records?"

"Have!"

When he came to the doctor's office and found a computer, August retrieved the case information from the mailbox.

Yang Ping read the information again, the heart is already edema, and it is trapped in a narrow space. The edema-entrapment forms a vicious circle. If measures are not taken immediately, the myocardium will soon be necrotic due to ischemia. At that time, the little duke will lose his heart. .

"What should I do?" August was very anxious.

Yang Ping tapped his fingers on the table a few times, and after a little thought, he said decisively: All the ribs in the left precordial area were removed to relieve the pressure on the heart, and then the parts where the ribs were removed were replaced with artificial titanium alloy mesh, artificially temporary. Support a generous space, so that the heart can be saved.

Yang Pingshun took a piece of paper and drew the titanium mesh structure with a pen.

"Just use this, print it out with a 3D printer, one end is connected to the sternum, and the other end is connected to the remaining ribs, so that we can buy time to wait for us to pass. In this situation, we cannot use spinal external fixation, only traditional surgical correction. "

Orthopedics is life-saving now, and we need to race against time.

Qin Xiaowei has an ICU for treatment, and he can't help him for the time being. Yang Ping has to go to Germany as soon as possible. The Germans have no experience in dealing with such cases. If one step is wrong, the patient will die.

Yang Ping came up with the plan in just a few minutes, and even the blueprint of the temporary titanium mesh has been drawn.

"Tell them, if you want to save the little duke, just do it, any hesitation will delay the opportunity, book the fastest flight."

The fastest flight will be tomorrow, and the flight will take more than ten hours.

"Charter!"

August doesn't care about money, it's just that this is not Europe, otherwise the Duke's luxurious private jet will take off at any time.

"Didn't Ning Qi prepare a special plane? It can take off at any time." Song Zimo reminded Yang Ping.

Yes, at this point the advantages of private jets are revealed.

Save lives against the clock.

Yang Ping took out his phone and called Ning Qi: I'm going to Germany right away, when will your plane take off?

at any time!

-

"This is August's first aid plan: remove all the ribs in the left precordial area, use titanium mesh to create a temporary ample space, so that the heart is fully decompressed, he is coming back as fast as possible, and his mentor will come to Hara Xing." Marcus finally got the plan and handed the printed titanium mesh drawings to Constantine.

Constantine took the blueprint and read it and suddenly realized why he didn't think that, like the craniectomy in brain surgery, first remove the ribs that bound the heart to decompress the heart.

Why didn't I think of it myself!

He muttered to himself.

Because a heart surgeon will never encounter such a case that requires decompression of the heart bone in his life, and of course he will not come up with such a clever move.

The airtight chest cavity has negative pressure. Once multiple ribs are removed, the soft tissue of the chest wall will sag with breathing, forming a flail chest. Therefore, a titanium mesh is needed for temporary support to maintain a rigid space.

Ingenious idea!
Constantine immediately ordered: prepare for the operation, and immediately follow the drawings to print out the titanium mesh with titanium alloy.

(End of this chapter)