godfather of surgery

Chapter 729

General Surgeon's Office.

On the professional imaging electronic screen, CT scan images of the head and neck of the wounded are presented on the screen, the cross-sectional images are switched one by one, and then the three-dimensional reconstructed stereoscopic images are rotated 360 degrees, and the bones of the entire head and cervical spine are extremely clear.

Traumatic atlanto-occipital dislocation!Has been diagnosed.

There was a bone cyst in the atlas, and a comminuted fracture was caused by trauma. Fortunately, the fracture spread around instead of invading the spinal canal.This prevented the boy from dying on the spot due to cervical spinal cord injury, but after being successfully rescued from the scene, his limb muscle strength has been maintained at level one.

This indicates that there is damage to the spinal cord, but if the damage does not worsen, there is a possibility of recovery after surgery.

The muscle strength of the limbs is at the first level, and the muscles of the chest and abdomen will be similar, and many muscles of the chest are respiratory muscles. Without the function of these respiratory muscles, breathing cannot be completed at all.

After the successful rescue from the trapped vehicle, Dr. Lu immediately performed a tracheotomy on the wounded, connected a simple ventilator, and relied on the ventilator to maintain breathing.

In addition to the traumatic atlanto-occipital dislocation, the wounded also had multiple fractures throughout the body, including comminuted fractures of the pelvis and a very large amount of blood loss.

Looking at the image on the screen, Yang Ping took a deep breath. Traumatic atlanto-occipital dislocation and atlas fracture, the chance of survival at the scene is very small. If there is a small mistake, the wounded can stop breathing and heartbeat.

"Atlanto-occipital fixation is no longer possible, we can only cross the atlas and implement occipital-pivot fixation." August suggested.

There are not many precedents for this kind of surgery to refer to, the number itself is very small, and the atlas is accompanied by comminuted fractures, there is no precedent to refer to, and the doctor's subjective initiative can only be used.

Yang Ping did not speak, but silently observed the video and pictures, thinking about the method and details of the operation.

As a doctor, you should be more serious than any profession. You only have one life, and it is fleeting.

"The wounded is already on the emergency operating table, and the pelvic external fixator is being fixed, and the blood vessels in the pelvis are embolized to stop the bleeding." Song Zimo kept abreast of the emergency situation and introduced it to Yang Ping.

The principle of first aid for trauma is that life comes first and everything else is put aside.

For such patients, hemostasis treatment is first performed to stabilize the volume of blood circulation, which is a routine operation.

However, if the pelvic fracture is comminuted, the blood loss is very large. After the pelvis is fixed with an external fixator in the emergency department to stabilize the pelvic volume, if the blood pressure is still unstable, emergency embolization is required to stop the bleeding.

If the bleeding cannot be controlled even by embolization and hemostasis, the last resort—cutting and packing to stop the bleeding comes in handy. A large amount of gauze is used to fill the retroperitoneal space, and the pressure of the gauze packing is used to compress the bleeding vessels to stop the bleeding.

"Let's go to the emergency department!"

The operation plan in Yang Ping's mind was clear, and he took everyone to the emergency department.

The operating room in the emergency department is in good condition, and this operating room is a hybrid operating room, which can perform interventional surgery or open surgery.

Miscellaneous operating room, this term is actually not accurate, it is more appropriate to call it a compound operating room.

In fact, it combines the 3D imaging technology of DSA, CT, MRI and other equipment with the [-]-level laminar flow operating room, so that both minimally invasive interventional surgery and traditional open surgery can be performed, so as to solve various complex operations and reduce Surgical risk, save operation time.

That is to say, it integrates the functions of image monitoring and surgical operation, it is as simple as that.

In the emergency operating room, Dr. Zhong from the Department of Traumatology and Orthopedics has installed a pelvic external fixator on the wounded, and Director Ji from the Interventional Department is doing emergency interventional vascular embolization for the patient.

The two experts in the Interventional Department, Director Guan specializes in interventional surgery of the cardiovascular system, and Director Ji is a generalist, he can do everything from trauma hemostasis to tumor embolism, etc. The interventional department of China is developing rapidly.

The two big cows usually have a good relationship in private, which is due to the tradition of Sanbo Hospital. From the establishment of Sanbo Hospital to the present, there has been a tradition of unity. Everyone does not fight internally. Everything is discussed on the table. Debate, seek solutions.

Yang Ping entered the operating room wearing a lead suit. At this time, Director Ji was fighting and Director Guan was watching the battle.

Director Guan knew that this kind of wound hemostasis was Director Ji's forte. He was a layman, and laymen couldn't talk nonsense, let alone intervene, so he just watched the battle and stood silently.

Yang Ping walked into the operating room lightly. He walked around the hand table until he walked to the side of the patient's head. He carefully lifted the drape over the head, and the brace appeared in front of him like a work of art.

Sure enough, Director Wei did not let him down. The skill accumulated for more than 30 years and the brace made by hand in the on-site emergency department played a good role in protection and escorted the patient back to Sanbo Hospital safely.

"Level [-] limb muscle strength." Dr. Lu followed up and introduced.

Yang Ping nodded, the muscle strength of his limbs is still at the first level, which means that there is still hope for recovery.

"Is this brace okay?"

Director Wei was also wandering around in the operating room. The chances of him coming to the operating room were very small, so he was not used to it, and the sterile cap was not very standard.

Yang Ping said with a smile: "Without your brace, there will be nothing for us in the future. Your brace is a life-saving artifact."

Director Wei touched the sterile cap like a child: "It's a little rough, as long as it doesn't delay your business."

"Blood pressure stabilized, stabilized!"

The anesthetist stared at the monitor screen and said excitedly.

There was a lot of sweat on Director Ji's forehead, and he turned his head and moved out of the operation area. Before the roving nurse had time to help wipe the sweat, Director Guan took out a stack of tissues and wiped the sweat off Director Ji's forehead.

Interventional embolism hemostasis not only requires high skills, but also has risks. It may lead to ischemic necrosis of the embolized limb. Of course, limb necrosis is better than death on the spot, so some methods can only be used after weighing the pros and cons.

Since the blood pressure has been stabilized, it means that the interventional embolization has succeeded in hemostasis.

"Old Ji, your technique of embolization and hemostasis is amazing." Director Guan admired him sincerely.

Director Ji shook his head: "If it weren't for Professor Yang's progress in anatomical research in this area, how could I have this level. I'm just using it as a theory and applying Professor Yang's results."

The premise of embolization and hemostasis is to be very familiar with the anatomy of the whole body blood vessels, and to have a very strong image recognition ability of angiography. These things all rely on some basic research and clinical experience.

"Professor Yang, when did you come?" Director Ji realized that Yang Ping was already standing behind him.

"Just arrived." Yang Ping stared at the blood pressure value on the screen.

"Cervical spine surgery is being done now, or is it in the second phase?" Director Ji was about to call it a day.

Yang Ping withdrew his gaze from staring at the screen: "After you are done, the wounded will be transferred to the trauma ICU, and the second-stage surgery will be performed after the hemodynamics are stable. Director Wei, can this be done?"

Because the second-stage operation needs to wait for many days, in this short period of time, the cervical spine fixation of the wounded is a big trouble. If the fixation is not reliable, it may be fatal if one is not careful.

For example, when the nurse turns over, not only the cervical spine must be very reliable, but also the several nurses responsible for turning over must cooperate very well, otherwise the cervical spine will be slightly distorted, and the consequences will be disastrous.

Director Ji and Director Guan have never dealt with Director Wei in the bracing room, so they are not familiar with Director Wei, but after all, they have been colleagues for 20 years and know each other.

Whether to operate immediately or to postpone the operation is a contradiction.

Immediate surgery can reliably fix the head and neck, but the wounded has just been pulled from the hand of death, and can no longer withstand the blow of another operation, and to fix the head and neck, special fixation equipment needs to be customized, and customized equipment cannot be delivered immediately Operating table.

Postponing the operation, that is, the second-stage operation, can allow the wounded to recover to a certain extent physically, especially after the hemodynamics are stable, the safety factor is much higher, but during the waiting period, the protection requirements for the cervical spine are very strict, and no damage can be done. error.

Therefore, Director Wei has become a key part of the treatment plan. Is he confident that the wounded's cervical spine will not have problems in the past few days.

"can!"

Director Wei said categorically that he decided to take his apprentices to personally guard the trauma ICU, responsible for immobilizing the head and neck of the wounded, and assisting in nursing and transporting.

With Director Wei's affirmative answer, Yang Ping was also relieved, and Yang Ping was still very confident in Director Wei's craftsmanship.

"Then the second-stage operation, transfer to the trauma ICU after the emergency operation." Yang Ping decided immediately.

Director Wei has never been so stressed. During the waiting time before the second-stage operation, the boy's life was hanging on his brace.

"Old Wei, your task is very heavy. This child's life is really hanging by a thread, and this thread is in your hands." Robert, who did not know when he appeared, joked.

"Relax, take a deep breath, the people will support you!" August encouraged Director Wei.

"My palms are sweating now."

Director Wei was a little nervous, but he immediately regained his composure and told himself: I am afraid of a ball, so I put a plaster cast on it. My old Wei can't handle it. Who else can handle it.

"Don't worry, pick a few experienced nurses to take care of the wounded. I will stay by the bedside 24 hours a day, so I don't believe I can't pass this test." Director Wei said confidently.

I have never had such a highlight in my life. At this moment, I can't let go of the chain.

(End of this chapter)