godfather of surgery

Chapter 95 Eight hundred milliliters of blood
"Aortic Blocking Forceps!"

The surgeon placed the aortic occlusion forceps in a convenient place in advance.

The ribcage is propped up from the midline!

Blood poured out, and the aortic blocking forceps took the lead, lightly and accurately clamped at the position after the aorta branched off the brachiocephalic trunk, blocking the blood supply from the heart to the lower body.

Several suction tubes are sucked at the same time to remove the blood in the chest cavity, which are all blood accumulations.

The blood subsided, the heart and lungs appeared in the field of vision, the warm heart beat rhythmically, and the lungs opened and closed under the drive of the ventilator.

The thick aorta originates from the heart, turns a bend, and extends downward into the thoracic aorta and the abdominal aorta.

The hood of the human body is opened, the engine is displayed in front of the eyes, it is still working, and life is visually displayed in front of the eyes in physical form.

Taking the original wooden stake as the dial, it is now at the 12 o’clock position. Except for the rupture of the diaphragm, no major blood vessel damage was found, and no damage to the heart and lungs was found. Due to the extrusion of the wooden stake, the position was slightly shifted. Quick ligation to stop bleeding.

However, this amount of bleeding must be the rupture of a large blood vessel, and the rupture is not at this location. Continue to explore.

The surgeon was calm, the movements of the hands were extremely fast, and the operation was advanced quickly and rhythmically, without any impatience, urgency and urgency.

Director Li is engaged in thoracic surgery. He pulls the hook on the side, and he has seen big bosses perform operations when he is studying. Shouldn't this kind of rescue operation be completed in a noisy and anxious urging?
How can it be so quiet, so calm, the ability of the surgeon to control the operation is extraordinary; the cooperation of this team is also impeccable.

The irrigation of the heart to the lower body is blocked, and the pressure of bleeding in the operation area is relieved; at the same time, the limited blood concentrates power to supply the brain tissue, and the brain tissue's tolerance to ischemia is far less than that of the trunk and limbs.

In the state of ischemia, the brain tissue can only safely persist for 3 minutes; while the abdominal organs that have stopped blood supply can tolerate it for 10 minutes.

The blocking of the aorta at this part can only take 10 minutes, because the patient is already in a state of hypoperfusion, and the blocking time should be less than 10 minutes.

He wants to complete the operation within 10 minutes and end the battle?
Tianyuan looked at the blocking forceps that had already gone up and understood the intention of the operator. He had to speed up and cooperate with Yang Ping. Although the task in the back road was not as dangerous and complicated as the front, it took 10 minutes to complete the operation, which was also extremely difficult.

The posterior approach is also a median incision, and the automatic retractor is opened, and the spine has been exposed. The spine is transected, and the spinal cord is damaged in the same plane. The pedicle screw and steel plate need to be fixed before and after, otherwise the whole body will lose the support.

A mid-sternal approach was made at 12 o'clock, and now a mid-abdominal incision was made at 6 o'clock, and the two approaches were retracted to both sides to fully expose the surgical field.

A mid-abdominal incision is made to cut the skin, subcutaneous, deep fascia, and three layers of abdominal muscles, reaching the abdominal cavity. Blood stasis bursts out, and the intestinal tube pours out, and is covered by a cloth bag made of sterile sheets.

The retractor was inserted, retracted from left to right, and cooperated with the chest spreader, and the surgical area was well exposed.

Similarly, the abdominal cavity was full of blood stasis, several suction devices were working at the same time, and it took a few minutes to suck clean.

The aorta and vena cava were pushed apart by the stake at the thoracoabdominal junction and moved to the right side. The penetration of the stake was a little skewed, just avoiding the aorta and vena cava, otherwise the ambulance would not be able to be taken.

Exploring the 6 o'clock position, the duodenum was ruptured, the pancreas was ruptured, and the bleeding vessels were ligated.

In fact, because the aorta is blocked, there is no bleeding. With the skill of anatomy, the surgeon can still easily find the broken blood vessel and ligate it.

"Blood pressure 54/37mmHg-"

Fatty Liang reported that his blood pressure had been dropping.

The compensatory ability of the human body is constantly weakening, and when it collapses, it is the time when the spark of life goes out.

"Blood! Why not yet?" The chief knife's voice was loud, but he didn't roar.

"A few more minutes! It's being delivered!" said Dr. Tao.

Although there are volunteers who donate blood, they have to go through the process, check blood types, check infectious diseases, and cross-match blood, which takes time.

The probe turned to the 9 o'clock position. There were a large number of blood clots around the aorta and vena cava, and fresh blood was flowing out. There should be a rupture here, and the blood that was retained in the blood vessels came out.

The finger went into the probe, and sure enough, there was a two-centimeter gap in the aorta, and the aorta was torn. This is a fatal injury. The general rescue time is only 6 hours. Within 6 hours, there are excellent and experienced major vascular surgeons. Doctors can save lives.

This 6 hours is just an average time, many with large ruptures die in an instant or within a few minutes.

Because of the squeezing of the wooden stake, the speed of the bleeding from the wound was reduced, and this patient bought a little time to come to the hospital.

There are two blocking forceps, and the upper and lower jaws are clamped to prevent the loss of residual blood. Now one milliliter of blood is also precious.

The vena cava was fine, and the liver was also squeezed and ruptured.

At the 9 o'clock position of the wooden stake, there is a nail, about three centimeters exposed, forming a hook, which is frightening and makes the scalp numb.

The hook just hooked into the aorta, tearing a gap, dangerous!

Snip the nail vigorously and carefully remove it.

"Blood pressure 50/32mmHg-"

The door of the operating room opened, and finally, two bags of blood were seen, and the itinerant nurse quickly hung up the blood. It seemed that the emergency command had already figured out a solution.

"Transfusion from the venous channel of the upper extremity!" Yang Ping reminded the nurse.

Director Tian's side is also investigating and stopping the bleeding.

The probe was completed at 9 o'clock, and began to probe at 6 o'clock. Another nail was found. It was roughly the same shape as the previous one, but the direction of the tip was opposite. The spleen was actually fine. The stomach and duodenum were torn and the nail was cut. ,take out.

If the ignorant and fearless try to pull out the stake, no matter which direction it goes, the nail will hook into the surrounding tissue, large blood vessels or organs, with disastrous consequences.

Director Li and Director Zhang have worked in grass-roots hospitals for many years, and they have also gone to major hospitals for further study. They have seen the world and mastered anatomy so well. Whether you can save it or not, you are lucky.

One unit of red blood cells, [-] milliliters of whole blood, and rapid infusion under pressure, the blood pressure has not yet tended to rise, but at least it has not dropped any more. I lost too much blood before.

"How is it?" The director of the medical department came in, and Director Miao was already on the operating table to rescue the fractured pelvis.

"Prepare pedicle screws and anterior steel plates to fix the spine. After the spine is crossed, the front and rear joints are fixed!" Director Tian said during the operation.

The director of the medical department called immediately to make arrangements. The pedicle screws and anterior steel plates were both available. They were originally intended for tomorrow's surgery patients, but they were brought here for emergency use.

"The blood pressure can't rise, the blood is not enough, and I have to lose." Liang Fatzi said.

The director of the medical department said: "We are trying to find a way. We have already drawn [-] people, and now there is only one volunteer who donated blood."

An orthopedic surgeon is so skilled in abdominal surgery, and Director Zhang is ashamed of doing general surgery.

Now, the upper, lower, left and right sides of the stake have all been separated, and the front and rear have formed a joint division, so the anatomical structure is clear.

"It's time to pull out the stake." Yang Ping raised his head, his neck was sore, this position was too difficult to do, and the operating vision was extremely poor.

"Aseptic expelling tape, four!" Yang Ping said.

Sterile expelling tape, which is commonly used in orthopaedics, it is not a problem to find a few at random.

Sterile exsanguination tapes are placed on the stage.

"Big straight pliers, the biggest!"

Straight forceps clamped the expelling tape and carefully passed it between the hole and the stake, and Director Tian caught it.

The four sterile expelling belts are all sent over, slowly opened, and pulled in the opposite direction, pulling the surrounding tissue away, forming a little gap with the stake to protect the surrounding organs and blood vessels.

Yang Ping and Director Tian carefully sent and pulled the stakes, and finally took them out safely.

Rinse, probe and debride again, and rinse again.

Tissue scissors, trimmed the aortic breach, and four zero-damaged blood vessel suture needles, started to repair the breach, and soon, the breach was repaired.

The diaphragm, liver, pancreas, stomach, and duodenum were repaired, and the bleeding was completely ligated again.

There is no fixed procedure in this kind of surgery textbook, and it depends entirely on the surgeon's rich experience and ability to apply knowledge.

The separation during the operation is like cooking a steak, and there is no accidental damage to a blood vessel, not even a small artery.

At the same time as the exploration, the bleeding small blood vessels were ligated and advanced layer by layer without any pause or repetition.

The whole process is like a thrilling prison robbery, a prison robbery against the death prison.

Director Li and Director Zhang thought that if they were asked to perform this operation, the patient would definitely not be able to be saved.

They invariably came up with the idea of ​​going to Sanbo Hospital for further study in their unconfused years.

"Four hundred milliliters of whole blood!" came again.

This man has donated eight hundred milliliters.

It is equivalent to the amount of bleeding of a severe femoral shaft.

A blood donation is generally no more than [-]ml, and if it exceeds, there is a risk. He donated [-]ml.

"There is only one volunteer, and the blood bank dares not collect blood anymore," said Dr. Tao.

With these [-] milliliters, at least it can hold up, and after a few units of red blood cells, it can hold up.

"Blood pressure! 76/42mmHg—"

There is a rise!Anesthesiologists report blood pressure dynamically.

Time is running out, let go of the blocking forceps, and the blood will flow all over the body.

All that's left is to fix the spine.

　Thanks for the reward of 666 starting coins in the cold night moonlight!

　　
　
(End of this chapter)