Doctor of Healing

Chapter 46 Cavernous puncture
Ji Xiang came to the emergency department of the Second Affiliated Hospital as quickly as possible.

This time the system tasks were not as calm as before, but kept flickering like a warning light.

Maybe this is the difference between emergency tasks, Ji Xiang didn't think much, threw the bicycle aside, and trotted into the hospital.

"Doctor Xiaoji!" Colonel Wang waved and lowered his voice to call Ji Xiang.

"Teacher Wang." Ji Xiang ran over in the crowd, "What's going on?"

At this time, the hall of the emergency department was in chaos, only the door of the emergency room was a little quieter.

Several people stood at the door with gloomy faces, and people kept reporting the situation to them.

Among the people who reported the situation, Ji Xiang only knew one person—Dean Zhao.

Dean Zhao, who was so full of stars that day, is now like the most inconspicuous little star, and he can't get close at all.

"Two died on the spot, and the others...exploded and caught fire. The number of burn patients has reached 16." Senior Colonel Wang sighed, and his short and fat body seemed to have shrunk a little.

No one would be in a good mood when they mentioned such a serious accident.

"Is it serious?" Ji Xiang asked nonsense.

"There were a few minor injuries, and those with moderate injuries were sent directly to the stage. Now there is a severely burned patient who couldn't establish a venous channel... People, I guess it's terrible."

Ji Xiang checked the system task and knew that this was the patient who was "waiting to die".

"I'll go and have a look." Ji Xiang said.

"Don't go." Colonel Wang sighed, "It's heavier than expected, two of them are already dead, and one can't even get a needle in. The anesthesiology department and the nursing department have tried it. It doesn't work. I'm about to leave now." .”

Ji Xiang was a little puzzled.

Seeing Ji Xiang's confused face, Colonel Wang knew that this little rookie didn't know what it meant, so he explained, "Three people who died in a major safety accident need to be reported, and the city has ordered the patients to be rescued."

"It's better not to save at this time." Boss Wu was in a low mood, hanging his head and muttering.

Colonel Wang shook his head, "Keep your voice down."

Mr. Wu sighed, Ji Xiang didn't know what kind of things they had encountered before he said such a thing.

But the gossip can be pushed back, and the most important thing now is to indwell the intravenous access.

You can't just watch people die, right?

But Ji Xiang didn't even know the most basic situation. He asked cautiously, "Mr. Wang, what's the patient's condition? Why can't the needle go in?"

"The whole body was burned, even the soles of the feet were burned, and only a small part of the right groin could see blood vessels." Colonel Wang said, "But there were rotten skin and blisters, just one blood vessel, and finally Director Xu from the anesthesiology department came to the hospital." Yes, try to place an IV line."

"and then?"

"Failure." Colonel Wang sighed again, "The blood vessels of severely burned patients are extremely precious. There was once a burn patient living in the aseptic room of the burn department. A doctor changed the dressing, and the venous channel fell off somehow. Yes, the doctor was pointed at the nose by the director of the burn department and scolded for a week."

"..." Ji Xiang was speechless, a rookie like him couldn't feel how serious the situation that Colonel Wang said was.

"Let's take a look on the stage later. Sooner or later you will have to rotate to the burn department." Colonel Wang said, "Let's see what the lighter patients look like first, so as not to be overwhelmed by then."

There is a strong meaning of support here, but Ji Xiang was a little anxious, he didn't say anything, and turned to go to the bathroom.

"There's no manners at all." Mr. Wu looked at Ji Xiang's tall back and said contemptuously.

"It's too hasty, coupled with nervousness, sphincter... even the gods can't stand the urination." Colonel Wang is very tolerant of Ji Xiang.

Ji Xiang found a quiet place, held his breath and entered the system space.

"Teacher, you know the mission." Ji Xiang asked anxiously after entering.

Although the time flow in the system space is different from the outside, Ji Xiang, a rookie, has been assimilated by the tense and depressive atmosphere unconsciously and immersed in it.

"I know." The system NPC bowed his hands and said slowly, "Go and see the simulator first, and then tell me your opinion on how to deal with it."

It turned out that it was ready, and Ji Xiang strode into the operating room without being polite to the system NPC.

A simulated man with burns all over his body was lying on the operating table. Ji Xiang glanced at it, feeling cold in his heart.

The whole body burns turned out to be like this.

The whole body of the simulated body is carbonized, and the slightly lighter areas are full of red plaques and blisters, without any complete skin. No wonder the needles can't stick.

"Generally speaking, scalp needles and indwelling needles in the groin are the most common ways to establish intravenous access for burn patients." The system NPC explained, "But this patient is seriously injured, and only the HY is basically fine. But there are also many blisters in the groin , take a look."

Ji Xiang gradually felt helpless.

The system task is correct, there is no way to indwell the intravenous access, and the patient's whole body is completely incomplete except for the palm-sized lower body.

"Teacher, how do we do this?" Ji Xiang asked blankly.

"I'll teach you." The system NPC said lightly, "I showed you the anatomy of the cavernous body on the first day, so tell me."

"There are a large number of cavernous sinus behind the cavernous body, which is equivalent to a valve. After being stimulated, the local smooth muscle relaxes, and a large amount of blood is pumped in..."

Ji Xiang said, and suddenly understood the meaning of the system NPC.

But... infusion from cavernous body puncture?Jixiang has never heard of such a method.

"Teacher, you mean the infusion through the cavernous body?" Ji Xiang was afraid that he might have misunderstood, so he asked tentatively.

"Hmm." The system NPC nodded.

Ji Xiang couldn't laugh or cry.

The cavernous body is not a blood vessel!

But logically speaking, it seems... yes.

But looking at the helpless expressions of Senior Colonel Wang and Mr. Wu outside, it is estimated that even the veteran of the urology department has never done similar things.

"The basic principle is this, I will operate it once and you will watch." The system NPC put on sterile gloves and began to operate.

Simply prepare the skin on the surgical area, and clean the remaining hair roots again.

System NPCs then proceeded to disinfect the skin around the stem.

Hold it with your index finger and thumb, fix the spongy body behind it, take the right side of the spongy body, and there is no subcutaneous vein area on the side.

"Attention, avoid damage to the dorsal neurovascular bundle and ventral urethra here."

The system NPC told Jixiang when he did this.

Ji Xiang nodded, he understands the operation of the system NPC, the difficulty is not high, it is just a matter of fixed thinking.

What he was curious about was whether it would work or not.

After all, Jixiang has never seen, heard of, or even thought about infusion through the cavernous body.

The NPC of the system uses a No. 6 infusion needle to pierce the corpus cavernosum about 45 cm through the side at a 2° angle, and then insert the needle about 0.5 cm after piercing the buffy membrane.

"There is a saying about the needle of the infusion set. I don't want to talk about it. You can feel it carefully in the future." The system NPC explained, "45° from the side is the best angle. In the patient's case, insert the needle 2cm. When the needle pierces the buffy membrane There will be a sense of loss.”

"Pierce the albuginea 0.5cm, and stop when you feel the feeling of being empty."

The system NPC sticks the needle in and opens the infusion channel.

The liquid was opened to the maximum and dripped in a dripping pot.

Jixiang's heart is beating wildly, it's that simple? !

The slippery liquid symbolizes vitality. If possible, the patient may have a chance!
Ji Xiang immediately helped the system NPC fix the needle with a dressing, and the system NPC adjusted the infusion rate to 50ml/min.

"It is difficult to replenish fluid after a large area burn, which is a clinically difficult thing.

Because the effective circulating blood volume drops sharply after extensive burns, immediate and rapid fluid replacement is the fundamental measure to rescue shock.

However, after extensive burns, the skin is severely damaged, and the blood vessels on the body surface are severely damaged. There are not many veins available for infusion, and there is even no place to wear them. Even the remaining skin is a valuable skin donor site and needs to be protected. "

After the system NPC finished all this, he looked at Ji Xiang and said lightly.

Ji Xiang vaguely understood the consciousness of the system NPC by referring to the gloomy expressions of the people outside the emergency room and the helpless expressions of Colonel Wang and President Wu.

Indeed, it is difficult for a doctor to accept that a living person cannot establish an intravenous access, so he is alive and dead.

"Deep vein puncture or incision requires skilled operators and local strict aseptic conditions, and is difficult and time-consuming. It is impossible to replenish a large amount of fluid in a short period of time, which affects the timing of rescue and the effectiveness of treatment."

"Teacher, is there any other way?"

"Bone marrow puncture is possible." The system NPC said, "However, extensive burns are a contraindication for bone marrow puncture, so it is not suitable at this time. Do it reluctantly, and subsequent infections and so on are big problems."

"The spongy body has its own advantages, first of all, the position is relatively hidden, it is not easy to burn, the skin is relatively intact, the anatomical position is relatively fixed, and it is easy to puncture.

The cavernous body is composed of many cavernous trabeculae and cavities. The cavities are actually sinus spaces that communicate with blood vessels. The blood sinus cavities are large and extensive, and return to the deep dorsal veins of the vagina, enter the pelvic venous plexus, and directly enter the systemic circulation. .

And another advantage is that the spongy body is surrounded by tough white membrane, so that the blood sinus remains open even in the case of insufficient blood volume. It is a relatively independent and complete tissue structure, so that the puncture can be fast, accurate and the success rate high. "

Ji Xiang's vague cognition gradually became clear with the explanation of the system NPC.

This is so much better than veins, especially the corpus cavernosum is surrounded by a white membrane, which is an independent tissue structure, and will not cause rescue failure due to hemorrhagic shock because the blood vessels in the whole body are deflated and the needle cannot be inserted.

"Teacher, why don't you promote it on a large scale in clinical practice?"

"It's relatively rare that there isn't a single blood vessel." The system NPC said, "Secondly, this operation may have side effects, so it should not be used unless it is absolutely necessary."

Ji Xiang nodded.

"You come."

The simulator was replaced by another one, Jixiang put on the gloves, and began to follow the needle sticking process of the system NPC step by step.

……

"Leader, this is Mr. Gu from the imperial capital, a member of the health care team." Dean Chen of the Second Affiliated Hospital and the leaders of the city introduced.

I happened to meet this guy, although he is not from emergency critical care medicine, but the name of the health care group is loud enough.

The patient couldn't be saved, and Dean Chen just wanted to use all means to tell the leaders that it wasn't that the hospital didn't do their best, but that the injury was too serious.

Dean Chen certainly knew the consequences of the death of three people.

(End of this chapter)