Chapter 62 Blood Vessels in Terms of Thickness
【Smooth medical road】 【】
Many diseases are just like deaf marriages, especially some traumas, which are equivalent to a group of people lifting the bride, breaking her legs, and sending them directly into the bridal chamber. As for the next step, it depends on whether the groom has seen the world or not. Wrong way.
A hospital below the third level is like a young man who can be excited for a long time when he sees a male and a female donkey fighting. This kind of hospital has the right to reject this kind of disease. After all, there is still a difference between real guns and live ammunition.
And a tertiary hospital, especially a key tertiary hospital in a province, no matter what you encounter today, it is almost impossible to open your mouth and say that it is too big to handle.
Trauma surgery, life-threatening trauma surgery, most of them are like this. After sending them in, the doctor's ability is directly linked to the patient's life.
This kind of moment is a matter of fighting hard, the patient is the same, and the doctor is the same.
Sometimes patients who do not even have time for anesthesia, let alone various related examinations. The disease at this time is like a man with hairy legs, pointing at the hairy legs and asking strangers to guess his name, it is really embarrassing.
For example, in the operation in the middle of the night, Ma Yichen could only judge the possible organs that were injured from the entrance of the meat stick. But he couldn't figure out which one it was, and sometimes there was not much difference between such an inaccurate guess and not knowing anything.
It's like guessing the father of the child through the belly, this damn only knows that the woman is pregnant, and the rest is up to God.
"Increase the indoor temperature, blood transfusion, and increase the amount of crystalloid fluid."
Zhang Fan took a look at the anesthesia while giving Xun Xun a verbal doctor's order.
The director of the anesthesiology department nodded to Zhang Fan. If there is a department in the hospital that is most cost-effective, it must be the anesthesiology department in the operating room.
For other departments, if you improve a little, you have to spend real money in it. There are even some departments, such as the Department of Obstetrics and Gynecology, and Nima knows that they need money to lie down and open their mouths. As for the Department of Anesthesiology, because there are more and more operations in the hospital, and it is also cooperating with experts from all over the world, the Department of Anesthesiology can handle the style of surgeons in the north and south.
After lowering blood pressure and heart rate, Zhang Fan started to operate.
It is very simple to stuff the gauze. Knead a piece of gauze into a ball, find the place where the blood bubbles appear and stuff it down, just like girls put things in their underwear, they are all spherical objects.
When it's available, it's different.
This thing stuffed into the underwear will be taken off slowly if it is gentle, and it will be pulled out directly if it is rough. During the operation, this thing should be taken while pressing, and the two hands alternate with each other.
This is to prevent bleeding.
"Fishing line! Double thread!" The equipment nurse quickly pulled out two silk threads, and the needle holder clicked to lock one end of the thread, and with a snap, the needle holder was placed in Zhang Fan's hand.
The fishing line is not really a silk thread for fishing, but one end is long, and the other end is bitten by a needle holder, which is for the convenience of knotting inside the abdominal cavity.
Then, Zhang Fan stretched out a finger along the gap in the gauze, and stuffed it into the blood-soaked warm gauze like a Zen finger.
Immediately afterwards, use more force to let your fingers pass through the gauze layer, and then close your eyes. This time, it is not to enter the system, but to rely on the sensation transmitted from the fingertips.
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【Smooth medical road】 【】
The sensitivity of a surgeon's fingers is generally not apparent, and some doctors may never use it in their lifetime, but top doctors may often encounter operations that require sensitivity.
Of course, the maintenance of the hands of top surgeons is not as perverted as playing the piano. In most cases, this can be used as an excuse not to wash the pot.
The pulp of the middle finger moved slowly towards the direction of the hepatic portal vein, Zhang Fan felt the direction of the blood flow.
If it is hepatic portal vein bleeding, if the fingertips are in the gauze group, you can feel a kind of head-on blowing from this direction, like the feeling of being peed on your hand, with impact, and the temperature is slightly higher than the gauze. This kind of judgment must be accurate and cannot be specious. If you say something like hepatic portal vein rupture, the assistants on the operating table will throw down the surgical forceps and strike you.
This kind of operation, the surgeon can hardly say
Suspicious words, otherwise the assistant would not know whether to cooperate next time. If the chief surgeon cannot make a judgment, he will apply for a superior doctor to help make a judgment.
After Zhang Fan stuffed his finger in, it only took about ten seconds to close his eyes and open his eyes. Men are naturally more curious about things with holes. Boys are not in the minority.
However, relying on the sensitivity of the fingertips, it is estimated that even a craftsman may not be able to do well, and it must be done in a short period of time, so in a hurry, so this stuff, medical stuff, wants to surpass most doctors, it is true that there is no talent No way.
"Not on the hepatic portal vein!" After Zhang Fan finished speaking, he immediately said, "Inferior vena cava." Ma Yichen was stunned, this damn pierced a thicker blood vessel.
This way of judging is unconventional. According to the conventional way of judging, that is, the way of ordinary doctors: first ligate the blood vessels around the hilum of the liver, and then make a comparison to see if the amount of bleeding is reduced, and then move it. Move the liver to see if the bleeding will intensify. The only advantage of this method is that it is less difficult, as long as a general surgeon who can ligate can judge it.
Of course, there are many shortcomings. The slower doctor under his hands has not yet completed the ligation, and the patient has already bled and hung up.
Moreover, the rupture of large veins and arteries is extremely prone to air embolism, and the mortality rate exceeds 90%.
When many people go for an IV drip, the nurse will take the medicine and put it on the ground, which is to vent the air. Of course, this amount of air does not reach the amount of embolism. A few small air bubbles enter the blood vessels, and the blood can directly dissolve the air.
However, it is also to prevent accidents, so sometimes, when a few air bubbles enter the blood vessels occasionally during the drip, it’s nothing to worry about. You don’t need to grab the nurse like an eagle catching a chicken, pinching someone’s neck and insisting on giving it to him. You suck it out.
But the big blood vessels are different. This kind of embolism is no different from fat embolism, entering the heart, myocardial infarction, entering the brain, cerebral infarction, and pulmonary infarction entering the lungs. Therefore, when Ma Yichen heard that it was the inferior vena cava, Ma Yichen felt like it was over and that he was going to put the table down today.
"Extend the incision!" Zhang Fan's tone became more and more serious.
The scalpel extends directly along the incision in the middle of the abdomen, and extends directly to the chest. The patient on the operating table feels like a new butcher on the butcher's shop, which is about to be divided into two halves.
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【Smooth medical road】 【】
"Don't touch the liver, a lot of gauze, quick!"
The gauze in the hospital is actually put in the pot before entering the operating room.
Just like the old-fashioned big aluminum pot for steaming steamed buns at home, it is estimated that people who are young have never seen this kind of pot.
Because it needs to be autoclaved, the gauze is put into the pot for autoclaving. If it is not used within 12 hours, or if it cannot be used up, no matter whether it has been opened or not, it must be autoclaved again when it is used again. Therefore, sometimes many people think that changing the dressing in the hospital is no different from changing the dressing at home.
Why don't you just apply some iodophor and cover it with gauze? A dexterous person can make it more beautiful than a rough doctor. In fact, it is not. Just a sterile condition, there is no way to achieve the level of the hospital at home. After all, no one is rich enough to get a large pot to cook gauze under high pressure for a wound.
The three itinerant nurses held the pots, like waiters serving food in a restaurant, opened the lids one by one, and poured the gauze on the instrument table.
It was too late to clamp with oval forceps.
While pressing the liver with his hand, Zhang Fan kept stuffing it with gauze.
Pressing the liver is afraid that someone will open the liver to find the bleeding point. This is quick, but if the liver is opened, a lot of air will enter the inferior cavity, and the bleeding point will be found and the patient will be killed directly.
"Is it blocking the blood flow to the whole stem?"
Ma Yichen asked, he already had the needle holder and suture thread in his hand.
"No, it's too late. Zhang Yuan, we need a blood transfusion. The hematology department only has 500 blood type B blood for the night." Director Huang of the anesthesiology department directly interrupted Ma Yichen's questioning.
For this kind of suture, all the passages of the liver must be broken first, from top to bottom, from the upper cavity to the lower cavity, and from the lower intestine. After blocking, the liver is then opened and sutured under direct vision
combine.
The suturing of small vessels and the suturing of large vessels are two different things.
Small blood vessels, especially those without names, are often ligated with a few needles. The so-called blood vessels with names are probably blood vessels that are about the same thickness as oil pen cores.
In terms of thickness, this is a way to express the importance of the vascular system. Just like men, this thing is afraid of being called a thin dog by people, especially women, because it will be abandoned if it is too thin. As for the large blood vessels, it needs to be sutured in three layers.
When Zhang Fan heard this, he didn't have enough blood.
"Go, ask the tea center blood bank."
Before the itinerant nurse picked up the phone, he heard Lao Chen outside the door and asked the itinerant nurse on the intercom, "When you have time, please tell Zhang Yuan that Ms. Zeng has already arrived at the hospital with several bosses from the high-tech zone. up.
They give their full support, money for money, people for people, and medicine for medicine. "
"Organize their blood donation in the high-tech zone." Zhang Fan was stunned for a moment, and said quickly, Zhennima fell asleep and hit the pillow.
In big cities, the central blood bank usually has more blood than key hospitals, but it is different in small cities, especially in Chasu. The development of Chasu Hospital not only killed a group of certain hospitals, but even swallowed up the epidemic prevention station and other tertiary hospitals. As for the blood bank, it was no problem.
The people in the blood bank, no one invites them to dinner now.
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【Smooth medical road】 【】
Among all medical units, the central blood bank is definitely among the top three in terms of leisure and reputation.
In particular, some directors of the blood bank have almost never eaten at home, because there are too many people who use blood, and not everyone has a blood donation certificate within three days. At this time...
What Ms. Zeng said to Zhang Fan was quite polite, as if she was advancing and retreating with Zhang Fan and the others. But outside the operating room, facing a leader who couldn't raise his hand at the gastrointestinal meeting, he almost pointed his nose and scolded.
"Our employees have been beaten into critical illness for no reason. Do we investors dare to invest? How did you guarantee it back then? Leader, please really use your heart to create something good for us. environment!"
The leader's face was livid, one side was angry, and the other side was also angry, Nima was too bullying.