A man in his forties came in. He was very fat. He fell on a stone after suffering a cerebral hemorrhage. The 120 doctor gave him a simple bandage.
This is a critically ill patient. CT shows that the bleeding volume is more than 100 ml, and there is also intraventricular hemorrhage. In the future, there may be blockage of the aqueduct, causing hydrocephalus.
The first step is debridement and suturing. In the past, we usually invited a neurosurgery doctor for consultation, but now it is not necessary and difficult to do so.
The reason why it’s hard to ask is that the inner and outer worlds are becoming more and more disharmonious. Needless to say, the number of hospital beds in the inner world has doubled, while the number of hospital beds in the outer world has dropped slightly.
Besides, there is no need to invite him. Liu Muchiao's debridement and suturing skills have reached a master level. Even if the director of surgery comes on stage, he is not as agile as Liu Muchiao.
Lu Lu and Wen Xingyu worked very actively. It didn't take long for them to make all the preliminary preparations. Liu Miqiao opened the gauze for the dressing, and blood suddenly came out.
The hemostatic forceps in Liu Muqiao's hand quickly stretched out and accurately clamped the bleeding point. This speed was so fast that it took the blink of an eye.
Lu Lu and Wen Xingyu were surprised. Is this action too fast?
They were also interns. At that time, when they saw such heavy bleeding, the only thing they could do in panic was to block it with their hands. How could they be so calm and discover the bleeding point so quickly?
It is very difficult to determine the bleeding point. The blood is mushy. Do you know where the bleeding is? Where are the blood vessels?
Liu Miqiao pinched it gently, and the bleeding immediately stopped. Pressing it with gauze, his vision became clearer.
Of course, the scalp is different from other places. There are too many blood vessels. The bleeding blood vessels are clamped, and the capillaries are still bleeding. Therefore, Liu Maqiao quickly checked the wound when his vision was clear for a short time.
There is not much necrotic tissue and not much sediment, so this kind of wound is easy to treat.
Next, rinse with salt water.
Then sew.
It took about five minutes to open the wound, and Liu Miqiao turned to today's main topic, hematoma puncture.
"Observe the pupils and vital signs." Liu Miqiao must understand before the operation.
"Needle-like pupils, blood pressure 160, 100, body temperature 39.7°C, breathing sighing, blood oxygen 67..." Zhao Yilin has actually been observing.
This patient is extremely dangerous. All the data above indicate that the intracranial pressure is very high and there is a risk of death at any time.
"Lu Lu made preparations for disinfection and other preparations, and Wen Xingyu drilled the holes." Liu Muqiao said.
Lu Lu and Wen Xingyu were stunned. Did you hear that right? With such a patient, do we still have a chance to take action?
"You heard me right, just listen to classmate Mu Qiao." Zhao Yilin said.
Soon, Lulu shaved her head, disinfected her skin, and determined the injection site.
Wen Xingyu picked up the electric drill and drilled a small hole.
Please!
Classmate Mu Qiao!
Now it’s time for you to get punctured.
"Which of you wants to try how it feels to pierce that membrane?" Liu Maqiao put on his gloves, but there was no sign of taking action.
"We?????? poke the membrane?"
"Lu Lu, come on."
"Me??????Why me?"
"You don't want to?"
"I do!"
After making sure there was no mistake, Lu Lu picked up the puncture needle and looked at Liu Miqiao, as if asking, can I start?
Liu Muqiao nodded.
Lu Lu lowered his head and started operating.
His hands are shaking a little. This is the first time and he will be a little nervous. This is normal. Everyone has a first time. Don’t be afraid. Don’t be afraid. Liu Muqiao doesn’t know how many times he has stabbed him!
It is said that it feels very good.
"Pa!" broke.
"Continue." Liu Maqiao said lightly.
"Continue?"
"Well, basal ganglia, 4 centimeters, very simple."
Lu Lu held his breath and pushed forward slowly. Suddenly, he felt a sense of disappointment. It was here.
"Don't move!" Liu Muqiao said.
After saying that, Liu Muqiao walked over and took the puncture needle from Lu Lu's hand. He wanted to control the patient's intracranial pressure.
Just now, he asked Lu Lu to puncture on a whim. How could he have so many scruples? It is rare for problems to puncture the dura mater, so why bother to practice breaking through the kraft paper?
Go directly.
There was another reason why he let Lu Lu do it for the first time. This patient was the best for puncture. Even if it was a little off, it didn't matter. It was like shooting a target. As long as it didn't miss the target, it didn't require 10 rings.
Everyone has a first time.
After Lu Lu has this experience, he will have confidence in the future.
However, at the most critical moment, Liu Miqiao still performed the procedure himself. He inserted another needle. This kind of patient needs double tubes, one in and one out, and drainage for a period of time.
Intraventricular hemorrhage is different, it affects the entire cerebrospinal fluid system.
The brain and spinal cord are connected, and there is a cerebrospinal fluid system. These fluids are circulated. The ventricles of the brain produce fluids, and the cauda equina absorbs fluids to maintain flow and constant pressure.
Intraventricular hemorrhage may block this duct, especially the central aqueduct in the brain, which is very thin. A small blood clot can block the circulation of cerebrospinal fluid.
Without circulation of cerebrospinal fluid, hydrocephalus will occur and develop into another disease.
Liu Muqiao slowly released the blood, very slowly.
Lu Lu and Wen Xingyu lowered their heads and watched Liu Miqiao's every move carefully. At this time, Liu Miqiao usually didn't speak. He was very serious and seemed to be listening.
Another person also stretched his head over and even competed with Lu Lu for space.
You don’t need to look to know that this is Dr. Zou’s head.
Others may have gradually forgotten the death of Dean Pi's relative last time, but Dr. Zou has not. Every time he performs a cerebral hematoma puncture, he will think of the person who died last time.
He is summing up experience.
He stretched his head over just to feel the intracranial pressure.
Listening, you definitely can't hear it, but you can feel it. The person holding the needle can feel the tension in his hand, and the people next to him can also feel this atmosphere.
"Report the inspection situation." Liu Miqiao did not raise his head, staring at the needle.
"The pupils are like pinpoints, the blood pressure is 156, 98; the breathing is like sighing; the blood oxygen is 82; it's still a fever, the body temperature is very high, what is the body temperature?" Zhao Yilin answered.
The nurse picked up the thermometer and said, "39.6."
Liu Muqiao didn't respond, so he injected some more blood, then stopped, waited for a while, and then injected some more blood.
Just like that, I waited for half an hour.
"How's it going?" He asked Zhao Yilin again.
"The pupils have become a little bigger, equal to the size of a circle. Breathing is a little better. Hey, blood pressure has dropped to 146,92; blood oxygen 88. The body temperature has also dropped a bit."
"This patient will probably take a long time." Liu Miqiao seemed to be speaking for himself, "The ventricles of the brain need to be flushed well. Doctor Zou, do you want to give it a try?"
Dr. Zou was stunned.
"Me?"
"Yes."
"No, no, no."
"Don't be afraid, come on, try it."
"No??????Okay."
Dr. Zou tried hard to control his hands. He couldn’t shake them! He couldn’t shake them! He couldn’t shake them!
However, I am still a little shaken.
"Pa!"
Liu Miqiao slapped Dr. Zou's hand hard, "Why are you shaking? You have done dozens of cases! If you don't work hard, Lu Lu will catch up."
Dr. Zou took the puncture needle from Liu Miqiao's hand, and wow! Suddenly he found that his hand stopped shaking.
"The current pressure is 8 centimeters of water column." Liu Miqiao said, "Think carefully. This pressure is the best. Hold on steady."
Dr. Zou didn't speak, he was seriously experiencing it.
8 cm.
8 cm.
8 cm.
He is thinking about it, and this feeling cannot be high or low.
This chapter has been completed!