Director Kong looked anxiously at the elevator entrance. As soon as Yang Ping came out, he immediately greeted him.
"Dr. Yang, I'm sorry, I called you over this weekend!" Director Kong looked embarrassed.
Yang Ping said modestly: "Director Kong is serious. Xiao Yang is always available. Is there anything you need from me?"
During the emergency, Director Kong was unambiguous and straightforward: "Mr. Ning suddenly suffered from respiratory failure in the morning, and his blood oxygen could not rise, hovering around 70. Director Jiang from the ICU looked at it and decided to use ECMO. They punctured and placed it in the emergency ward.
After the catheter was inserted, ECMO was connected. Although the blood oxygen level increased a little, it was still low, only 78. They considered that the tumor had squeezed and invaded the right external iliac artery and vein, causing the lumen to be narrowed and the flow rate of the blood to be drawn out was not good. Unit time
The amount of blood drawn out for oxygenation is too small to meet the demand. Miss Ning offered to ask you to come."
ECMO, nicknamed "Magic Lung", is an improved artificial heart-lung machine, also called extracorporeal membrane oxygenation, which can replace the function of human lungs or heart to a certain extent and for a certain period of time.
It draws the human blood from the veins, oxygenates it through the machine, turns it into oxygen-rich blood, and then injects it back to the human body through the veins or arteries.
If infused back into the human body through veins, it can replace the function of the lungs; if infused back into the human body through arteries, it can replace the functions of both the heart and the lungs. Doctors call the magic lung the last straw to save lives!
However, the price of this kind of machine is very expensive, so the cost of use is also very expensive, and it is not covered by medical insurance. It costs 60,000 to start up, and 10,000 to 20,000 for each day thereafter. For ordinary people, this is a sky-high price. For Mr. Ning, this is no need to consider.
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As the two walked towards the ward, Director Kong introduced the situation to Yang Ping. When they reached the emergency ward, the situation was also introduced in detail.
The emergency ward of Huaqiao Building is equivalent to a small ICU. It is equipped with all kinds of emergency equipment, including expensive magic lungs. Moreover, these equipments are not purchased by the hospital itself. Many of them are donated by patients who live here or have lived here.<
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Inside, Director Jiang from the ICU and his assistant were intubating, but he had already stopped, probably waiting for Yang Ping. Next to him, there were chief physicians or deputy chief physicians from the vascular surgery department, general surgery department, oncology surgery department, and color ultrasound room.
"You can't go in any further. Go back a little quickly. If you go in again, the blood vessel will break!" the deputy chief physician of the vascular surgery department reminded Director Jiang.
"Keep it down! Look clearly!" Director Jiang directed the doctors in the color ultrasound room.
The color ultrasound doctor lowered the probe slightly, and the blood vessels on the ultrasound image became clearer.
Mr. Ning was lying on the bed, with a sallow complexion and some confusion. He was covered with a blue sterile drape. Director Jiang had just completed the catheterization of both femoral veins. The catheterization of the left femoral vein went smoothly, but there was a hole on the right side.
Because of the stenosis, the catheter can no longer go deep. Now the right side is the tube that leads out the blood, and the left side is the tube that injects the blood.
Because of the stenosis of the right external iliac vein, the blood flow does not reach the expected flow rate. If it is switched, the right side is used as the input pipeline and the left side is used as the output pipeline, the result will not be any different. Even if the left side is led out for oxygen
If the combined blood is sufficient, but the flow rate of the blood sent back is too slow, it still cannot achieve the expected purpose.
"Dr. Yang, I have to trouble you again!" Miss Ning said.
She stayed with her all the time, squatting beside the bed, grabbing her father's hand, and smiling: "Dad, don't be afraid, Doctor Yang is here, he has a way."
Mr. Ning seemed to understand what his daughter said, but he couldn't speak. He nodded with difficulty.
In fact, Yang Ping was helpless as to what he could do to a patient with advanced liver cancer and systemic failure.
Doctors treat patients just like the epitaph of Dr. Trudeau in New York, USA: sometimes cure, often help, always comfort.
Mr. Ning stretched out a hand with difficulty and trembling, and Yang Ping held his hand tightly, cold and thin.
His lips trembled and he wanted to say something. Yang Ping brought his ear to his mouth and heard a few indistinct words.
"Help me --- delay it for a few more days ---" After saying these words, Mr. Ning seemed to have exhausted all his strength.
Yang Ping nodded heavily and held his hand tightly to show that he heard what he said. Trust, this kind of trust is so precious. With just a few words of dialogue on the operating table, you can entrust your life to yourself.
"Definitely, I will try my best to help you fight for it!" Yang Ping put down his hand.
Mr. Ning was once hospitalized in the Affiliated Hospital. For his condition, the Affiliated Hospital invited all the top oncologists in the industry, and even experts from overseas, for consultation. Unfortunately, he was already in an advanced stage, his whole body was exhausted, and the tumor had metastasized to many places.
The chance of surgery was lost, and tumor resection, liver transplantation, and lung transplantation could not be performed. So after interventional treatment for liver cancer, lenvatinib was used as targeted therapy. Later, when it became resistant, it was changed to regorafenib, and then
Please invite famous veteran Chinese medicine practitioners from the Provincial Traditional Chinese Medicine Hospital to provide traditional Chinese medicine treatment for Zhengzheng.
Because the hospitalization conditions in the Overseas Chinese Building in Sanbo can be said to be the best VIP ward in G city, I transferred to Sanbo and planned to spend the last part of my life in the Overseas Chinese Building in Sanbo.
"The bilateral subclavian and internal and external jugular vascular areas are severely invaded by tumors, and I dare not puncture and place catheters, so I want to place two tubes in the femoral veins on both sides. There is no problem on the left side, but the tube on the right side cannot be put in place. Look at the film,
The tumor has pushed the external iliac vein open, causing squeezing. The tube cannot go in. If it is pushed up forcefully, it may break the blood vessel and cause massive bleeding. If it is left here, the replacement blood flow rate will be too low and not up to standard, and the blood oxygen will still be
If you can't go up, your blood oxygen level is only 80, this won't work--"
Director Jiang has no regard for face at this time. He is a real person. In life-or-death situations, he will listen to whoever has the solution, whether he is a young doctor or a senior professor.
He is familiar with Yang Ping. He has also heard about the nerve root block last time. Needless to say, the fifth-stage reimplantation. The treasure that Director Han holds in the palm of his hand is not up to the standard. He is not qualified to stand at this time.
Here.
"You have worked hard, let me see!"
There is a reading light in the emergency ward, and the film has been hung up. Yang Ping went to the reading light to watch the film. Indeed, as Director Jiang said, the bilateral subclavian and internal and external jugular veins cannot be punctured, and only the bilateral femoral veins can be punctured.
, the right femoral artery and vein have been invaded and squeezed by the tumor, and the lumen is flattened. If the puncture is forced, once the blood vessel is broken, it will cause massive bleeding.
In Mr. Ning's situation, if there was a massive abdominal bleeding, the whole body would immediately collapse and multiple organs would fail. Magic Lung would not be able to save him.
But now if you only leave the catheter of the magic lung in its current position, there will be a narrow opening on it, and the blood flow will be too little, and the blood oxygenated per unit time will be too little, which cannot meet the needs of important organs at all. If a stent is used to support it,
To open it, you have to be able to pass it to open it.
No wonder the last physical examination for him showed that the temperature of his right lower limb was lower than that of his left lower limb, especially the peripheral circulation.
Using the knowledge gained from systematic anatomy training and Mr. Ning's CT scan, Yang Pingping began to compose a picture in the brain, superimposing sections one by one. Slowly, a three-dimensional anatomical diagram appeared in the brain. p>
This time it was still very difficult, and I failed to put it together several times, but it was a little easier than last time, which shows that there has been progress.
Based on the blood flow rate of the human body, Yang Ping simulated the blood flow in his mind, added the dynamic image of the blood flow, and a dynamic three-dimensional anatomical image appeared in his mind, which was quite clear.
It seems that brain composition is very important for the improvement of medical skills. The system uses anatomy to spare no effort to train itself in this ability, which is to lay a strong foundation for future improvement of medical skills. Yang Ping understands the intention of the system.
To successfully puncture and intubate, the catheter for the magic lung must be constructed. Yang Ping kept the image in his brain and turned to ask Director Jiang: "Director Jiang, is there still a catheter for the magic lung? Let me take a look?" p>
"Xiao Li, prescribe a tube for Dr. Yang to take a look at." Director Jiang ordered an ICU doctor next to him.
The cost of a pipe is very expensive, tens of thousands, but this is not the time to care about it, and there is no need to care about it.
Xiao Li opened the sterile packaged tube, and Yang Ping observed the complete catheter, copied such a catheter in his brain, and then simulated puncture and catheter placement based on the graphics constructed in his brain, so that Yang Ping had a clear idea.
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"That's it!" Yang Ping asked Xiao Li to put away the catheter.
"Let me try!"
Yang Ping put on sterile gloves and disposable sterile clothes, and stood next to the bed.
