Teng Guihua wanted to come over and ask a few questions, but Chang Juan stopped her. Chang Juan didn't want this woman to interfere with the doctor's treatment.
Although she is Fang Xiaoyun's mother, this mother has no daughter at all in her heart. Her daughter is just a money-making tool that is being exploited.
If it could be sold, this mother wouldn’t even blink an eye and would sell her daughter in exchange for money to pay the down payment and decoration for her son’s house.
"The doctor on duty in the interventional operating room is busy on the stage. A patient suffered from spontaneous intracranial hemorrhage and underwent interventional embolization. He needs to apply several coils. I reported it to the chief on duty. He is coordinating and calling the backup person over." p>
Song Zimo contacted the interventional operating room. Spinal arteriography requires very high skills from interventional doctors. They need to superselect the interspinal arteries one by one, push contrast agents, and identify them one by one.
Moreover, one of the anterior spinal arteries was embolized at that time. During the operation, the thrombectomy was performed and the anastomosis was re-anastomized. Once angiography was performed, the risk of embolization again increased significantly.
"How's it going? Fang Xiaoyun's condition!" Professor Zhang rushed to the orthopedic surgeon's office.
Yang Ping immediately reported his analysis and arrangements to Professor Zhang. Professor Zhang sat down and took a breath: "I have been thinking about it, it is too similar to a spinal dural arteriovenous fistula. I have encountered such a case before, but it appeared
The symptoms did not come so quickly. At that time, the patient suffered from low back pain and numbness and weakness in his lower limbs. He went to another hospital for lumbar disc herniation and underwent surgery. However, the symptoms were not relieved after the operation and he became completely paraplegic. Later, I considered this disease and did DSA.
It took 6 hours of spinal arteriography to find the fistula. Later, surgery was performed to deal with the arteriovenous fistula. The patient recovered the feeling and muscle strength of the lower limbs. Fang Xiaoyun's condition was more complicated. Spinal tuberculosis and spinal dural arteriovenous fistula were mixed together.
It is too rare for the disease to occur and cause paraplegia at the same time. If it is true, DSA will be arranged urgently. If the diagnosis is confirmed, the operation will be performed immediately and the patient will be placed in the hybrid operating room of the interventional department."
The hybrid operating room is a type of hybrid operating room, usually in a 100-level laminar flow operating room. It fully integrates DSA equipment and surgical equipment, and can complete interventional treatment, surgical operations and imaging examinations in one operating room, so that some complex operations do not need to be decomposed.
It can be completed in one go, reducing surgical risks, reducing patient transportation, and saving surgical time.
"We have made arrangements. The doctor on duty in the interventional department is busy and there is no manpower. The general on-duty is making arrangements and has called the backup person to come over." Yang Ping introduced.
Director Han also hurriedly arrived: "Xiao Yang, I contacted Director Shi from the interventional department, and they arranged for Director Ji to come over. Director Ji is the best in the interventional department and has done the most spinal angiography."
Great, at critical moments, Director Han can coordinate, create conditions for Yang Ping, and at the same time bear the risks for Yang Ping.
Although the general on-duty can also be scheduled, he will not be as attentive as Director Han. As soon as Director Han communicates with Director Shi, they will know who you need and immediately transfer Director Ji, instead of just calling a doctor.
Cope.
"Have you communicated with the patient?" Director Han asked.
Yang Ping nodded: "We just communicated and signed. The patient herself communicates well. Her mother, I think, is not a good person. She is always evasive and suspicious of this and that."
Director Han hummed: "She is an adult. She can agree to it. Her family members don't need to worry about it. Xiao Zhang, please bring her medical records."
Zhang Lin immediately brought over the medical records. Director Han looked through the medical records and signed his name in front of Yang Ping's name on the informed consent form for surgery.
"Follow your ideas. I'll take care of things. As doctors, there's no way we don't take risks. As long as we consider the interests of the patients, be fully prepared and control the risks, I'll have to make a call later.
Tell Mr. Zhao from the Medical Office. If family members have problems or potential disputes, go to them in advance to prepare a case."
Director Han handed the medical record to Zhang Lin. Professor Zhang waved, took the medical record and added his name: "Go ahead and do it. This case is relatively rare. Remember to collect information."
"Xiaowu, you are responsible for collecting information. Song Zimo and Zhang Lin will come on stage with me, and Fatty will anesthetize you." Yang Ping made arrangements on the spot.
"The interventional department called and asked us to send the patient. They came with two doctors and a nurse and opened a hybrid operating room for us to use." Song Zimo answered the phone and said.
Su Yixuan and Zhou Can quickly pushed the surgical instruments and microscopes to the interventional operating room. Orthopedic surgery requires many specialized instruments. Spinal surgery has a complete set of spinal surgical instruments. The interventional hybrid operating room only has some general instruments and no orthopedic specialist instruments.<
/p>
"Let's go, send the patient!" Director Han said in a deep voice.
Zhang Lin Xiaowu sent the patient and used a flat trolley to push Fang Xiaoyun to the interventional operating room. The interventional operating room is located on the second floor of the emergency building, where the chest pain center is also located.
The flat cart for comprehensive orthopedics is a new one. It has pneumatic wheels and is equipped with shock absorption. It makes no loud noise or vibration when pushed. Fang Xiaoyun's mother followed behind: "Hey! Hey! Hey! What are you going to do---
”
"Why are you talking so much nonsense!" Chang Juan blocked her, fearing that she would cause some trouble and affect the doctor's work.
There are barrier-free passages between each building, and the flat car is hurriedly pushed to the interventional operating room. Director Ji, his assistants and nurses are already waiting in the operating room.
"Mr. Zhang! Director Han!" Director Ji greeted respectfully.
"Doctor Yang!" Director Ji also greeted politely, but others ignored him.
Now Yang Ping is also a celebrity in the hospital, and everyone knows his abilities. The hospital is a place where technology is king. If the technology is good, everyone respects it in their hearts. If the technology is not good, it will be useless even if there is support from the backstage. Everyone does not say it in words, but in their hearts.
I will certainly look down upon it.
"Is this patient considering spinal dural arteriovenous fistula? The operation will take a long time. Each blood vessel must be superselected and tested. There is a possibility of failure. I will try my best."
Director Ji said it very honestly, but he was very happy. He had never encountered this rare case before. When he was studying in Fuwai, he heard it from the teacher. Now that he has encountered it clinically, he is naturally happy.
Professor Zhang encouraged him and said: "Don't worry, I have done DSA on this kind of patient. You do it and I will watch it for you in the audience."
The best thing is that the older generation of doctors are not like today, who can only guard their own territory. At that time, it was normal for them to dabble in some cross-technologies. Many old doctors could take X-rays themselves.<
/p>
"A week ago, this patient had an embolism in the anterior spinal artery of thoracic 9. During the operation, the thrombectomy was performed and the anastomosis was re-anastomized." Yang Ping introduced, and then Zhang Lin introduced the patient in detail.
Director Ji said: "The amount of contrast agent during the operation must be strictly controlled, otherwise it will easily cause re-embolization."
After handing over the condition, the young doctor under Director Ji signed the informed consent for DSA and the informed consent for iodine contrast agent.
The fat man underwent anesthesia and was under general anesthesia with endotracheal intubation. The people on Yang Ping's team were different. The fat man's anesthesia was fast and good. He was still talking here, and the anesthesia was over there, and he could brush his hands.
Director Ji admires this young team with excellent professional quality. This fat anesthesiologist is much better than his anesthesiologist, and his anesthesiologist is afraid of this and that.
"Then let's go ahead and do a DSA of the spinal arteries. We'll do a puncture of the femoral arteries and look for them one by one. It'll probably take five or six hours. Why don't you go out and take a rest first."
Director Ji, assistants and nurses put on lead clothes. Everyone looked for lead clothes to wear. Professor Zhang also wanted a lead clothes. The lead clothes were not breathable and heavy. They weighed dozens of kilograms. They could be worn for several hours.
A ten-year-old would feel very uncomfortable.
"We will perform DSA in the supine position now, find the fistula, and then switch to the prone position for you to perform the surgery, okay?"
Director Ji came back after brushing his hands, disinfecting the sheets, and wearing gloves.
"Thank you for your hard work, Director Ji!"
"It's okay, they are all doctors. This kind of thing happens all the time. It's my wife's birthday today and I asked her to have a meal with her. As soon as I sat down, I got a call. There is nothing I can do. Who asked us to be doctors?"
Can I change my mind to someone else?
It’s not necessarily possible. This kind of case requires a doctor with good skills to have a high success rate.
Director Ji is in his forties, with gray hair and a lean build. He is one of the directors of the interventional department.
The interventional department is divided into several wards, including the neurointerventional group, cardiovascular interventional group, and tumor interventional group. Lao Ji is in the cardiovascular interventional group, and the cardiovascular interventional group is also an important part of the chest pain center.
Lao Ji came from the Department of Cardiovascular Medicine. After getting married and having children, he started to engage in interventional medicine. Generally, those who engage in interventional medicine are often exposed to X-rays. Those who are not married and have children are not willing to engage in this profession. The hospital will not choose people who are unmarried.
Pick inside.
The femoral artery was punctured and a catheter guidewire was inserted. Lao Ji performed skillfully and successfully superselected the first interspinal artery.
We can only check them one by one. Too much contrast agent will not work, and too little will not work. The dosage must be accurately controlled, and the technique of super-selection of blood vessels must be gentle and precise.
"Push the contrast agent, Onipex!"
Onipex is a non-ionic iodine contrast agent, which is a safe intraspinal contrast agent. For spinal arteriography, you must choose a contrast agent that can enter the spinal canal.
"Okay, that's enough. You want a little less, right? Mr. Zhang!" Lao Ji asked Professor Zhang.
"Yes, too much can easily cause embolism." Professor Zhang has comprehensive knowledge and experience.
"Yes! When I went to Fuwai for further study, a colleague said that their hospital had a spinal artery angiogram. After the angiography, it caused spinal artery embolism, causing blood supply disorders to the spinal cord, spinal cord ischemia and necrosis, paralysis, and a lawsuit.
It’s been several years, but it’s better to have fewer people with high-risk factors.”
But too little will not play a developing role, so you have to be very careful about the amount.
"No, next one!"
There are twenty-four intercostal arteries alone. This is just the beginning. One blood vessel cannot be repaired in more than ten minutes.
"Teacher Zhang, would you like to go out and take a rest? I'll be fine here."
Director Han was afraid that he wouldn't be able to bear it, staying up late and wearing such heavy lead clothes.
Professor Zhang waved his hand: "It's okay. I have experience in this kind of case and have done this kind of DSA. I can give them some advice. You go out and take a rest outside. A few young men have to undergo surgery later."<
/p>
Professor Zhang's tone was stern, more like an order. He wanted to protect young people. After all, everyone was not married yet and had children, so they should try to reduce their exposure to X-rays.
"It's okay, I'm inside and want to see how the imaging is going." Yang Ping also wore lead clothing, and everyone else wore lead clothing.
Professor Zhang lost his temper: "Why are you disobedient? Just go out when you are told. There are so many people watching the fun!"
Director Han immediately ordered Yang Ping: "As long as Professor Zhang and I stay inside, you all can go out, do you hear me?"
After five or six hours of X-ray exposure, even a lead suit cannot fully protect you. Surgery will be required later. Orthopedic surgeons often deal with X-rays and try to avoid unnecessary exposure.
Okay, Yang Ping takes everyone out and goes to the locker room to rest.
Let's take a nap. If Director Ji finds the fistula, he will call everyone.
