The last 8 units of AB blood from the blood station are being sent to Sanbo Hospital. Subsequently, it will take a certain amount of time to initiate emergency procedures, gather family members, and volunteers to donate blood on site. Currently, only these 8 units can be used for rescue.
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"This is the driver, and there is a student next door. Both of them are seriously injured. Director Han said that you need to take a look at them."
Dr. Lu briefly introduced the condition. Whether these two patients can be saved depends on Yang Ping. Others are not so fast.
There were two policemen standing at the gate at the end of the corridor of the emergency operating room. The female driver was suspected of drunk driving. She rushed directly into the crowd without any braking action. She rammed into the crowd for the first time until she was blocked by obstacles, then reversed and went crazy.
Speeding up, crashing into another group of people a second time, and choosing a place with a lot of people to rush in, is suspected of committing a crime.
After understanding the situation, Yang Ping quickly browsed the CT pictures on the screen. The abdomen and pelvis were in a mess, and many large blood vessels should have ruptured. If treated temporarily conservatively, relying on blood transfusions to resist shock, the blood volume balance cannot be maintained, even if a pelvic external device is temporarily installed.
The fixed frame is still unable to maintain the volume balance of the pelvis, and the pelvic cavity is now full of bleeding points.
If you ask the interventional department to do interventional embolization, you won't be able to embolize so many places, and it won't be available in time.
The fastest and most effective method is interventional aortic balloon occlusion technology.
Puncture the femoral artery that is still intact on one side, send the balloon into the abdominal aorta, and then expand it in the abdominal aorta to block the abdominal aorta. This can block almost all bleeding below this level and greatly reduce bleeding. The balloon can even be sent to a higher position to control bleeding, cooperate with blood transfusion and fluid replenishment, temporarily stabilize blood pressure, and buy time for the operation.
This operation can be completed in one or two minutes.
The plan quickly took shape in his mind, and Yang Ping immediately ordered:
"Prepare REBOA!"
REBOA, Resuscitative Balloon Occlusion of the Aorta!
Dr. Lu, who was following, heard Yang Ping's order and immediately took out the resuscitative aortic balloon occlusion kit from the locker in the operating room.
These are commonly used in emergency operating rooms, but no one can use this technology as skillfully as Yang Ping.
At this time, Director Ouyang and Lao Jin had already rushed over. Yang Ping handed the wounded person to them and took Song Zimo and others to see the student next door.
"You guys do REBOA first!"
Yang Ping explained and immediately came to the operating room No. 2 next door.
The emergency department now has 6 operating rooms, all of which are multi-functional operating rooms integrating examination and surgery.
"Hemorrhagic shock, comminuted fracture of the pelvis, comminuted fracture of the sacral vertebrae, bilateral femoral shaft fractures, multiple rib fractures, hemopneumothorax, mediastinal hematoma, pulmonary rupture, severe pelvic fracture, unable to maintain blood pressure---"
The emergency doctor in charge of this patient reported the condition to Yang Ping.
"This female student, a high school student, and the driver just now are the most seriously injured."
Dr. Lu came here again. He is the doctor responsible for on-site first aid and should report Yang Ping's condition at any time.
Scanning the pictures on the screen, Yang Ping immediately made a judgment that this patient's condition was very similar to the one just now, and they were both on the verge of life and death.
"REBOA!"
Xiaowu didn't wait for the emergency doctor to take action, and took out the REBOA kit package from the cabinet and opened it. Yang Ping and Song Zimo had already put on gloves, with Song Zimo as their assistant.
Puncture, insert the cannula, and send the contracted aortic blocking balloon through the cannula.
In Yang Ping's mind, based on the patient's height, the CT scan image, the proportion of the image, and the amount of bleeding in each part, he quickly judged the precise anatomical position of each segment of the injured aorta and the height to which the balloon needs to be sent.
With quick action, the balloon is sent to the appropriate position and opened immediately. The opened balloon instantly blocks the lumen of the aorta, just like tap water closing the main gate, and most of the bleeding is controlled in time.
But this only temporarily blocks the bleeding. If the injured is to survive, blood needs to be replenished to maintain the perfusion of the body's important organs. Sufficient blood is needed to transport oxygen.
During this window period, we must seize the time to perform surgery to achieve true and long-term hemostasis, so that the injured can hope to survive.
This kind of surgery is nothing more than competing for time with bleeding.
If hemostasis and blood transfusion are completed before massive blood loss causes organ collapse, everything can still be reversed; if hemorrhage and blood transfusion are not completed before organ collapse, once the ischemia and hypoxia of important organs cross the critical point, they will immediately cause an avalanche and collapse.
There will be no way back.
"Continue the blood transfusion! Please come to the stage. I'll go next door and have a look. I'll be here soon."
Next door, Dr. Jin and Director Ouyang were performing a puncture and inserting the aortic balloon. However, because they did not judge the position accurately enough, they moved it up bit by bit to accurately expand the balloon.
"It's low! Up, up!"
Yang Ping simply went up by himself and pushed the balloon up for almost fifteen centimeters before expanding it.
"You guys do this one, and I want to do the one next door."
Yang Ping came here just to help insert the balloon and complete emergency hemostasis.
When Yang Ping returned to operating room 2, Song Zimo had already completed the sterilization and draping and was preparing for a thoracotomy. They all had full surgical authority and did not need the assistance of thoracic surgery at all.
The director of thoracic surgery stood at the door and just took a look. When he saw that Yang Ping and Song Zimo were performing the surgery, he changed the target of the consultation without saying anything.
With these two buddies here, what kind of thoracic surgeon do you need?
"After the chest is processed, the pelvis and bilateral femoral shafts will be done later. The pelvis needs to be reconstructed with steel plates, and both femurs need interlocking intramedullary nails---"
The emergency operating room had a full set of orthopedic instruments on standby, from the spine, pelvis to limbs. Several large boxes full of them were put to use at this time. Soon, several metal boxes wrapped in sterile sheets were wheeled over. p>
"Right-angle vascular forceps!"
Yang Ping took the vascular clamp and found that it was a curved clamp, so he immediately alerted the instrument nurse.
"Where's Su Yixuan, please call Su Yixuan!"
This kind of time-grabbing surgery can determine life or death in one second.
Yang Ping needs the best assistants and nurses with the best instruments to make the surgery as fast as possible.
At this time, there is no need to worry about other people’s face, simple and direct communication is the most effective.
"Coming!"
With a familiar voice and a tall figure, Su Yixuan walked in at the surgery door with her hands raised. She had already finished brushing her hands.
So timely!
When the equipment nurse on the stage saw this scene, she had to give up her position silently and wait for dispatch.
Immediately afterwards, circulating nurse Zhou Can and anesthesiologist Fatty Liang took their places to replace the original circulating nurse and anesthetist.
"The muscle relaxation is not enough and the abdominal muscles are too tight. I will use the pararectus abdominis approach later." Yang Ping told Fatty Liang in advance.
Fatty Liang made an OK gesture and immediately increased the dosage of muscle relaxants to relax the injured's muscles so that they could be easily retracted and exposed.
"Not enough blood! Why haven't you come yet?"
Fatty Liang glanced at the data on the monitor.
The blood that has been delivered has been transfused, and the last 8 units have just arrived at the blood bank. The emergency nurse has gone to collect it and has not returned yet.
"There are only 8 units of suspended red blood cells in stock now! The wounded next door is also type AB, so we can only allocate 4 units to us, and we have to wait for the follow-up!"
Zhou Can quickly grasped the situation, and she has been urging the nurse to take blood.
Damn! Four units, Yang Ping cursed in his heart.
Not enough, far from enough. Even 8 units are not enough, let alone 4 units.
Although there is only one 4 difference between 8 and 4, sometimes it hovers near the critical value. If you push it, it will be alive. If it is almost, it will be gone.
"Bring all 8 units, all of them!" Yang Ping ordered Zhou Can and went into surgery again.
Fatty Liang quickly estimated the accumulated bleeding, the blood being lost, and the blood that needs to be replenished.
4 units will definitely not work, but 8 units can push the injured away from the critical line. He understands why Yang Ping insists on 8 units. This is a problem of the critical point of life.
"8 units! Hurry!"
Now that the chief surgeon gave the order, the order to promote blood flow was given to Fatty Liang and Zhou Can.
The nurse who took the blood returned to operating room No. 2. The eight bags of suspended red blood cells were piled on the cart. Zhou Can pulled the entire cart over.
The nurse who took the blood was in a dilemma: "Dean Sun said, distribute it equally, 4 units on each side."
That is to say, only 4 units are given here, and 4 more units have to be sent to the No. 1 operating room next door.
However, if 8 units of red blood cells are used separately, none of the two seriously injured people can survive. If they are used collectively, this student still has hope.
"Leave it here. If there is any problem, Director Han will communicate with Dean Sun!" Fatty Liang tightly grasped the handle of the cart.
Fatty Liang did not dare to delay, intercepted 4 units of blood, and immediately reported to Director Han.
Director Han was nearby and soon appeared in the operating room.
"How's the situation?" he asked, leaning his head in.
Yang Ping immersed himself in the operation: "We are pulling back. We can't do it without blood. 8 units is very difficult. 4 units can stop now."
"I understand the situation. Ouyang and Ah Jin are holding on next door, saving each one one by one."
Director Han circled around the operating table, but couldn't see anything.
The two of them were just chatting.
Maybe the nurse who just took the blood also reported to her head nurse and the director of the emergency department, and Dr. Sun ran to operating room 2.
"Old Han, you are confused. You only have these 8 units of blood, so don't you just get an average score?"
Dean Sun anxiously persuaded Director Han.
He is a veteran in official circles and has his own considerations. The two injured people are now AB-type and both are seriously injured. If they are evenly distributed and everything is flawless in terms of ethics and procedures, whether they can be saved is another matter.<
/p>
But once these 8 units of blood are separated and given to one person, who should they be concentrated on?
No matter who it is concentrated on, no one knows and nothing happens; once someone investigates it and puts it on the line, it will be a big trouble.
If it is given to students, some people will say that although the female driver is suspected of committing a crime by drunk driving, she is still a life. Why should students be given priority? Where is the humanitarianism?
If it is given to a female driver, the student is innocent and fine, but was seriously injured by this drunk driver. Why should the life-saving blood be equally distributed with her?
"It must be divided evenly! The driver's family and the student's family are all outside. Reporters are also gathered around. Commissioners from the city government are also outside to supervise the rescue. The female driver's family also invited a professor from Nandu Affiliated One.
We are rushing over to support the rescue! We can't make any problems with the procedures." Dean Sun still said in a persuasive tone.
The implication is that as long as the program is correct and no faults can be found, it will be fine. As for whether these two can be saved, it depends on fate.
These days, when a doctor is tired and drinks a bottle of glucose, someone will come on line.
Director Han said slowly: "The critical ones have priority! After unanimous assessment by several of our experts, this wounded person is the most critical and needs these 8 units of blood the most. Those people surrounding the outside are not doctors. They know nothing.
Are they coming to the stage to perform surgery?"
"What are you doing? Old Han, what should I say to you?"
Dean Sun was angry in his heart. Dean Xia went out for a meeting. He is now the first person in charge and must bear the responsibility.
Director Zhao next to him said sternly: "Well, Dean Sun actually means the same thing. In terms of the current student's condition, he needs the blood the most. The limited resources are given to those who need it most. Is there any blood later? The blood bank is trying to find a solution.
Well, just wait a moment, it’s just 8 units of blood, what a big deal.”
Dean Sun had no choice but to acquiesce.
"I'll go next door to take a look, you guys are busy." Director Han walked around and went out again.
Fatty Liang stared at the bags of blood, fearing that someone would snatch them away in the blink of an eye.
This is something you can't help. Sometimes, you have to choose.
For example, in the hierarchical treatment of emergency patients, red patients are given priority, which is also a medical choice.
Because red patients have unstable vital signs and will die if they are not rescued, yellow patients can wait, and green patients are fine.
Sometimes, there are two lives in front of you, and you can only save one. Who to save, you have to choose one!
