The helicopter landed on the roof of Sanbo Hospital, and the emergency department sent Qin Xiaowei to the ICU and quickly connected him to the artificial liver.
Qin Xiaowei suffered from organ failure caused by heat stroke. Various examination results showed an imbalance of water and electrolytes, as well as severe liver failure. The levels of glutamic acid and aspartate aminotransferase soared to more than 10,000, indicating that there was a large amount of necrosis in liver cells. Therefore, it
The condition is very dangerous.
The cause of the disease is probably high-intensity exercise under the hot sun for a long time.
Heat stroke is a type of heat stroke and is the most dangerous type of heat stroke.
In layman's terms, heatstroke is a problem in the body's heat dissipation due to various reasons. The heat cannot be dissipated and accumulates in the body, causing the body temperature to rise. The rise in body temperature will bring about a series of problems.
Just like a mobile phone that cannot dissipate heat will malfunction or catch fire and explode, the same goes for people. If the heat accumulation cannot be dissipated, "failure" or "shutdown" will occur.
According to the severity of the condition, heat stroke is divided into three types: premonitory heat stroke, mild heat stroke and severe heat stroke.
Severe heat stroke can be divided into heat cramps, heat exhaustion and heat stroke. Heat stroke is the most serious form of heat stroke. Without timely rescue, the mortality rate is 80%.
On-site first aid for heat stroke is to cool down. Move the patient to a cool and ventilated place. It is better if there is air conditioning. Then quickly physically cool down and remove clothes to promote heat dissipation. The most convenient way to cool down is to pour cold water on the patient. Ice water is better.
, cooling down faster.
In addition to on-site cooling treatment, the goals of follow-up hospital treatment are to treat complications, save lives, prevent organ damage, and save organ function.
Qin Xiaowei has been cooled down at the scene and was quickly sent to the hospital by helicopter. There is still hope of rescue.
Yang Ping received a call from Dr. An and came to the ICU, followed by Xu Zhiliang. He came from the emergency department and might be able to help if he went to the ICU.
Qin Xiaowei Bei was placed next door to Li Jun. He was already intubated with a tracheal intubation and a ventilator was used to assist his breathing. The artificial liver was also started to operate to replace his almost non-functioning liver.
"The main thing is liver failure. He is currently in a deep coma. His heart function is still good. If severe heart failure occurs, we will also put him on ECMO." Dr. An said while checking the parameters of various instruments.
Everyone was worried that Qin Xiaowei would fall while climbing the rock with his bare hands, but they never expected that he would suffer from heat stroke after climbing up.
"He already had heatstroke symptoms when he was supposed to be climbing, but he was in good health and gritted his teeth and insisted on climbing the last step." Xu Zhiliang noticed something was wrong when he watched the video of his climb.
But if I hadn't persisted then, I might not even have a chance to be admitted to the ICU now.
Qin Xiaowei has no family members. His contract company pays his medical expenses, and Dr. An has to go out and explain his condition to the contract company.
Yang Ping could not help Qin Xiaowei for the time being, so he bid farewell to the ICU doctors and returned to the department.
——
Orthopedic Hospital Harlachen.
The little Duke has completed various examinations. He is sitting in a wheelchair and gasping for air. For him, this has become normal. During this time, his condition has worsened. His heart seems to be going to strike at any time. He will report his condition to the family doctor. The doctor
It is recommended to conduct a comprehensive inspection in advance.
I was supposed to go to Göttingen Hospital for a check-up in a few days, but now I'm going to Harlachen for the same check-up. It's just a good time to check carefully to see how deteriorated my heart is.
"Do you need oxygen?"
The nurse saw that the little Duke's face was not very good and his breathing rhythm was disordered, so she helped him lie down on the bed.
The little Duke nodded. He usually takes oxygen and sometimes brings a bottle of oxygen to class.
The nurse connected him with a nasal cannula to inhale oxygen, and the doctor began to auscultate his heart. The heart beat sounded weaker, and the situation was not good.
This is a VIP emergency ward. There will be doctors and nurses guarding the little Duke 24 hours a day. The ward is equipped with some first aid equipment. Although the equipment is not as complete as the ICU ward, it is enough to cope with most changes in the condition.
The little Duke had been admitted to the hospital once or twice due to heart failure. The doctors were like framers, trying their best to keep this critical heart alive until now.
Therefore, every time he comes to Harlachen, he must be admitted to the emergency room of the VIP ward to receive the most complete care.
In the conference room of Harlachen Orthopedic Hospital, the orthopedic experts have not left yet. They are immersed in collective learning of spinal external fixator technology.
Someone announced that all inspections of the little Duke have been completed and discussions can begin.
Everyone raised their heads, the screen lit up, and various data were laid out on it.
The condition of the heart worsened. Color ultrasound showed that the contraction was even weaker, and the electrocardiogram showed that the rhythm was also unstable.
The main force here is an orthopedic surgeon, but his knowledge is relatively comprehensive. However, no matter how comprehensive he is, he cannot be as good as a professional cardiologist.
Therefore, matters related to other specialties require help from other experts.
Norton, a cardiologist at Charité Hospital who was on the line, saw the little Duke's data and frowned: "His heart has deteriorated. You need to be more vigilant. The heart may completely collapse at any time. I'll come over."
The cardiologist saw some signs. There was a little fluid accumulation in the corners around the heart on the chest X-ray. The thickness of the heart wall increased slightly from the previous time, indicating that the heart was swollen. In a small space, compression and swelling would interact with each other.
influence, forming a vicious cycle.
"Before I come, increase the amount of diuretics. I wonder if there is any progress in surgery? The compression on the heart must be resolved, otherwise medical treatment will always be useless." Dr. Norton can only treat from internal medicine.
But for the bony compression of the little Duke's heart, we can only rely on surgical correction, and hardware issues must be addressed from the hardware.
In a sense, the little Duke's orthopedic surgery is actually a life-saving surgery. Unfortunately, because it is too difficult, no one has dared to operate on him.
"We have a new surgery that can correct spinal and thoracic deformities, but this process takes three to six months." Professor William spoke on behalf of orthopedic surgeons.
Norton shook his head: "Based on the current examination results, this process is too long. In theory, he needs orthopedics now to correct the deformity immediately to allow the heart to gain ample space. In this way, heart transplantation may be able to solve the problem."
"If the malformation is not resolved, no one can complete the heart transplant. The operating space and field of view are seriously insufficient, and the biggest problem is that the donor heart cannot be put in at all." Constantine, a cardiac surgeon at Charité Hospital, is also online.
As a heart transplant expert, he has been paying attention to the little Duke's disease and hopes to use heart transplantation to save the congenitally deficient heart. However, he is unable to do anything until the spinal deformity is resolved.
"Constantine, it would be best for you to come and have a face-to-face discussion. The little Duke's condition is not optimistic. The doctor just reported that his left ventricular ejection fraction is decreasing and B-type natriuretic peptide is increasing." Professor William
I feel like the little Duke may have an accident at any time.
"Okay, I'm going to come over right away and go with Norton." Constantine felt that the orthopedic problem had not been solved and he could only be a bystander.
———
"Gotenberg!" Doctor
Call the little prince by his name.
He had no strength to answer, as if he couldn't breathe, his face was pale, his body was cold, his blood pressure dropped to shock blood pressure, his lungs were filled with crackles, and his heart sounds were weak.
The doctor auscultated his heart and lungs and checked his pupils. He thought he would get better after resting for a while as usual, but now the situation is getting worse.
Increased dose of cardiotonic diuretic, no response!
ECMO!
The doctor realized the huge danger and made a decisive decision. The nurse immediately got busy and brought in various instruments.
The doctor was calm in the face of danger. He began to puncture and insert the catheter in the ward, and connected ECMO to stabilize the vital signs.
Well-trained doctors can often detect clues from subtle details and then act decisively. The chance of rescue is fleeting, and any procrastination will lead to regrets.
"Immediately report to the medical team leader and start the rescue process." The doctor in charge directed the subordinate doctors while rescuing the patient.
I am very skilled in various puncture and catheter placement, connection of various pipelines, and machine parameter settings.
The orthopedic department bosses and experts from other departments in the hospital were notified and were on their way. After the sound of leather shoes hitting the ground, the door of the emergency room of the VIP ward opened, and everyone rushed into the ward and gathered around the bed.
Due to severe heart failure, the little Duke's heart could no longer maintain the most basic circulatory needs and finally collapsed.
The big guys in orthopedics are unable to do anything. This is beyond the scope of their expertise.
They had just approved the spinal external fixator technology and were waiting with great anticipation for August to come back to perform surgery on the little Duke, but something like this suddenly happened.
However, they are used to this situation. The little Duke is often admitted to the hospital for emergency treatment because a cold worsens his heart failure, so orthopedic surgery seems so urgent.
Norton and Constantine from the Charité Hospital took a special plane to Harlaching Orthopedic Hospital.
Cardiology experts said there was nothing they could do. The heart was squeezed into a small gap and only surgical intervention could solve the problem. It was a hardware problem and it was difficult to achieve results through software operation.
But he was certain that the situation this time was worse than before.
Constantine stood in front of the reading light, his pen tip wandered over the images, and then said solemnly:
"His myocardium is tired, and the reason is the squeezing of the small space. If the small space can be opened and the heart can beat freely, it may be able to continue for a while. If the stenosis cannot be opened, ECMO can only be used to maintain life for a short period of time, and then
Waiting for heart replacement, but with such a deformed gap-like space, heart replacement cannot be completed at all."
This rhetoric has not changed for many years. As a cardiac surgeon, Constantine's disease involves spinal deformity. His knowledge structure cannot push him to imagine novel surgeries to resolve this crisis. His strategy is to rely on ECMO.
Maintain cardiopulmonary function and gain buffer time to think about countermeasures.
Soon, the old Duke, leaning on a cane and accompanied by the housekeeper, stood at the edge of the bed, looking at his dying son with tears streaming down his face. He didn't know whether he could survive this time safely.
His friend August was not here at this time, and he seemed to have lost support.
"Poor child, August has just found a doctor who can treat his spine." The old Duke took out his handkerchief to wipe his tears.
"Yes, sir, we also expected new technology to solve his problem, but unexpectedly arrived first. New technology for orthopedics will take at least three months, but Gordon's current state cannot wait for that long." Professor William expressed regret.
The technology definitely cannot be used.
"Where's Marcus?"
Professor Lloyd thought of this confident young man, he might be able to come up with a clever trick.
"He's calling August!"
Marcus was seen hiding in a corner on the phone.
——
"professor-"
August ran to catch up with Yang Ping, calling for Professor. At the last moment when the elevator closed, he pressed the switch.
"Don't get excited, Doctor Ao, what's going on?" Song Zimo held August steady.
"The little Duke is dying. His heart failure suddenly worsened and he is now maintained on ECMO." Dr. Ao gasped.
What are these days? Why are my ears full of ECMO?
"Don't be in a hurry. Speak slowly." Yang Ping and Song Zimo got out of the elevator and walked back to the office.
August followed behind and told Yang Ping everything about the little Duke's condition.
"Do you have any medical records?"
"have!"
When he came to the doctor's office and found a computer, August retrieved the case information from his mailbox.
Yang Ping read the information and found that the heart was already swollen and compressed in a narrow space. The edema and compression formed a vicious cycle. If measures were not taken immediately, the myocardium would soon become necrotic due to ischemia. At that time, the little Duke would have lost his heart.
.
"What should I do?" August was very anxious.
Yang Ping tapped his fingers on the table a few times, and after thinking for a while, he said decisively: Remove all the ribs in the left precordial area to relieve the pressure on the heart, and then replace the removed ribs with artificial titanium alloy mesh, which is artificially temporary.
Support a generous space, so that the heart can be saved.
Yang Pingshun held a piece of paper in his hand and used a pen to draw the structure of the titanium mesh.
"Just use this, print it out with a 3D printer, connect one end to the sternum, and the other end to the remaining posterior ribs, so we can buy time for us to get over it. In this case, we can't use an external spinal fixator, we can only use traditional surgical correction.
"
This chapter is not over yet, please click on the next page to continue reading! Orthopedics is life-saving now, and we need to race against time.
Qin Xiaowei has an ICU for treatment, so he can't help at the moment. Yang Ping needs to go to Germany as soon as possible. The Germans have no experience in dealing with this kind of case. If he makes a mistake, the patient will die.
Yang Ping came up with the plan in just a few minutes, and even the drawings of the temporary titanium mesh had been drawn.
"Tell them that if they want to save the little Duke, just do it. Any hesitation will delay the opportunity. Book the fastest flight."
The fastest flight is tomorrow, and the flight takes more than ten hours.
“Charter flight!”
August doesn't care about money, but this is not Europe, otherwise the Duke's luxury private jet will take off at any time.
"Isn't Ning Qi ready for the special plane? It can take off at any time." Song Zimo reminded Yang Ping.
Yes, the advantages of private jets are shown at this time.
It’s a race against time to save people.
Yang Ping took out his phone and dialed Ning Qi's number: I'm going to Germany right away. When can your plane take off?
at any time!
——
"This is August's first aid plan: remove all the ribs in the left precordial area, and use titanium mesh to create a temporary generous space so that the heart can be fully decompressed. He is coming back as quickly as possible, and his mentor will come to Halla
Happy." Marcus finally got the plan and handed the printed titanium mesh drawings to Constantine.
After reading the drawings, Constantine suddenly realized why he had not thought of removing the ribs that bound the heart to decompress the heart, just like craniectomy in brain surgery.
Why didn’t I think of that!
He muttered to himself.
Because cardiac surgeons will never encounter such a case that requires bone decompression of the heart in their lifetime, and of course they will not come up with such a clever trick.
The closed chest cavity has negative pressure. Once multiple ribs are removed, the soft tissue of the chest wall will sag with breathing, forming a flail chest. Therefore, titanium mesh is needed for temporary support to maintain the hard space.
Clever idea!
Constantine immediately ordered: Prepare for the operation, and immediately print out a titanium mesh from titanium alloy according to the drawings.