On the professional imaging electronic screen, the CT scan image of the injured person's head and neck is displayed on the screen. The cross-sectional images are switched one by one, and then the three-dimensional reconstructed stereoscopic image is rotated 360 degrees, and the bones of the entire head and cervical spine are extremely clear. Traumatic atlanto-occipital joint dislocation! Diagnosed.
There was a bone cyst in the atlas, which caused a comminuted fracture due to trauma. Fortunately, the fracture spread to the surroundings instead of invading the spinal canal. This prevented the boy from dying on the spot due to cervical spinal cord injury. However, after successful rescue from the scene, his limb muscles
The power is always maintained at level one.
This shows that there is damage to the spinal cord, but if the damage is no longer aggravated, there is a possibility of recovery after surgery.
The muscle strength of the limbs is at the first level, and the muscles of the chest and abdomen will be similar, and many muscles of the thorax are respiratory muscles. Without the function of these respiratory muscles, breathing cannot be completed at all.
After successfully rescuing the trapped vehicle, Dr. Lu immediately performed a tracheotomy on the injured person, connected him to a simple ventilator, and relied on the ventilator to maintain breathing.
In addition to traumatic atlanto-occipital joint dislocation, the injured also suffered multiple fractures throughout the body, including a comminuted fracture of the pelvis and a very large amount of blood loss.
Looking at the images on the screen, Yang Ping took a breath. Traumatic atlanto-occipital joint dislocation and atlas fracture. The chance of survival at the scene is very slim. Even if he is lucky enough to survive, any link from the emergency scene to the transfer to the hospital can be considered.
A small mistake can cause the injured to stop breathing and heartbeat.
"Atlanto-occipital fixation is no longer possible. We can only cross the atlas and implement occiputo-axial fixation." August suggested.
There are not many precedents for this kind of surgery to refer to. The number itself is very small, and the atlas is also accompanied by comminuted fractures. There is no precedent to refer to, so doctors can only use their subjective initiative.
Yang Ping did not speak, but silently observed the images and pictures, thinking about the method and details of the operation.
As a doctor, you should be more serious than any other profession. You only have one life and it is fleeting.
"The wounded person is already on the emergency operating table, and is being fixed with an external pelvic fixator, and the intrapelvic blood vessels are embolized to stop bleeding." Song Zimo kept abreast of the emergency situation and introduced it to Yang Ping.
The principle of trauma first aid is life first, everything else should be put aside.
For this kind of patient, hemostatic treatment is first performed to stabilize the volume of blood circulation. This is a routine operation.
When the pelvis is crushed and fractured, the blood loss is very large. After using an external fixator to fix the pelvis in the emergency and stabilizing the pelvic volume, if the blood pressure is still unstable, emergency interventional embolization is required to stop the bleeding.
If the bleeding cannot be controlled even with interventional embolization, then the last resort - incision and packing to stop bleeding, comes in handy. Use a large amount of gauze to fill the retroperitoneal space, and rely on the pressure of the gauze packing to compress the bleeding blood vessels to stop bleeding.
"Let's go to the emergency department!"
Yang Ping's surgical plan was clear, and he rushed to the emergency department with everyone.
The operating room in the emergency department is in good condition, and it is a hybrid operating room that can perform both interventional and open surgeries.
The term "miscellaneous operating room" is actually not accurate. It is more appropriate to call it a hybrid operating room.
In fact, it combines the 3D imaging technology of DSA, CT, MRI and other equipment with the surgical 100-level laminar flow operating room, so that both minimally invasive interventional surgery and traditional open surgery can be performed, thereby solving various complex surgeries and reducing costs.
Reduce surgical risks and save surgical time.
That is to say, the functions of image monitoring and surgery are integrated into one. It’s that simple.
In the emergency operating room, Dr. Zhong from the Department of Traumatology and Orthopedics has installed a pelvic external fixator on the injured person, and Director Ji from the Interventional Department is performing emergency interventional vascular embolization on the patient.
There are two experts in the interventional department. Director Guan specializes in interventional surgeries on the cardiovascular system, while Director Ji is a generalist. He can do everything from trauma hemostasis to tumor embolism. He specializes in many things and cooperates with each other tacitly, allowing Sanbo to
The interventional department is developing rapidly.
These two big guys also have a good relationship in private. This is due to the tradition of Sanbo Hospital. From its establishment to the present, Sanbo Hospital has a tradition of unity. Everyone does not fight among themselves and everything is discussed on the table.
Debate and seek solutions.
Yang Ping entered the operating room wearing a lead suit. At this time, Director Ji was fighting hard and Director Guan was watching.
Director Guan knew that stopping bleeding from this kind of trauma was Director Ji's specialty. He was an outsider, and outsiders couldn't talk nonsense, let alone interfere, so he just watched the battle and stood aside silently.
Yang Ping walked into the operating room quietly. He walked around the table and walked to the side of the patient's head. He carefully lifted the drape on the head, and the brace appeared in front of him like a work of art.
Director Wei did not disappoint him. The craftsmanship accumulated over more than thirty years and the braces made by hand in the on-site emergency department played a good protective role and escorted the patients back to Sanbo Hospital safely.
"The muscle strength of the limbs is first level." Dr. Lu followed up and introduced.
Yang Ping nodded, and the muscle strength of his limbs was still at the first level, indicating that there was still hope of recovery.
"Is this brace okay?"
Director Wei was also wandering around the operating room. The chance of him coming to the operating room was very small, so he was a little unaccustomed to it, and the sterile cap he wore was not very standard.
Yang Ping said with a smile: "Without your brace, we would have nothing to worry about later. Your brace is a life-saving tool."
Director Wei touched the sterile cap like a child: "The thing is a bit rough, as long as it doesn't delay your business."
"The blood pressure is stable, it's stable!"
The anesthesiologist stared at the monitor screen and said excitedly.
There was a lot of sweat on Director Ji's forehead, and he turned around and moved out of the surgical area. Before the circulating nurse could help wipe away the sweat, Director Ji took out a stack of paper towels and wiped the sweat off Director Ji's forehead.
Interventional embolization to stop bleeding not only requires high skills, but also involves risks. It may lead to ischemic necrosis of the limb on the side of the embolization. Of course, limb necrosis is better than death on the spot, so some methods can only be used after weighing the pros and cons.
Since the blood pressure has been stabilized, it means that interventional embolization has successfully stopped the bleeding.
"Old Ji, your embolization and hemostasis skills are amazing." Director Guan sincerely admired you.
Director Ji shook his head: "If Professor Yang hadn't made progress in anatomy research in this area, I wouldn't be at this level. I just use doctrine and apply Professor Yang's results."
The prerequisite for embolization and hemostasis is to be very familiar with the anatomy of blood vessels throughout the body and have a strong ability to recognize angiographic images. These things all rely on some basic research and clinical experience.
"Professor Yang, when did you come?" Director Ji realized that Yang Ping was already standing behind him.
"Just arrived." Yang Ping stared at the blood pressure value on the screen.
"Do you want to do the cervical spine surgery now or in the second phase?" Director Ji was about to call it a day.
Yang Ping retracted his gaze from the screen: "After you are done, the injured will be transferred to the trauma ICU, and the second stage surgery will be performed after the hemodynamics is stable. Director Wei, can this be done?"
Because the second-stage surgery requires waiting for many days, fixation of the injured's cervical spine in this short period of time is a big trouble. If the fixation is unreliable, it may be fatal if not careful.
For example, when turning over in nursing care, not only the cervical spine fixation must be very reliable, but also the coordination of the several nurses responsible for turning over must be very coordinated, otherwise the cervical spine will be slightly distorted, with disastrous consequences.
Director Ji and Director Guan have never dealt with Director Wei in the brace room, so they are not familiar with Director Wei, but after all, they have been colleagues for twenty years and know each other.
Whether to operate immediately or postpone the operation is a contradiction.
Immediate surgery can reliably fix the head and neck, but the injured person has just been rescued from death and can no longer withstand the blow of another operation. Moreover, to fix the head and neck, special fixation instruments need to be customized, and customized instruments cannot be sent immediately.
Operating table.
Postponing the operation, that is, the second-stage operation, can allow the injured to recover to a certain extent, especially when the hemodynamics is stable before performing the operation. The safety factor is much greater. However, during the waiting period, the protection requirements for the cervical spine are very strict, and no mistakes can be made.
Error.
Therefore, Director Wei has become a key part of the treatment plan. Is he confident that the injured patient's cervical spine will not have any problems in the past few days?
"Okay!"
Director Wei said categorically that he decided to take his apprentice to personally guard the trauma ICU, responsible for immobilizing the injured's head and neck, and assisting in care and transportation.
With Director Wei's affirmative answer, Yang Ping was relieved. He was still very confident in Director Wei's craftsmanship.
"Then we'll do the second-stage surgery and transfer to the trauma ICU after the emergency surgery." Yang Ping decided immediately.
Director Wei has never been so stressed. During the waiting time before the second-stage surgery, the boy's life hung on his brace.
"Old Wei, you have a very heavy task. This child's life is really hanging on by a thread right now, and this thread is in your hand." Robert, who didn't know when he appeared, joked.
"Relax, take a deep breath, the people will support you!" August encouraged Director Wei.
"My palms are sweating now."
Director Wei was a little nervous, but he immediately regained his composure and told himself: If I am afraid of a ball, I need to put on a plaster to make a brace. If I, Old Wei, can't do it, who else can do it.
"Don't worry, we'll pick a few experienced nurses to take care of this wounded person. I'll be at the bedside 24 hours a day. I don't believe I can't pass this test." Director Wei said confidently.
I have never had such a highlight in my life. At this moment, I cannot let go.
