The difficulties faced by the operation were perfectly solved. Yang Ping planned to personally talk to Lu Jiangbei’s family and sign an informed consent form for the operation.
This operation is not an ordinary operation. As the chief surgeon, he must communicate face-to-face with the patient's family to let the patient's family understand the risks and details of the operation in detail. At the same time, the doctor in charge, Dr. Zhou, and Director Pan of the trauma ICU are also present.
In the trauma ICU interview room, Yang Ping met Lu Jiangbei's mother, who was pushed in a wheelchair by relatives.
At that time, the family of three was trapped in the car. Fortunately, the mother's injuries were relatively minor and did not require surgery. However, she was also hospitalized, and she now had to take on the dual roles of family member and patient.
"Your husband is out of danger, but the child's injuries are very serious, especially the traumatic occipital-atlantoarticular dislocation and atlas comminuted fracture. Now he has high paraplegia. It is uncertain whether he can recover after the operation, but we will do our best.
Let’s go.”
Yang Ping's tone is very calm, and he always seems very rational when dealing with patients and their conditions. This kind of rationality sometimes makes people feel that he lacks a touch of warmth.
"Can I still take the college entrance examination?" my mother blurted out.
She knew that it was very inappropriate to talk about this issue at this time, and she should be more concerned about the child's injury, but somehow, the college entrance examination was deeply ingrained in her heart, and it seemed that she had to make way for anything. She was not indifferent, but almost instinctive
This question pops up.
In these years, all her energy has been focused on a few words - her children's college entrance examination, which has almost become the ultimate goal of her life.
"Now we are not talking about this issue. Now we are only talking about surgery. If he does not have surgery, it is still unknown whether he can survive." Yang Ping's tone remained calm.
He is a doctor, he does not care about the patient's life fate, he only cares about the patient's current physical fate.
The mother was slightly hesitant. She knew that even if she could take the college entrance examination, it would waste a lot of time. Every minute in the senior year of high school is very precious and can be converted into every cent of the grade.
Thinking that her many years of hard work might be in vain, she felt a lot of unwillingness.
"Doctor, he is a good student. Please help me and don't waste too much study time." The mother's eyes were floating, and she was making her last effort. She herself didn't want to struggle with this problem at this time, but she just couldn't let it go.
Yang Ping had to remind her again: "My responsibility is to let the child survive and live a better life. Nothing is more important than living."
Yes, nothing is more important than living. My mother’s eyes were a little dull and she repeated this sentence in her heart.
"Traumatic occipital-atlanto joint dislocation, atlas bone crushing, high paraplegia - the mortality rate is very high. Most of the injured died at the scene of the car accident. He was very lucky to be able to come to the hospital and go to the operating table, so
We must cherish and strive to keep him alive, understand? Only by living can we have everything. If we cannot live, everything is meaningless! You must understand that this is the trauma intensive care unit. Leaving here alive is the highest goal for every patient.
Goal, live! More than anything else."
Yang Ping's words hit the mother's heart directly. She closed her distracted eyes and touched the corners of her eyes: "Yes, living is more important than anything else."
"Can we start talking now?" Yang Ping took the medical records from the doctor in charge.
The mother nodded and tried to adjust her emotions. At this time, except life and death, everything else was as light as smoke.
---
Lu Jiangbei has a fever, with the highest temperature reaching 42 degrees Celsius!
Early the next morning, Yang Ping received a call from the trauma ICU. The call was from Director Pan.
Sudden high fever is undoubtedly terrible news for surgery, and the scheduled surgery has to be postponed.
Yang Ping rushed to the trauma ICU. Lu Jiangbei was lying on the bed, using physical cooling, including ice packs and blankets.
"I just checked the bedside chest X-ray and found infection in both lungs."
Dr. Zhou, the doctor in charge, looked a little anxious. He could have operated now, but he suddenly developed a high fever and the operation had to be postponed.
"Watch X movies!" Song Zimo suggested.
Dr. Zhou called up a chest X-ray on the electronic screen beside the bed. It was obvious that there was extensive infection in both lungs.
"I was fine during the day yesterday, but started to have fever in the middle of the night---I wish I had checked the chest X-ray earlier." Dr. Zhou felt ashamed and felt that he had not managed the patient well and caused trouble for everyone.
After reading the chest X-ray, Yang Ping said: "The patient's condition changes all the time, especially for this kind of patient. It is impossible to check the chest X-ray every day."
"Should we send him to the CT room for further chest CT examination?"
Lu Jiangbei only had a bedside chest X-ray. In order to understand the status of the lung infection in detail, a further chest CT examination must be performed. In this situation, it is best not to move as much as possible.
Yang Ping thought for a while: "Forget it, try not to move it, take a sputum sample for bacterial culture, and then do three sets of blood cultures. It looks like sepsis. Let's use antibiotics based on experience first, and then check the drug sensitivity after the culture results are available."
Experiment."
The operation must be postponed. Severe lung infection will lead to a decline in lung function. Although Lu Jiangbei now has a ventilator to assist breathing, it only helps the lungs to ventilate and cannot help her to ventilate.
The so-called ventilation is the exchange of gases between the lungs and the outside world, while ventilation is the exchange of gases between the alveoli and capillaries. Severe lung infection damages not only ventilation, but also ventilation.
Once the pulmonary infection gets out of control, it may cause respiratory failure, and finally rely on ECMO to support breathing. By then, it is basically a narrow escape from death.
"Based on the color of the sputum, it's probably Staphylococcus aureus. Let's take empirical medication first. As long as it's not MRSA, there's hope." Director Pan decided immediately.
As the director of the trauma ICU, Director Pan often deals with infections, and Director Pan handles them with ease. However, when this situation occurs before the operation, Director Pan is also stressed.
That night Lu Jiangbei had a fever, and Director Pan personally came to the hospital to investigate the cause of the fever. This kind of post-traumatic infection mostly has several causes: wound infection, infection in areas where blood accumulates in the body, lung infection, urinary tract infection, etc. After investigating these causes, it was confirmed that the infection came from the lungs.
Is it viral or bacterial? If it is a bacterial infection, what kind of bacteria are it? Generally, bacterial culture is required, but doing so for too long will delay treatment.
Therefore, before the bacterial culture results are available, empirical medication is needed to determine what microorganisms are based on the color, nature, viscosity, etc. of the sputum.
Medicine is an evidence-based science, but in the final analysis it is also an empirical science. In any case, it cannot escape its dependence on experience.
"Be more diligent in suctioning sputum and use a bronchoscope to suction sputum." Director Pan told the nurse who was suctioning sputum.
Lu Jiangbei's current muscle strength in her limbs and trunk is at level one, or slightly higher than level one, so her respiratory muscles have no strength, and it is difficult to even breathe, and there is no way to cough and expel phlegm.
The ventilator can only assist breathing, but cannot help excretion of sputum. The accumulation of sputum can easily cause infection.
The operating depth of ordinary sputum suction tubes is very limited and can only penetrate deep into the main bronchi, while fiberoptic bronchoscopy can penetrate deep into 3-4 level bronchioles or even deeper. Therefore, suctioning sputum with the assistance of fiberoptic bronchoscope is better than ordinary sputum suctioning.
A lot.
Fiberoptic bronchoscopy is a respiratory medicine technology and is often operated by respiratory physicians. Under the influence of comprehensive surgery, many doctors in Sanbo began to dabble in marginal and cross-specialties, forming composite technical capabilities.
Dr. Zhou has mastered the basic techniques of almost all specialties, such as bronchoscopy in respiratory medicine, gastrointestinal endoscopy in gastroenterology, dialysis in nephrology, closed chest drainage in thoracic surgery, etc.
These technologies were originally scattered in various specialties. If necessary, specialist doctors were invited to perform the operations in the form of consultations. Now with multi-disciplinary doctors like Dr. Zhou, there is no need for such trouble. Dr. Zhou operates alone.
Dr. Zhou began to suction sputum under the bronchoscope. He took a few specimens and sent them to the laboratory for bacterial culture.
"Professor, should we continue to send ICUs?"
August, who has returned to general surgery, took the initiative.
Robert wanted to punch this German guy to death. Every time he turned over, August was only responsible for the head. The one who contributed the most was Robert. He was the main force responsible for the torso. He also wore small clothes. August's clothes were intact.
There is no damage, but Robert's armpits have cracked on both sides.
Hearing that Robert took the initiative to ask for clothes, the head nurse said happily before Yang Ping could say anything: "The clothes have been prepared for you, but I still need to trouble you."
During this time, the ICU has been full. The girls are so busy that they are overwhelmed, and the male nurses are also too busy. It would be great if August and Robert could continue to help.
Lu Jiangbei's care is the most difficult among these patients. Just turning over requires the cooperation of several people, and he dare not relax even a little bit.
August and Robert worked in the ICU for several days, but the extra-large clothes were not delivered. After they were delivered, they returned to the general surgery department, so the extra-large clothes were not put to use.
But I didn't expect that Lu Jiangbei would have a fever now and the operation would be postponed. These sets of extra-large clothes could finally come in handy.
