Zhou Chengdu is almost drunk. Is this person an intern?
This was in the operating room. The patient was under general anesthesia and intubated. He was just in shock and low pressure, not cardiac arrest. There was an open intravenous channel. The operation was in progress. She said she was going to call the teacher. Why not give fluids quickly at this time?
Have you ever read the book?
All procedures for in-hospital emergency care are basically moving closer to the current good infrastructure. Tracheotomy and intravenous access are now readily available!
After hearing Zhou Cheng's words, she turned around anxiously.
"Epinephrine, 1 mg, intravenous injection! Hurry up!" Zhou Cheng urged in a louder voice!
This voice called her back.
Anesthesiologists in the anesthesiology department always have dopamine, norepinephrine, and epinephrine on hand during the operation, and dopamine and norepinephrine are continuously pumped in.
But now, this kind of continuous pumping is not enough, so intravenous medication is required!
"Circuit, speed up the intravenous infusion immediately, inject colloids and crystalloids under pressure at the same time, and raise the room temperature in the operating room to 25 degrees Celsius."
"Director Hu, Director Mo, please look for the bleeding point in the abdomen." Zhou Cheng said as he moved out of the way.
At this time, the patient suddenly went into shock and the senior anesthetist was not available, so someone had to step forward.
Neither Mo Youcheng nor Hu Kaihua stood up, so Zhou Cheng could only stand up.
"Device, please step down and call the head nurse and ask her to send someone to support immediately. The blood bank must send plasma products and blood products."
"Notify the anesthesiologist to come to the operating room immediately and take blood gas analysis immediately." Zhou Cheng stared closely at the patient's vital signs.
Currently, my heartbeat is very fast and my blood pressure is very low, which definitely exceeds the shock index.
Zhou Cheng is checking to see if there is ventricular tachycardia or ventricular fibrillation.
Although shock first aid in the operating room falls within the scope of the anesthesiology department, this anesthesiologist is really unreliable, so he can only stand up.
However, doctors in all clinical departments have the right to give medical orders when rescuing patients in the hospital. In the surgical ward, when a patient goes into shock, it is the surgeon who takes the role of issuing medical orders!!
"Take off your gloves, don't care about your clothes!" Zhou Cheng looked at the equipment nurse and was about to take off his clothes and cursed.
The other party quickly took off his gloves and walked to the timing panel in the operating room before making a call.
Zhou Cheng returned his gaze to the monitor, and then calmly gave the order: "20mg dopamine, intravenous injection!"
Dopamine can be injected intravenously. The general dose is 20 mg directly intravenously. It can also be treated by intravenous drip. When dopamine is intravenously dripped, the dosage is different, and its effects are also different. Dopamine is a neurotransmitter that can be used to help cells.
Deliver pulses.
Low-dose dopamine can relatively selectively dilate visceral and renal arteries. It can be used in patients who are unresponsive to diuretics to increase renal blood flow and maintain glomerular filtration rate; it can also act directly on renal tubules.
To achieve a diuretic effect.
Moderate doses of dopamine can increase the activity of adrenergic receptors in the heart and strengthen the contractility of the myocardium.
Large doses of dopamine can cause extensive vasoconstriction and have a blood pressure boosting effect.
While restoring blood volume, adding a large dose of dopamine can effectively ensure the blood supply to important organs.
The circulating nurse immediately responded and went to help the anesthesiology doctor start executing the medical orders.
At the same time, after the equipment nurse who had stepped down made a phone call, the anesthesiologist who was doing the blood gas analysis hurried over, his face turned pale.
Then I saw Zhou Cheng staring closely at the vital signs monitor, while Mo Youcheng and Hu Kaihua hurriedly searched for bleeding spots.
"How's it going?" he asked quickly.
"Now the patient's blood pressure has risen slightly, but it is still very low. It is estimated that the blood volume is still insufficient. What were the results of the previous blood gas analysis? Is there high potassium?" Zhou Cheng did not turn around, watching that the heart rate had risen to 130, calmly
ask.
Fortunately, the blood oxygen level is still normal for the time being. In other words, there is no shortage of blood oxygen in the peripheral blood supply for the time being. It should be just stress-induced hypovolemic shock, not other shocks.
The anesthesiologist saw that the patient's high pressure was only 40+, and immediately adjusted the dosage of norepinephrine and dopamine pumped through the vein, and then said: "There is slight hyperkalemia. Prepare insulin and glucose for intravenous infusion."
"Remove the compound sodium chloride first and replace it with soda water."
As he spoke, he quickly started squeezing the hanging whole blood into the patient's body.
Then he quickly took over Zhou Cheng's instructions: "Epinephrine, 1 mg, intravenous injection!"
Mo Youcheng and Hu Kaihua raised their heads: "There is no active bleeding in the abdominal cavity. We have already tied out all the blood vessels that should be tied out."
Seeing that the patient's blood pressure had risen a little, Zhou Cheng said: "It should be the stress caused by a large amount of blood loss when the hematoma was just incised, which caused a large reduction in circulation in the body."
"Teacher anesthesia, thank you for your hard work. At this time, you must be very careful and pay attention to the pulmonary edema."
When the anesthesiologist came, Zhou Cheng stopped taking over and waited until the blood pressure rose to above 60mmHg before he came to the operating table again.
The operation continued.
At this moment, Mo Youcheng and Hu Kaihua didn't dare to talk anymore. The situation just now was really scary. Fortunately, Zhou Cheng stood up immediately. Otherwise, as soon as the anesthesiologist ran away,
This surgery is absolutely GG!
But Zhou Cheng is a real tiger. He can even cut such a hematoma. Although he made complete preparations to minimize the blood loss, the undetectable vascular damage still caused a large amount of blood loss, causing irritation.
The patient is on the verge of shock.
After a while, the circulating nurse and the nurses in the operating room helped to open bilateral intravenous channels and started blood transfusions on both sides, and the patient's blood pressure was completely stabilized.
Then, the anesthesiologist began to diss his subordinate: "What on earth were you thinking? How could you even think about running out and calling someone at that time?"
"You are a deserter. If you run away, what will happen to the patients? Who will accept your job?"
"Teacher, me!" The little girl was almost crying now.
Zhou Cheng and others didn't say anything. The girl's behavior just now was really unprofessional. Maybe she was really scared, but as a doctor, if you are afraid of this, then change your career as soon as possible.
This hurdle must be overcome.
After that, the anesthetist did not dare to go out any more. He asked his students to take blood gas analysis and other operations, and he did not dare to leave the anesthesia table for even half a step!
Time passes slowly.
More than two hours passed.
Zhou Chengcai finally sutured all the blood vessels, and then carefully checked the circle again, and said: "Director Mo, this patient must be very cautious. If heart failure and thrombosis occur again, routine antibiotics should be taken after surgery."
Condensation.”
"Although anticoagulation will cause a loss of part of the blood, if the thrombus breaks off, the consequences will be disastrous. In addition, due to shock, one must be extremely careful about cerebral edema and seek neurosurgery consultation."
"After surgery, brain CT scans should be monitored regularly."
Although the temporary life was saved, if the follow-up care or medical instructions are improper, problems can easily occur again. If problems occur after the operation, no matter how good the current operation is, it will not help.
No matter how good the surgery is, what's the point of it if there are no people left?
"I know, Dr. Zhou, thank you for coming today, otherwise, this operation would be really difficult to explain!" Mo You said with lingering fear.
He had previously explored the entire abdomen and found no hematoma. He even closed the abdomen, but there was still retroperitoneal hematoma.
However, even if he discovered it for the first time, he would not dare to touch it.
He doesn't have Zhou Cheng's ability. If he moves, he will die.
Of course, if you don't move it and let it exist and continue to lose blood, the patient's final prognosis will still be catastrophic.
It can be said that the reason why this patient was able to survive was entirely due to Zhou Cheng.
When the shock occurred, if Zhou Cheng had not stepped forward immediately, the patient would still not be able to escape death!
Hu Kaihua also said: "Zhou Cheng, you have really worked hard today! On behalf of the patients and their families, I would like to express my gratitude to you."
Zhou Cheng heard this and saw that the operation was now over, so he asked one more question: "Director Hu, this patient's injury is very special. Why did you consider calling me?"
Not many people know that Zhou Cheng can perform vascular surgeries, and he rarely takes the initiative to perform vascular surgeries, mainly because he doesn't have the right expertise and is afraid of something happening.
Currently, only Yang Yifeng, Lu Bin and others are known.
Cai Dongfan, who was far away in Shashi, also knew about it.
Hu Kaihua then explained: "Dr. Zhou, it's like this. We originally wanted to invite Dr. Yang to come, but Dr. Yang was temporarily busy and couldn't come. However, he suggested that I ask you if you can come down."
"He said, this surgery is not simple, and it might be better for you to do it."
When Hu Kaihua said this, he saw Zhou Cheng looking directly at him with a meaningful expression.
Then he hurriedly explained: "Well, Dr. Zhou, please tell me, the patient undergoing this surgery is my child's teacher. She is a very good teacher. It's a pity that she is not a kind person."
"It has been several years since my child graduated, but we have always talked about her kindness. Naturally, I don't want to ask too much about her family affairs, but this time she was injured, so I have the shame to ask more questions."
"I had no choice but to ask her mother to go to the Traditional Chinese Medicine Hospital to find you in person. Doctor Zhou, please don't take it seriously!"
Hu Kaihua's explanation made Zhou Cheng feel warm inside.
There is true love in the world. Hu Kaihua can put so much thought into his child's teacher, which shows that this teacher is a person worthy of respect.
Indeed, her experience is worthy of sympathy, but there is nothing that can be done about it. It is not easy for outsiders to interfere.
After the operation, Hu Kaihua pulled Zhou Cheng aside, then took out a large envelope and planned to hand it to Zhou Cheng.
He also said: "Dr. Zhou, this is my personal opinion. This teacher is indeed a respectable person, so I did not tell her family members this."
"If it were other patients, I might not be able to do this, but if I can help, it's just a little bit of kindness. Please accept it."
Hu Kaihua is also good at talking. It is indeed difficult for this patient's family to charge such a large sum of money for a flying knife. In fact, Zhou Cheng is a little confused.
However, if Hu Kaihua gave it to him privately, then Zhou Cheng could take it anyway.
Zhou Cheng opened the envelope, took out a few pieces, and handed it back: "Director Hu, I took these. You can take back the rest. It is not easy for everyone to make money. If you think Teacher Zu is a good person, you can
Just pay her hospital bills."
"I have received both my heartfelt and actual gratitude, so I will go back first!"
Zhou Cheng took five hundred.
The main thing is that you don't get paid for throwing knives, which is against the rules.
By charging for knowledge, you have earned hard-earned money. It would be inappropriate not to take it. Of course, you can take it all, but there is no need to let Hu Kaihua spend money.
Hu Kaihua couldn't help all the patients, and the same was true for Zhou Cheng, so just think of it as doing a good deed.
Hu Kaihua naturally argued with Zhou Cheng for a while, but Zhou Cheng still insisted, and then went directly to the underground parking lot, without even eating, and returned to Changshi with Master Gu.
After arriving at Changshi, Zhou Cheng asked Master Gu how much the fare was.
But Master Gu said: "Dr. Zhou, Director Hu has already paid for the fare. I am only responsible for delivering you to your destination. Doctor Zhou, you don't need to worry about the rest."
As he spoke, he seemed to be quite familiar with the conditions of this consultation.
"Thank you for your hard work, Master Gu." Zhou Cheng didn't say much.
He made a trip from Chang City to Jin City, which was not easy for him. He was very tired, and then he went to find a place to eat.
When I was about to go to the operating room, Director Lu Bin called.
"Dr. Zhou, thank you for your hard work today. It's like this. The patient in the emergency room a few days ago is out of danger and is now waking up in the ICU. So over there in the ICU, I hope we can go there for a consultation.
.”
"Because the surgery was performed by you, Dr. Zhou, the director of the ICU is asking Dr. Zhou to do a consultation in person. What do you think?" Lu Bin's words were full of politeness.
Zhou Cheng frowned when he heard this. He knew that the patient's name was Fang Miaomiao.
"Director Lu, what about this consultation? Do I have to go there?" Zhou Cheng asked in return.
Mainly, what Xu Kairan said before made him feel a little uncomfortable. What kind of person did Lu Bin position him as?
I can't say whether Fang Miaomiao is right or wrong, but what I learned from Zhang Zhengquan is that Fang Miaomiao was not the first to be rescued from the car accident, but he was the first to arrive at the hospital!
This incident felt like a thorn in Zhou Cheng's heart, and he felt a little uncomfortable!
When Lu Bin heard this, his tone continued to be more flattering: "Dr. Zhou, the main reason is that you were the one who performed the previous surgery, so the director of the ICU thought it would be better for you to see it in person."
"You also know that there is almost no precedent for such an operation before. In the past, we just couldn't figure out the reason. There were not even any other reference signs."
"Dr. Zhou, how about we go together? I'll learn with you, and then I guess I won't have to worry about you, Dr. Zhou."
After Zhou Cheng heard this, he couldn't refuse anymore. At this time, if he refused again, it would seem a bit unreasonable. He nodded and said yes.
Then, Zhou Cheng and Lu Bin arrived at the door of the ICU. Maybe Lu Bin called in advance, so when Zhou Cheng arrived, many people were there.
Among them, there was also Fang Miaomiao's family member, Muyin. After seeing Zhou Cheng, he thanked Zhou Cheng very enthusiastically. Without further delay, the group, including Muyin, all wore isolation suits and entered the ICU.
in.
After entering, the girl's body was still covered with various tubes.
At this moment, he looked very depressed, his lips were pale and dry, and his face was bloodless. Although the endotracheal tube in his mouth was removed, he was still receiving oxygen.
Covered with quilt, he tried hard to open his eyes, his mouth was trembling and he wanted to say something, but he couldn't.
"Dr. Zhou, the patient's vital signs are relatively stable for the time being. It's just this leg that basically has no feeling. What should we do?" the director of the ICU asked directly.
Zhou Chenggong glanced at him, but without answering, he first explored the patient's peripheral blood supply and could feel the pulse of the dorsalis pedis artery. Although it was slight, it was still palpable.
As for activities?
Zhou Cheng first took the initiative to twist the skin near the ankle, but the patient felt nothing. Then, Zhou Cheng checked for pathological signs, which were negative.
This means that at least there are currently no neurological problems.
"Nerve repair takes a certain amount of time. Moreover, it is not certain whether activities and sensory functions can be restored after the nerves are sutured."
"If the nerve function fails to recover after surgery, neurological atrophy will gradually occur, but at least now there is a chance."
"Now, the patient's blood supply is good. Next, we can only look at the nerve repair. If it really doesn't work, it will be difficult to deal with it. Let's see if we can find a way later." Zhou Cheng frowned slightly.
He frowned and said this.
After hearing this, Fang Miaomiao's mother frowned and asked, "Dr. Zhou, is it possible that this nerve will not grow properly? Could it be during the operation?"
When Zhou Cheng heard this, his heart sank secretly, and he replied: "After the nerve is severed and then sutured, there will be a certain functional loss. This is a major limitation of the current medical level."
"Limb transplantation is a palliative rescue plan. You can expect to restore some functions, but it is best not to expect too much. You want to completely restore the normal motor and sensory functions of both lower limbs."
"That's also unrealistic."
"Are you Fang Miaomiao's family member? I don't know how to explain to you the rest, but under the circumstances, I have done everything I can, and I have tried my best."
Zhou Cheng didn't know if she was blaming him, but Zhou Cheng still wanted to tell the truth clearly.
It's been amputated, and you want to repair it as perfectly as if it had not been amputated. How is that possible? If you really want to trouble me because of complications or sequelae after surgery, then Zhou Cheng doesn't care, just follow the formal procedures.
.
Upon hearing this, Muyin immediately said, "Dr. Zhou, you misunderstood me."
"What I mean is, if you, Dr. Zhou, have other ideas, please tell us, Dr. Zhou, that as long as Miaomiao's leg can get better, we are willing to take the risk. We also ask Dr. Zhou to think of more ways.
We will definitely cooperate!”
Muyin is not stupid. After contacting friends and people in the medical field in the past two days, basically everyone is saying that this Miaomiao operation can be regarded as a miracle.
This kind of technique is not only unique in the world, but there are definitely few examples.
Being able to save both legs now and not have them amputated directly is all thanks to Zhou Cheng.
It's just that people are greedy. When greed is insufficient, they naturally hope that all functions should be retained as comprehensively as possible.
As for causing trouble for Zhou Cheng, she didn't dare to think about it.
You are also causing trouble for Lu Bin and the others. You have had your leg amputated without understanding anything about it. Are you capable of doing it?
When Zhou Cheng heard this, his heart moved a little: "It depends on the subsequent recovery. Right now, the blood supply is good, and the nerve repair will take a while. At that time, we will discuss the follow-up treatment based on the degree of residual function."
"Director Jing, for this patient, the postoperative anticoagulation and hormones should be continued for a few days. Until seven days after the operation, when the nerve swelling has subsided, the dosage can be reduced as appropriate, and then stopped."
Director Jing, the director of the ICU, heard this and said hurriedly: "Hey, okay, Dr. Zhou, this patient won't be able to stay in our department for a few more days. He will be transferred to your orthopedics department in a few days."
"At that time, Dr. Zhou, you can personally arrange the follow-up diagnosis and treatment plan. Dr. Zhou, your skills are indeed superb!"
This is not a commercial compliment, but a true admiration. He has been here for many years, and he has never heard of an amputation followed by a transplant. It is unheard of.
But Zhou Cheng was still able to do it, which is his mastery.
After checking the room, Zhou Cheng felt that there was no need for him to come here.
After leaving the ICU, Zhou Cheng was stopped by Fang Miaomiao's mother, Muyin. He first thanked her again, and then privately asked about Fang Miaomiao's situation before he breathed a sigh of relief.
"Dr. Zhou, I have really worked hard for you this time. I have always wanted to thank you in person, but I never had the chance. So, my husband and I are planning to treat Dr. Zhou to a casual meal to express our gratitude. Please
Dr. Zhou must not refuse."
"I hope Dr. Zhou can pay more attention to Miaomiao's follow-up treatment."
As the saying goes, don't hit someone with a smiling face.
Zhou Cheng smiled: "Let's just stop eating. Surgery is my job. No matter who encounters such a situation, as long as I have the ability and time, I will try my best to help."
"I have received your kindness. Thank you for your kindness." After saying that, Zhou Cheng was about to leave.
Seeing this, Muyin continued to smile and said: "Dr. Zhou, this is really just a casual meal, not a violation of regulations or anything like that? Dr. Zhou, this is just a normal human interaction. Dr. Zhou, don't be too polite."
"Mrs. Fang, I know what you mean, but there's really no need to eat. Whether I eat or not, I will definitely try my best. Thank you for your kindness. I have something else to do, I'm sorry." Zhou Cheng clasped his fists,
Then leave.
Some people's food is edible, but some people's food is definitely not that delicious.