Professor Fang Jingsheng's words made several other professors suddenly startled!
Although they didn't speak, they all looked at Fang Jingsheng from the Department of Vascular Surgery with questioning eyes. The meaning in their little eyes seemed to be saying, Big brother?
Are you really lying? Are you really going to call so many of us and just listen to a guy like this who doesn’t have all his hair?
Can you take responsibility?
"I also believe in Xiao Zhou." One of them, who looked young and wore thick glasses, suddenly said this.
"This should be Zhou Chengxiaozhou who spent some time in the No. 9 Hospital of Magic City. It's hard to say in other fields, but in orthopedics, he is indeed a very good teacher."
"Director Tong of our department has many praises for him!"
"Professor Fang, Professor Du! Professor Ni!" Although Zhou Cheng didn't know the person who spoke, he knew several other people.
Tong Dawei, as the director of trauma surgery, they are all professors and have the most exposure to emergency surgeries.
As long as Fu Youhan has some brains, he will not advocate for Zhou Cheng to bring out Tong Dawei's reputation!
"Professor Ni, you can just open the abdomen. Professor Du, you guys will continue to deal with the intracranial hematoma. After I have blocked the artery, I will open the arteriovenous fistula and restore the external circulation. In this way, the amount of bleeding in the limbs will be reduced."
If it decreases or even disappears, the blood pressure should also go up." Fang Jingsheng was also very sure.
When Zhou Cheng was at the No. 9 Hospital in Shanghai, he was also exposed to vascular surgery, so he was very confident in Zhou Cheng's thrombus removal. Now that Zhou Cheng is here, the whole process of embolization after embolization is not so scary!
If you can save your life, you may be able to save one or two limbs in the end. This is already an excellent result!
What else do you have to worry about?
The patient is about to die. Emergency call is needed. Life-saving is the most important thing!
Where is there so much time to make choices and hesitate?
If it's an elective surgery, what if we talk nonsense together for three days and three nights?
Central venous pressure (CVP) is the pressure where the superior and inferior vena cava enter the right atrium. It is measured through the superior and inferior vena cava or the right atrium internal catheter. It reflects the right atrial pressure and is one of the main indicators for clinical observation of hemodynamics.
.More suitable for monitoring critically ill patients than pressure measured from limbs.
I am asking how you can find the splenic artery, not why you want to embolize the splenic artery.
There are several bleeding points, can you put them in?
Now this?
Zhou Cheng actually didn't use any tools and just relied on the catheter.
Zhou Cheng nodded and said: "Okay. What I am going to do now is to embolize the brachial arteries of both upper limbs. The bleeding points in the brachial arteries are large and numerous, and the blood loss and blood loss speed are the highest!"
But during this operation, no matter who it was, they couldn't handle it casually when they got to the stage. This was the professional quality of a doctor. At the same time, Zhou Cheng was trying his best to control his emotions.
If it were so easy to open the abdomen, anyone could do it with a knife. How do you get in and how do you get out? You have to deal with the external oblique muscles, the rectus abdominis, these anatomical levels one by one.
processed.
And Fang Jingsheng was the one who knew Zhou Cheng quite well!
Du Li looked at Zhou Cheng seriously, then pursed his lips and asked, "Can you do operations?"
But, after all, it is just a game of chess, and abandoning the piece will just result in losing in the end.
What did you say?
besides?
I can only nod and say yes!
This is a better monitoring standard.
What about Zhou Cheng? He is a magical figure who can perform thrombectomy across lower limb arteries that are thinner than the femoral artery. Can you still believe what he says?
"After the spleen ruptures in acute abdomen, there will be a large amount of abdominal bleeding, which is very fatal."
Zhou Cheng started the operation position at that time. Although he could not see the direction of the blood vessels in the abdomen and could only see the blood vessels in the lower limbs, with this field of view, he could also insert the metal catheter into the common iliac artery.
The common artery then flows backward, passes through the abdominal aorta, and reaches the location of the celiac trunk.
Anesthesiology, general surgery, vascular surgery, and orthopedics, Zhou Cheng basically ‘handled’ four of them at once.
"Of course you come on stage. Go wash your hands quickly!" Fang Jingsheng was only thinking about himself at first, so he forgot that Zhou Cheng was not from Huashan Hospital. To go on the operating table, he had to be approved by at least one chief surgeon, such as Fang Jingsheng.
Lift.
Fang Jingsheng left the catheter sheath without asking any questions.
real or fake?
Just after hearing Zhou Cheng's words, the professor of the anesthesiology department stopped playing with everyone——
Zhou Cheng shook his head and said: "What I mean is that after drilling, use a guide wire and a hose, send the hose to the center of the hematoma, and then directly aspirate the hematoma."
Du Li had already peeled off his scalp, but the time was too short, and he hadn't had time to open the window. When he suddenly heard this, his eyes immediately raised: "You mean interventional embolization + conventional craniotomy for hematoma removal?"
Then, he blocked the splenic artery of Professor Ni's ruptured spleen in the acute abdomen that he was about to undergo.
Now Professor Ni, who was clearly running to save his life, chose the left upper quadrant approach in a hurry, incised the subcutaneous tissue, and was dealing with the muscle layer.
If you do it blindly, you are really playing with fire on the line of life.
Therefore, Du Li's words were not polite and even contained a slight threat.
Seeing Zhou Cheng taking over, Fang Jingsheng immediately went to the opposite side to perform embolization of other arteries. Zhou Cheng kept the arterial catheter sheath that Fang Jingsheng had just done.
Without the extremely fatal factors such as arterial bleeding in the limbs and splenic rupture, the life window can at least be extended from a few minutes to dozens of minutes, giving us longer time to deal with it!
This is where everyone is most vulnerable.
Fang Jingsheng could believe it then, but what about now?
For normal people, even if the spleen is completely removed, it will not greatly affect the quality of life, even if it is to save lives!
At this time, the ruptured splenic artery was blocked, which was naturally a very good thing.
Even if Zhou Cheng is somewhat capable.
Opportunities like this are fleeting.
Zhou Cheng sent the tip of the catheter to the splenic artery, crossing the left gastric artery and common hepatic artery!
While preparing to insert the embolic agent, he said to Fang Jingsheng over there: "Teacher Fang, should I embolize the splenic artery first?"
Some people will suffer from psychological stress disorder if only one leg is amputated. There will be all kinds of mental abnormalities, and they will all disappear. Only those with great courage can accept such a result.
Not to mention medical students, laymen all know that wherever there is a leak, plug it up, and when it comes to clothes, sew wherever there is a tear.
"I can prepare a mirror, but are you sure you can cure the bleeding? With such frequent bleeding points, even after the hematoma is cleared out with a cranial endoscope, there is a high possibility that bleeding will occur again."
But at least it will not add trauma and stress to the patient that is equivalent to amputation.
When Fang Jingsheng had just opened a catheter sheath port for the femoral artery, Zhou Cheng happened to take it over, and Fang Jingsheng also put in an embolic agent made of gelatin sponge particles.
Zhou Cheng’s voice is still very stable!
The anesthesiology department should not interfere with clinical treatment choices. This is true, and I am not pushing it too much, but I have to monitor and monitor the whole process, and adjust the patient's vital signs at any time. If you don't show me the patient's blood pressure, I will play with you.
A chicken feather?
I don't know anything about his death.
It's not easy in such a professional place.
Are you brave or timid?
If you are brave, why are you in such a hurry?
Just wait until the cranial endoscope is put in and slowly stop the bleeding, if you are timid.
He doesn't want to talk, argue, or show off, he just wants to save people.
If under the supervision of interventional surgery, Zhou Cheng can accurately send the catheter or guidewire to the splenic artery.
But the blood that comes out is present in the skull, which is a very fatal thing in itself. If a brain herniation occurs, no matter how fast it can die, he will die faster than you.
If you say you don't know how, I will beat you right now!
"Professor Fang, continue what you are doing."
Needless to say, Professor Fang Jingsheng's expression was confused from the moment he heard Zhou Cheng say that he wanted to embolize the splenic artery...
Du Li felt that I was embarrassed at that time!
If you had told me earlier, why would I open such a big scalp flap?
This move is called losing your legs and hands to save your life!
However, under normal circumstances, if a person is alive and has no limbs, then think about it again, what is the quality of life of this living body itself?
What is the meaning of his life? In addition to bringing psychological comfort to his family, will he himself have to endure psychological suffering that is more terrible than death throughout his life?
Now I am so honest that I act like a younger brother on stage, not like an associate professor of orthopedics at all.
And even if you want to use cranial endoscopy, you still need to open a bone flap!
It’s just that the prescription method may not be consistent with the current one. You need to shave your head in advance and then position it.
Now that we can't think of any better solution in a short period of time, we can only bite the bullet and treat a dead horse as a living horse.
Fang Jingsheng felt like he had been violated again!
Zhou Cheng's previous suggestion of embolizing the limbs also sent away the orthopedic surgeon Fu Youhan who was invited to evaluate whether to perform amputation.
Without a field of vision, Zhou Chengcheng roughly felt the position of the blood vessel lumen, then frantically tested it, and finally!
Zhou Cheng’s kid?
Do you know that this patient can be delayed to death by you?
When Professor Ni heard Zhou Cheng's words, he looked at Neurosurgery Professor Du Li.
Deembolize bleeding from the brachial artery from the femoral artery.
He knew that Zhou Cheng must have said such a basic explanation in order to avoid a quarrel.
Are you still playing?
It seems like this is a basic operation that everyone knows!
Basic operations 6,6 must be banned!
In fact, Zhou Cheng really spoke calmly, mainly to avoid quarrels, and to avoid confrontations and explanations with others.
Because of intracranial hemorrhage, it is generally not possible for patients to die due to insufficient blood flow!
But although these words are not very harmful, they are extremely insulting!
After spleen rupture and bleeding, the bleeding can be stopped by embolizing the splenic artery.
It means opening a window for drainage or even a craniotomy to stop the bleeding. To stop the bleeding and clean the hematoma, it can be done directly by running the water.
Du Li can't do it himself. If you push me to this point and don't do it yourself, and then ask me to try, then you will really get beaten. Young man, I have to tell you in advance.
clear.
But if he wasn't allowed to monitor his blood pressure, he would have wanted to run away on the spot. Damn it, I'm going to give you anesthesia, and if you don't let me monitor your blood pressure, how can I play with you?
"If the splenic artery is embolized in advance, the amount of bleeding can be reduced and we will buy a lot of time for rescue." At this time, Zhou Cheng thought Fang Jingsheng didn't understand, so he explained it this way to avoid too many disputes.
In the art of war, there are green mountains left, so you don't have to worry about having no firewood.
Fang Jingsheng had just finished the operation on his side, and Zhou Cheng had completed a relatively large project on his side.
Zhou Cheng didn't want to waste any more time, he just wanted to perform the operation well.
Zhou Chengcheng stepped forward and asked: "Teacher, can I also come on stage to help?"
When playing chess, there are ways to lose the rook to save the commander, or abandon the son in thirteen moves.
When Professor Chu from the Anesthesiology Department heard this, what else could he say?
At most, the bifurcation at the celiac trunk is smaller.
In terms of time spent, this surgery is the fastest and optimal solution!
Okay. Not satisfied yet, Zhou Cheng finally took action on neurosurgery again.
It proves that this young man really has something!
"Ah?" Fang Jingsheng was on the other side!
After hearing Zhou Cheng's words, he was so frightened that he shivered.
You have embolized the splenic artery. If I open the abdomen now, can I still call for emergency laparotomy to save the patient's life?
Originally, a ruptured spleen was fatal, but now that you have done this, Professor Ni will just become a part-time worker!
It seems that whether he performs laparotomy faster or slower, it is always just an operation and has nothing to do with the patient's life or death!
What Fang Jingsheng is thinking is, can you stop asking me questions all the time that even exceed my current understanding of the upper limit of treatment?
Zhou Cheng immediately ran out of the operating room, washed his hands, put on a surgical gown and went on stage.
He thought there was something wrong with his ears, but Gang Zhoucheng seemed to say that he was going to have a splenic artery embolism.
"No? Professor Fang, I didn't mean to cause trouble or interrupt? It's just that you blocked the arteries of all four limbs clinically? How can I monitor my blood pressure?"
How fragile is the brain?
Zhou Cheng said: "There are MRA and conventional MRI here. We can actually try a minimally invasive method to release a few hematomas inside."
Finally, after a certain moment.
Zhou Cheng felt that the distal end of the catheter had reached a certain direction after reaching the celiac trunk. But he had to control the catheter to reach the celiac trunk, pass through the first left gastric artery and the second common hepatic artery, and reach the location of the splenic artery!
The origin of this project is similar to an operation Zhou Cheng had undergone before when he was in Changshi.
It's equivalent to saying.
Fang Jingsheng looked up at Professor Ni from the Department of General Surgery, and then asked Zhou Cheng: "Is the splenic artery embolization done?"
This operation is similar to Zhou Cheng's operation of tying up the splenic artery to stop bleeding.
How does this blind exercise feel?
Zhou Cheng couldn't care less about how to explain the operation after the operation, and looked for traces of various branches as if cheating.
His movements were already very deft, but he couldn't bear the fact that Zhou Cheng was not a human being. He had already performed the most fatal movements before he even entered. Because the first thing he had to do was cut off his spleen.
The only thing is to tie up the splenic artery.
and!
After Zhou Cheng had done this, he was not greedy for credit. Instead, he continued to read the current diagnosis of Lu Qianzhou and then suggested: "Teacher Fang Jingsheng, and Teacher Du? Do you think we can now treat ruptured cerebral aneurysms?" How to deal with the hematoma in the brain?"
First of all, although the limbs may not be saved.
This is an emergency surgery. Three minutes can be enough to kill someone. It can be the difference between life and death.
It's not too obscure, but it's not as smooth as other surgeries, and it's always a bit awkward.
The operating room has indications.
In fact, in the past, this kind of arterial embolization hemostasis was mostly used for internal iliac artery embolization of postpartum hemorrhage, and it was used to prevent bleeding!
He has never used this method of directly embolizing the femoral artery to stop bleeding. This is a life-saving method of amputation.
In the operating room, the surgeon only treats the patient. It is the anesthesiologist who really cares about the patient's life. Do you really think highly of me?
"Professor Chu, we monitor CVP directly! I'll give it to you!" Fang Jingsheng said.
Then, the operation started step by step.
Do I not understand basic anatomy and anatomy knowledge?
After all, a laparotomy is an operation, not a stabbing. You just take the knife and pull it directly into the stomach.
According to his understanding, if this time was not so urgent and the patient was not ordered to die by the hospital, he would not dare to let Zhou Cheng do this.
He reacted for a while before he figured out the direction of the blood vessel.
Sometimes, it doesn’t mean that the more minimally invasive and the faster the surgery, the better!
Rather, it depends on the situation that can be handled and the recovery after surgery.
Originally, Du Li also had to perform a craniotomy to remove the hematoma and a craniotomy to stop the bleeding, which was also very urgent.
When Du Li heard this, he suddenly felt like a good guy.
Zhou Cheng's speech was unbelievably calm!
…
Even the branch arteries from the splenic artery to the splenic hilum.
Can you perform interventional surgery without interventional monitoring????
"Okay!" Since Fang Jingsheng knew Zhou Cheng, he also recognized Zhou Cheng! In addition, the people in the orthopedics department also had a certain understanding of him.
The tip of the guidewire was sent to the splenic artery!
Is this believable? Can this be believed?
But in a situation like this, what can you do if you don’t believe it?
Is the distance from the femoral artery to the dorsalis pedis artery as far as the distance from the femoral artery to the splenic artery?
The arterial bifurcations you encounter in the middle are all relatively large!
"Cranial endoscopy is actually not suitable for this kind of disease." Du Li felt that he still had to talk about the pros and cons of the matter first.
About ten minutes later.
So those in the general surgery department have plenty of time to prepare for spleen removal or suturing.
This is the unchanging truth!
In the actual medical process, unless there is a special problem with the brain, you will usually think about tying all the major arteries of a person's limbs. The first reaction is whether the patient can survive and whether the bleeding can be stopped. Can amputation save life?
"Wait a minute, what did you just say?"
It's as if the person who was obviously supposed to be one of the protagonists had already let go and prepared his most superb acting skills. But when he arrived on the set, he suddenly became a dispensable supporting role...
It can also achieve the effect of stopping bleeding.
Splenic artery interventional embolization is more commonly used than femoral artery embolization, but it is more commonly used as a first-line treatment for giant spleens and hypersplenism.
Being able to monitor CVP is naturally more standard and more reassuring.
Fang Jingsheng didn't dare to speak. Although he was a vascular surgeon, the blood vessels in the brain had always been a disease dealt with by neurosurgery!
Even if there are interventional departments today that perform surgeries on intracranial hematomas, they are performed by professors of neurosurgery themselves. Interventional departments do not dare to operate intracranial hematomas alone.
Do you know where the splenic artery is?
Fang Jingsheng was really a little scared!
Indications for CVP testing: 1. Severe trauma, various types of shock and acute circulatory failure and other critically ill patients. 2. Various major and medium surgeries, especially major cardiovascular, cranial and abdominal surgeries.
And this is the scope of neurosurgery. You should leave the problem to Du Li, the neurosurgery specialist, not to me, okay?
In addition to reaching the splenic hilum, the splenic artery!
There are also the subgastroepiploic artery and the short gastric artery!
What Zhou Cheng wants to do now is to seal the splenic artery first, and then seal the splenic artery!
Du Li's expression immediately became very exciting.
Zhou Cheng's proposal is certainly feasible in theory. However, patients with ruptured aneurysms have relatively large aneurysms. Under monitoring, embolization can be performed to prevent recurrence of bleeding, and then surgery can be performed.
Removable spring coil.
However, when he heard Zhou Cheng's words, Fang Jingsheng trembled and raised his head. Then Fu Youhan was also stunned and looked at Zhou Cheng. His mouth under the mask was slightly open, choking on his curse words!
Malego dogecoin stuff!
What do you think you are here for? After finishing the vascular surgery, you have to teach the professor of neurosurgery?
Although Zhou Cheng didn't know why Lu Qianzhou was injured.
Today’s young people are really not ready to be human beings!
As soon as you enter the hospital, you immediately overturn the job of the anesthetist who monitors vital signs. Instead of monitoring the arteries of your limbs, you directly monitor CVP. You have no choice.
This young man cannot be timid.
Patients with high blood pressure or cerebral aneurysms can undergo minimally invasive interventional surgery after arterial rupture and bleeding, but this is all done under interventional monitoring!
"This minimizes blood loss from ruptured arteries in both upper extremities."
Fang Jingsheng is from the vascular surgery department. It was not difficult for him to place the monitor himself.
However, under such circumstances, Zhou Cheng, who understands both orthopedics and vascular surgery, is indeed the best candidate.
It would be different if the aorta was directly blocked and the Q was blocked!
This is very risky, there is no field of vision at all, and you can only rely on your hands! There is also your own control of the anatomical distance.
"I can try." Zhou Cheng narrowed his eyes.
Neurosurgery is a very close department to spinal surgery in the Department of Orthopedics, so when Zhou Cheng was simulating, he would accidentally acquire some corresponding skills and understanding.
In particular, the final manifestations of injuries to important intracranial structures were classified as orthopedic activities, and Zhou Cheng's understanding became deeper.