By the time the pre-hospital emergency doctor on the ambulance jumped out of the car and ran to the conference room, Li Fengmin's operation had basically reached the final stage.
Dr. Chen first clamped the distal end of Li Fengmin's external iliac vein with his left index and middle fingers. With the help of a tourniquet at the base of his thigh, he completed a vein occlusion and hemostasis without a hemostat. Then he carefully cut Hu Jia's veins.
The hemostatic patch is attached to the vertically torn part of the external iliac vein. It is like putting a rubber patch on a punctured bicycle tire, except that there is no need to apply any strange adhesive on the contact surface between the patch and the blood vessel.
, and there is no need to polish the outside of the blood vessels that need to be repaired in advance.
According to the operating requirements of the Takeda tachosil patch, Dr. Chen inserted his hands into Li Fengmin's stomach and never let go. According to the instructions, after the patch comes into contact with blood, it takes about a minute for the coagulation substance to be activated until the coagulation substance is enough to stick the patch.
time. And there were not enough conditions at the scene for Dr. Chen to make a visual judgment when the surgical field was sufficient, so for the sake of safety, Dr. Chen simply stuffed both hands into Li Fengmin's stomach. The left hand held the patch.
The tablet continued to exert pressure on the damaged blood vessel, and the right hand continued to maintain the position of "blocking" the external iliac vein. He only occasionally loosened his fingers and then pinched them back immediately. This was to prevent the blocking effect from being too good.
As a result, the patch does not come into contact with enough blood and cannot adhere to the blood vessel.
Li Fengmin's situation is actually very dangerous. Bleeding exceeding 1,500 ml is undoubtedly the primary risk. If it were in a well-equipped operating room, the hemoperitoneum that Dr. Chen used to use a curved plate would actually be removed by the corresponding equipment.
After recovery and purification, about one-third can be continued to be infused back into Li Fengmin's body. With the support of plasma and crystalloid, these risks can be overcome.
Not long after Dr. Chen announced that the patch worked well and the bleeding from the external iliac vein had been effectively stopped, the pre-hospital emergency doctor rushed into the conference room. Then he screamed "Ouch" in fright at the scene in front of him and pulled the hand in his hand.
The first aid kit ran out again.
"Come back!" Doctor Chen waved his hand toward the door in a dumbfounded voice, "Have you brought high-concentration sodium chloride injection or 706?"
Generation 706 plasma, which is hydroxyethyl starch injection with a concentration of 6%, is a commonly used blood volume expansion solution in clinical practice. It is mainly used to reduce the need for blood transfusion during surgery and for emergency rehydration in burns and other situations.
You must know that there is definitely no blood transfusion device in the ambulance, and there is no blood preparation. For Li Fengmin, who has already developed symptoms of hemorrhagic shock, if the blood volume can be expanded now, it will certainly be more conducive to subsequent recovery. Without plasma,
, it’s not bad to have some crystalloid and colloid. A certain amount of highly permeable crystalloid can mobilize the blood stored in the organs to enter the circulation system, while the plasma substitute 706 can further increase the blood volume, which helps to ensure Li Fengmin’s circulation.
There is enough fluid in the system. This is very positive for maintaining brain perfusion.
"706 is not available, but sodium chloride injection has a concentration of 7.5%." The pre-hospital first aid officer was still trembling and wanted to leave first, but when he heard the other party's words, he realized that the person on the emotional stage was not some cannibal feasting.
Instead, a group of colleagues are rescuing people.
"It's okay, bring it first." Dr. Chen slowly took out his hands, waited for a while, and then slightly turned the sigmoid colon, which was a little in the way. After confirming that there was no other bleeding, he relaxed a little. "Abdominal cavity first.
Don’t rush to close it all, just close part of it. You may have to deal with it again after you get to the hospital.”
Surgery is not as simple as sewing up a person's belly after it is over. Generally speaking, how you cut it, you have to sew it back. After you cut the skin, fascia, and muscles, you have to sew the muscles and fascia back.
, the skin is sewn back one by one. And you can’t just use one style to sew it back from beginning to end. Muscles need stronger sutures to prevent them from cracking during exercise, and fascia needs stronger ones.
Continuous overlock suturing. According to different needs, different techniques and sutures of different thicknesses are used for suturing. This is an essential ability for a qualified surgeon.
Dr. Chen, who dared to perform laparotomy and exploratory surgery in this environment, has naturally gone far beyond the limit of what the word "qualified" can express. With more than 35 years of surgical experience and many years of experience in dealing with difficult and severe patients,
He was able to subconsciously allocate all resources during the operation. This ability told him that under the current situation, it was impossible to complete a "qualified" "abdominal closure".
The sutures Hu Jia found were prepackaged synthetic sutures with their own leather needles, but they were only available in two models: No. 4-0 and No. 0. The No. 4-0 suture was only 45cm long, while the No. 0 suture was longer, but
It's only 60cm. Not only is it not long enough to close the abdomen, but the thread is either too thick or too thin, making it impossible to use.
And the most important thing is that this is not the operating room of the First Affiliated Hospital of Tongde Medical College in Yunhe City. There is no surgical team that Chen Tianyang is used to working with next to it. This is the conference room of a five-star hotel in Sanya. Under the illumination of spotlights
Below, Chen Tianyang could even see some hairy pollutants floating in the air.
Even if he uses the existing resources to close his abdomen, after sending Li Fengmin to the hospital in Sanya, the doctors here will still have to open his abdomen again for abdominal lavage and disinfection. Then it is better to save some effort and use line 0 first.
Connect the skin around the belly to prevent Comrade Li's intestines from accidentally being thrown out during transportation.
Sun Lien diagnosed the cause of Li Fengmin's illness, while Chen Tianyang was the chief surgeon of the operation, and Hu Jia was the person in charge of providing the intraoperative instruments. The three of them had to go to the hospital with the ambulance, and the others involved in the operation
The veteran experts, led by the person in charge of the hotel, went to the bathroom to clean the blood stains on their bodies.
"You are so brave." In the slightly crowded ambulance, the pre-hospital emergency doctor who finally calmed down said to the three people in front of him, "Without anesthesia and without circulatory support, how dare you do laparotomy?
"
"If he doesn't do this operation, he will be dead." Chen Tianyang was the chief surgeon. He glared at the pre-hospital emergency doctor with dissatisfaction, "If we wait for your car to arrive, Lao Li will have to wait for a blood transfusion to support him."
"But when you perform surgery under those conditions, you are not afraid of postoperative infection?" The pre-hospital doctor also knew that the patient's condition was urgent, but he always felt that the behavior of the three people was a bit over the line. "That place is not a hospital, and it is definitely not suitable.
Where is your medical license registered? Even if you are both doctors, you might be held accountable for illegally practicing medicine."
"Postoperative infection? You have to be alive to get the infection." Chen Tianyang spread his hands disdainfully, "As for the surgery, I am the chief surgeon anyway, even if the license is revoked, it will be for me alone. Also, who said we are practicing medicine?
?”
The pre-hospital emergency doctor choked on the last rhetorical question.
"We are just a group of brave people with corresponding professional abilities." Chen Tianyang smiled slyly, "You understand that we are brave enough to do justice?"