Under the shadowless light, the operation is still in progress.
Dr. Cao's surgery turned into a combined thoracoabdominal surgery, not surprisingly. Tong Chunlai, director of cardiac surgery, was in charge of the heart, while the liver was left to deputy director Chen Hua. Zhao Chongxi, chief director of the Department of Hepatobiliary Surgery, was rushing to the hospital from home.
Director Chen's task is to separate the peritoneum and stop bleeding before Director Zhao Chongxi arrives to take over.
"The blood bank has provided a reserve of 6,000 milliliters, and the inventory may not be enough... The blood bank just called and said that the hospital still has a reserve of 1,600 milliliters..." The circulating nurse in the operating room told Chen Hua
The director whispered, "They have transferred the blood from the city blood center and it will be delivered in about half an hour."
There are many bleeding holes on Dr. Cao's body, and there are more than ten wounds on the body surface, but half of them are not too deep, and the amount of bleeding is acceptable. Even if the portal vein of the upper limb is broken, the amount of bleeding so far is only about 400.
About milliliters. Other blood is almost concentrated in the chest and abdominal cavity.
Pericardial effusion means bleeding in the heart. Sun Lien's injection in the emergency room bought Dr. Cao some time, but the situation is still not optimistic. His left ventricular lateral myocardium was damaged, and the left anterior interventricular branch and left anterior interventricular branch were damaged.
The descending branches are all damaged. Damage to these three places alone resulted in more than 100 ml of bleeding in about one minute. What’s even more troublesome is that when in the pericardium, due to the pressure of the pericardium itself, the amount of bleeding from these wounds
It wasn't too big. But when Director Tong Chunlai opened Dr. Cao's pericardium with a scalpel, a large amount of blood spurted out. The blood quickly covered the surface of the heart and all surgical fields.
Although he lost his field of vision, Director Tong remained calm. After cleaning the blood on the surface of the heart with a suction device, he dictated to his assistant, "Record, there is a wound about 4.5 mm deep on the outside of the left ventricle, with a length of about
One centimeter. There is damage to the left anterior interventricular branch and left anterior descending branch, about one millimeter. There are no other obvious wounds."
The thickness of the left ventricle of an average adult is about 11 to 16 mm. Although the 4.5 mm wound did not directly penetrate the myocardium, the trauma caused was already serious. If it directly penetrated the myocardium and caused a heart rupture, I am afraid that Dr. Cao would not be able to survive it.
On the operating table.
"Cannulate the ascending aorta and inferior vena cava and prepare for extracorporeal circulation." After his assistant said that the recording was completed, Director Tong quickly issued an order to the doctor responsible for perfusion. "Stop the cardiopulmonary bypass as soon as possible."
Although from a technical point of view, Director Tong can also sew the myocardium and blood vessels directly on the beating heart. However, both the coronary artery and coronary vein are damaged, and the cut myocardium is also within the blood supply range of the anterior descending artery.
Internally. If more surgical plans are used to block the superior and inferior vena cava and cause the heart to idle, the damaged myocardium will inevitably accumulate waste and become hypoxic due to the empty heart. However, a high-k+ depolarization asystole plan is used.
, can minimize the degree of myocardial damage and create good conditions for further surgery.
"Give me a minute!" The ascending aorta and inferior vena cava were being intubated nervously on the operating table. Director Zhao Chongxi, who had rushed over, finally arrived at the operating room. He walked with difficulty through the doctors who were waiting for news in the corridor.
They rushed into the operating room, "What's going on?"
"Grade four liver injury, penetrating injury to the left liver lobe, rupture of the proper hepatic artery, and hepatic vein." Director Chen Hua, who was responsible for early separation and hemostasis, lowered his head and replied. His hands were buried in Dr. Cao's abdominal cavity, and he
The liver was pushed down toward the operating bed, while the first porta hepatis was blocked with atrial appendage forceps, the subhepatic inferior vena cava was blocked with vena cava anastomosis forceps, and the suprahepatic inferior vena cava was compressed with fingers. At this moment, Director Chen Hua wished he had three heads and six arms.
Two fingers compressed two veins, and the large amount of hemoperitoneum made his gloves slippery, making compression very difficult.
Director Zhao Chongxi came over, carefully looked at the damage on the liver, and immediately asked the instrument nurse for a suture needle and a needle holder. At the same time, he said to Chen Hua, "You hold still for now while I suture."
The accumulated blood in the abdominal cavity was sucked into the blood recovery purifier through the straw held by the assistant. After purification, it was reinjected into Dr. Cao's veins. But his blood pressure continued to drop. Six thousand milliliters of blood was sent from the blood bank.
There were only 800 milliliters of blood left.
No one spoke in the operating room, and the air was as oppressive as a solid body. No one had the heart to tell jokes and chat. Even with the capabilities of the Fourth Central Hospital, this kind of trauma is still extremely dangerous. Thanks to Dr. Cao's presence in the hospital when he was stabbed,
You should know that most patients with hepatic vein rupture and hepatic artery bleeding cannot survive the laparotomy. Even if they can go to the stage for laparotomy, they are likely to die from massive bleeding before the doctors can complete the suturing of the blood vessels.
Normal adults generally have about 4,000 ml of blood in their bodies. Now doctors have transfused about 5,200 ml of blood into Dr. Cao's body. Almost all the blood in his body has been completely replaced.
The operation on the liver must not only be fast, but also ensure the quality of the completion. Looking at the chest cavity opened by Tong Chunlai, Director Zhao, who was in charge of the operation, knew that Dr. Cao had no chance of a second operation. Either solve the problem once and for all, or watch idly by.
He died because of a problem that was not solved in the first surgery. There was no third option.
What is the chance that a patient with a blood transfusion of more than 4,000 ml will survive the operation? Zhao Chongxi shook his head and drove all these irrelevant thoughts out of his mind. There was only one patient lying on the bed, a patient with severe liver trauma.
.Keep a calm mind and just complete the surgery as before.
Sun Lien stood with Shen outside the operating room without saying a word.
Xu Yourong and others stood a little further away, also silent. Dr. Pascal looked at Sun Lien with some worry, and whispered to his colleagues, "His behavior is too abnormal."
Zhou Ce nodded and said nothing, and Yuan Pingan responded, "When encountering something like this, we should only worry if it's the same as usual, right?"
Xu Yourong whispered, "Dr. Cao is his roommate, and the relationship is closer than ordinary colleagues."
Zhou Ce rolled his eyes, "What you said is meaningless. If one of us is stabbed, will he feel better?"
"If you have time to argue, why not think about what to do later." Dr. Pascal glared at the two of them. He is the oldest and has the first seniority in the treatment group. It is perfect to play the role of a stabilizer at this time.
It couldn't be more appropriate, "I remember there is a special psychotherapy consultation department in the hospital, right?"
Yuan Pingan nodded, "I've heard of this department, but I've never seen anyone in it."
"Then they will be very busy during this period." Dr. Pascal sighed, "I hope the operation goes well. If bad news comes when the door is opened, it will be a big trouble."
Outside the operating room, Shen lowered his head and trembled twice, then quickly and covertly wiped away his tears, and then raised his head again to look at the monitor screen on the wall. A few lines of words on it simply showed the situation in the operating room, "Under operation."
"It's been almost an hour." Shen finally couldn't bear it any longer. She asked Sun Li'en in a low voice, for fear that her voice would affect the doctors who were operating inside, "Is this normal?"
Sun Lien was silent for a while and then nodded, "Brother Cao's injured organ is more complicated to deal with. The longer the operation takes, the better the effect will be." If such a large-scale combined operation involving the heart and liver can be performed within an hour, When it's over, I'm afraid it will only be accompanied by bad news. The longer the doctors take to operate, the greater the chance that Dr. Cao will survive.
Although he seemed calm on the surface, Sun Lien was already in a state of panic. About ten minutes ago, two nurses from the central nursing station pushed in two freezer boxes with the logo of the central blood station on them. Operating room. Sun Lien knew at a glance that it contained blood urgently transferred from the blood bank.
Even the fourth hospital's blood station didn't have enough blood. When Sun Lien realized this, he felt his heart tremble suddenly.
He stared at the door of the operating room, with no other thoughts in his mind.