Chapter 214 Intervention Section (Subverting Theory for the Alliance Leader 03)
From the perspective of treating gastric bleeding alone, we can see how different and different the current medical education system is from its actual application. The only correct way to stop gastric bleeding, which is regarded as the golden rule in textbooks, is to use a three-chamber two-chamber method.
Capsular tube. After placing the three-lumen and two-capsulated tube into the patient's stomach, air is injected into the tube through a syringe to expand the gastric pouch to achieve compression and stop bleeding.
Theoretically speaking, the three-lumen two-capacity tube has few side effects, the equipment is cheap, and the operation is not too difficult. It is an ideal treatment method for gastric bleeding and hemostasis. However, the reality is that the scope of use of the three-lumen two-capacity tube is severely limited.
Limited, because it requires patient cooperation, in actual use it is far less effective than using hemostatic agents or cauterization to stop bleeding under gastroscopy. In the face of more severe gastric bleeding, doctors will choose to perform interventional surgery on the stomach when gastroscopy is ineffective to stop bleeding.
Arteries are embolized to relieve bleeding symptoms.
However, Dean Wu Youqian directly decided to use interventional treatment instead of gastroscopy to stop bleeding. The thinking process was actually very similar to Sun Lien's "inferential diagnosis".
In the case of severe infection, patients may experience severe gastric bleeding when they do not eat or drink, which may mean the occurrence of DIC.
There are five main causes of DIC, the most common of which is severe systemic infection. Followed by trauma, organ damage, tumors and obstetric disasters, as well as other causes that cause massive consumption of coagulation factors.
When a patient with an unknown history of severe systemic infection suddenly suffers from moderate or above gastric bleeding without the trigger of gastric ulcer, as a doctor, the first thing that should come to mind is not the bleeding caused by ulcer which is common in clinical practice, but the first stage manifestation of DIC, which is
Symptoms of spontaneous bleeding.
For the treatment of patients with such serious conditions, doctors must always be highly vigilant and try to rule out the most serious possibility as soon as possible. This is also the main reason why Director Wu Youqian directly decided to perform embolization treatment. If it is DIC, gastroscopy will not only stop the bleeding
It will not be effective, but will lead to further aggravation of DIC due to consumption of coagulation factors. If not, embolization therapy can also be effective, and the patient himself will not face more risks.
In the medical industry, experience has always been part of strength.
Standing outside the clean room, Sun Lien breathed a sigh of relief after hearing Dean Wu's arrangements. The old dean was indeed a ruthless person who could decisively stop bleeding with bare hands in the French operating room. His judgment on the patient's condition was simply unreasonable.
After the patient vomited his first mouthful of blood, Sun Lien saw the (mild DI) status prompt on the status bar. At the same time, Dean Wu had already begun arranging for the transfusion of frozen plasma and whole blood.
In order to replenish coagulation factors and the patient's lost blood. After the second vomiting of blood, Director Wu Youqian directly decided to perform embolization on Hou Huiying to stop the bleeding. This should have been judged that the patient had DIC symptoms, so he chose to stop the bleeding so resolutely.
The method is really quick, accurate and ruthless.
Sun Lien began to see the wise people and began to reflect on whether in his usual medical activities, too much emphasis on detecting evidence would affect the timeliness of rescue. However, after some careful consideration, Sun Lien was somewhat frustrated to find that Dean Wu's plan
He can't learn technology at all.
Carrying out high-risk treatment based on only some indirect evidence is probably something only a dean-level expert like Wu Youqian would dare to do. He has probably seen hundreds of times more patients than the girls Sun Lien has seen. Others
The medical staff would not raise any objections to Dean Wu's judgment. But Sun Lien could not. Even though he had gained some fame in the hospital, he was still a trained doctor who needed to use other people's prescription rights.
Instead of spending some time for treatment, it is better to complete the examination as quickly as possible and then use tangible evidence to prove your diagnosis plan. This is better than encountering objections from other doctors during diagnosis and then having to spend time convincing them to come.
safe.
After spending a long time thinking about it, I found that I couldn't copy the other party's more effective approach. After understanding this fact, what followed was almost irresolvable depression and frustration. While Sun Lien himself was frustrated,
I suddenly understood the thoughts of Xu Yourong, Yuan Pingan, and even Dr. Pascal.
It turns out that it is such a frustrating thing to see a road, but you can't walk on it at all.
"Embolization of bleeding veins?" In the interventional operating room, several young doctors looked at each other. They discussed it together, then shook their heads and said, "Dean Wu, this operation is too difficult, we can't do it."
The patient's condition has been clarified through preliminary angiography. Hou Huiying does have symptoms of gastric ulcer. Since there is no obvious abnormality in the arteriography, it is certain that the bleeding site is not the artery, but her gastric vein. Although gastric ulcer is common
Bleeding mainly causes arterial bleeding, but because Hou Huiying's ulcer is deep and she is likely to have liver cirrhosis, Hou Huiying's gastric bleeding is actually the more troublesome gastric venous bleeding.
The gastric vein hemostasis through interventional surgery is two levels more difficult than the arterial interventional embolization of the gastroduodenal artery. First, venous embolization requires the guidewire, the main medium of the interventional surgery, to pass through the venous valve.
When the venous valve is injured, embolization is performed via the liver, through the portal vein, and then up into the gastric vein. In actual surgery, it is already difficult to get the guidewire to reach this position. And then placing the embolization is even more troublesome.
.The width of human veins is generally wider than that of arteries. It is extremely difficult for conventional platinum rings to embolize gastric veins, and gelatin sponge particles must be used to assist embolization.
As for the interventional department of the Fourth Hospital... at least the second-line doctors on duty do not have this ability.
"We are really not sure about doing this operation in an emergency." Doctors from the Fourth Hospital said everything else was fine. Anyway, with Dean Song here, they would dare to do anything to treat illnesses and save lives as long as the means and purpose are correct. But.
The premise of being bold is to be careful. The second-line doctor currently on duty must clearly raise the difficulty to the old director, "If you can't wait, I can do it. In fact, if there is bleeding in the gastric fundus vein, wouldn't the effect of gastroscopic ligation be quite good?"
"
"The patient has signs of DIC, and the hemostatic strength of gastroscopic ligation is not enough." Of course, Dean Wu Youqian knows that gastroscopic ligation is simpler and more convenient, but the patient has already shown signs of bleeding, so under this condition, a ligation with relatively low hemostatic strength is used without any problem.
It is different from drinking poison to quench thirst. What's more, severe bleeding and renal dysfunction are also contraindications for gastroscopic venous ligation.
"I have called Director Xiong. He will arrive in ten minutes." Outside the operating room, Song Wen pressed the intercom and said to everyone in the intervention room, "Teacher Wu, please maintain the patient's vital signs first.