Ling Ran rushed directly to the operating room.
Lu Wenbin, who pretended to be strong, breathed a sigh of relief, and quickly reported: "The patient's skin temperature dropped by 2.5 degrees Celsius, his skin was pale, and his swelling was +. I used it..."
"He smokes?" Ling Ran was not surprised.
The dependence on nicotine is extremely strong, and the difficulty of withdrawal is no less than that of opium smoke.
Ordinary people may fail to quit smoking if they have a strong subjective will. The smokers who had their fingers replanted did not expect that their fingers would be broken, and they were not ready to quit smoking. There will always be people who do not obey the smoking cessation order requested by the doctor. It is also because of this that there are a large number of orthopedic surgeons in Europe and the United States who refuse to replant severed fingers for smokers.
Lu Wenbin didn't expect Ling Ran's reaction to be so slight, so he nodded, and said again: "It is said that he inhaled twice, but this time he only took one sip."
"How much is not important." Ling Ran went to see the patient's condition, and then asked, "Did the patient's family members sign the consent form for the operation?"
"I signed it. I told them that the anastomosis was suspected to have embolism, so the anastomosis was removed and the artery was reattached. I also told them that the second time would be very risky. The patient's family members insisted on keeping their fingers." Lu Wenbin was a little frustrated. Even if the second reattachment is successful, the blood circulation may not be established, and the functionality of the fingers in the future cannot be compared with the previous one.
For residents who have just started replanting amputated limbs and have a sense of accomplishment, this kind of thing is worse than 20 hours of continuous work.
Ling Ran has always been happy and angry, and he didn't say much, just said: "Then do it."
Reattaching the artery is much simpler than replanting a severed finger. It is just two more cuts. For him, from confirming the location of the embolism to rebuilding the blood vessel, it is nothing more than half an hour of work. Or is he deliberately slowing down? speed situation.
When replanting the amputated finger last time, Ling Ran considered the possibility of nicotine ingestion, so when suturing, he sewed up an extra blood vessel to increase the blood flow rate.
This time, Ling Ran tried his best to protect Mao Haipeng's blood vessels, leaving enough room for blood circulation.
After an operation was over, the medical staff in the operating room were not in the mood to chat.
The blood circulation crisis is not instantaneous. When such a severe vascular embolism occurs, the condition of the blood vessels in the severed finger is not optimistic. It's like a road with a serious traffic jam, and it is likely that there are already many sections of traffic...
The body with multiple injuries is likely to supply more platelets under the stimulation of nicotine. From the literature point of view, let the rats with docked tail replantation smoke, the adsorption of platelets will increase by 10%, and the corresponding low growth rate of endothelial cells is only one-fifth of the normal group.
Ling Ran could use surgical means to remove the embolism of the anastomosis, even very clean, but for the inside of the blood vessel of the severed finger, he could only use medicine.
The biggest difference between medication and surgical methods is that surgical methods are dominated by doctors, and the efficacy of drugs is often related to people's own adaptability.
It's like sports people often use banned drugs. Some people use banned drugs and quickly get a huge breakthrough, while others don't change much, and some even regress. reacted differently.
For example, the heparin used for anticoagulation generally has a very good effect, but some people have very good effect or extremely poor effect.
At this moment, in order to keep Mao Haipeng's finger, the medicine given to him only achieves a general effect, which is probably not good enough.
Lu Wenbin also saw this, and after finishing the operation, he deliberately said, "It's better if I stay in the hospital and watch over Mao Haipeng."
Ling Ran took off his gloves and surgical gown, thought for a few seconds, and said, "Yes."
"I try to keep my fingers." Lu Wenbin was familiar with Ling Ran's temperament, and took the initiative: "Then I won't participate in the operation tomorrow."
"Okay. Take a day off tomorrow and suspend the operation." Ling Ran no longer requires a large number of operations every day. Compared with tang suture, the replantation of severed fingers consumes more energy, energy and time.
Even if Ling Ran is in good health, sooner or later Lu Wenbin and Ma Yanlin will be unable to hold on.
After all, at the stage of replanting the amputated finger, the assistant's responsibilities have also changed a lot, and he is no longer a simple hook man. In addition, the two of them had to do ward rounds, write medical records, and make doctor's orders, etc. Even if they were replaced by two people, it would not be easy.
After today's episode of the smoked man, Ling Ran also wants to rest.
Lu Wenbin completely gave up resting.
Replantation of amputated fingers is similar to other types of surgical operations. There are most cases in the early stage. If you can get through, the replanted finger has a high chance of survival.
Lu Wenbin stayed up all night, taking the doctor's orders at any time to cooperate with the medicine, hoping to increase the success rate.
During the daytime of the second day, Lu Wenbin still couldn't leave Mao Haipeng.
And then another night.
During this period, Lu Wenbin only slept for a while intermittently, but whenever there was any disturbance or the regular vibration of the mobile phone, he would wake up.
This kind of life is actually not unfamiliar to Lu Wenbin. When he cooks pig's trotters, that's what he does. Calculate the time well, put the raw material in whatever material should be put in, and seize the free time to rest and sleep...
It's just that compared to pig's trotters, it is too difficult to wait until the color of the severed finger changes.
third day.
Ling Ran checked the room as usual.
Lu Wenbin stood up with disheveled hair, and stood on the other side of the hospital bed together with his family members.
Mao Haipeng looked at the front blankly, his fingers were still gray, even with a slight black gray.
"Show me the medication records." Ling Ran asked for the medical records, from top to bottom.
Unlike physicians, surgeons usually use simple and crude medicines, aiming at solving symptoms, and not pursuing deep causal connections. Even so, Ling Ran could still see Lu Wenbin's attempts and efforts in his doctor's orders.
Dilate blood vessels, reduce blood viscosity, improve recovery ability, enhance cardiopulmonary function... Lu Wenbin did everything he could.
Ling Ran put down the case and looked at Lu Wenbin.
Lu Wenbin's eyes wandered, he was unwilling to meet Ling Ran.
Ling Ran waited quietly.
After a long time, Lu Wenbin finally said hoarsely, "I can't keep it... amputate."
When Mao Haipeng's wife heard him speak, she was mentally prepared, but at the end, she couldn't help shedding tears: "Why...why do I still have to amputate my limbs? I took so many medicines and suffered twice..."
The woman was crying helplessly, and Ling Ran could only watch silently. Ask yourself, if he could predict the future, he might make a different decision, such as direct amputation, stricter measures to quit smoking, at the very least, he can give up the second reconnection, or even refuse Lu Wenbin's nursing request, which can save a lot of resources , saving patients and family members from paying, whether it is money, energy, time, or mental trauma and physical torture.
But what if the future cannot be predicted
Ling Ran thought, most likely he would replant Mao Haipeng's severed finger.
Nicotine does not necessarily lead to amputation, nor does Mao Haipeng necessarily smoke...
"Amputation is the only option right now." Ling Ran was finally able to give an inevitable answer.
The woman wept, and said, "Can't I just cut it off? How can I do it without fingers..."
"A severed finger that has become necrotic is a great risk to other fingers. It is best to send it to the operating room now." Ling Ran looked at his watch and said, "We will finish it as soon as possible."
The patient's family hesitated again and again, but in the end they all looked at Lu Wenbin.
"It can only be intercepted." Lu Wenbin was also helpless.
After a few words of persuasion, the family members finally signed a new informed consent form, and Mao Haipeng was pushed into the operating room immediately.
six hours later.
Ling Ran stood in front of Mao Haipeng again.
Mao Haipeng's hand was completely wrapped up, and one of his fingers was missing, but his whole body became a little more energetic.
Seeing Ling Ran, Mao Haipeng was a little agitated, and said "Thank you" inarticulately, then coughed violently, and said a little more clearly: "Doctor Ling, I'm sorry to trouble you."
"How do you feel?" Ling Ran asked.
"It's okay, I don't want to recover anymore, and the pressure is still low." Mao Haipeng showed an ugly smile, and it can be said that he was thinking about it.
"Rehabilitation still needs to be done... um..." Ling Ran paused, because a new primary treasure chest had just appeared in front of him.
Achievement: Patient Heartfelt Appreciation
Achievement description: The heartfelt gratitude of the patient is the greatest compliment to the doctor.
Reward: Junior Chest
Ling Ran looked at Mao Haipeng quite surprised, it was the first time he saw a patient who could give "heartfelt thanks" twice.
He shook his hand and opened the treasure chest by the way.
I saw another silver-gray book appear amidst the radiance, and on the title page was written impressively:
Intermittent horizontal mattress inversion suture (specialization), also known as Hulst's suture, is mostly used for suturing the seromuscular layer of the gastrointestinal tract.
Ling Ran was surprised again, and it was also the first time he had seen two hits after opening the box.
"It's good to have the amputation, so that you won't have to worry about it in the future." Mao Haipeng explained almost to himself, and kept groping with his other good hand on the bed sheet.