"What should I do if there is no signature from the patient's family?" Su Yun asked.
"Look for Director Lin," Zheng Ren said.
"Well, the job of the medical office is to provide clinical protection." Su Yun said disdainfully: "But it doesn't include people like you!"
"Emergency first aid, are there any other methods?" Zheng Ren said, "Ask Zhao Yunlong if the signing is complete. After working for a long time, I guess I should be able to sign this time."
"how do you know?"
"It takes a whole day to do a head MRI, let alone iabp." Zheng Ren said: "The condition is not very good. Let's issue a critical illness notification. The patient will come back as soon as he is sick enough."
"..." Su Yun frowned, "Are you sure?"
Zheng Ren sighed and looked helplessly at the patient's red system panel that was dripping blood.
"You may also need extracorporeal membrane lung support. Will you do it?"
"No problem." Su Yun said with certainty.
ECMO is an extracorporeal circulation technology that goes out of the cardiac operating room.
Its principle is to draw venous blood from the body out of the body, oxygenate it through artificial cardiopulmonary bypass made of special materials, and then inject it into the patient's arterial or venous system to partially replace the heart and lungs and maintain oxygenated blood supply to human organs and tissues.
There is no ecmo in Haicheng City No. 1 Hospital. The first time Zheng Ren saw this thing after graduation was on the body of Dr. Mehar.
Zheng Ren smiled bitterly and shook his head, "Have you seen the MRI?"
"The diagnosis of moyamoya disease is very clear." Su Yun said: "If the upper body has extracorporeal membrane lung, a large amount of heparin will enter the circulation system. Do you think it will aggravate moyamoya disease and cause cerebral hemorrhage?"
"Well, the possibility is very high." Zheng Ren said it quite politely. He had just entered the system operating room and tried an extracorporeal membrane lung operation.
But less than two hours after the operation, the patient died of cerebral hemorrhage.
This is a dilemma.
Heparin anticoagulation is inconsistent with bleeding, hemolysis, and poor tissue compatibility of biomaterials. The road of exploration is long. On this road, there are countless dead people, but there are also countless living people.
Su Yunxia's extracorporeal membrane lung, technically speaking, there is no problem.
But Zheng Ren judged that large amounts of heparin would cause cerebral hemorrhage, so Su Yun hesitated. Using extracorporeal membrane lung is technically extremely difficult, not to mention the cost.
"Looking for neurosurgery?" Su Yun asked.
"See Lin Ge first, right away!" Zheng Ren said, "The operation was performed when the heart stopped beating, and the blood was heparinized, so it is likely that... Why hasn't Zhao Yunlong come back yet?"
"I'll make a phone call to urge you." Su Yundao said.
"You watch, I'll take a look." Zheng Ren packed up the IABP's things, took a look at the patient's vital signs, opened the door, and strode into the corridor of the EICU.
Facing him, Zhao Yunlong walked back quickly holding a piece of A4 paper.
"Old Zhao, I have something to ask you." Zheng Ren waved.
"I'm worried that I might have a cardiac arrest after I go back to do the IAP." Zhao Yunlong said hurriedly.
"It's done." Zheng Ren said.
"Are you... done?" Zhao Yunlong said in surprise, then lowered his voice and hurried to Zheng Ren's side, "Boss Zheng, did you just do it?"
"Well, if you have a heart attack, you can't do it without doing it. Now the condition is slightly relieved, but not much." Zheng Ren said: "I am considering using extracorporeal membrane lung support for a period of time, but there is a contraindication."
"Moyamoya disease? Can you diagnose it?" Zhao Yunlong was in trouble.
"Yes." Zheng Ren said, "How did you explain to the patient's family before opening the chest?"
"I didn't have time to explain at first. The patient was sent to the operating room for surgery while external chest cardiac compression was being performed." Zhao Yunlong said: "Later, before starting extracorporeal circulation, I explained to the patient's family that I suspected moyamoya disease and blood disease. Heparinization is likely to cause cerebral hemorrhage.”
"What did your family say?" Zheng Ren was most concerned about this question.
If the family members cooperate, there is at least a 30% to 50% chance that the patient can be saved.
But if the patient’s family doesn’t cooperate…
It would be happier to just give up on the rescue. In that case, there will be much fewer medical disputes and conflicts.
After being put on extracorporeal membrane lung, it is hard to say whether the patient will die or live. But for families of hesitant patients, the cost of hospitalization has soared.
However, without extracorporeal membrane lung, the patient will definitely die. The only difference is that he can live for a few more hours.
He felt so tired, and Zheng Ren didn't want to face this situation.
But life is like this, and it is impossible to let yourself do whatever you want like in a systematic operating room.
"The patient is in her second marriage, and her current husband said she wanted to give up treatment." Zhao Yunlong said, "But her daughter just came over and insisted on treatment, and she signed the contract happily."
Just as Zheng Ren's heart sank, it rose again.
Such a complicated family environment, no wonder I had to wait a day before even having an MRI.
To be able to undergo surgery and survive, Zhao Yunlong had already taken a huge risk.
"I'll go take a look." Zheng Ren said.
"Boss Zheng, Professor Zhang is communicating with the patient's family outside." Zhao Yunlong said, "Let's go later."
"What are you communicating about?" Zheng Ren could hear a hint of discomfort in Zhao Yunlong's tone.
"To be honest, it is unlikely that the patient will survive again." Zhao Yunlong said frustratedly.
No one expects the patient to live more than the chief surgeon and bedside doctor. This expectation is very complex and difficult to describe in one sentence.
Zheng Ren also knew that after Professor Zhang finished his explanation, the family members would most likely give up treatment, and the patient would be dead.
As long as the patient's family gives up rescuing and withdraws IABP, the patient will die when the next rapid ventricular beat occurs and the heart fails.
He sighed deeply.
"Is it an economic problem?" Zheng Ren asked.
"Well, my family is not very well-off." Zhao Yunlong said: "As a migrant worker, I haven't paid any social security in my hometown."
"What if I..." Zheng Ren paused mid-sentence.
Zhao Yunlong patted Zheng Ren's shoulder helplessly, said nothing, and walked back to the ward in silence.
Live broadcast of emergency rescue, upper body extracorporeal membrane lung
The success rate of Xinglin Garden’s live broadcast is a very critical factor.
As for the patients’ various problems themselves, what can be done with extracorporeal membrane lung? In Moyamoya disease, because the blood in the body is heparinized, a tiny aneurysm ruptures and bleeds, and the patient dies.
For mature business operations, this is completely untrue.
The reputation Zheng Ren has worked hard to accumulate along the way will be fatally damaged by the patient's death.
But... what Zheng Ren is thinking about is not the matter of upper body extracorporeal membrane lung, but the surgical treatment of moyamoya disease.
Block the bleeding area first, and other things will be easier to solve.
Zheng Ren judged that if there was support from the extracorporeal membrane lung and the bypass surgery was performed without any problems, the patient would still have a chance of surviving.