"Old Mu is undergoing surgery, what's wrong?" Su Yun asked lazily.
"The patient's heart has stopped!" the nurse shouted, turned around and ran back.
Well…
Is it the surgery room next door
Su Yunhuo stood up suddenly and saw Zheng Ren turn around through the leaded glass. He didn't even tear off the sterile clothes, opened the air-tight lead door with sensors, and strode out.
"Mr. Wu, don't worry, the boss and I will go there." Su Yun strode away without forgetting to explain to Mr. Wu.
At Mr. Wu's age, he was really afraid that if he participated in the emergency department, he would suffer a myocardial infarction first.
The interventional operating room of Pengcheng Development Zone People's Hospital is small, with only five operating rooms. The airtight lead door of the operating room with the red operating light on inside was closed, and panicked sounds came from the operating room.
"Push the medicine! Atropine 1mg!"
Zheng Ren walked over quickly and immediately saw a pale system panel, and the diagnosis on it was blurred. Diagnoses such as coronary atherosclerotic heart disease and carotid artery stenosis can be vaguely seen.
The doctor in the circulatory department was doing heart compressions, and the nurse was drawing medicine and preparing for injection.
The surgery screen showed that the carotid artery intervention site was at the bifurcation of the right internal carotid artery, where the pressure receptors are more sensitive, and reflex regulation mainly responds to pressure sensing in a short time, as fast as a few seconds.
This is to do a coronary stent, and the heart stops when the carotid artery stenosis is opened by preposition surgery.
Zheng Ren glanced at it, saw the situation clearly, and entered the system operating room directly.
Su Yun quickly followed Zheng Ren. Seeing that the nurse was a little slow in taking the medicine, he said, "Lao He!"
Lao He did not respond, but walked over directly, silent and firm. He walked to the ambulance, broke open a tube of atropine, drew it into a syringe, opened the tee and injected it directly.
Emergency rescue tests the psychological quality and technical level.
The little nurse was like a new recruit who had just entered the battlefield. She was immediately frightened when she heard the roar of cannons. How could she be as skilled as Lao He, a veteran who had experienced countless battles, large and small.
My technical level was average to begin with, but if I panicked again, there would really be nothing left.
"Lao He, intubate." Zheng Ren suddenly said, "Turning, push the ventilator over. Su Yun, do heart compressions, increase the intensity and frequency."
After speaking, Zheng Ren tore off the sterile clothes, took off the sterile gloves, and turned around to clean his hands.
Su Yun did not hesitate, walked to the surgeon's side, bumped his shoulder, and pushed the surgeon away from the position where the heart was being compressed outside the chest.
The magician was dumbfounded.
But at this time, if a doctor who could confidently take over the rescue appeared, she would not stop him.
At the beginning of the operation, the balloon was slightly inflated and the patient suffered cardiac arrest. The circulatory department is supposed to be very good at emergency first aid in this area, but after 30 seconds of compressions, I didn’t see my heart beating again, so I panicked.
"You, go charge the defibrillator." Zheng Ren went to brush his hands, and Su Yun took over the rescue command.
He is such a carefree commander and has the style of a great director.
Atropine, dopamine, and epinephrine were pushed in one after another. Lao He completed the tracheal intubation as quickly as possible and handed the balloon to the assistant doctor.
Zheng Ren brushed his hands and came in, putting on sterile clothes.
"Boss, what should I do?"
"The stenosis of the carotid artery still needs to be opened, where is Lao Mu?" Zheng Ren glanced and saw that Su Yun was performing chest heart compressions at a frequency of 110 times/min. The waveform on the ECG monitor had not yet recovered, and It's the same as in the system operating room, there's a bit of urgency.
"Boss Zheng, I'm here." Mu Tao finished the last steps of the operation and hurried in.
When the doctor from the Circulation Department saw Mu Tao come in, he finally saw a savior and said hoarsely: "Professor Mu, the patient has cardiac arrest..."
"Boss Zheng, what should we do?" Mu Tao asked with a frown.
"You push the ventilator, and I'll remove the stent." Zheng Ren stood at the surgeon's position and glanced at Su Yun.
"Look what I'm doing. I'm not wearing a lead suit. Just do it quickly." Su Yun kept his arms straight and continued to perform cardiopulmonary resuscitation.
The airtight lead door slowly closed, and Zheng Ren had already begun to step on the line at this time.
The position of the balloon changed slightly, and Zheng Ren moved it inside again, found the stenosis of the carotid artery, opened the stenosis section, and inserted the CRISTALLO ideale-SE 6-9mm×40mm self-expanding stent.
As the carotid artery opened, Su Yun's movements gradually slowed down.
The squeeze fluctuation on the patient's ECG monitoring also gradually returned to ventricular tachycardia, and after a few seconds, sinus rhythm returned.
Zheng Ren stopped stepping on the line and said, "Wear lead clothes."
Su Yun glanced at the values of the monitor, nodded, and turned to put on the lead clothes with Lao He.
"..." The surgeon from the Circulation Department stood beside him with a blank look on his face.
"Xiao Sun, what's going on?" Mu Tao asked.
"The patient's diagnosis was coronary atherosclerotic heart disease, exertional angina, arteriosclerosis of both lower limbs, and carotid artery stenosis. I originally wanted to solve the carotid artery stenosis first, and then remove the stent, but I didn't expect that the heart stopped as soon as the balloon was inserted. ”
Mu Tao nodded.
Significant carotid artery stenosis is an important risk factor for perioperative stroke in patients with coronary stents. The incidence of stroke is as high as 3% to 11%, and is positively correlated with the degree of carotid artery stenosis.
The patient's condition was clear, and there were no problems with the preoperative diagnosis and surgical indications.
The treatment was correct, and the surgery was normal. The carotid artery stenosis should be resolved first. It's just that the patient's cardiac arrest lasted a little long, so he was immediately confused.
"Boss Zheng." Mu Tao asked softly.
"Tell me about the operation process." Zheng Ren said, "There should be no big problem, don't be nervous."
"The patient's condition is much better. Does he still need a ventilator?" Mu Tao asked.
"It must be used." Su Yun came back from wearing a lead suit and said disdainfully: "Patients with coronary artery stenosis suffer a stroke due to carotid artery stenosis during the perioperative period. The prognosis is very poor, and the mortality rate is about 50%."
Mu Tao is an interventional doctor, not a circulatory doctor. If he helps with the rescue and coronary stent surgery, he will be fine. But when it comes to more detailed things, especially pathology and physiology, he is beyond his capabilities.
"Tell me about the process." Zheng Ren reminded him again.
"Preoperative angiography showed 90% stenosis of the proximal right internal carotid artery. I used a super-smooth guidewire to send an 8F MPAI guide tube to the right common carotid artery, a SpiderRX 5.0mm to the distal right internal carotid artery, and a Sapphire 4.0mm×20mm ball. Capsule, give 15 atm. After 5 or 6 seconds, the patient's heartbeat stopped."
The surgeon should be the director of the Circulation Department of Pengcheng Development Zone People's Hospital. Under Zheng Ren's pressure, he directly became a junior doctor and began to report on the operation process.
Emergency first aid, when there is basically no effect, someone comes forward, which is undoubtedly a relief for the surgeon.
In the face of cardiac arrest, he could command the rescue so firmly and confidently. Needless to say, his technical level was much higher than his own.
"Well, it squeezed the carotid artery pressure sensor." Zheng Ren said, "Cardiac arrest after balloon expansion, followed by ventricular fibrillation and malignant arrhythmia, are common complications."
"Boss Zheng, I thought I had to give up the surgery." Mu Tao let out a sigh of relief and said.
"No. The cardiovascular activity center in the brain controls the activity of the heart and blood vessels through the sympathetic nerve and vagus nerve to maintain arterial blood pressure at a certain level."
“When the balloon expands, the arterial baroreceptors immediately feed back this information to the cardiovascular center through the incoming nerves, and the activity of the cardiovascular center will change accordingly, causing the heart rate to slow down, peripheral blood vessels to dilate, and blood pressure to decrease. "
"The pressure in the balloon rises too fast, the diameter is too large, the pressure is too high, the expansion duration is too long, and the sensitivity of the baroreceptor reflex is too strong, which may be the cause of cardiac arrest."
"It will be cured by surgery. You will be able to recover in a while." Zheng Ren smiled.
"Old Mu, where is Elder Wu?" Su Yun suddenly asked.
"Teacher is looking at the patient during the operation..." Mu Tao said.
"That's okay. We're going to prepare for the next surgery there, and this one should be solved soon." Zheng Ren smiled.
"We don't need to remove the heart stent," Su Yun asked, looking at the surgeon.
"No... No, it's troublesome." The magician said politely in a low voice.
At this time, getting the patient back is equivalent to getting himself back. The surgeon feels that he cannot express his gratitude enough.
It's just that she is still a little confused now, still immersed in the nightmare of the patient's sudden death and has not recovered.