"Is this Mr. Zheng from 912?" Director Xu asked doubtfully.
"Yeah." Zheng Ren nodded.
"Why are you here!" Director Xu was pleasantly surprised, and the previous unhappiness that made him open it again and take a look disappeared.
Seeing Director Xu turn around to step down, Zheng Ren said quickly: "Director Xu, the operation is not over yet! Open it first and take a look."
"oh oh."
This time, Director Xu didn't insist at all. His principles and stance flew to the sky together with his previous anger.
"Boss Zheng, I've admired you for a long time." Director Xu suppressed his excitement and said, "Why are you obsessed with Director Qiu? He is an anesthetist."
"Why are you talking?" Director Qiu said unhappily.
Zheng Ren saw Director Xu start to twist the wire in the opposite direction, and then took a look at the waveform of the ECG monitoring and the radial artery pressure curve, and felt that there was still enough time.
"You're welcome." He said lightly, and then said: "Don't withdraw the extracorporeal circulation yet, prepare to establish it again immediately!"
The cardiopulmonary bypass technicians were already dumbfounded. The legendary Boss Zheng? ! For a whole 6 hours, I didn’t notice any difference.
No, keeping your breasts closed is a big deal. Director Xu and Director Qiu didn't notice anything unusual on stage. They refused to close their breasts at the last moment. What on earth was going on? Hold back and say nothing, only to be slapped in the face at the last moment
No, no, the cardiopulmonary bypass technician immediately got rid of all the messy things in his mind. Boss Zheng said there was a problem. If he opened it and found nothing, he would be slapping himself in the face.
Su Yun saw Director Xu's expression of admiration and his hand twisting the wire was trembling slightly. He thought it was funny and said, "Director Xu, please be steady and hurry up."
"Oh, oh, don't worry." Director Xu was as meek as a different person. He was no longer as cold as an iceberg, but responded like an intern.
"Boss Zheng, what's going on?" Director Qiu whispered in Zheng Ren's ear.
"The ECG oscilloscope does not match the radial artery pressure curve wave. Consider the mitral valve..."
Zheng Rengang had just finished speaking when the ECG monitoring alarm suddenly sounded, and then the ventilator began to use sharp alarms to alert people in the operating room that something was abnormal.
"Hurry up! Prepare for extracorporeal circulation." Zheng Ren has already switched to the surgeon mode. In this room, he is the unique king!
Although they still didn't understand why, everyone in the surgery room started to move. Director Xu didn't have time to express his admiration to Boss Zheng and Su Yun, so he took the time to unscrew the wire.
At this time, the blood pressure drops sharply, and the peak value of the arterial waveform decreases and gradually becomes a straight line.
"Dopamine, speed up."
"Epinephrine, 1 mg intravenously."
"Another shot of adrenaline!"
"Hurry up and prepare for extracorporeal circulation to be re-established."
"Open the chest faster! Open the opening according to the valve replacement."
As instructions were issued one after another, the peaceful atmosphere in the operating room disappeared.
Director Qiu and the circulating nurse were busy working as fast as they could, with their feet barely touching the ground, as if they were flying in the air.
I was most afraid of this situation, but fortunately Boss Zheng reminded me, otherwise it would have taken 10 minutes just to twist the wire. During this period of time, drugs are needed to maintain the patient's vital signs. Judging from the blood pressure, the drugs may have a little effect at the beginning, but they will soon be of no use.
It is difficult for vasopressor drugs to maintain the patient's blood pressure, the average blood pressure is 20 to 30mmHg, and the heart rate also rises to 120 to 130 beats/min. Not counting this, the SpO2 waveform of the patient's left hand is consistent with the pressure waveform of the right radial artery and is also straight.
Needless to say, everyone present knew what a straight line meant.
MD, what happened!
After 20 seconds, the waveform recovered slightly. But before everyone's nervousness could relax, another straight line appeared in their field of vision.
This situation occurs repeatedly, and the intervals become shorter and shorter, and the heart rate also rises to 120 to 150 beats/min. The blood flow in the radial artery pressure measuring tube is smooth, indicating that the radial artery pressure measuring tube is normal and is not a problem with the machine. But something really happened!
Director Xu opened the chest as quickly as possible and started to establish extracorporeal circulation. Because of Zheng Ren and Su Yun's previous reminders, this period of time was shortened to a certain extent.
"Aortic root pressure measurement!" Zheng Ren said in a deep voice.
Director Xu immediately began to measure the patient's aortic root pressure, which was the same as the radial artery... He immediately started to sweat again.
Boss Zheng didn't just aim at nothing, but saw something abnormal. What the hell happened? ! Director Xu felt that his hands were cold, and the movements in front of him became extremely slow, as if he had entered another world.
Not only is the aortic root pressure measurement consistent with the radial artery, the aortic root becomes softer, and the valve sound of the biological valve disappears. This all means one thing... something happened to the location of the valve just replaced!
Extracorporeal circulation was established urgently and the patient was transferred for a second time.
Because I was reminded in advance, the preparation time for the extracorporeal circulation machine did not delay the operation. When the heart is opened, the posterior mitral valve chordae tendineae rupture from the vaginal muscle, causing the chordae tendineae to become embedded in the artificial valve and cause the valve to become stuck.
It’s really stuck! Director Qiu and Director Xu looked helplessly at the scene in front of them, feeling horrified.
The free tendineae were resected and the native flap was still used for continuous suturing. It's not difficult to deal with, at least for Director Xu. The final twist and difficulty lies in the cooperation between the surgeon and anesthesiologist.
After observing an abnormal situation, whether the anesthesiologist is aware of it is the key to being able to alert the surgeon in time. Under the pressure of the surgeon's strong aura, not all anesthesiologists can stick to their own judgment and perform a second thoracotomy as soon as possible to detect abnormalities.
Mitral valve chordae tendineae rupture followed by valve stuck is an uncommon complication of valve replacement surgery.
This occurrence may be related to the patient's heart failure. Director Xu felt a little innocent. After the valve replacement was completed, he observed carefully for a few minutes and saw that there did not seem to be a problem with the mitral valve chordae tendineae, so he continued to the next step.
Who would have thought that something would happen after closing the chest.
What a deal! You can't do the job of a doctor. There are big pits everywhere. Who knows which pit will get buried in one day.
After emergency severing of the mitral valve chordae tendineae, the biological valve began to work again and the alarm sound of the instrument disappeared.
The rest is routine operations. Director Xu looked up at Boss Zheng and whispered: "Boss Zheng, thank you."
"You're welcome." Zheng Ren also let out a sigh of relief. At first he saw something vaguely wrong with the electrocardiogram and radial artery pressure curve. It was only after he entered the system operating room that he was sure something was wrong.
But why is Su Yun so determined
Zheng Ren glanced at Su Yun with some doubts.
"Why are you looking at me?" Su Yun was taking down the anesthesia order and looked up at Zheng Ren as if he was sensing something.
"How did you decide?"
"There is a problem, but I'm not sure. Seeing how sure you are, I'm sure too. It's such a simple thing." Su Yundao said, "It's amazing that I re-opened the chest by mistake. It delayed the operation for half an hour. We went back in despair. ”
Zheng Ren spread his hands.