Time is no longer measured in days or hours, but in seconds.
As time passed by, the patient's invasive arterial blood pressure continued to drop steadily, and the heart rate no longer changed drastically when it reached more than 150 beats/min.
But this kind of tachycardia is already very scary. You don’t know when it will drop off a cliff and the patient can be declared dead.
The blood oxygen saturation dropped to about 66%, which was not enough oxygen. The anesthesiologist has started to change the ventilation to 100% pure oxygen ventilator.
Under the influence of pure oxygen, blood oxygen saturation rises briefly and then drops steadily.
"Director Liu, it's a gas embolism." The anesthesiologist was a little flustered. All the possibilities he could think of were ruled out, leaving only this diagnosis with a huge mortality rate.
Damn it if there's a gas embolism, the anesthesiologist's voice trembled when he said this.
Director Liu took a look and saw that the Hem-o-lock was placed at the bifurcation of the renal vein to completely clamp the renal vein. There was no possibility that a large amount of carbon dioxide would flow along the vein and enter the blood circulation due to the pressure difference when establishing pneumoperitoneum.
He denied the anesthesiologist's statement, but still cautiously stopped intraperitoneal inflation of carbon dioxide immediately and pulled out Traloca to relieve pneumoperitoneum
However, there was still no change in the patient's condition. Rescue medication had been given, and the vital signs displayed on the monitor were still declining.
"Call Director Miao." Director Liu said in a deep voice.
The traveling nurse was stunned for a moment, as if time had returned to half a year ago. No matter what happens, it can be solved by just calling Director Miao.
But she didn't hesitate, and didn't care that Director Miao had retired now. Instead, she immediately dialed Director Miao's phone number.
…
…
Director Miao was sitting at home, chatting and gossiping with Zheng Ren and Su Yun.
We chatted all over the place, but we didn't talk about medical treatment. I have been working for a lifetime, and now I have disbanded and returned to work. Let all that go away from me.
"Director Miao, my mother also dances square dance at home, and I just don't understand what's so good about it. Please tell me what the benefits are." Su Yundao said, "How come the old man and the old lady are so proud despite the weather? This stuff."
"Let's all join in the fun together." Director Miao said with a smile, his voice full of anger. He has basically fully recovered. Except for a slight problem when walking due to the broken end, everything else is fine.
"There's nothing to do at home all day long, so being idle is nothing but idleness."
"I have a dog at home. Why don't you help me walk the dog? Please cross it by the way. Heizi's leg was broken during the earthquake relief work and he can't run fast. Don't worry, I can compare with your legs and feet." Su Yun smiled. asked.
Just as Director Miao was about to laugh and curse, the phone rang.
He leaned back on the sofa and picked up his phone leisurely. After glancing at it, it was the phone number from the operating room. He sat up straight and the smile on his face disappeared, leaving only majesty and solemnity.
"What's wrong, Director Miao?" Su Yun asked.
Director Miao waved his hand and did not answer Su Yun's words, but directly answered the phone.
"What's wrong?" Director Miao asked in a deep voice.
There was a blah blah blah sound from the other side of the phone. It was very fast and loud, and both Zheng Ren and Su Yun heard some fragments.
Uh... The patient's condition was not good during the operation? !
The two looked at each other. If they were at 912, they would have rushed to the operating room by this time.
But now at Director Miao's house, waiting for a car to arrive, and then rushing to the hospital, the cucumbers and vegetables are already cold.
Department of Urology, I have a laparoscopic nephrectomy surgery this afternoon. Did I touch a blood vessel that I shouldn’t have touched
"Video, let me check on the patient's condition." Director Miao said in a serious voice after listening to the brief introduction.
After hanging up the phone, Director Miao saw Zheng Ren and Su Yun looking directly at him and explained: "During laparoscopic nephrectomy, my blood pressure and heart rate suddenly became unstable, and my blood oxygen saturation dropped rapidly."
That’s true!
"Did you touch a blood vessel?" Su Yun asked.
"No, if it touches the blood vessel and stops the bleeding, it will be over." Zheng Ren said, "It probably happened out of nowhere. Is it caused by the vagus nerve reflex?"
Director Miao shook his head slightly, "Cardiac arrest caused by vagus nerve during nephrectomy is rare. Generally, medication will be enough."
Just as he said this, the sound of WeChat video sounded, and Director Miao connected the video request.
"Director, patient..." Director Liu's voice came from the video. He held his mobile phone and pointed the screen at the laparoscopic TV screen. "There is no bleeding. The patient's blood pressure and heart rate..."
"Heart has stopped! Cardiopulmonary resuscitation!" the anesthesiologist shouted loudly.
Zheng Ren and Su Yun quickly gathered around Director Miao and looked at the screen.
The heart rate dropped off a cliff, the blood oxygen saturation was 52%, and the alarms on the ventilator and monitor kept sounding. Even when the three people saw this scene at home, their bodies naturally secreted a large amount of dopamine, adrenaline, and glucocorticoids.
"The anesthesiologist will adjust the operating table so that the head is lowered and the feet are higher." Director Miao said.
But that side of the screen was a mess. The anesthesiologist was pushing medicine and Mr. Yu was doing heart compressions. Everyone was panicking because the problem hadn't been found yet.
"Anesthesiologist! Xiao Liu, adjust the bed position so that the head is low and the feet are high!" Director Miao raised his voice and said without doubt.
The bed was quickly adjusted to an angle, and the position was changed as Director Miao said.
Adrenaline, isoproterenol, cidilan, instructions for intravenous injection came out from Director Miao's mouth one after another, and the doctor's orders were carried out on the other side of the video.
It was like an invisible hand turned back time and returned to the past again. At this time, Director Miao was standing in the operating room presiding over the rescue.
"Director Miao, what are you considering..."
"Establishing pneumoperitoneum will cause gas embolism." Director Miao said with certainty.
If Zheng Ren was present, he could use the system panel to make a judgment; if Director Miao was not there, Zheng Ren would probably have to think about it for a while before he could be sure.
After all, gas embolism caused by the establishment of pneumoperitoneum is so rare. At least Zheng Ren himself has never encountered a similar situation when he performed laparoscopic surgery in general surgery.
After laparoscopic nephrectomy, Zheng Ren quickly searched for similar information in his mind.
For patients with kidney disease, laparoscopic nephrectomy is a minimally invasive, safe and effective surgical treatment. However, since pneumoperitoneum needs to be established, the risk of air embolism is inevitable
The incidence of gas embolism is very low, about 0.002%~0.02%, but once it occurs, the fatality rate can be as high as 50%
Reviewing the literature, there have been only 5 reports of gas embolism in laparoscopic renal surgery so far
Jiang is still old and spicy. It is estimated that Director Miao has encountered a similar situation and can tell what happened at a glance.
After all, Director Miao was one of the first surgeons in China to use endoscopic surgery, and he had never encountered any situation before.