"Find someone to do transesophageal echocardiography!" Director Miao continued.
Su Yun had already picked up the phone and the call was placed on Lao He's phone. Lao He was already getting ready to get off work, humming a little tune and sitting in the duty room smoking a cigarette.
When he received Su Yun's call, Lao He didn't ask what happened. He only knew that it was a urological surgery and that he needed to do a transesophageal echocardiography immediately.
Lao He has a very high level of B-ultrasound and is one of the few doctors who can use ultrasound to diagnose pneumothorax. This kind of skill is one of the few that can be demonstrated in front of Boss Zheng. He didn't expect that he would think of himself when he saved the table.
Pushing the bedside ultrasound machine, Lao He trotted into the operating room.
The operating room was busy, and the strange thing was that Lao He didn't see Boss Zheng and Brother Yun. Director Liu of the Department of Urology was holding a mobile phone in his hand, constantly changing the angle, and the voice of Director Miao directing the rescue came from the mobile phone.
I'll go... Lao He was startled for a moment, then his heart became clear and he immediately realized what happened.
Director Liu is confused!
It has been a habit formed over many years. When I encounter a problem and I can't solve it myself, I call the director immediately.
At this critical moment of life and death, Director Liu had forgotten that Director Miao had retired and had transformed from a front-line clinical director into an elderly man who danced square dances every day and took care of himself leisurely.
Director Miao's voice coming from the mobile phone was still calm, full of domineering and unquestionable aura.
Where are Boss Zheng and Brother Yun? Lao He pushed the bedside ultrasound machine to the patient's head and took the opportunity to look around.
no one!
Ignore it for now, Brother Yun said to do a transesophageal echocardiography.
Lao He quickly put the transesophageal ultrasound probe into the patient's mouth, avoiding the tracheal intubation, and overcoming the interference of Yu Zong's external chest heart compression, and put the probe into the esophagus.
"Mr. Yu, stop for 20 seconds!" Lao He shouted loudly.
"Less than, stop for 20 seconds while the anesthesiologist performs an echocardiogram." Director Miao's voice came, and the memory contained in Yu's body made him immediately stop the action of chest heart compression.
"Gas was found in the right heart! Gas was also found in the left heart!" Lao He quickly scanned and saw the gas in the heart. He reported it to Director Miao in the mobile phone video, recorded the image, and took out the probe.
"Put a small sponge pad on the right side!" Director Miao's voice came, "Continue to press and perform intermittent cardiopulmonary resuscitation. Central venous catheter..."
"Director Miao, I'll do this." Boss Zheng's voice came out in the video.
Lao He felt enlightened, but he didn't think too much about why Boss Zheng was at Director Miao's house. Instead, he quickly pushed the bedside ultrasound machine aside, found the central venous puncture kit in the cabinet, and quickly came to the patient's side.
A lot of people had already squeezed into the patient's head, and Lao He didn't even explain, but forcefully broke open the space. At this time, the phone rang. He took out the phone before puncture, turned on the speakerphone, and put it aside.
"Lao He, do a central venous puncture." Boss Zheng's rich and steady voice came.
Lao He felt calm, and while preparing to puncture, he said: "Right away, 22 seconds!"
He used a modified subclavian central vein puncture method to find the best puncture point at the intersection of the vertical line in the center of the right clavicle and the horizontal line of the sternoclavicular joint, with the needle tip pointing toward the lower edge of the thyroid cartilage for puncture.
After entering, the central venous catheter extends downward and enters the right heart. Lao He was quite confident in his own skills, and he finished the time in 22 seconds, exactly.
"It has an air lock effect. After you go in and inhale, you can feel the pressure." Boss Zheng's voice came from the mobile phone.
Although Lao He knew everything he said, he felt a little more stable for no reason.
"It has entered the right atrium." Lao He said, "The gas is being pumped out."
After constant testing, the syringe did not pump smoothly due to the air lock effect.
The air lock effect, also called air lock phenomenon, is a blocking phenomenon of gas in flowing liquids caused by different pressures in the liquid. This phenomenon usually occurs at high points between pipelines and is the reason why general centrifugal pumps cannot pump liquid.
Lao He tried a little bit, and suddenly the syringe in his hand moved slightly, moving a short distance, about 5ml.
"Boss Zheng, extract 5ml of gas." Lao He quickly extracted the blood and gas while reporting to Zheng Ren.
"Go on, I just saw the echocardiogram and there is still air in the ventricular cavity."
Zheng Ren said while holding the mobile phone.
"Boss, it's normal to have gas in the atrium. I've never understood why there is gas in the ventricle." Su Yun asked standing aside.
Although he was not in the operating room, he could still feel the breath full of adrenaline and dopamine.
Zheng Ren shook his head and said, "There are too few cases, and I don't know much about it. The existing cases show that most of them are double-chamber pneumocystis, and there is no congenital disease of right-to-left shunt."
Paradoxical air embolism is when gas absorbed into the venous system ends up in the arterial system
It usually occurs in patients with right-to-left shunt of the heart. The gas accumulated in the right atrium or right ventricle enters the left heart system through the right-to-left passage, causing coronary artery or cerebral artery embolism
This is a question. Now in the emergency department, the two of them have a tacit understanding and do not continue to discuss this issue.
Lao He's operation was passable and even overflowed a lot. Soon the air in the left heart was also pumped out, and the problem that caused the cardiac arrest was resolved.
After about 20 minutes of continuous chest compressions and intermittent defibrillation, the patient's hemodynamics and respiratory function stabilized
Director Miao let out a sigh of relief, put his phone aside, and leaned against the back of the sofa. Zheng Ren looked at his expression. There was no fatigue, only relief and joy after the tense and exciting emergency rescue.
"Director Miao, are you tired?"
"I'm not tired." Director Miao said with a smile, "This is the first time for an old man like me to conduct rescue operations through a mobile phone."
"The sword never grows old!" Su Yun extended his thumb and praised.
"I have encountered gas embolism caused by laparoscopy once before. I was confused at the time and thought about it while rescuing me. But that time I made a mistake and easily thought of carbon dioxide entering the blood vessels. After symptomatic treatment, the patient had no postoperative complications. I was discharged from the hospital within a few days."
"How many years ago did it happen?" Su Yun asked.
"It's the end of the last century." Director Miao said.
"At that time, laparoscopic surgery had just been launched, and you encountered gas embolism? Why didn't you write a case report?" Su Yun asked curiously.
"The case report... has been written." Director Miao said, "I thought this case should be rare. I didn't even submit it to a journal with a Chinese prefix, so I went directly to The Lancet. Unfortunately, my English is average and I don't know the format well. Clearly, in the end it’s all over.”
So that was it, Zheng Ren smiled.
"Director, how are you doing?" Director Liu's voice came from the mobile phone.