The operation of the built-in floating catheter is very simple. Zheng Ren put on sterile gloves and completed the operation within 1 minute.
A floating catheter was implanted in the right internal jugular vein. At this time, the cardiac output was measured to be 6.1L/min, and the SVO2 was 51%.
The anesthesiologist picked up a pen and paper and started to calculate. Zheng Ren said in a deep voice, "No need to forget it. The systemic circulation resistance is 760/cm5."
"..." Both the anesthesiologist and Zhao Yunlong were startled. Not only them, but also Su Yun was startled.
To measure cardiac output using a floating catheter, you need to calculate the systemic circulation resistance through a relatively complicated formula. Did Boss Zheng calculate it mentally
You must be cheating, Su Yun calculated the same number 5 or 6 seconds late, and he silently cursed in his heart.
"Boss Zheng, your cardiac output is so low?" Zhao Yunlong asked.
"Prepare to open the chest." Zheng Ren said, "There is probably something wrong with the myocardium."
Myocardium... This judgment is too far removed from cardiac tamponade. Zhao Yunlong could also figure out the reason, but it was a rare situation after all.
"Boss Zheng, did the blood from pericardial tamponade seep into the myocardium?" Director Zhang Lin asked.
"I think so. We'll find out after opening it and taking a look." Zheng Ren glanced at it and asked, "Is the beauty here?"
"Boss Zheng, Xiao Xie has gone to pick up your surgical equipment. They will be here soon." The circulating nurse said, "She just contacted me."
Zheng Ren nodded, and he began to hold his arms and look at the image data of the patient's last echocardiogram.
Su Yun and Zhao Yunlong positioned the patient and began to wash and disinfect hands. Xie Yiren also arrived carrying a box of instruments in a sterile package.
"Old Zhao." Zheng Ren suddenly said in a deep voice.
"Huh? Boss Zheng." Zhao Yunlong indicated that he heard it.
"Call the ICU and prepare an isolation room." Zheng Ren said.
Isolation room? Zhao Yunlong was stunned for a moment, but did not ask why. He had already finished brushing his hands and asked the anesthesiologist's assistant to make a call. He stretched his head over to contact the ICU about the isolation room.
"Is it necessary to do delayed breast closure?" Su Yun frowned and asked, "Is it so serious?"
"I think it's probably because the myocardium was more seriously damaged after IABP was administered." Zheng Ren turned around to wash his hands and expressed his views on the patient.
Director Lang was stunned when he heard what Boss Zheng said. After taking IABP, the myocardial damage was even more serious... Is this talking about his own mistakes
He was a little angry and confused.
If someone said this in Nanshan City, they would definitely be blaming someone else, but this is 912, so it shouldn't be the case. Director Zhang Lin was very enthusiastic. She came from home in the middle of the night and waited for her in the office.
Even this was not enough, Director Zhang Lin also contacted Nobel Prize winner Boss Zheng for thoracotomy surgery.
He is a Nobel Prize winner, is it necessary to put the blame on yourself? It's not necessary at all, okay? What seemed like a big deal to him seemed like an ordinary case to him.
However, IABP is of great benefit to patients with myocardial ischemia in clinical practice. Director Lang has developed this technology ten years ago, and it can be said that it has been used by countless people.
During diastole, the balloon is inflated, aortic diastolic pressure increases, and coronary artery pressure increases, increasing blood and oxygen supply to the myocardium. Before cardiac contraction, the balloon is deflated, aortic pressure decreases, cardiac afterload decreases, and cardiac ejection resistance decreases. , Myocardial oxygen consumption decreases.
IABP can effectively increase myocardial blood supply and reduce oxygen consumption, benefiting patients with coronary heart disease the most.
Why does Boss Zheng still say it’s IABP’s fault? And what is he going to do? Delayed breast closure? Should the patient go back to the ward with his chest open and dripping with blood
Isn’t Boss Zheng afraid of patients getting infected after surgery? To be honest, he didn't understand what Professor Su just said about delayed chest closure, but it just sounded very unreliable.
Director Lang's various thoughts intertwined and collided with each other, and he pondered in a daze. By this time, the operation had begun.
The surgical instrument box full of metallic texture is so eye-catching. The instrument nurse and the surgeon cooperate so well that they don’t even use words to communicate.
Under the shadowless lamp, no one spoke, only tacit cooperation.
There was even no eye contact between the surgeon, assistants, and equipment nurses. It seemed as if this kind of surgery was performed ten or eight times a day, and no one was interested in communicating at all.
Director Lang got behind Boss Zheng and saw the sternum saw opened the sternum and exposed the pericardium.
"It's not caused by pericardial tamponade." Su Yun said, "The ultrasound is fine."
"Yeah." Zheng Ren said his first sentence at this time, only one word.
The pericardial wall was lifted up and the suction device was inserted in the moment the pericardium was cut. Director Lang carefully observed the pipe of the suction device and found that only a small amount of blood came out.
It's not cardiac tamponade, but why is the patient's myocardial pulse so weak and his blood pressure still unable to rise under the influence of norepinephrine and dopamine? Director Lang was confused.
As the pericardium was cut open with delicate scissors, a swollen heart appeared in the surgical field. The heart showed overall dilation and swelling-like changes, and the left ventricular activity was poor.
"Ouch!" Su Yun said in surprise, "Is it all swollen like this?"
Zheng Ren did not speak, but continued to search. It was soon discovered that the single spear drainage hose used for pericardiocentesis had pierced the surface of the left ventricle of the heart and was partially ruptured. New bleeding was still seen on the surface of the heart wound.
Sure enough, it was his own fault, the pericardial puncture caused secondary damage... When Director Lang saw this scene, his hands and feet were numb and cold.
Could it be that similar symptoms appeared because of the damage to the left ventricular myocardium caused by pericardiocentesis
It can't be done either, he defended himself in his heart. This is an instinctive reaction of human self-defense. It is just seeking advantages and avoiding disadvantages. It is the same for everyone.
Why do you want to have pericardiocentesis? Isn’t it because the patient’s symptoms of chest tightness and chest pain were not relieved after the stent was removed
Director Lang defended weakly in his mind, but under the shadowless light, Zheng Ren had already cut off the pericardium with scissors, used 3×3cm autologous pericardial patch to continuously suture along the periphery of the wound, and partially repaired the puncture point damage on the surface of the heart to stop the bleeding.
"Boss Zheng, I'm late." Lao He walked in while tying the mask strap.
"Oh, it's not too late." Zheng Ren said, "The operation is almost finished."
"..." Lao He was startled for a moment. Isn't it too late? Boss Zheng doesn't usually talk like this. While saying it’s not too late, I told myself that the operation was almost done…
"Prepare for transesophageal ultrasound." Zheng Ren said.
"Okay." Lao He didn't have time to think about it and immediately started busy.
"Zheng...Boss Zheng, what are you planning to do?" Director Lang asked in a low voice, stuttering.
"I can't close my chest, let's do a B-ultrasound to check." Zheng Ren said, gently closing his chest with both hands.
The chest was not completely closed, but as Zheng Ren's hand exerted force, the sternum tried to come together, and the monitor alarm sounded crazily.