"Oh, as long as you're satisfied." Zheng Ren's expression was a little stiff. He had something on his mind and didn't bother to deal with Sister Zhao, so he said calmly.
Seeing that Zheng Ren behaved differently from usual, Sister Zhao asked, "I think the patient is in good condition. Are you worried, Mr. Zheng?"
"Yes, Sister Zhao." Zheng Ren said: "The patient is considering traumatic carotid artery injury. Looking good now, maybe a spurt of blood will spurt out in the next second and the person will be dead."
Sister Zhao was surprised. Even an experienced clinical assistant doctor had never seen such a situation as Zheng Ren mentioned. She dubiously operated the machine and performed a CTA on the patient's neck blood vessels.
The examination took more than 20 minutes, and Zheng Ren asked Su Yun to send the patient back.
He also forgot to tell Su Yun not to let the patient move.
Su Yun knew the importance, and Zheng Ren's worries were also his worries.
There are more emergency patients, and we see more strange things. This is the only way to sail a ship that lasts ten thousand years with caution.
Su Yun once treated a patient with spontaneous pneumothorax in the imperial capital.
The patient came in walking and was diagnosed with left spontaneous pneumothorax with 60% lung tissue compression. The patient reported a history of pneumothorax and recovered after being given closed drainage treatment.
This kind of patient has nothing to say, the medical history is simple, and the treatment is simple. If you refuse to undergo thoracotomy or thoracoscopic surgery, you can just use a chest bottle and observe it for a few days.
However, after the chest bottle was inserted, dark red blood began to flow out along the chest tube.
Su Yun was not careless. He moved a stool and sat next to the patient to observe the drainage situation of the chest bottle.
Two hours later, the drainage per hour had reached about 200ml.
Su Yun made a prompt decision, explained the condition to the patient's family, and opened the chest for exploration.
The result is dumbfounding.
Because the patient had undergone closed drainage once, there were adhesions in the lungs and pleura. In this spontaneous pneumothorax, when the lung tissue was compressed, the adhesion area on the top of the pleura was torn.
Intraoperative exploration revealed only an avulsion area as large as a female fingernail, with blood oozing from this area.
Even with such a small amount of bleeding, the bleeding is not obvious when the chest cavity is under positive pressure. When the air is removed and the chest cavity returns to normal pressure, a large amount of blood begins to ooze.
When he came to the stage, the patient was already in the early stage of hemorrhagic shock.
Almost everyone was gone.
If Su Yun is a little careless.
If there is a major rescue operation that day, everyone will be on stage, which will delay observation and treatment time.
if…
In any case, the patient will die in the ward.
Therefore, for clinical doctors, there will be a flaw, and any doubts or lack of confidence will be infinitely magnified.
Perhaps, this is also a kind of pessimism and a kind of obsessive-compulsive disorder.
Nowadays, Zheng Ren and Su Yun use this attitude to treat patients with suspected carotid artery scratches.
Seeing that Zheng Ren hadn't left, Sister Zhao knew that he was anxious, so she rushed to release the film.
When the CTA image of the neck blood vessels appeared on the screen, both of them were stunned.
A triangular piece of glass inserted into the carotid artery.
Although the carotid artery bleeding was prevented, no one could say when this unstable factor would cause problems.
The moment Zheng Ren saw the broken glass, he immediately picked up his cell phone and called Su Yun.
"Shards of glass were seen in the patient's carotid artery. Do not press the scratched area on the left side. Be sure not to press!"
"Yes, please invite the vascular department for consultation, notify them, and prepare for emergency surgery."
"Comfort the patient and stabilize the patient's mood."
After the explanation, Zheng Ren let out a sigh of relief and put his phone away.
If you can find a problem, you can solve it.
The most difficult and dangerous period for this patient has passed.
This kind of surgery was first performed by general surgery. After all, it was a neck surgery. But as the vascular department was separated, it fell under the vascular department.
It wasn't that Zheng Ren couldn't give it a try, but he didn't have any consumables that could block the carotid artery. Second, the surgical training time has been exhausted. Without some training, who would dare to touch the carotid artery
As for the technical strength of the Vascular Department of Haicheng City No. 1 Hospital, it may not be able to handle this operation.
But Zheng Ren didn't care either.
If surgery is not possible, you can go on stage together, superselect, enter the carotid artery, and place a covered stent at the bleeding site.
Although the handling of the latter is not rigorous and informal, the methods that can save lives are good.
"Mr. Zheng, how did the glass get in?" Sister Zhao asked while doing post-processing.
"It is estimated that high-speed moving glass fragments pierced the skin. Moreover, there are no obvious signs of injury from such glass fragments on the surface of the body, but the condition inside the body is very serious." Looking back now, Zheng Ren can't help but feel scared.
With a little carelessness, the patient will bleed profusely as the glass fragments fall off the carotid artery at some point, and then die within a minute.
Taking the newly printed film, Zheng Ren hurried back to the emergency department.
The director of the vascular department was also grabbed from the cafeteria.
Because the vascular department is a small department and there are not many related surgeries, there are no hospitalizations.
A small hospital has all kinds of irregularities.
When Zheng Ren walked in, Director Fan of the Vascular Department was walking out.
The two met face to face. Zheng Ren raised the film in his hand and said, "Director Fan, can you take a look?"
Director Fan nodded cautiously, and Zheng Ren called the patient's lover to the office, found a reader and plugged in the film.
On the CTA of the blood vessels in the neck, the triangular glass fragment less than 1cm is particularly glaring.
Almost as soon as I saw the film, the piece of glass "stabbed" out of the film like a horror movie.
"Director Fan, prepare for the operation," Zheng Ren said.
"Sigh." Director Fan shook his head and said, "The patient's life is really big."
Zheng Ren was convinced.
If there weren't many coincidences, the 120 ambulance that pulled it to the hospital would have been just a corpse.
The diagnosis was clear and there was nothing to say. The emergency surgeon issued a hospitalization order, and Director Fan hurried back with the patient to prepare for the operation.
Recovery from this type of surgery is also very quick.
Zheng Ren estimated that he would be discharged from the hospital in two or three days after the operation.
Many big things, once discovered, are trivial.
For injuries and diseases that can lead to death, the diagnosis is clear and the patient can be discharged from the hospital within two or three days after surgery. Thinking about it, it is indeed her destiny.
After working in clinical practice for a long time and seeing more, I slowly began to believe in fate.
At the scene of the car accident, the patient who was hit without a human form was discharged from the hospital and went home after half a month or a month.
Zheng Ren has also witnessed cases in which the patient suddenly became incontinent and lost consciousness three to five days after being hospitalized. (Note 1)
So let’s talk, people…
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Note 1: Carotid artery intimal avulsion, this case was encountered by a friend of mine when he was in neurosurgery. Later, I checked the book and found that the probability was one in 50,000.
As for the carotid artery case, I remember that there was a similar content in the American TV series "The Good Doctor". This case is selected from "journalvascular surgery". There are some aspects that I find very magical. But clinically, there are some low-probability events.