Back in 2002 as a doctor

Page 271

And he is still grateful for his previous choice.

"Furosemide, another 20." Zhou Congwen said in a deep voice.

"Okay, right away."

Liu Wei handed over the suction tube to the assistant and pushed the medicine by himself.When pushing furosemide this time, his hands didn't shake at all, and the speed was very fast.

After this series of treatments, the patient's symptoms finally improved at 19:45 after transfusion of 600ml of plasma.

Zhou Congwen finally stood up straight and took half a step back, but his eyes were not off the monitor.

The patient's vital signs finally went up a little bit, although slowly, but unwaveringly.

"It's almost done, hurry up and do the surgery." Zhou Congwen said, looking at Director Sui, his eyes off the ECG monitoring for the first time since he entered the operating room.

"Oh oh oh." Director Sui couldn't say anything other than oh.

The words that ridiculed Zhou Congwen before "flyed" back at this moment, and slapped his face with pain.

The blood gas analysis of the blood test every 10 minutes also showed that the patient's condition was gradually improving. Zhou Congwen stopped directing the rescue and continued to perform chest compressions for 10 minutes. Even he felt very tired.

"That's it. I went to the next door to check the breast vase, and I got off if I have nothing to do." Zhou Congwen turned around and waved his hand.

"Xiao Zhou, don't go." Director Sui was in a hurry, and shouted to Zhou Congwen in spite of face.

"Huh? What's wrong."

"What should the patient do next? How to deal with it?" Director Sui asked hastily.

He didn't know anything, his eyes were darkened, what would the patient do if he went down?What if it stops again!

Although it would be embarrassing to ask Zhou Congwen what to do, it was better than calling him cheeky in the middle of the night.

Director Sui simply cheated and planned to keep Zhou Congwen for one night.

"And then? Send it to the ICU..." Zhou Congwen was startled, paused, and smiled wryly.

There is no ICU in the third hospital, what the hell.

"Let's do it first. Send it back to the ward after surgery. I'll go and see it overnight." Zhou Congwen said helplessly.

There is not even an ICU, and it has not been issued in this day!

Zhou Congwen was a little crazy.

This kind of serious illness... Zhou Congwen's heart was full of sadness, and the orthopedic doctor must not know how to deal with it, and he had no sleep all night.

Chapter 0471 Tourniquet Shock

Zhou Congwen sighed.

"I'll go to the next door to take a look at the breast vase, and if there's nothing wrong, I'll come back and wait."

After speaking, Zhou Congwen turned and opened the door of the operating room to leave.

It's just that his posture is a bit weird. Just as his back was about to bend down, it seemed that he was hit by an invisible fist, and then he straightened up.

"Director Sui, it's dangerous." Liu Wei said with lingering fear when he saw Zhou Congwen going out.

At this moment, Liu Wei was not in the mood to throw back Director Sui's mocking words about Zhou Congwen, and hit him in the face.

Some disputes are normal. Hospitals are also part of society, and doctors are human beings. Conflicts are inevitable.

But that is when the patient's condition is stable.

The patient had a sudden cardiac arrest just now, which was beyond everyone's expectations.

If it hadn't been for Zhou Congwen to prepare all kinds of rescue items in advance, and to stand up and preside over the rescue at the first time, the patient would have been cold by now.

Director Sui performed the operation with his head down, and even a simple suture was done three or four times with trembling hands before it was completed.

He didn't speak, but sighed deeply, and thousands of words were contained in one sigh.

"Director Sui, I remembered." Liu Wei said seriously, "During my internship, I was anesthetized with my master at the People's Hospital. There was a patient with a broken thigh, whose leg was almost amputated by the grinding wheel."

"Huh?" Director Sui was going to accept the baptism of ridicule like a storm, but he didn't expect Liu Wei to talk about the past, and he was taken aback.

"The operation is almost done. Less than 10 minutes after the patient's tourniquet was opened...only 10 minutes later, he suddenly disappeared." Liu Wei frowned and tried to recall.

"..." Director Sui also thought of several similar cases in the legend.

It's just that the old doctors who talked about these things said that people have their own lives, and the operation was done well, but suddenly it disappeared, so where can I reason.

Director Sui thought so deeply.

But after seeing Zhou Congwen's rescue today, he knew that he was wrong, and those "experienced" old doctors were also wrong.

This is a disease, not a life.

"Did you think it was caused by hemorrhagic shock?" Director Sui asked in a low voice.

"Well, there was no discussion afterwards. Everyone believed that hemorrhagic shock caused cardiac arrest." Liu Weiyue said in a lower voice, as if a child who made a mistake was caught on the spot.

Although there are not many such patients, anesthesiologists can always meet them after working for a lifetime.

The patient died, but he didn't know why!

Liu Wei suddenly remembered the death of a parturient in the obstetrics and gynecology department, the arrhythmia caused by oxytocin, and the family members of the patient almost smashed the hospital. The doctor still didn't know why after the final discussion.

If I hadn't encountered a case myself, I still had the heart to go to the medical record room to search for information. I am afraid that the next time I encounter it, I will still be at a loss, and the patient's life and death can only depend on fate.

Liu Wei was a little helpless.

There are many branches of medicine, like a vast ocean, and there must be many more books than one body, and it is impossible for one person to master them all.

Even if I have this heart, I must have this strength.

But what about Zhou Congwen?

Like Director Sui, Liu Wei fell silent, followed by a sigh.

The operating room is like a battlefield between battles, filled with the smell of gunpowder smoke, no one speaks, everyone is taking a breath and taking a rest.

About 10 minutes later, Zhou Congwen opened the door and came back.

"Congwen, how about that side?" Liu Wei asked.

"The breast bottle is fine. I asked Brother Xue to help inflate the lungs. There is no air or blood." Zhou Congwen said naturally.

"Where did Puwai do it?"

"The spleen was removed, and the liver is being repaired." Zhou Congwen seemed to want to say something else, but changed the subject, "What did we do?"

"..." Director Sui shuddered.

He immediately remembered the last time Zhou Congwen almost pointed at himself and Wang Chengfa and cursed.

Although Zhou Congwen kept reasoning and threw back the scapegoat that they both threw on Shen Lang, but in the eyes of Director Sui, it was just cursing.

As long as he said that he was wrong, he would yell and curse. Like a shrew, Director Sui's subconscious mind has always understood this way.

But Zhou Congwen... Director Sui didn't think he looked like a shrew, but vaguely felt that he was his teacher.What's wrong, I scolded me a lot, and then taught myself how to do it.

Zhou Congwen didn't know what Director Sui was thinking, so he leaned over to take a look.

"Hurry up." Zhou Congwen said lightly, "The anesthesia time should be as short as possible, which is good for the patient."

Director Sui was speechless. Although his hands were better, they were still trembling slightly.

As a surgeon, with shaking hands during surgery, there are countless ways for others to humiliate themselves.

Director Sui was also ready to accept the humiliation, and he was not prepared to fight back.

Zhou Congwen helped himself solve a big head-scratching problem, and he should be scolded a few times. Director Sui lowered his head and tried to calm his emotions, and seized the time to perform the operation.

But what he didn't expect was that Zhou Congwen said, "Brother Liu, lend me the stool."

"Okay." Liu Wei bent down and moved his stool to a corner, "I'm exhausted from chest compressions."

"Yeah." Zhou Congwen nodded, "I can't say I'm exhausted, but I'm definitely a little tired."

"Take a breath, do you want some sugar?" Liu Wei asked with concern.

"No need, I'm not used to drinking that stuff." Zhou Congwen smiled, "Every time I drink candy, I feel my throat is blocked by a pile of cotton wool, and I start to feel flustered and short of breath, and then SVT."

"Hahaha!"

Liu Wei smiled dryly, and quickly stood beside Zhou Congwen and asked, "Congwen, what happened just now?"

"Tourniquet shock." Zhou Congwen replied simply.

"what?"

"It's quite difficult." Zhou Congwen explained lightly, "Generally speaking, it takes about an hour for a tourniquet to stop bleeding, and it must not exceed one and a half hours. into a state of sudden shock."

"Here, especially for patients with thigh injuries. If you say loosen the tourniquet, the femoral artery is still broken, and a stream of blood is sprayed directly to the opposite wall. Moreover, the patient is still in shock. Loosening the tourniquet is useless, but it is directly less 500 blood.

Just say don't loosen the tourniquet, it's easy...the current situation may happen. "

"Is there no way to avoid it? Or is it prevention?" Liu Wei asked enthusiastically, "It's like oxytocin."

The little orthopedic doctor was startled suddenly, "Oxytocin? Can it also be used in our surgery?"

"Do your surgery well, what are you going to say?" Liu Wei scolded.

He has an attitude when speaking to Zhou Congwen, but when speaking to the young orthopedic doctor, his nose is not his nose, and his eyes are not suitable for his eyes. The tone of the old doctor teaching the young doctor is obvious.

Chapter 0472 turned out to be like this!

"It's not the same." Zhou Congwen said, "Many people have studied tourniquet shock, the first time was during World War I. Military doctors found that after the wounded who had used a tourniquet opened the tourniquet, many people said that the wound stopped bleeding, but People went into shock and died quickly."

"Yeah!" Liu Wei thought of the situation he had encountered before, and nodded repeatedly.

"There is a hypothesis that after the tourniquet is inflated for 8 minutes, the partial pressure of oxygen in the mitochondria of the cells drops to 0, resulting in anaerobic metabolism, followed by a decrease in nicotinamide adenine dinucleotide, which quickly produces intracellular acidosis.

Hypoxia and acidosis lead to the release of myoglobin, intracellular enzymes and potassium ions, and a large amount of acidic substances, adenosine, and exotoxins enter the blood. "

"The second hypothesis is that when the blood flow of one lower extremity accounts for about 15% of the peripheral circulating blood volume, the ischemic extremity undergoes reperfusion when the tourniquet is relaxed, resulting in a drop in blood pressure.

This situation reduces the coronary perfusion of the heart, resulting in severe hypoxia of the heart; the heart rate increases and the oxygen consumption increases. "

"In a short period of time, the sympathetic-parasympathetic vagus nerve and acid-base electrolyte disturbance will cause changes in the cardiac conduction system, which will eventually lead to the inability of the heart to empty effectively and cause cardiac arrest."

"The third hypothesis is that..."

To Liu Wei's surprise, Zhou Congwen made twelve hypotheses in a row, and each of them sounded like the truth.

It turned out that there were still so many situations, and I didn't know any of them, not even the tourniquet shock, Liu Wei was ashamed.

On the operating table, Director Sui petrified like a fossil.

He stared blankly at the operation area, holding the needle holder in his hand, his hand no longer trembled, but froze in mid-air.

Originally, he disdained Zhou Congwen's "preaching" at the beginning, but a young doctor knew that the idea of ​​endorsement crushed Zhou Congwen's heroic appearance who had just directed the rescue.

Director Sui didn't seem to want to admit that the rescue was directed by Zhou Congwen, and he was trying to forget what happened just now.

But every time Zhou Congwen uttered a possibility or hypothesis, his heart felt uncomfortable as if being held by an invisible big hand.

But at the fifth point, Director Sui was already numb, and a feeling emerged in his mind—it turned out to be such a feeling.

It turned out to be so!

This feeling became stronger and stronger, so much so that Director Sui forgot that he was on the operating table, and in front of him was a patient who was anxious to get off the stage.

"How come there are so many possibilities." Liu Wei sighed.

"Well, there is no revolutionary breakthrough in existing medicine, so there is no way." Zhou Congwen sighed, "There are many papers about the specific situation, but the academic circle has discussed it for many years, and there is still no conclusion."

"Because there is no definite conclusion, everyone is arguing, so even the term tourniquet shock has not been determined. The progress of basic science can drive the progress of clinical practice, which is impossible."

Zhou Congwen switched to Huang Lao's "preaching" mode unknowingly, but Liu Wei didn't hear it.

Zhou Congwen's words were a bit preachy to others, but when Liu Wei contacted a sudden death patient he had encountered before, his back was already covered with sweat.

Every fresh human life, just because there is no progress in basic subjects... No, the blame cannot be pinned on basic subjects.

If I had known for a long time, I would have prepared early for patients who had lower extremity tourniquets in the future, and it seemed that many patients could have avoided accidental deaths.

Although it is not [-]% avoidable, it will also increase the possibility of successful rescue, or give a chance for rescue.

Thinking about it, Liu Wei bent down unconsciously.

"Congwen, is it more common to use tourniquets for lower extremity trauma combined with tourniquet shock?"