v3 Chapter 2718： If I go back to before
Time is no longer calculated in days or hours, but in seconds.
One second per second, the patient's invasive arterial blood pressure is falling steadily, and the heart rate does not change sharply when it exceeds 150 beats per minute.
But this kind of tachycardia is already very scary. I don't know when it will be a cliff-like fall, which can declare the patient dead.
Blood oxygen saturation has decreased to about 66%, oxygen is not enough, and the anesthesiologist has begun to change to 100% pure oxygen ventilator ventilation.
Under the action of pure oxygen, blood oxygen saturation briefly rises and then steadily decreases.
"Director Liu, it's gas embolism." The anesthesiologist was a little flustered, and all he could think of was ruled out, leaving only this diagnosis with a very high mortality rate.
If the gas embolism is fucked, the anesthesiologist's voice will tremble when he says this.
Director Liu took a look. Hem-o-lock was placed at the bifurcation of the renal vein and completely closed the renal vein. There was no possibility of a large amount of carbon dioxide flowing along the vein when the pneumoperitoneum was established, and the blood pressure could enter the blood circulation.
He denied the statement of the anesthesiologist, but still cautiously stopped the intragastric inflation of carbon dioxide immediately, and pulled out the troxa card to relieve the pneumoperitoneum?
患者 But the patient's condition has not changed, the rescue medication has been given again, and the vital signs displayed on the monitor are still decreasing.
"Call Director Miao." Director Liu Sheng said.
The itinerant nurses lingered for a moment, and time seemed to return to half a year ago. No matter what happens, just call Mr. Miao and you can solve it.
However, she did not hesitate, and did not care that Director Miao is now retired, but immediately called Director Miao's phone.
Uh ...
Uh ...
Director Miao Miao sat at home, chatting with Zheng Ren and Su Yun.
I talked about everything, but I didn't talk about medical treatment. I have been working for a lifetime, and at this time, I have returned to the field and let everything go away from myself.
"Director Miao, my mother dances square dances at home, so I don't know what's good. You tell me what the benefits are." Su Yundao, "Why can't it be rain and wind, the old lady is so proud? This thing. "
"Let's have fun together together." Director Miao said with a smile, full of vitality in his voice, he has basically recovered completely. Except for a small problem when walking with a fracture and a broken end, everything is fine.
"There is nothing to do at home for a day, idle is also idle."
"There is a dog in my house, or can you walk me for nothing? By the way, cross it. During the earthquake relief, Kuroko's legs were broken and he couldn't run fast. Don't worry about it, it's comparable to yours." Su Yun laughed Asked.
Director Miao Miao was about to laugh and curse, and the phone rang.
He leaned his back on the sofa and picked up his mobile phone leisurely. I glanced at the phone in the operating room. The whole man sat upright, his smile was hidden away, only majesty and solemnity remained.
"What happened to Director Miao?" Su Yun asked.
Director Miao Miao waved her hand and did not answer Su Yun's words, but directly connected to the phone.
"What's wrong?" Director Miao Shen Sheng asked.
哇 The voice of wala wala came from the phone. It was very rapid and loud. Zheng Ren and Su Yun both heard some clips.
Alas ... the patient's condition is bad during surgery? !!
The two looked at each other. If it was 912, I was afraid that they would have rushed to the operating room at this time.
But now at Director Miao's house, when a car arrives and then arrives at the hospital, the cucumber dishes are cold.
Urology, there is a laparoscopic nephrectomy in the afternoon. Is it a blood vessel that should not be touched?
视频 "Video, I look at the patient." Director Miao said solemnly after listening to the brief introduction.
The phone hung up, and Director Miao saw Zheng Ren and Su Yun staring at each other straightly, and explained: "Laparoscopic nephrectomy, suddenly blood pressure, heart rate is unstable, and blood oxygen saturation drops rapidly.
That's true!
"Did you run into a blood vessel?" Su Yun asked.
"No, it's over if you stop bleeding from the blood vessels." Zheng Rendao, "It is probably inexplicable. Is it caused by the vagus nerve reflex?"
Director Miao Miao shook her head slightly. "The sudden cardiac arrest caused by the vagus nerve during nephrectomy is rare, and medication is generally good."
Xi Gang said here that the voice of WeChat video sounded, and Director Miao connected the video request.
"Director, patient ..." The voice of Director Liu came from the video. He held the mobile phone and pointed at the laparoscopic TV screen.
"Heart stopped! Cardiopulmonary resuscitation!" The anesthetist roared loudly.
Zheng Ren and Su Yun quickly gathered around Director Miao and looked at the picture.
Heart rate declines steeply, blood oxygen saturation is 52%, alarm sounds continuously on ventilator, monitor, even if you see this scene at home, all three people naturally secrete a large amount of dopamine, epinephrine, glucocorticoid.
"The anesthesiologist adjusts the operating table, lowers his head and feet," said Director Miao.
But on the other side of the screen, the anesthesiologist is pushing medicine, Yu is always doing cardiac compression, because everyone has paniced because the problem has not yet been identified.
"Anesthetist! Xiao Liu, adjust the bed, lower your head and high your feet!" Director Miao raised the volume and said without a doubt.
Soon the bed was adjusted to an angle, and the position was changed as Ms. Miao said. On the other side, the doctor's order is executed.
I was like an invisible hand dialing back the time and back to the past once again, at this time Director Miao stood in the operating room and presided over the rescue.
"Director Miao, are you considering ..."
"The establishment of pneumoperitoneum, resulting in gas embolism." Director Miao said with certainty.
If Zheng Ren is present, you can use the system panel to make judgments; if there is no Director Miao, Zheng Ren estimates that it will take some time to determine.
After all, the establishment of gas embolism caused by pneumoperitoneum is so rare, at least Zheng Ren has not encountered a similar situation when he performed the endoscopic surgery of general surgery himself.
Laparoscopic nephrectomy, Zheng Ren quickly looked for similar information in his mind.
For patients with kidney disease, laparoscopic nephrectomy is a minimally invasive and safe and effective surgical treatment, but because of the need to establish pneumoperitoneum, the risk of air embolism is inevitable?
The incidence of tritium gas embolism is very low, about 0.002% ~ 0.02%. Once it occurs, its fatality rate can be as high as 50%?
Reviewing the literature, so far only 5 cases of gas embolism in laparoscopic renal surgery have been reported?
Ginger **** is still old and spicy. It is estimated that Director Miao has encountered a similar situation and can see what happened at a glance.
After all, Director Miao was one of the earliest surgeons in China who used laparoscopy to perform surgery.
One second per second, the patient's invasive arterial blood pressure is falling steadily, and the heart rate does not change sharply when it exceeds 150 beats per minute.
But this kind of tachycardia is already very scary. I don't know when it will be a cliff-like fall, which can declare the patient dead.
Blood oxygen saturation has decreased to about 66%, oxygen is not enough, and the anesthesiologist has begun to change to 100% pure oxygen ventilator ventilation.
Under the action of pure oxygen, blood oxygen saturation briefly rises and then steadily decreases.
"Director Liu, it's gas embolism." The anesthesiologist was a little flustered, and all he could think of was ruled out, leaving only this diagnosis with a very high mortality rate.
If the gas embolism is fucked, the anesthesiologist's voice will tremble when he says this.
Director Liu took a look. Hem-o-lock was placed at the bifurcation of the renal vein and completely closed the renal vein. There was no possibility of a large amount of carbon dioxide flowing along the vein when the pneumoperitoneum was established, and the blood pressure could enter the blood circulation.
He denied the statement of the anesthesiologist, but still cautiously stopped the intragastric inflation of carbon dioxide immediately, and pulled out the troxa card to relieve the pneumoperitoneum?
患者 But the patient's condition has not changed, the rescue medication has been given again, and the vital signs displayed on the monitor are still decreasing.
"Call Director Miao." Director Liu Sheng said.
The itinerant nurses lingered for a moment, and time seemed to return to half a year ago. No matter what happens, just call Mr. Miao and you can solve it.
However, she did not hesitate, and did not care that Director Miao is now retired, but immediately called Director Miao's phone.
Uh ...
Uh ...
Director Miao Miao sat at home, chatting with Zheng Ren and Su Yun.
I talked about everything, but I didn't talk about medical treatment. I have been working for a lifetime, and at this time, I have returned to the field and let everything go away from myself.
"Director Miao, my mother dances square dances at home, so I don't know what's good. You tell me what the benefits are." Su Yundao, "Why can't it be rain and wind, the old lady is so proud? This thing. "
"Let's have fun together together." Director Miao said with a smile, full of vitality in his voice, he has basically recovered completely. Except for a small problem when walking with a fracture and a broken end, everything is fine.
"There is nothing to do at home for a day, idle is also idle."
"There is a dog in my house, or can you walk me for nothing? By the way, cross it. During the earthquake relief, Kuroko's legs were broken and he couldn't run fast. Don't worry about it, it's comparable to yours." Su Yun laughed Asked.
Director Miao Miao was about to laugh and curse, and the phone rang.
He leaned his back on the sofa and picked up his mobile phone leisurely. I glanced at the phone in the operating room. The whole man sat upright, his smile was hidden away, only majesty and solemnity remained.
"What happened to Director Miao?" Su Yun asked.
Director Miao Miao waved her hand and did not answer Su Yun's words, but directly connected to the phone.
"What's wrong?" Director Miao Shen Sheng asked.
哇 The voice of wala wala came from the phone. It was very rapid and loud. Zheng Ren and Su Yun both heard some clips.
Alas ... the patient's condition is bad during surgery? !!
The two looked at each other. If it was 912, I was afraid that they would have rushed to the operating room at this time.
But now at Director Miao's house, when a car arrives and then arrives at the hospital, the cucumber dishes are cold.
Urology, there is a laparoscopic nephrectomy in the afternoon. Is it a blood vessel that should not be touched?
视频 "Video, I look at the patient." Director Miao said solemnly after listening to the brief introduction.
The phone hung up, and Director Miao saw Zheng Ren and Su Yun staring at each other straightly, and explained: "Laparoscopic nephrectomy, suddenly blood pressure, heart rate is unstable, and blood oxygen saturation drops rapidly.
That's true!
"Did you run into a blood vessel?" Su Yun asked.
"No, it's over if you stop bleeding from the blood vessels." Zheng Rendao, "It is probably inexplicable. Is it caused by the vagus nerve reflex?"
Director Miao Miao shook her head slightly. "The sudden cardiac arrest caused by the vagus nerve during nephrectomy is rare, and medication is generally good."
Xi Gang said here that the voice of WeChat video sounded, and Director Miao connected the video request.
"Director, patient ..." The voice of Director Liu came from the video. He held the mobile phone and pointed at the laparoscopic TV screen.
"Heart stopped! Cardiopulmonary resuscitation!" The anesthetist roared loudly.
Zheng Ren and Su Yun quickly gathered around Director Miao and looked at the picture.
Heart rate declines steeply, blood oxygen saturation is 52%, alarm sounds continuously on ventilator, monitor, even if you see this scene at home, all three people naturally secrete a large amount of dopamine, epinephrine, glucocorticoid.
"The anesthesiologist adjusts the operating table, lowers his head and feet," said Director Miao.
But on the other side of the screen, the anesthesiologist is pushing medicine, Yu is always doing cardiac compression, because everyone has paniced because the problem has not yet been identified.
"Anesthetist! Xiao Liu, adjust the bed, lower your head and high your feet!" Director Miao raised the volume and said without a doubt.
Soon the bed was adjusted to an angle, and the position was changed as Ms. Miao said. On the other side, the doctor's order is executed.
I was like an invisible hand dialing back the time and back to the past once again, at this time Director Miao stood in the operating room and presided over the rescue.
"Director Miao, are you considering ..."
"The establishment of pneumoperitoneum, resulting in gas embolism." Director Miao said with certainty.
If Zheng Ren is present, you can use the system panel to make judgments; if there is no Director Miao, Zheng Ren estimates that it will take some time to determine.
After all, the establishment of gas embolism caused by pneumoperitoneum is so rare, at least Zheng Ren has not encountered a similar situation when he performed the endoscopic surgery of general surgery himself.
Laparoscopic nephrectomy, Zheng Ren quickly looked for similar information in his mind.
For patients with kidney disease, laparoscopic nephrectomy is a minimally invasive and safe and effective surgical treatment, but because of the need to establish pneumoperitoneum, the risk of air embolism is inevitable?
The incidence of tritium gas embolism is very low, about 0.002% ~ 0.02%. Once it occurs, its fatality rate can be as high as 50%?
Reviewing the literature, so far only 5 cases of gas embolism in laparoscopic renal surgery have been reported?
Ginger **** is still old and spicy. It is estimated that Director Miao has encountered a similar situation and can see what happened at a glance.
After all, Director Miao was one of the earliest surgeons in China who used laparoscopy to perform surgery.
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