v3 Chapter 2719： The sword is not old
"Find someone to do transesophageal echocardiography!" Director Miao continued.
Wu Suyun has picked up the phone and called Laohe's phone. Lao He was preparing to leave work, humming Xiaoqu, sitting in the duty room and smoking a cigarette.
He received a call from Su Yun, and Lao He didn't ask what had happened. He only knew that it was a urological operation, and he was going to do transesophageal echocardiography immediately.
Laohe's b-ultrasound level is quite high, and he is one of the few doctors who can judge pneumothorax with ultrasound. This technique is one of the few that can be blown in front of Mr. Zheng. He did not expect to think of himself when he rescued Taiwan.
Pushing the bedside echocardiography machine, Lao He ran into the operating room.
忙 Busy in the operating room, weird is that Lao He did not see Boss Zheng and Yuner. Director Liu in the urology department held the mobile phone in his hand and constantly changed the angle. The voice of Director Miao directing the rescue came from the mobile phone.
I go ... Lao He froze for a moment, then she was clear in heart, and immediately realized what was happening.
This is Director Liu's push!
The habit formed over many years, after I encountered a problem, I could not solve it myself, and I asked the chief director for the first time.
At the moment of life and death crisis, Director Liu had forgotten that Director Miao had retired, from the chief clinical director to an elderly person who danced square dance every day and took care of himself.
主任 Director Miao's voice from the mobile phone is still calm, full of domineering and unquestionable breath.
What about Boss Zheng and Yuner? Lao He pushed the bedside echocardiography machine to the patient's head and took the opportunity to take a look around.
no one!
I don't care anymore, Yun Geer said to do transesophageal echocardiography.
Laohe quickly put the transesophageal ultrasound probe into the patient's mouth, avoided tracheal intubation, and overcome the interference of always doing chest heart compression, and sent the probe into the esophagus.
"Yu total, stop for 20 seconds!" Lao He growled loudly.
"Less than, stop for 20 seconds, the anesthesiologist will do echocardiography." Director Miao's voice came, and the memory contained in the main body made him stop the action of chest heart compression as soon as possible.
"The gas was found in the right heart! The gas was also found in the left heart!" Lao He swept quickly and saw the gas in the heart. After reporting to the director Miao in the video of the mobile phone, he left the image and took out the probe.
"Put a small sponge pad on the right side!" Director Miao's voice came, "Continue to press, intermittent cardiopulmonary resuscitation. Central venous catheter ..."
"Director Miao, I'm here." Boss Zheng's voice came out in the video.
Lao He's heart was bright, but he didn't think too much about why Boss Zheng was at Director Miao's house, but quickly pushed the bedside echocardiography machine aside, found the central venipuncture kit in the cabinet, and quickly came to the patient.
The patient's head has been crowded a lot, and Lao He didn't explain it. At this point the phone rang, he took out the phone before puncturing, turned on the handsfree, and set it aside.
"Lao He, do a central venipuncture." Boss Zheng's thick, steady voice came.
Laohe was calm in his heart, while preparing to puncture, he said, "Immediately, 22 seconds!"
He used a modified subclavian central venipuncture method to find the best puncture point at the intersection of the right clavicle central perpendicular to the horizontal line of the sternoclavicular joint, and the needle pointed at the lower edge of the thyroid cartilage for puncture.
After entering, the central venous catheter extends downwards and continues into the right heart. Lao He is quite confident in his technology, 22 seconds, no difference.
"There is an airlock effect. You can feel the pressure when you pump in." Boss Zheng's voice came from his mobile phone.
Even though Lao He knew what he said, he was more stable in his unexplained heart.
"Has entered the right atrium." Lao He said, "Pumping gas."
Keep trying, because of the air lock effect, the syringe does not twitch smoothly.
The air lock effect is also called air lock phenomenon. It is a blocking phenomenon caused by different pressures in the liquid in the flowing liquid. This phenomenon usually occurs at the high point between the pipelines, which is the reason why general centrifugal pumps cannot pump liquid.
Laohe tried a little, suddenly the syringe in his hand moved slightly, moved a short distance, about 5ml.
"Boss Zheng, draw 5ml of gas." Lao He quickly drew the blood and gas while reporting to Zheng Ren.
继续 "Continue, just watching the echocardiography, there is still air in the ventricular cavity."
Zheng Ren said with a mobile phone.
"Boss, it is normal to have air in the atrium, I have never wondered why there is air in the ventricle." Su Yun asked aside.
Although I was not in the operating room, I could still feel the breath of adrenaline and dopamine.
Zheng Ren shook his head and said, "There are too few cases, and I don't know too well. The existing cases show that most of them are double-chamber gas, and there are no congenital diseases with right-to-left shunts."
Abnormal air embolism is the gas absorbed into the venous system and finally enters the arterial system?
It usually occurs in patients with right-to-left shunt of the heart. The gas that accumulates in the right atrium or right ventricle enters the left ventricular system through right-to-left channels, causing coronary or cerebral artery embolism?
This is a question. Now in the emergency department, they both have a tacit understanding and did not continue to talk about this issue.
Laohe's operation passed the level, and even overflowed a lot. Soon the left ventricle gas was also extracted, and the problem leading to cardiac arrest was resolved. UU Reading at
After continuous chest compressions and intermittent defibrillation for about 20 minutes, the patient's hemodynamics and respiratory function stabilized?
Director Miao breathed a sigh of relief, set her phone aside, and leaned her back on the sofa back. Zheng Ren looked at his expression. He was not exhausted, only the relieved and happy after the emergency and emergency rescue.
"Director Miao, are you tired?"
"Not tired." Director Miao laughed. "It is the first time I have encountered this old man through a mobile phone to direct the rescue."
"The sword is not old!" Su Yun extended his thumb and praised.
"Laparoscopy caused gas embolism once before. At that time, I was stunned, thinking about the rescue. But that time, I made a mistake, and it was easy to think of carbon dioxide entering the blood vessels. After symptomatic treatment, the patient had no complications after surgery. He was discharged in a few days. "
"How many years ago?" Su Yun asked.
"The end of the last century." Director Miao said.
"Just when you started the laparoscopic surgery, you encountered gas embolism? Why didn't you write a case report?" Su Yun asked curiously.
"The case report ... was written." Director Miao said, "I thought that this case should be rare. I didn't even submit a periodical in the middle of the period, and went directly to the Lancet. Unfortunately, I am in English and have no format. Too clear, in the end nothing will be left. "
I was like this, Zheng Ren smiled.
主任 "Director, how are you?" Director Liu's voice came from his mobile phone.
Wu Suyun has picked up the phone and called Laohe's phone. Lao He was preparing to leave work, humming Xiaoqu, sitting in the duty room and smoking a cigarette.
He received a call from Su Yun, and Lao He didn't ask what had happened. He only knew that it was a urological operation, and he was going to do transesophageal echocardiography immediately.
Laohe's b-ultrasound level is quite high, and he is one of the few doctors who can judge pneumothorax with ultrasound. This technique is one of the few that can be blown in front of Mr. Zheng. He did not expect to think of himself when he rescued Taiwan.
Pushing the bedside echocardiography machine, Lao He ran into the operating room.
忙 Busy in the operating room, weird is that Lao He did not see Boss Zheng and Yuner. Director Liu in the urology department held the mobile phone in his hand and constantly changed the angle. The voice of Director Miao directing the rescue came from the mobile phone.
I go ... Lao He froze for a moment, then she was clear in heart, and immediately realized what was happening.
This is Director Liu's push!
The habit formed over many years, after I encountered a problem, I could not solve it myself, and I asked the chief director for the first time.
At the moment of life and death crisis, Director Liu had forgotten that Director Miao had retired, from the chief clinical director to an elderly person who danced square dance every day and took care of himself.
主任 Director Miao's voice from the mobile phone is still calm, full of domineering and unquestionable breath.
What about Boss Zheng and Yuner? Lao He pushed the bedside echocardiography machine to the patient's head and took the opportunity to take a look around.
no one!
I don't care anymore, Yun Geer said to do transesophageal echocardiography.
Laohe quickly put the transesophageal ultrasound probe into the patient's mouth, avoided tracheal intubation, and overcome the interference of always doing chest heart compression, and sent the probe into the esophagus.
"Yu total, stop for 20 seconds!" Lao He growled loudly.
"Less than, stop for 20 seconds, the anesthesiologist will do echocardiography." Director Miao's voice came, and the memory contained in the main body made him stop the action of chest heart compression as soon as possible.
"The gas was found in the right heart! The gas was also found in the left heart!" Lao He swept quickly and saw the gas in the heart. After reporting to the director Miao in the video of the mobile phone, he left the image and took out the probe.
"Put a small sponge pad on the right side!" Director Miao's voice came, "Continue to press, intermittent cardiopulmonary resuscitation. Central venous catheter ..."
"Director Miao, I'm here." Boss Zheng's voice came out in the video.
Lao He's heart was bright, but he didn't think too much about why Boss Zheng was at Director Miao's house, but quickly pushed the bedside echocardiography machine aside, found the central venipuncture kit in the cabinet, and quickly came to the patient.
The patient's head has been crowded a lot, and Lao He didn't explain it. At this point the phone rang, he took out the phone before puncturing, turned on the handsfree, and set it aside.
"Lao He, do a central venipuncture." Boss Zheng's thick, steady voice came.
Laohe was calm in his heart, while preparing to puncture, he said, "Immediately, 22 seconds!"
He used a modified subclavian central venipuncture method to find the best puncture point at the intersection of the right clavicle central perpendicular to the horizontal line of the sternoclavicular joint, and the needle pointed at the lower edge of the thyroid cartilage for puncture.
After entering, the central venous catheter extends downwards and continues into the right heart. Lao He is quite confident in his technology, 22 seconds, no difference.
"There is an airlock effect. You can feel the pressure when you pump in." Boss Zheng's voice came from his mobile phone.
Even though Lao He knew what he said, he was more stable in his unexplained heart.
"Has entered the right atrium." Lao He said, "Pumping gas."
Keep trying, because of the air lock effect, the syringe does not twitch smoothly.
The air lock effect is also called air lock phenomenon. It is a blocking phenomenon caused by different pressures in the liquid in the flowing liquid. This phenomenon usually occurs at the high point between the pipelines, which is the reason why general centrifugal pumps cannot pump liquid.
Laohe tried a little, suddenly the syringe in his hand moved slightly, moved a short distance, about 5ml.
"Boss Zheng, draw 5ml of gas." Lao He quickly drew the blood and gas while reporting to Zheng Ren.
继续 "Continue, just watching the echocardiography, there is still air in the ventricular cavity."
Zheng Ren said with a mobile phone.
"Boss, it is normal to have air in the atrium, I have never wondered why there is air in the ventricle." Su Yun asked aside.
Although I was not in the operating room, I could still feel the breath of adrenaline and dopamine.
Zheng Ren shook his head and said, "There are too few cases, and I don't know too well. The existing cases show that most of them are double-chamber gas, and there are no congenital diseases with right-to-left shunts."
Abnormal air embolism is the gas absorbed into the venous system and finally enters the arterial system?
It usually occurs in patients with right-to-left shunt of the heart. The gas that accumulates in the right atrium or right ventricle enters the left ventricular system through right-to-left channels, causing coronary or cerebral artery embolism?
This is a question. Now in the emergency department, they both have a tacit understanding and did not continue to talk about this issue.
Laohe's operation passed the level, and even overflowed a lot. Soon the left ventricle gas was also extracted, and the problem leading to cardiac arrest was resolved. UU Reading at
After continuous chest compressions and intermittent defibrillation for about 20 minutes, the patient's hemodynamics and respiratory function stabilized?
Director Miao breathed a sigh of relief, set her phone aside, and leaned her back on the sofa back. Zheng Ren looked at his expression. He was not exhausted, only the relieved and happy after the emergency and emergency rescue.
"Director Miao, are you tired?"
"Not tired." Director Miao laughed. "It is the first time I have encountered this old man through a mobile phone to direct the rescue."
"The sword is not old!" Su Yun extended his thumb and praised.
"Laparoscopy caused gas embolism once before. At that time, I was stunned, thinking about the rescue. But that time, I made a mistake, and it was easy to think of carbon dioxide entering the blood vessels. After symptomatic treatment, the patient had no complications after surgery. He was discharged in a few days. "
"How many years ago?" Su Yun asked.
"The end of the last century." Director Miao said.
"Just when you started the laparoscopic surgery, you encountered gas embolism? Why didn't you write a case report?" Su Yun asked curiously.
"The case report ... was written." Director Miao said, "I thought that this case should be rare. I didn't even submit a periodical in the middle of the period, and went directly to the Lancet. Unfortunately, I am in English and have no format. Too clear, in the end nothing will be left. "
I was like this, Zheng Ren smiled.
主任 "Director, how are you?" Director Liu's voice came from his mobile phone.
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