v3 Chapter 2757： Don't make this mistake next time

When the sternum is closed, blood pressure fluctuates abnormally, and repeated ventricular arrhythmias occur repeatedly with a heart rate of 170-180 beats / min.

This is the value that appears when the sternum is not completely closed. If the sternum is forcibly closed, the patient may not go to the operating table.

"Boss Zheng, was there a judgment before the operation?" Zhao Yunlong knew Zheng Ren's choice was right, he asked softly.

"Echocardiography shows that the patient's heart is swollen, but this is not the main reason. The basis for judging the delay in closing the chest is the previous treatment." Zheng Ren began to prepare for the delay in closing the chest, explaining.

"Boss Zheng, are you going to do ultrasound now?" Lao He pushed the machine in and asked.

"it is good."

Laohe didn't mind that he was brought to the operating room by his boss Zheng in the morning just to do a transesophageal ultrasound examination, so he could do whatever he wanted, Laohe didn't complain.

In general anesthesia and ventilator intubation, it is also a technology to successfully complete transesophageal echocardiography, not everyone can.

"Wait a minute." Old He Fei ran to the computer, plugged in a U disk, and the song of good luck came out.

"Now I won't have surgery if I don't listen to this song." Lao He explained with a smile.

Although the operation has reached the last step, Lao He still insists on playing good luck.

Stepping on the beat of good luck, Lao He felt that his body was a bit lighter, and fluttering like a feathered ascendant.

难度 Difficult operation became smooth in his hands. After a few minutes, Lao He said softly, "Boss Zheng, SAM sign is obvious."

SAM sign is a sign in M-mode ultrasound diagnosis.

Mainly refers to the forward movement of the anterior mitral systole, and obstructive hypertrophic cardiomyopathy is not a slowly rising platform in the systolic CD segment, but an abnormal waveform that protrudes upward, that is, toward the ventricular septum. This phenomenon is called systolic forward motion and is referred to as SAM sign for short.

"Give a small amount of beta-blockers to quickly replenish plasma." Zheng Ren ordered a doctor, and then started the step of delaying the chest closure.

"The dose of Levosimendan was adjusted to 0.in." Zheng Ren said, the Xie Yi people have handed over the child-type sternal spreader.

Zheng Ren replaced the adult sternum spreader with a small child type, and then observed blood pressure, central venous pressure, heart rate and heart rhythm, cardiac contractility, and pulse oxygen saturation at the same time.

His hand slowly changed the sternal stretch, looking for the best for blood pressure stability, heart rate does not slow down or significantly increased, no ventricular arrhythmia, decreased CVP, strong myocardial contraction, no cardiac expansion, and increased oxygen saturation s position.

"Boss, you are too fine." Su Yundao, "It is not necessary to perform surgery in millimeters, the heart-thoracic operation is rugged!"

仁 Zheng Ren smiled. Su Yun's rough estimate was different from others' understanding.

"The more accurate position is, the faster the postoperative recovery. If there is no accident, the edema can gradually subside in 2-3 days, and the old Zhao can close his chest in about 5 days." Zheng Rendao.

云 Zhao Yunlong lowered his head, watching intently the way Boss Zheng moved the child-type sternum spreader.

Every angle, every distance, every action has a saying, but Zhao Yunlong knows that this is a kind of instinct formed by rich surgical experience, for fear that boss Zheng himself could not explain it.

I still look carefully, go back and think carefully, if you have the next opportunity, you can try to do it, Zhao Yunlong thought.

Place the pericardium and mediastinal drainage tube, and seal the incision and spreader with a sterile transparent surgical film.

送 "Send it to the ICU." Zheng Ren turned and stepped down, and then turned back and asked, "Lao Zhao, do you often do delayed chest closure surgery?"

"Occasionally, very rarely. But Icu's doctors and nurses have experience, Boss Zheng is assured." Zhao Yunlong knew what Zheng Ren asked for this, and he answered immediately.

行 "Yes, that's it."

Even if the chest is delayed, the completion of the operation has reached the level of 101%, Zheng Ren said he is very satisfied with it.

The patient should be fine.

"Boss Zheng, thank you." Director Lang bowed deeply and said softly.

"You're welcome." Zheng Rendao, "IABP should not be used, this time I have experience, I will not make this mistake next time."

"Next time ..." Director Lang muttered.

"Huh?" Zheng Ren heard something in Director Lang's words and gave him a puzzled glance.

But Director Lang did not continue to say anything, but asked, "Boss Zheng, isn't IABP very symptomatic? Every time I encounter a similar situation, I use IABP to solve it."

"Can't be too dogmatic." Zheng Rendao, "Clinically judge the early symptoms of pericardial tamponade, and then immediately perform emergency measures such as pericardial puncture and drainage to alleviate. At this step, your treatment is okay, and it is great."

Seeing that Director Lang's mood was wrong, Zheng Ren did not over-stimulate him, but praised him rarely.

"We did not see the common situation of pericardial tamponade caused by hemorrhage caused by coronary perforation during the operation. It is said that even if there is pericardial puncture and drainage, this situation is more or less rare."

"Boss Zheng, it was caused by the rupture of the small branch." Director Zhang Lin asked.

"It should be, it can also be considered that the small branch is ruptured. As the pericardial pressure increases, the damage point has healed." Zheng Rendao, "Luck is indeed worse, in fact, this patient may be better if he does nothing. Some ~ www.novelhall.com ~ Director Lang was speechless, and the words of Boss Zheng made him feel ridiculous.

The absurd black comedy style and nonsense words are not suitable for the operating room, and Director Lang said it was unacceptable.

"But I think it is more likely because the patient is older, and his main reason for the pericardial tamponade is the highly congestive swelling of the myocardium, not the pericardial hemorrhage." Zheng Ren explained, "My analysis should be on you. Cardiac edema due to widespread myocardial infarction during PCI. "

"Myocardial edema is severe in the early stage of myocardial infarction, and its left coronary advantage, the larger scope of myocardial infarction, leads to this special change."

"In other words, it is not the pericardial tamponade caused by coronary rupture and bleeding, but the pericardial tamponade caused by acute necrosis and exudation."

"In this rare case, all the operations you did after Director Lang were wrong." Zheng Ren finally told the truth.

"Although the IABP measures adopted have reduced the patient's ventricular afterload, they have not reduced the pressure on their own pericardium in time, so the symptoms are getting heavier."

"..."

Director Jilang listened to Boss Zheng's condition about the patient's condition, and his judgment on the patient's condition was not the small coronary artery rupture and bleeding that Director Zhang Lin said before, but it was another complication.

Suddenly, Director Lang was a little stunned.

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