Chapter 1852 Doctor's Responsibility
"The patient was diagnosed with pulmonary torsion before the operation. Because of the long course of the disease, when he was admitted to our hospital, his condition suddenly worsened." Su Yun began to introduce, "Old He, please turn down the voice of the song!"
Lao He pretended not to hear, and went to adjust the ventilator.
"Boss, tell me about Lao He." Su Yun was dissatisfied.
"A chest opener." Zheng Ren didn't hear it, and reached for the chest opener, stuffed it into the chest cavity, and began to screw the screws.
With a rattling sound, the chest cavity was opened. The size is just right, the ribs are elastic to the maximum, but there is no concurrent fracture.
"During the operation, it was found that the middle lobe of the right lung was shifted upwards and rotated about 170° counterclockwise. It is a very standard value, because it is written as 180° in various textbooks." Su Yunlianmai began to chatter, "Lung congestion can be seen with the naked eye. Seriously, ischemic lesions have appeared on the edge."
He knew why Zheng Ren was in such a hurry, because if he followed the steps, it might take 5 minutes to cause the edge of the necrotic area to die forever, making it impossible for ischemia and reperfusion.
And if it is completely necrotic, the blood perfusion after correcting the torsion will bring all the necrotic tissue into the blood circulation of the body.
Bacteremia or something, that's how it happened.
If time is too late and similar problems are found, direct resection of the lung lobe is the best choice.
How will the boss choose?
While Su Yun was nagging, he helped Zheng Ren.
His actions have to be delayed a little bit, because in the live broadcast of Lianmai, he cannot ask or communicate, and the quality of Lianmai is extremely high.
Zheng Ren didn't hesitate, he immediately started to loosen his right lung.
"Generally, for lung torsion, the surgical option is resection. However, our 912 emergency department has a high level of first aid, and we don't waste time. The patient's lung has not died yet, so we can choose to keep it." Su Yun said.
Ringer walked in, just in time to hear this sentence.
This sentence is like the Nine Heavens Sanskrit, which makes him happy. Boss Zheng did not forget to advertise the rhythm of the 912 during this live broadcast of the surgery.
"Old He, get ready!" Zheng Ren said.
"Ready."
With Su Yun's assistance, Zheng Ren twisted the middle lobe of the right lung to restore the original anatomical structure.
Lao He's fiberoptic bronchoscope with suction tube has already been inserted.
"The strength of anesthesia is very important. The anesthetist uses a fiberoptic bronchoscope to directly look at the sputum. Boss, give Lao He a shot." Su Yun said.
Zheng Ren raised his head and glanced at Lao He.
Lao He was happy in his heart, but without the slightest expression on his face, he sucked sputum with the fiberoptic bronchoscope seriously and attentively. Try to show the style of the great anesthetist he imagined, and strive for perfection.
"A large amount of plasma-laced phlegm was sucked out. I won't explain in detail why there is such a secretion." Su Yun said while starting to deal with the bleeding spots left by Zheng Ren when he just opened his chest.
Crackling, crackling, electric burns flying, touch the bleeding point, touch it and leave.
There is nothing to explain here, Su Yun said lazily, Fang Lin used the hemostatic forceps to cooperate with Su Yun to stop the bleeding.
Zheng Ren remained motionless, staring at the patient's right middle lobe of the lung.
"The surgeon is observing the blood supply of the patient's right middle lobe. From the looks of it now, the right middle lobe should be preserved." Su Yun stopped the bleeding while talking about what Zheng Ren was doing.
"Now I leave a question for you who are watching the live broadcast - in the next 20 minutes to 60 minutes, blood tests will be carried out continuously. What items do the surgeons need to check?" Su Yun said.
Fang Lin was also a little surprised, and after thinking hard, he asked in a low voice, "Brother Yun, do you want to check serum potassium and lactate dehydrogenase?"
"Well, after so many years, there is no tacit understanding at all." Su Yun sighed and said, "If you speak, anyone with good ears will hear you."
"..." Fang Lin lowered his head, and exposed Su Yun's blood vessels with a hemostat.
The small ones are burned directly, while the large ones need to be ligated.
Soon this side was dealt with, and the three of them stood on the operating table, nothing happened.
Before the start of the stage, I was very busy, and after opening the chest cavity to reset the middle lobe of the right lung, it changed from extremely dynamic to static.
This kind of operation is generally rare, and the most common is to wait for intraoperative freezing. In a well-trained hospital, 20-30 minutes from the pathology department is enough to produce the results.
But it's a bit weird to wait for the live surgery.
Taking advantage of the waiting time, Su Yun began to tell the patient's previous medical history with the singing of good luck.
His memory is excellent, and he only read the test sheet once in the thoracic surgery department before the operation, and he took it out and began to analyze it logically.
Time passed quickly, blood was drawn three times in a row, and the values of serum potassium and lactate dehydrogenase did not increase significantly.
Zheng Ren heaved a sigh of relief.
The patient's lungs should have been preserved.
"Serum potassium and lactate dehydrogenase are all fine, now the operator is starting to investigate." Su Yun began to say to Mai: "It's been an hour, and the operator finally moved! Friends who watched the live broadcast, do you have any traces?" A little excited?"
While probing the pulse of V4 and V5, Zheng Ren asked, "Are you also so out of tune when you were doing the live broadcast for Liu Xuzhi?"
"Boss, do you have to do surgery seriously? Friends, have you heard the background music? Taste it! It's hard to believe that the world's top surgeons like this song."
Zheng Ren didn't pay attention to this guy, he was broadcasting live, so he couldn't just hit him in the face with a hemostat, right?
Reach out, clap the needle holder in the palm of your hand.
Zheng Ren began to suture the middle and lower lobe of the right lung.
This is to prevent the right middle lobe of the right lung from twisting again after surgery. If the ligament is absent or weak, it should be fixed with other lung lobes.
"One hour after returning to normal physiological structure, the bloody sputum disappeared." Seeing that the suction tube in Lao He's hand only sucked out a small amount of white foamy sputum, Su Yun began to take out the fiberoptic bronchoscope, and explained.
"Why do we have to wait for an hour? The first thing to do is to see if the patient's right middle lobe of the lung can be preserved. I... the surgeon will not easily perform a simple and crude operation that causes great damage."
"Removing a lobe of the lung will cause a loss of about 20% of the patient's respiratory function. Although it will not affect life, it will affect the quality of life more or less."
"Waiting for one hour during the operation means that the quality of life of patients after surgery has been improved for decades."
"That's a doctor's job, isn't it, boss."
"Surgery, talk less." Zheng Ren felt that it was really unreliable to open the microphone, and it was fine for Su Yun to talk and laugh at ordinary times. But today when the mic is turned on, no one else speaks, only Su Yun speaks.
Originally, I didn't feel much about the singing of Good Luck, but today I feel that Su Yun's voice is mixed with the singing of Good Luck, which is very ear-piercing.
"In order to control airway secretions, the patient was mechanically ventilated for about 12 hours after the operation, and the patient's condition was observed before extubation."
"Because there may be thrombus remaining in the pulmonary vein stump, antithrombotic therapy with warfarin was given postoperatively."