Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Chapter 199 One patient after another!

Seeing that the patient is awake now, the blood oxygen saturation has reached about 95, and the vital signs are still stable.

Only then did Lin Yi explain to Wang Qiaoya and the others how the patient fell into a coma.

"First of all, the patient's head does not have any trauma, and the pupils are equal and the reflex is normal, so coma caused by head trauma is basically ruled out."

"Look at his right side of the chest again. There is a crepitus to the touch. This is a manifestation of subcutaneous emphysema, indicating that the patient has a rib fracture on the right side."

"Moreover, there is a drum sound on percussion, but no breath sound on auscultation. What does this mean? It means that this patient has a pneumothorax."

"And his sudden coma was caused by tension pneumothorax!"

Having said that, Lin Yi glanced at Wang Qiaoya and Chen Qiang.

"Tension pneumothorax, do you know?"

Chen Qiang lowered his head and pondered for a moment, then shook his head and said:
"do not know."

Wang Qiaoya blinked and said:

"Tension pneumothorax, also known as hypertensive pneumothorax."

"Common rupture of larger alveoli, or larger and deeper lung lacerations or bronchial rupture."

"The opening communicates with the pleural cavity and forms a valve, so when inhaling, air can enter the pleural cavity through the opening."

"When you exhale, the valve closes, preventing the air in the cavity from going back into the airway to be discharged."

"In this way, the air accumulated in the pleural cavity continues to increase, and the pressure continues to rise, compressing the injured lung and causing it to gradually collapse.

"It pushes the mediastinum to the healthy side, squeezes the lung of the healthy side, and creates a serious obstacle to respiratory and circulatory functions."

"Sometimes the high-pressure gas in the pleural cavity is squeezed into the mediastinum and spreads to the subcutaneous tissue, forming subcutaneous emphysema in the neck, face, chest, etc."

Lin Yi couldn't help but nodded slightly, it seemed that Wang Qiaoya's theoretical knowledge was indeed in place.

But then, he couldn't help saying to Wang Qiaoya:

"Although you have memorized the definition of tension pneumothorax quite clearly, you must master it thoroughly and use it in real terms."

"You encounter this kind of patients, but you don't know how to deal with them. Otherwise, no matter how good you memorize the definition, what's the use?"

Wang Qiaoya couldn't help but nodded in agreement.

Indeed, her current situation is that her theory is in place, but she has no actual combat experience.

When you really meet a patient, even if you know the knowledge of the disease, you can't judge it, and it's still useless.

But she is just a regular trainee, and she really has little clinical experience, so there is no way around it.

So she will follow Lin Yi more in the future and strengthen her practical study!
These emergency patients are valuable learning experiences for her.

The patient had just improved, and the ambulance brought another patient with an open comminuted fracture of the left thigh.

His left thigh was a bloody mess, and his left lower limb had been bent at a strange angle.

"This patient injured the femoral artery, and he is bleeding very badly now, please come and rescue him quickly."

The emergency doctor pushing the patient, shouted.

Now every doctor has patients.

Lin Yi happened to have a little free time, so he asked Wang Qiaoya and Chen Qiang to look at the patient with tension pneumothorax just now.

And he went to see patients with massive bleeding by himself.

The patient's injuries were serious, but he didn't cry out in pain. He was obviously in shock, and the bleeding had to be stopped as soon as possible, followed by a blood transfusion.

Lin Yi gently picked up a cotton pad pressed on the wound and inspected the wound.

A blood arrow shot out immediately.

Lin Yi quickly suppressed it again.

"He injured his femoral artery and has to be operated on ASAP!"

The emergency doctor said quickly.

In this patient's case, the entire left thigh was comminuted.

And skin, muscle, blood vessel and nerve damage are particularly serious.

His femoral artery was directly broken.

If only the general bandage hemostasis method is used, the femoral artery bleeding cannot be stopped at all.

Either go to the operating table immediately and give him surgery.

But judging from the current situation, it is unrealistic to immediately go to the operating table for surgery.

Because there are not enough people, everyone is busy.

Even now, no medical staff is idle.

But ambulances are still coming here, bringing patients here.

How can we spare personnel to go to the operating table for surgery?
Generally, it can only be dealt with briefly temporarily.

Once it involves major surgery that requires more than two medical staff, it is possible to wait until all trauma patients are completely stable.

Certainly not right now.

Wanting to stop the bleeding of this traumatic patient with a ruptured femoral artery as soon as possible, Lin Yi thought of a way.

He wants to do REBOA for the patient!

REBOA stands for resuscitating balloon occlusion of the aorta.

At present, this is the only way to prevent femoral artery bleeding.

"I need catheter, 14 gauge needle, arterial blockage occlusion balloon. 20ml saline, hurry up."

After thinking about the countermeasures, Lin Yi immediately told the nurse what he needed.

The nurse at the side hurriedly took all these things over.

Afterwards, Lin Yi disinfected the root of the patient's left thigh and prepared to puncture the femoral artery.

"What are you doing?"

The emergency doctor who helped was pressing the patient's wound.

Looking at Lin Yi's operation, he couldn't help asking in doubt.

"I'm going to give him resuscitative aortic balloon occlusion. Only in this way can he completely stop the bleeding."

"But now there is nothing ready-made, I can only make a simple one."

After Lin Yi finished speaking to him, he stopped talking nonsense and directly inserted the puncture needle into the common femoral artery.

It stands to reason that resuscitative aortic balloon occlusion requires ultrasound guidance to be performed accurately.

But now the situation is urgent, it is impossible to push the patient to do a color Doppler ultrasound.

However, with Lin Yi's expert-level surgical ability, he does not need color ultrasound guidance.

Because he is very familiar with the distribution of blood vessels in the human body, and can pinpoint the location through feeling!

Lin Yi inserted the puncture needle into the common femoral artery without any difficulty, and then implanted the catheter sheath.

A catheter with a balloon is placed, extending up to the abdominal aorta, and the balloon is inflated to hold it in place.

It's that simple!
Lin Yi said: "You can let go."

The emergency doctor and the nurse at the side looked at Lin Yi in disbelief.

They have been pressing the patient's left thigh tightly, not daring to slack off.

It wasn't until they heard Lin Yi say that it was all right, that they let go of their hands suspiciously.

Looking at the patient's femoral artery stump, no more blood flowed out at this time.

"Successful, it's amazing, Dr. Lin!"

The nurse praised sincerely.

The emergency doctor also cast admiring glances at Lin Yi.

In the ambulance, he pressed the patient all the way, and the bleeding continued.

As a result, Lin Yi completely stopped the bleeding in a few minutes, and he looked like a master.

Song Borui was rescuing a craniocerebral injury patient in the next bed.

However, he witnessed Lin Yi performing resuscitative aortic balloon occlusion the whole time.

Immediately amazed!

(End of this chapter)