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

Chapter 272 Surgical trio!
Lin Yi looked at her and said:
"Ma'am, your condition does not necessarily mean stomach pain. I still suggest that you continue to have a CT scan after the symptoms are relieved."

"Okay, doctor, thank you."

After the signs stabilized, the female patient was transferred to the observation room.

Lin Yi returned to the office and told Wu Jiang and Yin Liang about the patient.

After Yin Liang finished listening, he pointed to the text on the medical record and showed it to Lin Yi, and said:

"I made an incision in the chest, put the aorta and superior and inferior vena cava into the catheter, connected to the artificial heart-lung machine for extracorporeal circulation, and then replaced the heart valve... Well, there is no problem so far, so the problem is Where is it?"

Lin Yi frowned, staring at the medical records on the table.

Twenty minutes later, Yin Liang suddenly jumped up from his chair, ran to Lin Yi, and showed Lin Yi the medical records.

"I know! Brother Yi, I know, I know the reason..."

At this time, Nurse Zhang rushed over in a panic and said to Yin Liang.

"Doctor Lin, the patient's condition has recurred again."

"What? Repeatedly?"

Afterwards, Yin Liang and Lin Yi hurried to the observation room.

"Doctor Lin!"

Nurse Zhang pointed to the hospital bed where the patient was lying.

"hematuria!"

Following the direction of nurse Zhang's finger, Lin Yi saw that the patient's pants were dyed red, and the red liquid even spread on the bed sheet.

The problem got serious.

"Patient, have you seen anything like this before?"

"It happened to me before, but I came to the emergency room because I had trouble urinating."

In the middle of the conversation, the patient suddenly experienced shortness of breath.

"Doctor Lin, the patient's blood oxygen saturation has dropped to 81%, and the blood pressure is also dropping."

"Another ampoule of norepinephrine diluted in normal saline, and a diuretic!"

"receive!"

Nurse Zhang replied.

"Oxygen is inhaled with the upper mask, and the oxygen flow rate is 10L/min."

"OK."

The oxygen saturation of normal people is between 90% and 95%, and problems will occur if it is lower than 90%.If it falls below 80%, it is a very urgent situation.At present, the patient's blood oxygen saturation is 81%, and the situation is not optimistic.

"What happened?"

The figure of Zhou Chao appeared in the observation room.

"Director Zhou, the patient's blood pressure is dropping, and norepinephrine has been given. In addition, the patient's urine output is less than 5cc/hour, and diuretics have been added. Also, the oxygen saturation has dropped to 81%, so I am wearing it now. Oxygen masks."

Lin Yi introduced the current situation of the patient to Zhou Chao.

"Has the patient had an arterial blood gas test?"

Zhou Chao asked while checking the patient's condition.

"pH7, PaCO46mmHg, SaO61%"

Yin Liang took the patient's test sheet and handed it to Zhou Chao.

Zhou Chao looked at the test sheet, and then said:
"If the patient's signs are stable again, I suggest to observe again."

Then, the three of them walked out of the observation room.

"Wait a moment!"

Lin Yi on the side shouted to Zhou Chao.

"Director Zhou, the patient has had hematuria, and look!"

After Lin Yi finished speaking, he pointed to the patient's abdomen.

"The patient's abdomen was also unusually swollen."

Yin Liang and Zhou Chao followed the direction of their fingers and saw that the patient's abdomen was indeed slightly swollen.

"What is your opinion?"

The current Zhou Dynasty listens to Lin Yi's opinion very much.

After all, I have seen too many miracles and inconceivable things in Lin Yi.

"Could the patient have acidemia?"

Lin Yi threw out his own ideas.

"Acidemia?"

Zhou Chao looked at Lin Yi and asked.

"Yes, if the guess is correct, then the patient is very likely to develop multiple organ dysfunction syndrome within a few days, leading to septic shock and death."

"This...how could this be?"

Zhou Chao's voice trembled slightly.

"Because of double valve replacement."

Lin Yi said in a low voice.

"Double valve replacement?"

Zhou Chao stared at Lin Yi with wide eyes.

"It is very likely that the blood clot is dislodged because of the catheter placed in the left atrium. Normally, the blood clot in the left atrium may dislodge, so the catheter is rarely inserted into the left atrium now. Instead, it is directly cut Safer. Of course, I admit it would have been easier to cannulate the left atrium. However, I looked at the surgical notes and it was recorded that the catheter was inserted into the left atrium and an incision was made...”

"Where was the surgery performed?"

"Our courtyard..."

"Who is the chief knife?"

Lin Yi squeezed out two words:
"Song Wei."

"Song Wei?"

Zhou Chao asked Lin Yi in disbelief.

"Yes."

"Is it a doctor..."

Zhou Chao did not say that word.

Of course Lin Yi knew what Zhou Chao was going to say, he shook his head:
"Director Zhou, I don't think the actual situation is what you imagined. After all, Song Wei is also an expert in thoracic surgery, so there will be no such low-level mistakes."

"I suspect that a catheter placed in the left atrium during surgery accidentally dislodged a blood clot that happened to create an obstruction in the bowel. So that's why the patient had hematuria and bloating, plus a drop in oxygen saturation. You see Had the arterial blood gas results, so you know there's some truth to what I'm saying. I think if the next step is to give the patient a colonoscopy, there's a very good chance that an ischemic injury will be found…"

"But……"

Zhou Chao couldn't help hesitating.

"The focus now is not to study whether it was accidental or man-made, but to treat the patient as soon as possible. As time goes by, the patient's organs are gradually necrotic. Therefore, we should perform surgery on the patient as soon as possible to remove the necrotic area. Otherwise, it will be very difficult for patients to survive this level."

After saying this, Lin Yi looked at Yin Liang and said:

"I'm sure you'll all support me."

Yin Liang nodded immediately.

"Yes! We will help you. But don't we really need to inform Song Wei about this?"

Zhou Chao also said to Lin Yi.

"I'll get in touch with him, but he certainly doesn't have time to think about that right now..."

Lin Yi couldn't help but said helplessly.

"why?"

"I asked, he went out to investigate, and he won't come back for a while."

"All right."

Zhou Chao nodded.

At this time, the ear-piercing alarm of the ECG monitor in the observation room sounded again.

The three returned to the observation room in a hurry, and the situation of the female patient was repeated again.

"The patient has repeated symptoms and can't wait for Song Wei anymore. Prepare the operating room immediately, and we will operate on the patient!"

After speaking, Lin Yi, Yin Liang and Zhou Chao pushed the patient's stretcher to the operating room.

In the operating room, Lin Yi, Yin Liang, and Zhou Chao went into battle together.

The anesthesiologist said to Lin Yi:

"Doctor Lin, the patient's general anesthesia has been completed."

"Okay, please check the patient's signs at any time."

"The patient is breathing normally, with a body temperature of 37 degrees and a slight fever. The blood pressure is 3/100mmHg, the heart rate is 75 beats/min, the oxygen saturation is 72%, and the oxygen flow rate is 81L/min. Although the patient's blood pressure is a bit low, I think the operation can be performed. "

The anesthesiologist gave advice after checking the patient's signs.

"Okay, thank you for your hard work."

After Lin Yi confirmed, he looked at Zhou Chao and Yin Liang again.

"Now that everything is ready, let's check the colon of the patient first to make sure that our judgment is accurate, and we will perform a colonoscopy first."

As the endoscope moved into the patient's body, Yin Liang and Zhou Chao looked nervously at the monitor.

"Wait a minute! Lin Yi, look at this."

Zhou Chao narrowed his eyes and pointed to somewhere on the monitor.

"About 11cm from the entrance to the colon, there are severe ulcers in this part of the colon, as if some parts have been necrotic."

Zhou Chao's words made all three of them nervous.

"Should a biopsy be done?"

Zhou Chao said with a solemn expression.

"There is no time. The patient's condition is very unstable now, and he may not be able to wait for the results of the biopsy. Besides, it is easy to cause massive bleeding, so he does not meet the conditions for biopsy."

Lin Yi rejected Zhou Chao's suggestion.

"Besides surgery, we have no choice now. We can basically confirm that the patient is ischemic colitis, but fortunately, I don't think the patient has any ulcers in the rectal part, which is also a blessing in misfortune."

Ischemic colitis is a group of syndromes caused by vascular occlusive or non-occlusive diseases of the colon, with insufficient blood supply to the colon as the main symptom.Ischemic colitis is mostly caused by non-occlusive ischemia of the middle colic artery of the superior mesenteric artery and the right colic artery.A small number are caused by occlusive ischemia caused by tiny emboli or thrombosis.Sub-gangrenous type, a type and narrow type.

"Okay, since you all agree with the treatment plan, let's start. The purpose of the operation is to first remove part of the patient's necrotic small intestine and part of the large intestine."

Lin Yi looked up at the clock hanging on the wall, and then announced the start of the operation.

After the disinfection was completed, Lin Yi stretched out his hand and used a scalpel to cut open the patient's abdomen accurately and skillfully.

"Sure enough, both the upper and lower colons seem to have a tendency to become necrotic. But fortunately, the scope is not very wide at present, as long as the necrotic part is removed."

After opening his stomach, Lin Yi relaxed a little.

"Sweat!"

Nurse Zhang picked up a piece of clean gauze and wiped the sweat off Lin Yi's forehead.

Soon, Lin Yi went to take out the patient's necrotic colon, with precise movements without any mistakes.

"Resect about 80cm of necrotic bowel, the next step..."

"Bleeding!"

Before Lin Yi finished speaking, a gust of blood gushed out.

"Open a vein, and the suction device cleans the abdominal cavity!"

"Seeing the amount of bleeding may be a broken vein."

Without saying a word, Lin Yi directly stretched his hand into the patient's abdominal cavity.

"Stop it."

"Nurse Zhang, please give me the 9-0 thread, I need sutures."

As Lin Yi judged, it was indeed a vein with an ulcer that was damaged under abdominal pressure.Fortunately, with Lin Yi present, the bleeding was stopped in an instant, and no gas embolism occurred.

Afterwards, Lin Yi quickly clamped the opening with separating forceps, then lifted it gently, and quickly sutured and tied the knot with 9-0 suture.

"Sewn up."

"Brother Yi, fast enough!"

Yin Liang gave Lin Yi another thumbs up.

After stopping the bleeding, Lin Yi carefully checked the patient's abdominal cavity. There was no bleeding, ulcer or gauze.

"Close your belly and prepare to enter the second stage."

The second stage of the procedure involved clearing the catheter of the patient's left atrium from an accidental blood clot.

Yin Liang looked up again at the clock hanging on the wall, and the time had passed nearly two hours.

"Prepare for extracorporeal circulation."

With Lin Yi's order, everyone in the operating room became busy.

Extracorporeal circulation is a life support technology that utilizes a series of special artificial devices to drain the returning cardiac venous blood out of the body, conduct gas exchange through artificial methods, adjust the temperature and filter, and infuse it back into the arterial system in the body.In the process of extracorporeal circulation, because the artificial device replaces the functions of the human body, it is also called cardiopulmonary bypass, and the extracorporeal circulation machine is also called an artificial heart-lung machine.

The purpose of extracorporeal circulation is to separate the heart from the circulation and perfuse cardioplegia in most cases, so that the surgical field outside the heart is basically free of blood, and other end-organs are fully oxygenated and perfused. Perform surgery.

"incision."

After Lin Yi finished speaking, Yin Liang handed the high-frequency electric knife to Lin Yi.Then Lin Yi made an incision slightly below the sternal notch and about 5cm below the xiphoid process.

After more than an hour of intense surgery, Lin Yi's physical strength did not show any signs of decline, and his hand holding the scalpel was still very stable.

Yin Liang looked up at Lin Yi who was concentrating on operating the high-frequency electric knife. Sweat continued to flow from his forehead.

"Nurse Zhang, please wipe Dr. Lin's sweat."

Nurse Zhang quickly wiped the sweat off Lin Yi's forehead with gauze.

"Saw the breastbone."

As the second assistant, Zhou Chao had already prepared by the side with an electric bone saw.

Lin Yi used an electric knife to incise the patient's sternal periosteum along the middle, and then continued to dissect the xiphoid process and separate the retrosternal space.

Subsequently, Zhou Chao immediately cut the sternum longitudinally along the midline with an electric bone saw.

"Lin Yi, stop the bleeding!"

Lin Yi quickly used electrocoagulation to stop the bleeding of the periosteum, and then used bone wax to stop the bleeding of the sternum.

"Yin Liang, come here."

I saw that Yin Liang made a longitudinal midline incision of the pericardium, up to the reflexion of the ascending aorta, and down to the diaphragm.In addition, an incision was made on both sides of the lower part of the incision, and then the pericardial incision margin was sutured to the soft tissue outside the bilateral sternum.Immediately afterwards, the sternum was opened with a spreader to expose the patient's heart.

"call……"

After Yin Liang finished all this, he let out a sigh of relief, at least he has entered the next stage.

"Extracorporeal circulation can be established."

After Lin Yi finished speaking, the extracorporeal circulation system was quickly established.

"The system is functioning normally."

With the work of the extracorporeal circulation system, the surgical field of the heart is also cleared.

"Nurse Zhang, wipe off your sweat."

Lin Yi's whole body was drenched with sweat, and every movement was dripping with sweat.

Nurse Zhang took the gauze and wiped Lin Yi's sweat over and over again.

"From now on, I will remove the remaining clots for the patient."

With continuous exploration, it was found that there were still residual blood clots in the patient's left atrium, and Lin Yi carefully took out the blood clots one by one.

"Director Zhou, clamps. Yin Liang, saline, aspirator, clean up the surgical field."

(End of this chapter)