This doctor has a system

Chapter 87 87. Explosive myocarditis 2
Another nurse started testing the device, which had to function properly before the balloon catheter could be inserted.

"The family members agreed." Guan Jiangpu called the nurse's station, "I'll ask her to sign now."

Gao Feng chose the right femoral artery as the puncture site. Logically, the skin should be prepared in the groin area first, but there is obviously no time at this time.

And student Wei Shuai is very strong, he has very little hair there, which is luck among misfortunes.

Gao Feng struck very quickly, and the nurse who was helping him was a little flustered at first, so Gao Feng had to slow down.

Firstly, a central venous catheter is inserted for the patient, and a dedicated continuous cardiac output (PiCCO) monitoring catheter is placed in the femoral artery. And PiCCO module connected.

Next is the measurement link, inject a certain amount of ice saline from the central vein, pass through the superior vena cava→right atrium→right ventricle→pulmonary artery extravascular lung water→pulmonary vein→left atrium→left ventricle→ascending aorta→abdominal aorta→ Femoral artery→PiCCO catheter receiving end.

The monitor can describe the entire thermodilution process as a curve, and then analyze the curve waveform. By continuously measuring the area under the aortic pressure waveform, the patient's continuous cardiac output can be obtained.

"Okay." Gao Feng was sweating a little, "Let's take a look."

A few nurses started to finish the work, and Wei Shuai was quickly and ruthlessly inserted the catheter by a beautiful nurse.

"Sit here and rest." A nurse moved a high round stool for Gao Feng, and she took a special look at Gao Feng's badge.

Guan Jiangpu just came back from signing at this time, and Wei Shuai's father was hanging up on the phone over there, so he could only try his best to comfort him for a while.

"Can it be saved?"

"Let's take a look. You sit there for a rest first, and I'll call you if you need anything." Guan Jiangpu didn't dare to give a positive answer. He was afraid that Wei Shuai's mother would ask again, so he turned around and left in embarrassment.

"Finished?" Guan Jiangpu, who returned to the Cardiac Intensive Care Unit, looked confused, "Done?!"

He looked around carefully and found no problem, "Brother, it's amazing." He was a little regretful, but unfortunately he didn't see the operation process. He can do it, but he is not very proficient and needs someone to explain it to him.

Gao Feng was still a little dignified, "The hemodynamics are still not stable, I guess we need to go to ECMO." He stood here and looked at it for a while, and according to the changes in the pattern of the intra-aortic balloon counterpulsation, the effect of the counterpulsation is not very good .

"Wait for Director Lu to come back and have a look." Guan Jiangpu asked the nurse to take some vasoactive drugs.

"Brother, your name is Gao Feng? Why haven't I seen you before?"

"I only came to work this year, so I came to you this time." Gao Feng focused on Wei Shuai's intra-aortic balloon counterpulsation graphic.

The system has not reminded him that the task is completed, and he gradually became restless.

Director Lu is a bald old man, this kind of image is very common in hospitals, his hair is even less than that of Director Pan in the Respiratory Department.

How to say that sentence: extremely clever.

The extremely (intelligent) Director Lu came late, "A patient in Shennei had a heart attack and was not rescued." He kept panting heavily, "How is this patient?"

"Has the intra-aortic balloon counterpulsation been applied?" He felt relieved, "Jump, you can do it. You always pulled me when you did it before. Now I'm not here, so you're doing very well."

Director Lu checked the pipeline, "Well, it's pretty good."

Guan Jiangpu was a little embarrassed, "Director, Dr. Gao from the Respiratory Department did it."

Director Lu was a little surprised. Respiratory doctors seldom do this. "Have you ever done it in sub-severe respiratory disease?" He looked at Gao Feng and said.

"Yes, Director." Gao Feng followed his words and replied, "Now the effect of this patient's counterpulsation is not very good, should he go to ECMO?"

Gao Feng will be a little impatient, and it may be meaningless to observe later.

Director Lu looked at the intra-aortic balloon counterpulsation graph again. The patient's oxygen saturation was not very good. He pondered for a while, "Come on, have the family members signed it? The cost must be discussed in detail."

This Extracorporeal Membrane Oxygenation (ECMO) costs about 6 yuan just to start it up, and the daily cost will be about 1 to 3 yuan, which is not affordable for ordinary people.

When it comes to elderly patients, especially those with poor financial conditions, Director Lu seldom mentions this to their family members, which is boring.

"The patient's family conditions are not bad, the key is this one son." Guan Jiangpu reported to Director Lu: "Just now the patient's father said that the treatment will cost as much as it costs."

"Prepare things!" Director Lu got ready.

"Let me do it, Director." Gao Feng knew that it was inappropriate to stand up at this time, but he didn't want to worry about it.

"I've done it many times before, and I'm very proficient." Gao Feng ignored everyone's slightly surprised eyes, "Director, you just need to hold me back."

"Alright." Director Lu hesitated for a moment.

After agreeing to Gao Feng, he regretted it a little, this young man, don't mess it up. "If something goes wrong, I'll take over right away." He said to himself in his heart.

"Then I'll help you." Director Lu came up.

The core parts of extracorporeal membrane oxygenation (ECMO) are membrane lung (artificial lung) and blood pump (artificial heart), which can provide long-term cardiopulmonary support for patients with severe cardiopulmonary failure and win precious time for critically ill rescue.

The principle is simple to say. When ECMO is running, blood is drawn from the vein, and then oxygenated by membrane lungs to expel carbon dioxide. The oxygenated blood can be returned to the vein (VV bypass) or to the artery (VA bypass).

Wei Shuai's situation is more suitable for VA bypass, which is a combined cardiopulmonary alternative.

Gao Feng quickly threaded the guide wire into the patient's blood vessel, and used three different types of dilators along the guide wire to establish vascular access. His hands were so flexible that Director Lu felt that there was a black shadow in front of his eyes.

"Slow down," he said.

Gao Feng slightly slowed down the speed, "Catheter!" After that is the most critical link of inserting the venous line.

In order to prevent the patient's blood from clotting and forming a thrombus, heparin should be injected continuously.Director Lu operated carefully, his hands were steady.

The movements of the two formed a sharp contrast, one fast and one slow, one moving and one still.

Guan Jiangpu on the side didn't know who to look at, "Wairi, what kind of thing is this?!"

After the femoral vein was catheterized, Gao Feng successfully inserted the catheter into the internal jugular vein.

Director Lu looked dumbfounded, this is too fast.He thinks his level is good, and this ECMO is not too difficult, but it is the first time he has seen such an artistic one.

"Look at the position with the color Doppler ultrasound." He whispered to Gao Feng, at this moment he suddenly became a little unconfident.

Although Gao Feng knew that he would not make mistakes, he still followed Director Lu's advice.

"very good!"

"Turn it on." Gao Feng said to the nurse.

After the ECMO machine started running, Wei Shuai's oxygen saturation immediately improved, and his hemodynamics gradually stabilized.

(End of this chapter)