super anesthesiologist

Chapter 133 Large area skin avulsion injury (please subscribe, please collect, thank you!!!)

Lin Xiaobei knew something was wrong when he saw Tian Peng's expression.He also leaned over to check, and felt a little puzzled at first, because he didn't see anything unusual.

Wearing gloves, Tian Peng gently pulled the skin of the patient's iliac crest.Lin Xiaobei immediately frowned.

The skin on the patient's back is mobile!
Seeing that Lin Xiaobei understood, Tian Peng was ready to start the operation.

"Tian Peng, don't move, don't move until the blood comes." Lin Xiaobei reminded.

The injury on the patient's back must be very serious, otherwise he would not go into shock.Without sufficient blood supply, do not easily explore unknown wounds, even if serious contamination may occur.

Because once the wound is opened, the bleeding will be more violent, and patients who are already in shock are likely to suffer sudden cardiac arrest.

But surgeons are often reluctant to think so.Doctors have a disease called "obsessive-compulsive disorder", that is, when they see a patient with a disease they are good at, they want to deal with it in time.

Tian Peng at this time is like this.He saw that the skin on the patient's back had detached from the muscle tissue, which meant that the avulsion injury on the patient's back must be very serious.

As a hand surgeon, I know very well that skin and soft tissue injuries will not be a single trauma, but usually compound injuries of blood vessels, nerves, fascia and tendons.At this time, two points are particularly important: whether infection occurs and the length of ischemic time.These two points almost directly determine the effect of surgery on prognosis.

Tian Peng was very anxious, and time was equivalent to life to him.And if you treat it early, the possibility of infection will be greatly reduced.

"Let's see what's going on first?" Tian Peng asked with luck.

"Don't look at it, don't move this patient without blood supply, it's really dangerous." Lin Xiaobei insisted.

"Negative value from Tian Peng, +50."

"I'll just take a look."

"No, don't look at it. You can see that as soon as you move it slightly, the patient's blood pressure drops drastically."

"Negative value from Tian Peng, +100."

"I won't make a fuss, just take a look." Tian Peng muttered.

Sometimes anesthesiologists are unkind, very unlikable, and that's why.

You think the patient's condition is very critical, and the priority is to save his life. If his life is gone, what's the use of other treatment measures, no matter how perfect they are?
But the surgeon always likes to take chances. Maybe he took the risk and dealt with it?Maybe the patient made it through?Once it is handled successfully, it will become a classic that others worship.

But they are seldom, and they are very unwilling to think about, what should the patient do if his life is in danger?It has to be said that the current tense relationship between doctors and patients has played a considerable role in restraining the risky behavior of surgeons.

Director Lin Chaobing once said that when he first learned anesthesia, he didn’t even have a monitor or an electric knife, so the surgeon dared to perform heart valve repair surgery. Even the general surgeons who don’t have a lot of blood loss don’t dare to do it...

Tian Peng said that he just wanted to see what was going on, but once Lin Xiaobei let go and saw the specific wound, his obsessive-compulsive desire to continue dealing with it would become even stronger.

"See what it can do? You just wait for the blood source to come and do it together. Now unless I am not in charge of the anesthesia for this operation, none of you can move without the blood coming. Whoever moves will be responsible for the accident." Lin Xiaobei's attitude was very tough.

This is the quality he should possess as an attending doctor, and he is not afraid of offending others.No matter how good the personal relationship with Tian Peng is, it won't work. At this time, there is no sympathy.

"Negative value from Tian Peng, +100."

"Negative value from Guo Peng, +50."

"From..., +50."

Several doctors in the audience frowned, their dissatisfaction was palpable.

At this time, the atmosphere in the operating room was very dull and depressing, and Lin Xiaobei kept receiving wave after wave of negative values.But he didn't change his face and remained unmoved.

……

The waiting blood source finally arrived in 30 minutes, with 6 units of suspended red blood cells.Although it is far from enough, it can relieve the urgent need.

"Shall we start?" Tian Peng asked impatiently.

"Okay." Lin Xiaobei told Liu Qin to prepare for a blood transfusion. It would be good to transfuse 2 units first to supplement the blood.

Immediately turn the patient over to the prone position.

Lin Xiaobei and Liu Qin checked the blood samples, and suddenly they heard exclamations from the stage.

Lin Xiaobei took a look, even though he had a lot of knowledge, he couldn't help but take a few breaths.

Tian Peng has already cut all the bed sheets of the patient, so the injury on the patient's back is completely exposed.

The patient's skin from the buttocks to the rib waist (about the position of the 12th rib) was completely torn off into a piece of human skin, and it was incomplete.Where there is no skin covering, the muscles, blood vessels and fascia are completely exposed, bloody and shocking.

It is estimated that it was due to the compression and bandage in the supine position just now, and the bleeding from the wound was not obvious.But this does not mean that the bleeding is not serious. In fact, even with such a large wound, even if it oozes blood, it is a terrible hemorrhage.

Tian Peng lifted up the remaining skin, and the equipment nurse on the stage couldn't help but look away.

During Tian Peng's process of washing the wound, the patient's blood pressure quickly dropped to 75/42mmHg. After boosting the blood pressure, expanding the volume, and blood transfusion, the three major measures were combined, and it took a few minutes to rise back to 102/58mmHg.

If there is no timely blood source replenishment, the consequences will be unimaginable.

Human blood vessels are like a river, and red blood cells are like boats driving in the river, transporting important substances absorbed to various tissues of the body in a timely manner.

Although a large amount of rehydration can also expand the capacity, it cannot solve the fundamental problem.It's like drinking water when you're hungry.

Anesthesiologists are responsible for saving lives, which not only refers to the first aid skills of anesthesiologists, but more often to the maintenance of the patient's vital signs.

Tian Peng muttered while washing, as if complaining that Lin Xiaobei didn't let him do it earlier.

"The patient's vital signs are okay now?" he asked resentfully.

To him, missing first aid was murder.But he didn't know, sometimes he was impatient and couldn't eat hot tofu.He saw that the vital signs of the patient on the monitor were close to normal, that was the result of Lin Xiaobei's timely treatment.

After rinsing, the problem now is how to deal with such a huge wound.

Lin Xiaobei, as an anesthetist, has no right to interfere with the surgeon's operation.But you can give them advice to minimize the bleeding in the book.

At this time, there is no need to consider what kind of suture is the most beautiful for the patient, nor can we pursue the most trouble-free surgical method.

The goal of any surgery is to minimize bleeding during the operation and to first let the patient get through this difficult time.Even if the effect of the surgery is not good, you can have multiple surgeries later.

Nowadays, many traumas do not advocate one-time treatment, but advocate multiple treatments, especially in the replantation of severed limbs.

Tian Peng meant to simply pressurize and bandage first, while Lin Xiaobei suggested that he use hemostatic gauze to block the obvious bleeding area first, and then treat it in small pieces like silkworms eating mulberry leaves.

Lin Xiaobei's meaning was obvious, whatever method should be used to deal with less bleeding.Tian Peng's simple pressurized bandage will spread out the entire wound like swallowing dates. Although there will be no bleeding after the bandage, a series of treatments before the bandage will aggravate the bleeding of the wound.

Tian Peng's face was clouded again. As a friend and colleague, it was inconvenient for him to get angry on stage, but Lin Xiaobei kept getting negative points from him, so he knew that he seemed calm, but was actually extremely upset inside.

　I am working hard, thank you for enjoying the cup of milk tea.

　　If you haven't had the first cup of autumn, can't you catch up with the last cup?

　　
　
(End of this chapter)