super anesthesiologist

Chapter 34 Teacher Lin, how did you do it?
The heart has atria and ventricles.The atrium recycles blood from all parts of the body, which is equivalent to a container; while the ventricle pumps the blood recovered from the atrium, which is equivalent to a power pump.The beating of the heart is not a whole beating. It starts from a part called "sinus node" and spreads from the atrium to the ventricle, like a doromi, one ring after another, and it will never stop until the end of life.

Bigeminy is a normal heartbeat plus an advanced beat, which interferes with the normal heartbeat, just like people behind in line suddenly jumping in front.

In most cases, this advanced beat will not affect the pumping function of the heart, just like the people who jump in line will not have much impact on the entire team.But for patients with a history of heart disease, the risk of this arrhythmia is magnified exponentially.

A downward shift in the ECG ST is a typical manifestation of myocardial ischemia, which is also consistent with the negative effects of bigeminy.

"Dean Li, please pause." Lin Xiaobei shouted.

"What's the matter?" Wang Xuguang hasn't found the problem yet.

Dean Li and his assistant also looked puzzled.

"That patrolling sister, please help me to see how much blood is coming out now?"

The itinerant nurse bent down, fiddled with the suction device, and stood up after a while, "About 600ml."

"600ml?" Lin Xiaobei muttered, why did he suddenly bleed so much?

Under normal circumstances, such an operation in the Affiliated Hospital of S University will not exceed 300ml, but Dean Li and the others have only done half of it, and there will be more bleeding later.

"We don't have an ultrasonic knife like yours, and we don't have hemostatic gauze." Wang Xuguang said in a low voice.

It turned out that Dean Li and the others used old-fashioned electric knives and ordinary gauze, so his hemostatic effect is not bad.

The scalpel has undergone several major changes, from the original iron blade to the alloy blade, then the electric knife was invented, and then the ultrasonic knife.

The advantage of the electrosurgical knife is that it can stop bleeding, but it is easy to cause leakage during the operation and cause severe burns. Especially the old-fashioned electric knife does not have much advantage over the alloy blade.

What is popular now is the ultrasonic scalpel, which is a favorite magic weapon of surgeons. It not only has good hemostatic function, but also causes less damage.It is very popular in large hospitals.

The only disadvantage is that it is too expensive, and it needs to be equipped with corresponding instruments and equipment, which can cost millions of dollars for any set.

Dean Li and the others don't even have hemostatic gauze.

This kind of gauze is different from ordinary gauze pieces. It is rich in thrombin, so it can quickly seal the capillaries when it is pasted on the wound surface, and it has a very good effect on bleeding from the wound surface.

What really causes excessive blood loss during the operation is the seepage of these microvessels. Although it is not obvious, it is continuous. After a long time, it will cause fatal hemorrhage, which is the same as boiling a frog in warm water.

Hemostatic gauze is also extremely expensive, costing more than 500 per piece.Ordinary gauze is only a few yuan a piece.

"Principal Li, you should press it with gauze first." Lin Xiaobei suggested.

No matter how critical his operation is, saving the patient's life is the most important thing.At this time, he may be able to remove the tumor soon, but Liu Gensheng may not be able to bear the loss of hundreds of milliliters of blood after a wave of operations.

It is necessary to slow down first to reduce the patient's continued bleeding.

Another very important point is to correctly handle the abnormality of the patient's electrocardiogram as soon as possible to prevent coronary heart disease. Acute myocardial infarction during the operation can be troublesome.

"Do you have nitrate sustained-release tablets here?" Lin Xiaobei thought there must be, right?It's not an expensive drug either.

"I don't have it here. I wonder if the internal medicine department has it." Wang Xuguang scratched his head and said.

"Ask!"

He made a phone call and said, "Yes, ask them to deliver a box, it'll be right away."

Waiting is the most tormenting, especially when the patient's condition is slowly deteriorating, the feeling of being helpless is simply overwhelming.

The patient's electrocardiogram showed that the condition had changed from bigeminy to atrial fibrillation, and the waveform was jagged and jagged.Atrial fibrillation is the systolic fibrillation of the atria. The atria draw back peripheral venous blood through diastole, and then contract and squeeze the sucked blood into the ventricles, and then the ventricles pump out to various tissues throughout the body.

When the atrium contracts, the fibrillation is essentially contraction weakness. It is doing useless work. It not only increases the oxygen consumption of the myocardium but also fails to transport the blood from the atrium to the ventricle. Doctors often call this situation "heart failure".

The most deadly factor of atrial fibrillation is not the insufficient blood supply to the myocardium, but the formation of thrombus in the local area due to poor blood flow. This kind of thrombus is not fixed, but it is migratory, and follows the blood like a ghost. The flow is floating around, and once an important blood vessel or organ is blocked, it is easy to be life-threatening.

Wang Fan, the former Bayi women's basketball player, died of pulmonary embolism. Acute pulmonary circulatory failure occurred after the pulmonary artery branch was blocked by venous thrombosis in the lower extremities.

Wang Xuguang's hospital is so small, and the box of medicines from the internal medicine department should arrive quickly, but Lin Xiaobei felt that the waiting time was too long.

The patient's vital signs could not wait any longer, and the heart rate of atrial fibrillation jumped to 130 beats/min.The heart is violently doing useless work, just like a drowning person struggling in vain in the river, but it is even more detrimental to itself.

"Wang Xuguang, call your nurse to draw blood and check the myocardial enzyme spectrum." Based on his feeling, Lin Xiaobei judged that Liu Gensheng had suffered a myocardial infarction, but he needed an objective diagnostic evidence, so he could explain it to the patient's family.

The electrocardiogram continued to change. Although there was no Q wave, the ST segment was slowly rising, and an upright T wave appeared!
"Do you have a cardiac catheter here?" Lin Xiaobei asked.

"How can we have such advanced things here!" Wang Xuguang was not in a hurry, he hadn't realized that the patient's life was on the verge of danger.

"This patient has already suffered a myocardial infarction." Lin Xiaobei said coldly.

Everyone, including Dean Li, looked at him in horror.

No matter how poor a doctor is, he also knows what "myocardial infarction" means, especially in a rural hospital of their level.

The most important thing to do at this time is to transfer the patient to another hospital immediately.But half of the operation has been done, and the bleeding is still going on. Which hospital is willing to accept such patients?

Even if the higher-level hospital agrees to accept it, it will definitely assign responsibilities clearly, and it will be Dean Li and the others who will bear the responsibility at that time.

Moreover, if the patient is transferred out in this state, he may die on the way before reaching the hospital.

"Then what should we do?" Wang Xuguang asked with a mournful face. He was full of confidence at first, but now he was completely panicked.

"Do you have any materials that can be used as guide wires?" Lin Xiaobei asked.

"We don't do intervention, where does the guide wire come from?"

Neither this nor that, Lin Xiaobei secretly annoyed.Through the analysis of the electrocardiogram, he has roughly determined the cause of Liu Gensheng's myocardial infarction and the location of the coronary artery blockage, but he can't do anything without equipment. He can't put his hands into the patient's chest to pull out the thrombus, right?
"Mr. Lin, do you think this will work?"

Lin Xiaobei saw that Wang Xuguang took out a central venipuncture kit from the anesthesia cart.

"So you have this!" He said happily.

"I made this when I was studying in your hospital." Wang Xuguang was a little embarrassed.

What he said "make" is actually stealing.Almost all advanced students have this common problem. They secretly hide and steal something they like when they are studying in a big hospital.

For this phenomenon, the heads of anesthesiology departments in various hospitals turn a blind eye.These advanced students study for half a year or even a year and have contributed a lot to the department. As long as it is not expensive equipment such as ultrasound and bronchoscope, they will pretend not to know.

Most people like to steal laryngoscopes, laryngeal anesthesia tubes, pressurizers, etc. Few people steal such puncture kits.It is too bulky to hide easily.

"Hurry up and prepare heparin water." Lin Xiaobei ordered, of course he would not pursue Wang Xuguang's theft, and even thanked him.

"Ms. Lin, you—"

He originally thought that Lin Xiaobei was going to wear the internal jugular vein, which was also a good learning opportunity for him.

But Lin Xiaobei touched the patient's right elbow.

Does he have to wear expensive veins?It might as well go directly through the subclavian vein!

Dean Li and the others sat at the end of the bed, the compression was very effective, and the wound did not bleed anymore.

They also looked at Lin Xiaobei suspiciously, wondering what he was up to.Out of trust and respect for his anesthesiologist, it is inconvenient to question him.

Lin Xiaobei felt the patient's brachial artery, fixed the position, and started puncturing after disinfection.

Wang Xuguang couldn't understand what he was doing at all, he only saw Lin Xiaobei pushing the guide wire in, but withdrawing the catheter instead.

Normally, the catheter should be sent in, and the guide wire should be withdrawn.

Why would he do the opposite?
Lin Xiaobei sent the guidewire to a certain distance, suddenly stopped, pinched the end of the guidewire with his thumb, index and middle fingers and gently rubbed and rotated it. After stirring for a while, he pulled out and pressed the puncture site.

"Mr. Lin, what are you doing?" Wang Xuguang was really puzzled. In his eyes, Lin Xiaobei was acting like a wizard, mysterious and unpredictable.

"I use a guide wire to break up the patient's coronary thrombus, which can temporarily relieve the thrombus blockage." Re-opening the blocked channel will greatly improve the blood supply to the myocardium. As long as the ischemia time is not long, then there should be no massive myocardial infarction.

This method is far better than drug thrombolytic treatment. The slow return of the electrocardiogram to sinus also indirectly proves that his first aid measures are effective.

Lin Xiaobei spoke as calmly as water, but the listeners were as shocked as stone breaking.

The guide wire was sent to the coronary artery?
Are you kidding me?
Although Dean Li and Wang Xuguang are not experts in cardiovascular disease, they still have basic knowledge reserves.It is not unheard of to send a guide wire to the coronary artery, but under the conditions of their hospital, there is no relevant equipment, let alone fluoroscopy guidance, let alone interventional treatment, even drug thrombolysis is unimaginable.

But the electrocardiogram alarm gradually disappeared, and the normal "beep" sound returned.Wang Xuguang could still understand the basically normal electrocardiogram, and the patient seemed to be fine.

"You continue the operation and pay attention to stopping the bleeding." Lin Xiaobei said to Dean Li.

"Ms. Lin, how did you do it? It's amazing!" Wang Xuguang said with admiration. This is the first time he has seen a divine operation that does not use perspective to intervene.

"I can't tell you this. Anyway, as long as the bleeding doesn't continue, the patient should be fine."

At this time, there was a knock on the door, "Doctor Wang, the nitrous oil sustained-release tablets you asked for have arrived."

(End of this chapter)