Auto chess in the operating room

Chapter 24 Sudden Vasospasm

"Isn't this just vascular anastomosis?"

Shen Jun looked at the operating table. For chief doctors like them, if the surgical procedures are divided into levels, ordinary suturing is the lowest level. Vascular anastomosis is slightly more complicated, but it is only between level one and level two. Very basic surgery.

Generally speaking, in large hospitals like city hospitals, there will be Gui Peisheng, who rotates in various departments, usually about 15 months in general surgery, mastering disinfection, aseptic technique, water and electrolyte balance and disorder, surgical shock, trauma, surgery Infection, preoperative preparation and postoperative treatment principles, etc.

As for the mastery of surgical procedures, the most basic ones are: surgical dressing change techniques, surgical incision, exposure, suture, ligation, hemostasis, etc.

Therefore, suturing is the basic skill of a doctor. For such a basic operation, Cheng Jian could not move his eyes, which Shen Jun never imagined.

"Is there really something special about it?"

Shen Jun also calmed down and looked at the screen:
Tang Lou fixed the traction line at the anastomosis of the blood vessel, and now controls the suture at the midpoint of the two needles, and uses it as a traction line to suture with equal margins and stitches between them.

The difficulty here is to control the equilateral distance and equidistance. This is a microsurgery, and the distance in the field of vision is different from the actual distance, so it must go through repeated training before it can be handy.

This kind of micro-operation is like a watchmaker with an eyepiece repairing complex and precise gears and components.

The gears are dead and hard, but the human tissue department is active, and it is likely to ooze blood. The situation changes rapidly, and each operation has a specific situation for each operation, so the test is not only the movement, but also the calm response.

The most important principle of suturing the margins and stitches of blood vessels is not to leak blood. It does not mean that the denser the suture, the better. If it is too dense, it will increase the chance of vascular embolism.

Theoretically, the margin of the sutured blood vessel should be 1 to 2 times the thickness of the vessel wall, and the needle distance should be 2 to 3 times the margin.

The precision required for this control is undoubtedly very high. It is amazing that ordinary doctors can control it within this range, and occasionally a few needles will exceed the range.

But now under the magnification of the live broadcast camera, everyone is stunned.

Margins: 1x, 1x, 1x.
Tang Lou's every needle pierced the hearts of the senior doctors present, and they were all in a daze, which I'm afraid textbooks dare not write like that.

Margins: 2x, 2x, 2x.
While everyone was still immersed in the magical operation, Tang Lou had already completed the blood vessel on one side, flipped the vascular clamp and blood vessel, and exchanged the position of the traction wire.The stump of the vessel was flipped to the unsewn side.

".heparin water.."

Tanglou controlled the suturing steps very clearly and did not get carried away at all. This kind of operation would probably make the doctors present proud for a while. This kind of technique is worth bragging about all day long.

After the flushing was completed, Tang Lou didn't even forget to flush and confirm the remaining thrombus and foreign matter in the cavity again.

After finishing, he did not rush to anastomosis because it was the same blood vessel, but observed again to confirm that there was no sutured vessel wall.

"Careful, meticulous, it really is a textbook-like surgical procedure, professional!"

Naturally, Shen Jun did not escape the law of true fragrance and couldn't help but admire it.

"I see it so much that I want to go to the operating table to suture a case." Cheng Jian looked at Shen Jun's reaction and was very proud. The surgery he admired was naturally worth learning for everyone present.

In the next half of the coincidence, the same technique was repeated, but everyone watched with gusto, eager to press the pause button and give a good explanation.

Tang Lou loosened the blood vessel clamp and gradually began to restore blood flow to this artery.

"Not good, vasospasm!"

In the observation room, everyone felt as if they were performing an operation, their moods went up and down, and their hearts sank when they saw the vascular spasm. There were still some little surprises.

Of course, this is also one of the charms of surgery. Sudden accidents really test the nerves of doctors. For experienced doctors, this kind of situation is too common.

No matter how many examinations you have done before the operation, how rigorous department consultations you have gone through, and how comprehensive plans you have formulated, the moment you cut your belly open.

Just like the classic line in "Forrest Gump", life is like a box of chocolates, you never know what the next one will taste like.

This is why doctors need to go through regular training and rotation, often for two or three years.

General interns have been writing inpatient medical records in the past few years, with no fewer than 60 minor cases and no less than 15 major medical records.

It took a few years to experience enough to go from participating to completing several operations under the guidance of superior doctors.

Many interns have spent all their enthusiasm, confused, shrunk, and changed careers at the beginning of their careers.

However, being able to enter a large hospital and have an internship career is already a blessing from God. Some departments in tertiary hospitals have reached such a perverted level that they are not suitable unless you have a doctorate.

Medical students were angels with broken wings in their previous lives, and this statement is not bad at all.

Senior doctors who have experienced the 81-[-] crisis are all very curious about how Tanglou will deal with it next.

Liu Tong also clenched his fists: "I don't believe you, an intern, can handle such a sudden situation."

Everyone looked at the operating room intently.

Li Fan was also nervous at the same time. They say that the authorities are confused, but the bystanders know better. Li Fan really wanted to say that the bystanders are even more confused.

".2% lidocaine, fast"

Tang Lou's order clearly appeared in everyone's breath-holding.

"It's amazing. Lidocaine is a commonly used local anesthetic in medical clinics. It was first used to treat arrhythmias. It is currently the first choice drug to prevent and treat acute myocardial infarction and various heart diseases complicated by rapid ventricular arrhythmias."

"By controlling the heart rate and slowing down the pumping of blood, thereby reducing the load on the blood vessels, this trick really solves the problem from the source."

Everyone in the observation room applauded secretly.

"Because the operation is full today, the department's standing lidocaine has run out, and it has been transferred to other departments, and now there is no more."

The nurse returned nervously.

Li Fan was also in a cold sweat beside him. How could he have thought that lidocaine would be used in the vascular anastomosis, but the vascular spasm came too suddenly, and today's situation is special, all departments are crazy busy, and so is the nurse's station.

The current allocation is estimated to be a bit overhanging.

Everyone in the observation room and the operation raised their hearts again, and everyone who didn't know it turned their attention to Tang Lou, waiting for his decision.

"Papaverine dilution?"

The little nurse shook her head, her nerves tensed instantly, and she felt like crying under the pressure.

Feel guilty!

Everyone was already amazed by the proposal of Tanglou's second solution, but it was a pity that it still didn't exist.

After all, it is a county hospital, and it is a special period when the operating rooms in each ward are full and the staff is stretched. Li Fan performed many operations in a row, and he did not think too carefully, and the pre-operative preparation was indeed insufficient.

Shen Jun in the observation room was also sweating.

"It's okay, there is no diluent of papaverine, so we can use warm saline to wet compress the anastomosis. Although the effect is not good, it is still the best way at present."

Tang Lou said calmly, with a warm tone, which immediately relaxed the little nurse's tense nerves.

Looking at the professional Tanglou, the little nurse's eyes were full of admiration. Not everyone can make a temporary decision on the best solution according to the corresponding medical conditions in such a short period of time.

This requires erudite knowledge, a solid foundation, and an extraordinary mind.

(End of this chapter)