Great doctor starts with adding points

"Xiao Wu, do you have any special itinerary at the moment?" Wu Xie and Cao Zhiyuan had just been working as takeaway partners for lunch in the department.

We were only halfway through the meal when Fu Jinjin called and asked. And Fu Jinjin frowned tightly, and his tone was slightly bleak.

"Director Fu, I'm in the department, didn't I go out?" Wu Xie hurried back with a bad premonition in his heart.

This Fu Jinjin asked directly, maybe there is some emergency?

It's just that I am the head hospital of the trauma surgery department, so why don't I know about it?

"Just now the director of the Trauma Surgery Department of the State People's Hospital, Director Agricultural Xuequan, called and said that there was another patient with active pelvic hematoma. He asked me if you could help me. This patient is his relative." Fu Jinjin's tone was relatively cautious.

When Fu Jinjin said this, he did not expect that the phone was taken away.

"Doctor Wu, I am Agricultural Xuequan from the State People's Hospital. Could you please come over and do me a favor, this person is my brother today." Agricultural Xuequan said on the phone.

"Ah? Okay, I'll come first, Director Farmer."

"But last time, there was old Professor Xue..." Wu Xie didn't dare to be careless, and explained this while getting up.

Just kidding, with this kind of disease, after Li Cong's last surgery, people died from such a dangerous disease in Minda Hospital on the second or third day.

Even if Wu Xie had a successful treatment experience, he is still not sure how the old Professor Xue diagnosed the arteriovenous injury.

Wu Xie's current level of nuclear magnetic film reading skills has been raised to the expert level, but it is still not accurate enough. It is estimated that only more advanced nuclear magnetic film reading skills can find clues.

How dangerous is such a case, the slightest misconduct can lead to death!

"Dr. Wu, you and I are both in orthopedics. I can call you, which proves that I can accept all consequences."

"I operated the knife myself, I couldn't do it."

"The danger is even greater!" Nong Xuequan's tone was ponderous, still struggling.

"Okay!" Wu Xie could only watch while walking.

When colleagues invite you to perform surgery, it is very easy to communicate with those who are easy to communicate with, but if you encounter difficult ones, it will be very troublesome.

It's just that such a bad face is not given, and it is also a life. The last time Wu Xie drank, there was really nothing he could do.

After Wu Xie arrived at the State People's Hospital, he quickly entered the operating room, and sent Tang Yuewei a message that he was temporarily absent from the Minda Hospital and came to the State People's Hospital, and then went to the operating room.

Wu Xie found out that in the operating room, the Director of Agriculture Xuequan called many people, including Director Xiong from Minda Hospital and other directors of the Trauma Surgery Department of the State People's Hospital.

The patient's vital signs are now fluctuating.

If the blood loss exceeds 20%, there is a high possibility of shock at any time...

"Xiao Wu. Hurry up to the stage, we have to investigate faster, and investigate according to the last investigation idea." After Wu Xie came in, Nong Xuequan hurriedly urged Wu Xie.

When Wu Xie heard this, his eyes tightened a little, and he rejected the proposal of Agricultural Science Quan: "Let me look at MRI or CT first. The damaged blood vessels of each disease are different, so we can't generalize!"

"If you strictly follow the process, you may take a detour."

This is just a joke, where are the blood vessels damaged by the variable hematoma in the pelvis all similar?

If we continue to follow the sequence of investigations last time, it is better to conduct extensive investigations, and save as much as we can!

"Okay!" Nong Xuequan replied helplessly, obviously very excited.

"Director Nong, do you want to step down and take a break?" His junior doctor asked, obviously the mood swings of Nong Xuequan were too high now.

"No!~"

"Let Xiao Wu take a look first, let's open the pelvis first, to save a little time." Fu Qianjin, who had already arrived on the stage, suggested this.

Look to Agronomy for advice. This expression can only be regarded as a dead horse doctor.

They were not sure if Wu Xie could see the clues, but none of them had such a level, and they even specifically asked experts and professors in the province to see the hidden arterial damage from the MRI, and Precise positioning, very few.

Unless it's a CTA.

But where there is such a patient with pelvic hematoma to go for CTA, it is of little significance.

"Let's take a look first." Nong Xuequan was talking, and he had already started to expand the opening to his lower abdomen.

Wu Xie raised his hands up, not above his shoulders, not below his abdomen, tilting his head, and asked the anesthesiologist to slowly flip through the various layers in the MRI.

After Wu Xie's MRI reading skills were upgraded to the expert level, he really focused on the lesion at a glance, that is, the whitened edema.

Then I saw the damaged part, anatomy, layers, and the layers of the current MRI scan and the plane scanned by the MRI machine...

However, this is still not enough!

what to do?

It is impossible for Wu Xie to increase his MRI reading skills to the wishful level with his current knowledge.

The skill of hand surgery was added last time.

I knew it shouldn't be added.

However, hand surgery skills are actually very important.

Wu Xie's mind was racing wildly.

If the accurate diagnosis fails, then you have to find another way.

In a middle-aged male, most of the venous plexuses in the sacrum burst due to a fall injury, but there was no arterial injury.

Vein is a place to hold blood, and its blood capacity is greater than that of arteries, so the amount of bleeding is huge. It is estimated that the pelvis is already a mass of blood and flesh, and it is a waste of time to explore the arteries...

But?

How should the bleeding be stopped?

Like last time, continue to ligate the access artery?

Or go directly to the vein break to tie off the bleeding?

Or puncture the access vein, how should Tui Xuepai's hematoma evacuation be used?

This is another way of thinking, this is the category of hemostasis, Wu Xie's thinking has become a little dull...

"It can't be done, the blood pressure has dropped very badly! Now the high pressure is only 64mmHg, and two channels are already used for blood transfusion!" The anesthesiologist began to shout anxiously, and began to urge at the same time.

"You guys have to be a little faster."

Seeing this, Wu Xie didn't care too much. After keeping all the key points in mind, he hurried to wash his hands and get dressed.

Headache, very headache, this is Wu Xie's only consideration at the moment.

Because this is a salvage surgery that is somewhat beyond Wu Xie's current real level, so he has to spend more brain cells and start spinning rapidly to be able to treat this patient, not like before.

The level of skills is more advanced than the types of diseases encountered, and you can easily handle them with ease.

If you don't know the specific diagnosis, you can only follow the two simple routines of wounding and stopping bleeding.

To push the basic anatomy——

"The presacral venous plexus is the branch of the presacral vein at the tail end of the spinal venous system. Its real source is the branch of the spinal canal. The presacral venous plexus is its extraspinal system. The bleeding of the presacral vein injury is the Blood banks from the entire spinal venous system."

"The lateral sacral vein is connected to the internal iliac vein, and the middle sacral vein is connected to the left common iliac artery. The venous system in this system has no venous valves, so it will cause massive bleeding in a short time."

"Is it the injury of the anterior sacral venous plexus, or the injury of the sacral vertebral vein..."

"In fact, most of the injuries to the anterior sacral venous plexus are located in the lateral sacral vein and the middle sacral vein, that is, at the junction with the internal iliac and common iliac veins. If the wound is small and the amount of bleeding is considerable, it can be sutured in time."

"But if it's just an injury to the presacral vein, it's even more troublesome. The existence of the presacral vein network is a ticking time bomb."

In Wu Xie's mind, there was a voice constantly reminding herself.

This is a web-like structure, not like a spider web, but very similar to a spider web. Each vein may be connected to multiple veins, and the connection is within a short distance, and there will be involvement.

Electrocoagulation is ineffective, and compression for hemostasis may compress and break the venous wall in other parts, causing re-injury and bleeding!

When he got to the stage, Wu Xie took a deep breath.

Said: "Director Nong, there is no other way now, so we can only try this method."

"My idea is this, we don't know where the diagnosis is, but we can first find the left and right common iliac veins, and after finding the left and right common iliac arteries, we don't ligate the veins first, but block the veins first, and use our fingers to temporarily Create an artificial reverse venous valve!"

"After pinching the veins on both sides, see if the hematoma will increase. If it increases, it proves that the bleeding point is most related to the left and right common iliac arteries, and then confirms the left and right internal and external iliac veins in the same way!"

"If, I mean, if, in a very extreme situation, the patient's injury reaches the venous sinus, that is, the sacral vertebral vein, then you can directly find the tail vertebral vein, and then don't tie it off, use a large gauze Pack it for 20 minutes, and use large gauze to stop the bleeding physically until no bleeding occurs."

"Press the anterior sacral vein foramen with bone wax, and use gelatin sponge more!"

"If you encounter a hematoma of the vertebral venous plexus, then wait slowly." Wu Xie explained speculatively, but what he said was so many and complicated that it almost made Nong Xuequan, Fu Jinjin and others almost dumbfounded up.

The degree of blood vessels in the presacral venous plexus is so complex that it is difficult to figure it out.

"Okay!" However, just after Wu Xie finished speaking, Agricultural Xuequan nodded as if he had made up his mind.

When Wu Xie heard this, he immediately began to expose quickly, and he could only pass through all the arteries first.

Go in the direction of the vein.

Fortunately, Wu Xie's previous speculation was correct. This patient did not have an arterial injury. Therefore, his adventure had a miraculous effect in the first step.

And if there is an arterial injury, then Wu Xie will be in a more troublesome situation.

Then we found the left and right common iliac arteries and the branches of the internal and external veins!

Wu Xie didn't dare to be careless, and used the concept of "pushing blood" to artificially create a vascular valve with his fingers!

Then quickly looked at the hematoma.

The hematoma is growing, which means that the hematoma in this case is related to the left and right common iliac veins, just because of the lack of venous valves!

If he could find the bleeding point, he would have a new idea after a long time.

If the diagnosis is unknown, stepping down rashly is really a big taboo, and every step is terrified.

But the diagnosis of some patients, if your preoperative level is not enough, you can’t figure it out. They can only die inexplicably.

Wu Xie tried the left and right internal and external iliac veins again. Using the same method, he also found blood reflux!

These operations can completely prove that the existence of this hematoma is closely related to the veins of the lower extremities, so the next step to prove is whether it is directly connected to the venous system in the spinal canal!

Can it be cut or pierced with a knife.

If it can pass through the tailbone without affecting the size of the hematoma? Then!

Wu Xie gave it a try with anticipation!

The hematoma was slowly getting bigger.

Wu Xie's face immediately turned pale!

The hematoma this time was the most dangerous type, directly damaging the venous system in the spinal canal!

"Don't move, Director Nong and Director Fu, this operation cannot be stopped by coagulation and other methods for the time being, we have to find another way!"

"It communicates with the venous system in the spinal canal, and ordinary hemostasis is temporarily insufficient, temporarily insufficient."

The corners of Wu Xie's eyes were covered with fine sweat. This feeling of reluctance to perform surgery is really uncomfortable!

"Use large gauze to stop the bleeding first." Wu Xie ordered.

Nong Xuequan and Fu Jinjin didn't dare to move!

What Wu Xie didn't know was that the last patient Fu Jinjin treated last time died like this.

Neither Fu Jinjin nor Nong Xuequan dared to move, and the other assistant naturally did not dare to move.

"It doesn't work either." But soon, Wu Xie vetoed his own suggestion.

Because Wu Xie is also a temporary test, he has no way + to fully speculate on the real situation of this patient.

Wu Xie's mind was racing wildly.

At present, there is only one good news, that is, the temporary hematoma is still limited, but when the activity increases, it means that there is still bleeding and bleeding.

If the pressure of internal bleeding is so great that the hematoma bursts, then it will be a big deal!

This is not right either!

"What are we going to do now? Xiao Wu." Nong Xuequan looked at Wu Xie, and the only way he could think of for a moment was to take gauze and stuff it indiscriminately, not daring to cut it easily!

After breaking open, blood gushed out like a fountain!

Wu Xie is still clarifying his thoughts, at this time, his thoughts must be clear!

Don't be in a hurry, the more anxious the more chaotic, the more anxious the more panic.

Don't rush, don't rush. You can't get anything in a hurry, just follow the steps.

"Wait a moment."

"Director Nong, let me think about it again." Wu Xie's head hurt a little.

So Wu Xie didn't pay attention to everyone's eyes!

However, it was half a minute later.

Wu Xie, who closed and opened and kept closing and searching his knowledge reserve and professional basic memory, opened his eyes again with certainty.

Immediately afterwards, Wu Xie looked at Nong Xuequan and Fu Qianjin firmly, and said, "Director Nong, let's tie the root of the internal iliac vein first."

"This is only part of the venous return. At this time, the venous return in the external iliac and common iliac veins cannot be allowed!"

"Puncture the internal iliac vein?" Agricultural Xuequan raised his head, very puzzled.

Fu Jinjin also looked up at Wu Xie.

There is no doubt, just waiting for Wu Xie to confirm.

At this time, Wu Xie is the chief surgeon. When there is a disagreement between the chief surgeon and his assistant, they can communicate with each other, but they will definitely respect the chief surgeon's opinion.

"Zha!" Wu Xie replied firmly.