medical simulator

If there is a delicacy in Huaguo called Huaguo on the tip of the tongue, then what Zhou Cheng is showing now is that life is beating on the fingertips.

Maybe one wrong step could lead to eternal doom, but Zhou Cheng resolved them one by one. This kind of operation, in her eyes, was very psychedelic, and even had a kind of unimaginable acrobatics...

Zhou Cheng did not relax his mood and opened the hematoma. Although in theory, it could reduce the patient's bleeding, but the heart stimulation caused by this sudden burst, and the burden on the whole body caused by the decrease in blood volume are just too much. start.

"Mr. Anesthesiologist, it will be hard for you to take care of it next time, especially pay attention to electrolyte imbalance and acidosis." If it is in other places, it is really difficult for Zhou Cheng to give advice to the anesthesiologist.

However, the performance of Xuanxuan's equipment nurse just now made him a little scared, so even if it made the anesthetist unhappy, he could only say a few more words.

The anesthesiologist listened, smiled, did not reply, but still went to draw blood, and at the same time, asked the subordinate doctor to contact the blood bank to get blood immediately, and added a little booster drug at the same time, and slightly reduced the dose of anesthesia !

At this time, the dose of the drug may become a burden on the patient.

Seeing these details, Zhou Cheng felt relieved. This anesthesiologist is at least reliable.

Moreover, although the hematoma was temporarily resolved, this did not mean that all life-threatening risks were completely relieved for patients who were comatose during the operation.

Zhou Cheng then said: "Director Dong, you can do the stitching of the tiny blood vessels. I'll do the stitching of the femoral artery!"

Zhou Cheng's meaning is obvious. Now these blood vessels are all tied up. No matter how bad it is, it doesn't matter much if the suture is not good. question.

Mo Youcheng knew that Zhou Cheng was worried about his poor skills, but he didn't say much, just nodded: "Doctor Zhou, I will try my best."

Then, Mo Youcheng and Zhou Chengcheng switched places.

When Mo Youcheng began to suture the blood vessels in a decent manner, he took a quick glance at Zhou Cheng and found that Zhou Cheng's technique when suturing the femoral artery was also very delicate.

If it was at other times, he would definitely see and learn more shamelessly, but now, this opportunity is gone!

The people in the orthopedics department are also helping Zhou Cheng suture the femoral artery, studying hard, and are still flattering.

"Doctor Zhou, I really worked hard on you today. Otherwise, we might not have been able to discover this retroperitoneal hematoma in the first place. Under such circumstances, if the patient steps down, the consequences will be unimaginable!~"

"Furthermore, even if we find such a hematoma, there is nothing we can do. Doctor Zhou, thank you for your hard work!" Although the words were flattering, they were still sincere.

Zhou Cheng nodded, not proud: "It should be, I'm glad I didn't come here in vain, I can finally do something."

"Director Hu, should I leave it to you to do the follow-up debridement of this operation?"

"Doctor Zhou? This debridement?" Director Hu of the Orthopedics Department was stunned: "Why don't you continue to trouble Dr. Zhou? This operation is not trivial. I am afraid that after the operation, because of our limited ability, some accidents will happen. misfortune."

The same debridement, before Hu Kaihua did not believe that there is any big difference between different doctors, isn't it all debridement?

But now, Hu Kaihua felt that he was wrong, and he was wrong. In fact, there is a huge gap between debridement and debridement. It is not at the same level as Dr. Zhou Cheng.

If possible, he would rather that Zhou Cheng can solve this operation, avoid unnecessary surgical technical errors, and bring inevitable consequences!

Hu Kaihua spoke so bluntly, Zhou Cheng didn't say much.

He just smiled: "Director Hu, you're too good, let's come together. Although there are several incisions in the current femoral artery, and they are not on the same axis, but?"

While Zhou Cheng was talking, suddenly, the monitor next to the anesthesiologist blinked beeping beeps and flashing red light!

The anesthesiologist's expression changed suddenly: "The patient's blood pressure has reached a critical value!~"

"I'll call the teacher!" After finishing speaking, he was about to leave the operating room and ask his superior doctor.

"You can't go!"

"Intravenous injection of epinephrine! 1mg! Immediately!~"

Zhou Cheng immediately stopped all operations and calmly ordered.

Is Chapter 318 worth it? !

Zhou Chengcheng is almost drunk, is this person an intern?

This is in the operating room. The patient is under general anesthesia and intubation. She is in shock and low pressure, not in cardiac arrest. There is an open venous access. The operation is in progress. She said that she is going to call the teacher. Why don't you give me a quick rehydration at this time?

Have you ever read a book?

All the first aid processes in the hospital are basically moving closer to the current good infrastructure, tracheostomy and venous access are all ready-made now!

Hearing Zhou Cheng's words, she turned her head anxiously.

"Epinephrine, 1mg, intravenous injection! Hurry up!" Zhou Cheng increased his voice, urging!

This voice called her back.

Anesthesiologists in the Department of Anesthesiology, during the operation, dopamine, norepinephrine, and epinephrine are always on hand, and both dopamine and norepinephrine are continuously pumped.

But now, this continuous pumping, the dose is not enough, and it must be administered intravenously!

"Traveling, speed up the intravenous infusion immediately, pressurize the colloid and crystal infusion at the same time, and raise the room temperature in the operating room to 25 degrees Celsius."

"Director Hu, Director Mo, pay attention to find the bleeding point in the abdomen." Zhou Cheng moved away while talking.

At this time, the patient suddenly went into shock, and the senior anesthesiologist was not there, so someone had to stand up.

Neither Mo Youcheng nor Hu Kaihua stood up, so Zhou Chengcheng could only stand up.

"Device, you step down, go and call the head nurse, and ask her to send someone to help immediately, and urge the blood bank to send plasma products and adult blood."

"Notify the anesthesiologist, come to the operating room immediately, and draw blood gas for analysis immediately." Zhou Cheng's eyes were fixed on the patient's vital signs.

At present, the heartbeat is fast and the blood pressure is very low, which definitely exceeds the shock index.

Zhou Cheng is looking to see if there is ventricular tachycardia or ventricular fibrillation.

Although the first aid for shock in the operating room belongs to the category of the anesthesiology department, but this anesthesiologist is really unreliable, so he can only stand up.

However, for the rescue of patients in the hospital, doctors in all clinical departments have the right to order doctors. In the surgical ward, when a patient is in shock, it is the surgeon who assumes the role of issuing doctor's orders! !

"Take off the gloves, don't care about the clothes!" Zhou Cheng looked at the equipment nurse, ready to undress, and cursed.

The other party hurriedly took off the gloves, and then walked to the timing panel in the operating room before making a call.

Zhou Cheng returned his gaze to the monitor, and then calmly issued orders: "Dopamine 20mg, intravenous injection!"

Dopamine can be injected intravenously, and the general dose is 20 mg directly injected intravenously, or it can be treated by intravenous drip.When dopamine is intravenously dripped, the dosage is different, and its effect is also different.Dopamine is a neurotransmitter that is used to help cells transmit impulses.

Low-dose dopamine can relatively selectively dilate visceral and renal arteries, and can be used in patients who do not respond to diuretics to increase renal blood flow and maintain glomerular filtration rate; it can also directly act on renal tubules, to achieve a diuretic effect.

Moderate doses of dopamine can increase the activity of adrenergic receptors in the heart and strengthen the contractility of the heart muscle.

Large doses of dopamine can cause extensive vasoconstriction, which has a pressor effect.

While restoring the blood volume, a large dose of dopamine is added to effectively allow the blood to ensure the supply of vital organs.

The itinerant nurse immediately responded and went to help the doctor in the anesthesiology department to carry out the doctor's order.

At the same time, after the resigned equipment nurse made a phone call, the anesthetist who was doing the blood gas analysis hurried over, his face turning pale.

Then I saw that Zhou Cheng was staring at the vital signs monitor, while Mo Youcheng and Hu Kaihua were quickly looking for bleeding points.

"What's the matter?" he asked quickly.

"Now the patient's blood pressure has risen slightly, but it is still very low. It is estimated that the blood volume is still insufficient. What is the result of the previous blood gas analysis? Is there any high potassium?" Zhou Cheng did not turn his head, seeing that the heart rate had risen to 130, he calmed down ask.

Fortunately, the blood oxygen level is still normal for the time being, that is to say, there is no shortage of blood oxygen in the peripheral blood supply for the time being, and it should only be stress-induced hypovolemic shock, not other shocks.

The anesthesiologist saw that the patient's high blood pressure was only 40+, and immediately adjusted the dose of norepinephrine and dopamine pumped into the vein, and then said: "There is a slight high potassium level, and insulin and glucose are prepared for intravenous infusion."

"Remove the compound sodium chloride first and replace it with soda water."

While speaking, he hurried to squeeze the hanging whole blood into the patient's body.

Then he quickly accepted Zhou Cheng's instruction: "Epinephrine, 1mg, intravenous injection!"

The itinerant nurse hurriedly repeated: "12:14 epinephrine 1mg, intravenous injection."

The equipment nurse began to take notes.

Mo Youcheng and Hu Kaihua looked up: "There is no active bleeding in the abdominal cavity. We have already done all the blood vessels that should be cut off."

Seeing that the patient's blood pressure had risen a bit, Zhou Cheng said: "It should be that when the hematoma was just cut, a large amount of blood was lost, which greatly reduced the internal circulation and caused stress."

"Teacher anesthetist, you have worked hard. At this time, you must be very careful to pay attention to the pulmonary edema."

When the anesthesiologist came, Zhou Cheng didn't overstep his bounds, and waited until the blood pressure rose above 60mmHg before coming to the operating table again.

The operation continued.

At this moment, Mo Youcheng and Hu Kaihua didn't dare to speak anymore. The situation just now was really scary. Fortunately, Zhou Cheng stepped forward immediately. Otherwise, the anesthesiologist would have run away. This operation is absolutely GG!

But Zhou Cheng, a real tiger, can cut even such a hematoma. Although he has made thorough preparations to minimize blood loss, the undetectable vascular injury is still a large amount of blood loss, causing irritation.

The patient is on the verge of shock.

After a while, the roving nurse and the nurses in the operating room helped to open up the bilateral venous access, and the blood transfusion started on both sides, and the patient's blood pressure was completely stabilized.

Then, the anesthesiologist began to diss to his subordinates: "What on earth were you thinking? At that time, how could you think of running out and calling someone?"

"You are a deserter. If you run away, what will the patient do? Who will accept your job?"

"Teacher, me!" The little girl was about to cry right now.

Zhou Cheng and the others didn't speak. The girl's performance just now was really unprofessional. Maybe she was really scared, but as a doctor, if you are afraid of this, you should change careers as soon as possible.

This hurdle must be overcome.

After that, the anesthesiologist didn't dare to go outside again, and his students were asked to take blood gas analysis and other operations, and he didn't dare to leave the anesthesia table for half a step!

Time passed slowly.

More than two hours passed.

Zhou Chengcai finally sewed up all the blood vessels, and after a careful inspection again, he said, "Director Mo, this patient should be very cautious. If heart failure and thrombosis occur again, routine anti-inflammatory drugs are required after surgery." Coagulate."

"Although anticoagulation will lose part of the blood, if a thrombus falls off, the consequences will be unimaginable. In addition, because of shock, you must be extremely careful about cerebral edema, and consult a neurosurgeon."

"After surgery, it is even more important to monitor the brain CT regularly."

Although the temporary life was saved, if the follow-up care or doctor's orders are improper, problems will easily occur again. If there is a problem after the operation, no matter how good the current operation is, it will not help.

No matter how good the operation is, what's the point of doing it when people are gone?

"Understood, Doctor Zhou, today, it's fortunate that you came, otherwise, this operation would be really hard to explain!" Mo You said with lingering fear.

He had checked the entire abdomen before, but no hematoma was found. He closed the abdomen, but there was still a retroperitoneal hematoma.

However, even if he found out the first time, he didn't dare to touch this thing.

He didn't have Zhou Cheng's ability, if he moved, he would die.

Of course, if you don't move it, let it exist, continuous blood loss, and the final prognosis of the patient is still catastrophic.

It can be said that the reason why this patient survived was all due to Zhou Cheng.

When the shock happened, Zhou Chengbu stood up immediately, and the patient still couldn't escape this death!

Hu Kaihua also said: "Zhou Cheng, you have worked hard today! On behalf of the patients and their families, I would like to express my gratitude to you."

Hearing this, Zhou Cheng saw that the current operation was over, so he asked one more question: "Director Hu, this patient's injury is very special, why did you consider calling me?"

Zhou Cheng knows how to do vascular surgery, not many people know about it, and he rarely takes the initiative to perform vascular surgery, mainly because he is not professional and afraid of accidents.

So far, only Yang Yifeng, Lu Bin and others are known.

Cai Dongfan, who was far away in Shashi, also knew about it.

Hu Kaihua then explained: "Doctor Zhou, it's like this. We originally wanted to invite Dr. Yang to come, but Dr. Yang has something to do and can't come, but he suggested that I ask if you can come down."

"He said, this operation is not easy, it might be better for you to come."

When Hu Kaihua said this, he saw Zhou Cheng staring at him with a meaningful expression.

Then he hurriedly explained: "Well, Doctor Zhou, please tell me, the patient in this operation is my child's teacher. She is a very good teacher, but it's a pity that she is not nice to others."

"My child has graduated for several years, but we have been talking about her kindness. Naturally, I don't want to ask too much about her family affairs, but this time I was injured, so I also healed it and asked more shamelessly."

"I asked her mother to go to the Chinese medicine hospital to find you in person, but it was a helpless move. Doctor Zhou, don't take it to heart!"

Hu Kaihua's explanation warmed Zhou Cheng's heart.

There is true love in the world, and Hu Kaihua's ability to put so much thought into his child's teacher is enough to show that this teacher is a person worthy of respect.

Indeed, her experience is worthy of sympathy, but there is nothing to be done about it.It is not easy for outsiders to intervene.

After the operation, Hu Kaihua pulled Zhou Cheng aside, and then took out a big envelope, intending to hand it to Zhou Cheng.

He also said: "Doctor Zhou, this is my personal wish. Teacher Zu is indeed a respectable person, so I didn't tell her family members about it."

"If it is another patient, I may not be able to do this, but it is a little thought to help, please accept it."

Hu Kaihua can also speak. It is true that this patient's family has such a difficult time. At this time, he still charges such a large amount of fees for throwing knives. In fact, Zhou Cheng is a little bit entangled.