crazy scalpel

Round corners, brown glass windows, and green wall paint.

The shadowless lamp on the roof and the lifting lamp next to the bed were all turned on.

A group of doctors and nurses in light green sterile gowns are busy surrounding a baby on the operating table in the middle.

This baby is Guan Yao, the son of the Guan couple suffering from stenosis.

His current condition is very bad.

Because babies have poor tolerance to blood loss, and Guan Yao's blood vessels are too thin, the speed of infusion can't keep up, so even though Xie Ke has tried his best to control the bleeding to a very low state, he is still facing a crisis.

Fortunately, the three main controllers present, the chief surgeon Xie Ke, the assistant Cai Tianqiao, and the anesthesiologist Feng Daqiang, were all superior to ordinary people in terms of experience and level, which gave Guan Yao a chance to be rescued.

First of all, Xie Ke felt the abnormality of the child, so he stopped the action of removing the skull in the herringbone area.

It was at this time that Feng Daqiang reminded the child's physical indicators in time.

Xie Ke observed the bleeding on the scalp and found that the amount of bleeding was actually very little. Even if the child was in shock because of the child's intolerance, the blood pressure should not drop sharply.

At this time, Cai Tianqiao's reaction was not slower than his. He observed the child's limbs, finally fixed the child's ankle, stretched out his hand habitually, and ordered the equipment nurse: "No. 10 knife."

Although the equipment nurse reflexively wanted to hand over the knife, she looked at Xie Ke on the way.

Cai Tianqiao, as the director of the Department of Brain Surgery at the No. [-] City Hospital, is a frequent visitor to this operating room for large-scale brain operations, and the equipment nurses are very familiar with him.

However, as a professional nurse in the operating room, she is also very clear that Xie Ke is the chief surgeon of the operation that is going on now.

So she's waiting for Shayk's affirmation.

Even at Cai Tianqiao's level, he couldn't mess with the rules of the operating room.No rules no standards.There can be no disputes during the operation, and everything is subject to the opinion of the surgeon.

When Xie Ke saw the place where Cai Tianqiao was holding his hand, he understood his plan.

Cai Tianqiao wanted to cut the vein open.

Because Guan Yao's blood vessels were too small, coupled with the sudden drop in blood pressure, his veins became more shrunken and thin.This made it impossible for them to perform venipuncture on Guan Yao. In this way, the only way to increase the amount of blood transfusion is to cut the vein open and then connect the blood vessel to the catheter.

If the infusion needle is used forcibly to puncture, not only the blood vessel may be damaged due to repeated puncture, but also the time for rescue may be wasted.

So if it was Shayk, he would also choose to have the vein cut.

Generally speaking, the superficial veins of the extremities are selected for incision, such as the basilic vein and median cubital vein on the arm, and the great saphenous vein originating from the medial end of the dorsal venous arch of the foot.

The basilic vein on Guan Yao's left hand connected to the middle of the elbow had already been controlled by the anesthetist's infusion before the operation, so Cai Tianqiao chose the front of the medial malleolus of his right foot, which is where the great saphenous vein ascends along the inside of the calf.

If it was Xie Ke, he would also choose here.

Cai Tianqiao’s choices coincided with Xie Ke’s, so he nodded and signaled the equipment nurse to carry out the operation according to Cai Tianqiao’s instructions.

The instrument nurse handed the knife to Cai Tianqiao.

Cai Tianqiao was not dissatisfied with her initial hesitation, but instead gave her an appreciative look.

Xie Ke should not move at this time. While watching Cai Tianqiao perform the phlebotomy, and waiting for the blood pressure of the child to recover, he thought carefully about the reason.

Because it is a shallow cut, Cai Tianqiao chose a smaller size 10 blade with a smaller handle.

In surgical operations, generally small blades with long handles are used for deep cutting, and medium and large blades above No. 20 are used with ordinary handles for shallow cutting.For shallow cutting, use a small blade with a small handle.

Cai Tianqiao first disinfected the skin on Guan Yao's inner ankle, and then used 1% procaine for local anesthesia.

Then he used a scalpel to make an incision parallel to the direction of the vein, which was very small, less than 1 centimeter.

Shayk was fascinated by his behavior.

According to the general method, an incision of about 2 cm should be made, and then the great saphenous vein is found in the subcutaneous tissue, and a section of blood vessel about 2 cm long is separated, picked up with vascular forceps, and the distal end is ligated.In order to avoid accidentally tying the saphenous nerve parallel to the blood vessel, the tissue around the vein should also be stripped cleanly.

Then cut off nearly half of the vein wall obliquely, insert the silicone tube into the lumen of the vein, push it in about 5 cm, and then ligate the proximal end of the vein.

This is the practice taught in textbooks, and the teacher also said so in class.

Of course, the disadvantage of this approach, Xie Ke is also very clear, that is, the blood vessel will lose its normal function due to ligation after surgery.Although there are other collateral vessels that can ensure blood circulation, it will inevitably have some impact on the peripheral blood return.

And Cai Tianqiao doesn't seem to want to do this. Does he have a better way?

Xie Ke looked at the incision made by Cai Tianqiao, it was only about half a centimeter.With such a small incision, even the veins cannot be separated and exposed, what on earth is he going to do?

While Xie Ke was thinking hard, the others did not behave unexpectedly.

Obviously, the anesthesiologists and nurses who have worked with Cai Tianqiao are familiar with his methods, and this also shows that the methods used by Cai Tianqiao are also quite effective.

Cai Tianqiao found the venous vessel from the incision, and did not lift it out. Instead, he used a trocar to insert it directly into the vessel lumen from the anterior wall of the vein.

This does not look complicated, but it is not simple in practice. Cai Tianqiao completed it in only two to three minutes from cutting the belt to suturing.

The difficulty of this is that to find the blood vessel from a small incision, it is necessary to insert the needle into the blood vessel cavity under direct vision. If the insertion is not accurate, it will become quite troublesome.

But its benefits are also obvious and very appreciated, that is, less damage and no sequelae.

In fact, this is an improved surgical method combined with phlebotomy and puncture, and Xie Ke immediately acquired this skill.

Since there is no need to separate and ligate blood vessels, the time is almost doubled, and an effective infusion channel is quickly established.

With the two infusion ports on his hands and feet both working, Feng Daqiang finally heaved a sigh of relief and told everyone: "The blood pressure is back."

At this time, besides learning Cai Tianqiao's operation method, Xie Ke basically found the root cause of Guan Yao's low blood pressure!

To be sure, Xie Ke asked Cai Tianqiao to come and see.From the bone groove on the right side of the sagittal suture where Guan Yao was bitten open, there is a small hematoma under the dura mater.

Under Xie Ke's reminder, Cai Tianqiao obviously also saw the hematoma.

However, looking at the coagulation of the hematoma, it is obvious that he did not just bleed because of the operation.

This is a pre-existing hematoma!

Because Guan Yao suffers from stenosis, his brain structure may be restricted from growing due to the closure of the cranium.When the brain grows, once it is squeezed, it will easily cause bleeding. Judging from the current situation, Xie Ke and the others can't even determine the source of this hematoma!

What's more, under Guan Yao's dura mater, there may be more than one hematoma!And this is the real reason for his blood pressure drop.

Xie Ke said affirmatively to the circulating nurse: "Turn up the room temperature by one or two degrees, and prepare to move the C-arm."

Cai Tianqiao had no objection to this. In fact, even if he had objections, it would be useless, because Xie Ke was the one who performed the surgery.

The purpose of raising the room temperature is to take care of the baby's body temperature.Of course, doing so may not be so comfortable for the doctors and nurses in the operating room, but everything is based on the safety of the patient.

The moving C-arm is used for x-ray imaging to determine the number and location of the hematoma.

After taking CT scans from various angles, including the forehead, Shayk basically determined the location of the bleeding and the number of blood clots.

There were quite a few clotted hematomas, about ten of them.The bleeding location is in the posterior cranial fossa.

The cause of the bleeding, as Xie Ke expected, was due to the limitation of brain growth and being squeezed.

The good news is that it is probably because Xie Ke performed the first phase of surgery for Guan Yao two weeks ago, which greatly relieved the pressure on his brain, especially the front half of the brain, so now he is bleeding Volume is decreasing and tending to stop.

However, there are hematomas in the posterior cranial fossa, which pose a great threat to the life of the child, and they must be removed.

If it is normal, external drainage of cerebrospinal fluid or other more conservative treatment methods may also be considered.But now, the scalp has been lifted, and even after the skull is bitten off, the blood clots underneath can be seen through the dura mater, so there is no reason not to clean them up by the way.

What's more, the existence of these blood clots has already caused hypotension and heart rate slowdown, Xie Ke will not leave them in Guan Yao's brain no matter what.

Shayk: "I'm going to cut the dura mater and flush out the subdural space. If there is active bleeding, I need to open a bilateral bone window."

Cai Tianqiao: "Yes, but is there enough time?"

Xie Ke looked at him: "The child's condition is not very good, and there may be a risk of shock again at any time. It is best to perform bone groove reconstruction and hematoma removal at the same time."

When he said this, Cai Tianqiao instantly understood that Xie Ke was planning to make the best use of everything, since he had already come to be an assistant anyway, so he had to help him to the end.

Xie Ke didn't care what others thought, he began to give orders on his own: "The nurse prepares the hemostatic sponge and may wrap the venous sinuses. Add a head pad under the head. Director Cai is responsible for wrapping the herringbone area with silastic strips The second assistant is responsible for lifting the dura mater, and I will rinse it. The anesthesiologist will come over and check and fix the intubation again."

As soon as Xie Ke's voice fell, everyone acted according to his words.

This time, instead of standing beside him as an assistant, Cai Tianqiao stood opposite Xie Ke.

In order to save time, they will perform two different operations at the same time.

Cai Tianqiao was also moved by the calmness and confidence in Xie Ke's eyes!