Chapter 220 Dangerous brain herniation, using blood to find the bleeding point
Not long after, he rushed to the neurosurgery emergency room.
There were more than a dozen doctors and nurses surrounding a bed in the emergency room.
There was also a blond man who was suspected to be a family member standing beside the bed and looking at him worriedly.
"So he's a foreign friend. No wonder the Department of Neurosurgery attaches so much importance to him."
It must be explained that this is not a matter of worshipping foreign things.
Letting foreign friends feel the beauty of China as much as possible can attract more foreign friends to come and invest or work. This is a far-sighted vision.
In the past, Zhou Can always felt that it was too flattering when he saw foreign friends being treated preferentially in the country.
I felt very contemptuous about this.
Later, as his knowledge grew, his thinking gradually became more open, and he slowly understood the profound intention of preferential treatment for foreign friends.
Treating foreign friends well can gain their friendship and recognition. They will also be more willing to work and invest in such a kind, peaceful and welcoming country, which can drive the development of economy, science and technology.
"Doctor Zhou is here!"
This nurse should be the one who called Zhou Can just now.
Zhou Can had a slight impression of her, her name was Shu Qian.
"Director Wen, Director Wu..."
Zhou Can walked over and greeted these bigwigs from the Shenwai sect.
There were four chief physicians alone, and seven or eight attending doctors and resident doctors. The hospital attached great importance to this patient.
Otherwise it would be impossible to mobilize so many medical resources.
"Doctor Zhou, can you take a look at the film and medical records first? The patient has a cerebral hemorrhage and was sent here not long ago. A CT scan of the head was taken."
After Wu Baihe said a few words to Zhou Can, he leaned over again to carefully check the patient's condition.
Zhou Can took the CT film and looked at it. He saw many white spots on it. In one place, there was a huge white spot.
White spots on brain CT scans are often caused by brain calcification, hemorrhage or tumors.
The patient is now in a deep coma and does not respond to calls or pats on the shoulders.
When I opened my eyelids, my eyes were dull and my gaze was blurred.
This shows that her condition is very serious.
Those small white spots are probably just calcification of the pineal gland or choroid plexus. This physiological calcification will not have much impact on the patient and does not require treatment.
The key lesion site should be the huge white spot.
White spots on brain CT usually refer to high-density lesions. The specific cause of their formation should be comprehensively judged based on the size, location, CT value, space-occupying effect and degree of compression of surrounding brain tissue.
Zhou Can had been undergoing neurosurgery training for several months and had already learned how to read brain CT scans, color ultrasounds , X-rays and other films.
The cause of this patient's illness is actually easy to diagnose.
The intracranial pressure is very high, the brain tissue is squeezed and displaced, and brain herniation has occurred, which has a very high mortality and disability rate.
At present, the bleeding site can be roughly located below the falx cerebri.
When the brain herniation formed in this area exceeds a certain degree, it is far more dangerous than the general brain herniation. For example, foramen magnum herniation usually causes respiratory failure or respiratory arrest. Before the onset of the disease, there will be symptoms such as neck stiffness, pupil dilation, and brain stem hypoxia.
In general, the onset of foramen magnum hernia is gradual, giving doctors time to rescue.
The patient is most likely suffering from subfalcine herniation, which has a very high mortality and disability rate. A large amount of nerve tissue will be displaced or cut, and most of the nerves will be necrotic, leaving doctors with very little time to rescue them.
Many patients die before they even have time to have their skulls drilled.
"Xiao Zhou, after examining the patient, what do you think of his condition?"
Lord Wen probably just wanted to test Zhou Can.
There are several chief physicians on site, so diagnosing the cause of the disease is certainly no problem.
It's not a particularly rare disease in itself.
"It should be a subfalcine herniation accompanied by intracranial hemorrhage and intracranial hypertension. The patient's condition is extremely dangerous. When the subfalcine herniation is mild, it will only cause paralysis of the lower limbs on the opposite side and difficulty urinating. This patient is already in a deep coma, which means that the displacement of brain tissue caused by brain herniation is already extremely serious. The best way is to open the skull immediately. Judging from her current condition, it may be too late to open the skull with a traditional craniotomy. Immediate trepanation cranioscopic surgery may give her a glimmer of hope."
In such a situation, Zhou Can would naturally not play any tricks to hide his shortcomings.
Instead, he stated all his diagnostic opinions truthfully.
As for whether the chief physicians will adopt it, it depends on their opinions.
"It seems that inviting Dr. Zhou to participate in the rescue was an extremely correct decision! Your diagnosis is basically consistent with ours ."
If you listen carefully, you will find that Wu Baihe was asking Zhou Can to come over, rather than asking Zhou Can to come and participate in the rescue.
The fact that the chief of neurosurgery was so polite to him was enough to show the status of Zhou Can in the eyes of the chief physicians of neurosurgery.
"Issue a critical illness notice immediately! Then talk to the family. If they agree, have them sign a surgery notice immediately, and then send the patient to the operating room for emergency surgery."
Wu Baihe acted decisively and made a series of arrangements.
Any kind of brain herniation is extremely dangerous. In this case, more than half of his body was already in the brink of death, and emergency surgery was his only chance of survival.
"But the site of intracranial bleeding has not been identified yet. If we rashly perform surgery, there will be too many uncertainties. This operation is inherently very risky. I'm worried..."
A chief physician raised the question with a worried look on his face.
"The patient's current condition cannot wait for angiography. I have performed intracranial surgery for so many years and I know the structure of the brain very well. I can only rely on my experience. Let's do it!"
The name "Top Scalpel" is not for nothing. Wu Baihe's understanding of the brain structure probably exceeds that of anyone else.
Even without taking X-rays, he was confident that he could successfully complete this high-risk operation with the help of his rich surgical experience.
After Wu Baihe gave the order, he went to talk to the foreign friend in person.
I really didn't realize that Wu Baihe not only has the reputation of being a top scalpel, but also speaks fluent English.
Communication with the family members went very smoothly.
He quickly agreed to the surgery.
The nurse immediately took out the clippers to shave the patient's hair and made preparations for the operation.
The patient was quickly rushed to the operating room.
Dr. Feng, the best anesthesiologist at Tuya Hospital, was also called in to work overtime.
Zhou Can helped to anesthetize the patient.
Unlike the anesthesia for ordinary patients, this patient's anesthesia surgery requires many techniques and key points, and requires that the general anesthesia surgery be completed in the shortest time possible.
Dr. Feng and he worked at full capacity, and the two cooperated with each other in a very good understanding. After some effort, they were finally able to successfully perform general anesthesia on the patient.
[Anesthesia experience +1. ]
[You completed general anesthesia for the first time on a patient with brain hernia, and were awarded +100 anesthesia experience points. ]
This was the first time that Zhou Can received an experience point reward for anesthesia, and it was as high as 100 points.
This surprised him greatly.
However, the implementation of this anesthesia surgery was indeed full of challenges, and it also allowed him to learn many more advanced skills.
In particular, many of them are learning about the protection and stabilization of patients' vital signs in emergency situations, including preoperative medication, for the first time.
"Dr. Zhou's surgery is fast. You can cut the scalp layer."
Wu Baihe didn't invite Zhou Can to come and watch the fun.
In addition to Zhou Can's endoscopic surgery skills, which can serve as a backup surgeon when necessary, Zhou Can's ability to perform rapid surgeries is unmatched by other doctors.
There are only two doctors who can perform quick surgery in the entire Tuya Hospital.
That is Dr. Xu and Zhou Can.
Unless it is absolutely necessary, Dr. Xu would not be asked to participate in this kind of rescue operation.
Although that incident happened a long time ago, Dr. Xu's identity is still highly sensitive.
This operation involved foreign friends, so the hospital was extremely cautious.
If the patient cannot be rescued and the list of surgeons is reported, and someone with ulterior motives sees Dr. Xu on the list, it will be a big trouble.
Zhou Can's sharp knife skills were learned from Dr. Xu. Although he was still far from perfect, it was still usable.
Zhou Can stood at the main operating position and lived up to expectations, cutting the scalp layer as quickly as possible according to the drawn incision position.
Zhou Can was not allowed to perform the subsequent skull drilling.
If the drilling is not done properly, it can easily cause serious harm to the patient.
Any surgeon would dare to drill a hole in a removed bone flap, but drilling a hole directly in a patient's skull requires extremely high technical skills, and even an ordinary deputy chief physician would find it difficult to complete this operation.
Under the skull is the dura mater, and below that are important brain tissue, brain stem, blood vessels, and nerves.
Any injury to any part of the body will cause unpredictable damage.
This directly leads to the patient's respiratory arrest and cardiac arrest, which is a normal thing.
Therefore, skull drilling must be performed by a chief neurosurgeon with extensive surgical experience.
Wu Baihe personally drilled a hole and opened a window in the patient's skull.
An assistant used a mastoid traction device to stretch the scalp so that Wu Baihe could open the bone window smoothly.
Wu Baihe was seen carefully drilling a hole in the patient's skull, while Zhou Can stood beside him watching and learning.
Skull windowing, whether by drilling a hole or cutting a bone flap with an electric saw, is extremely dangerous.
The main problem is that it is difficult to grasp the right degree.
After Wu Baihe completed the window opening, he cut open the dura mater and used an endoscope to begin the brain hematoma removal surgery for the patient.
He cleared the patient's intracranial hematoma bit by bit, and his movements were like he was caring for a baby.
I was afraid that excessive movement would hurt the baby.
The brain tissue inside the skull is actually more tender and fragile than that of a baby. Any carelessness can cause irreversible serious consequences.
Zhou Can stood on the stage, staring at the endoscope screen from time to time, and from time to time he looked at how Director Wu's hands operated the endoscope.
"Oops!"
After Wu Baihe cleared part of the hematoma from the patient's skull, his face changed drastically, and a hint of solemnity and tension appeared between his brows.
"Director Wu, what's the matter?"
The doctors around were worried.
"After the blood clots were drained, the patient's brain began to bleed. Since there was no time for angiography before the operation, it is not easy to find the bleeding point now. If the bleeding cannot be stopped in time, the patient will die soon."
Wu Baihe thought that his rich experience was enough to deal with any situation.
Unexpectedly, the bleeding point was very hidden and I couldn't find it after searching for two rounds.
The rescue has lasted for more than three and a half hours, and the patient's hope of survival is becoming increasingly slim.
According to international rescue experience, if emergency surgery for brain hernia takes more than four hours, the patient can basically be declared dead.
The rescue has been going on for nearly four hours now, but the bleeding point cannot be found, and the brain cells at the end of the blood supply will die due to ischemia.
This death of brain cells and brain tissue is irreversible.
Wu Baihe is old after all. He rushed to the hospital in the middle of the night and performed such a long operation. He was obviously exhausted physically and mentally.
But when it comes to endoscopic surgery, none of his deputy chief physicians or chief physicians are particularly good.
"Director Wu, why don't you let Zhou Can take your place for a while!"
Director Wen was watching anxiously from the side.
Although the surgical team consisting of so many chief physicians and deputy chief physicians is magnificent, they cannot work together at all.
The most I can do is help the anesthesiologist to stabilize the patient's vital signs.
Wu Baihe was the only one who performed the operation.
“Doctor Zhou, are you confident?”
Wu Baihe stopped the operation and turned to ask Zhou Can, who had wanted to volunteer for a long time under the operating table.
Senior doctors usually ask, "Are you confident? How sure are you?"
Instead of asking like the family members, "Can the disease be cured? How many days will it take to recover? Can the patient be saved?"
Doctors are people who have performed surgery themselves and understand the hardships and uncertainties involved.
But family members and patients don’t understand this.
It is impossible to force the doctor to give a definite answer.
"have!"
Zhou Can's answer was brief and powerful.
"Come on, try to see if you can find the bleeding point! I believe you also watched me searching with the endoscope probe just now. The areas that have been explored can basically be ruled out. Be sure to operate carefully and do not injure the important blood vessels and nerves in the brain stem and under the arachnoid membrane."
After Wu Baihe gave up his position as the surgeon, he did not step down from the operating table.
Instead, he stood by and watched.
Zhou Can secretly felt lucky that his hemostasis technique had just been promoted to level five not long ago, which allowed him to dare to challenge the hemostasis task of this operation.
He had been watching from the audience just now.
If I'm not mistaken, the bleeding site is most likely a cerebral hemangioma or a ruptured malformed blood vessel.
Wu Baihe has extensive experience in surgery and would have been able to find larger hemangiomas long ago.
For a small hemangioma, the amount of bleeding should not be so large.
Then there is only one possibility left, that the cause of bleeding is the rupture of abnormal blood vessels.
He operated the endoscopic probe and carefully explored the cranial cavity.
Different from Wu Baihe's method of investigation, Zhou Can deliberately did not suck out the new bleeding in the cranial cavity , allowing it to form a blood pool.
"Is this even okay? Why do I feel like he's playing around?"
"It's a bit of a joke to let a trainee do this."
"It's really worrying to watch. It's a pity that my endoscopic skills are not good enough. Otherwise, if I were to do it, I should be able to find the bleeding point."
Many doctors on the scene looked anxious.
They thought it was ridiculous to let Zhou Can perform this operation.
Zhou Can, standing on the operating table, was not affected by the outside world's doubts, but stared at the endoscope screen intently. The endoscope in his hand changed its angle slightly and moved slowly.
He didn't know what abilities other doctors would have after their hemostasis skills reached level five.
Anyway, when his hemostasis skills reached the fourth level, he was able to track the approximate location of the bleeding point by the blood flow and the ripples on the surface of the accumulated fluid.
Suddenly, his eyes lit up.
"The bleeding point turned out to be hidden in the right brain ball. No wonder Wu Baihe couldn't find it."
This location is easily overlooked.
Even if the probe is found nearby, it can be easily and quickly removed.
"Hey, hey, how did the endoscope move in? It's dangerous!"
“Stop it now!”
Several chief doctors were scared to death after seeing Zhou Can's operation.
Zhou Can did not stop, but instead confidently probed directly into the target position inside the brain ball.
This operation process is actually very difficult.
Fortunately, his grasping and transferring skills had both reached level 4, which came in handy when he moved some brain tissue to create a favorable space for endoscopic examination.
[Grasping skill experience +1.]
[Successfully grasping important brain tissue for the first time, reward grasping experience points +100. 】
[Experience gained in teleportation +1.]
[For the first successful transmission and pulling of important brain tissue, you will be rewarded with +100 experience points for the transmission technique. ]
Every difficult operation must be rewarded heavily.
Zhou Canle was delighted.
An even bigger surprise was yet to come, as he took a picture of something that excited him.
"We found the bleeding point! It turned out to be a ruptured blood vessel with blood."
As soon as Zhou Can's probe reached the bleeding location, he saw blood gushing out and the blood washed onto the probe.
The amount of bleeding was considerable.
It must be a ruptured artery.
And they are not small arteries, but cerebral arteries with relatively thick diameters.
No wonder the patient is unable to stop the bleeding with his own clotting ability.
"Great! That's great! Finding the bleeding point means the patient's chances of being saved are much greater!"
Wu Baihe was extremely excited.
The doctors who had questioned Zhou Can shut their mouths one by one, feeling ashamed for their rash words and actions.
No one expected that Zhou Can could actually find the blood vessels causing intracranial hemorrhage.
It took only nine minutes.
At this moment, some people even think that it might be more beneficial to the patients if Zhou Can took over Wu Baihe's position as the surgeon earlier.
