Chapter 267: Fighting against Death, Extraordinary Courage and Courage
After arriving at the cardiothoracic surgery department, I originally wanted to ask the doctors and nurses which operating room I was in.
He found it all unnecessary.
There is no need to ask at all.
Because medical staff were constantly jogging in and out of Operating Room No. 3, each with a serious look on their face.
Outsiders may not be able to see anything, but insiders can tell at a glance that something has definitely happened.
Medical staff only become so nervous when the patient's life is in danger.
Various rescue supplies were transported in to save lives.
When doctors and nurses from multiple departments of the hospital receive a call for help, they will rush over to participate in the rescue work as soon as possible.
Zhou Can followed two nurses into the operating room.
There were not enough clothes in the operating room, so the nurse temporarily placed a large pile of disposable protective clothing.
It can also be used in emergencies.
The protective suit is not breathable and will be very hot and stuffy when worn. Doctors will definitely feel very uncomfortable if they wear it during surgery.
Saving lives is the most important thing now. After changing his clothes, Zhou Can quickly walked into the operating room.
"Director Xue! Director Le!"
Zhou Can found that many of them were familiar faces. He had spent three months in the cardiothoracic surgery department and basically knew all the full-time doctors and nurses in this department.
He couldn't greet all the ordinary medical staff one by one, so he only greeted Director Xueyan and Director Le.
"You are finally here, please help and see if we can save the patient!"
When Director Xueyan saw him arrive, she felt a little more hopeful.
"Okay! Let me first understand the patient's basic condition."
While Zhou Can agreed, he learned about the patient's accident through Director Xueyan's introduction.
The patient, a 41-year-old male, accidentally fell down the stairs at home, with his left limbs landing first. After falling, he got up on his own and did not feel much discomfort.
When it was almost time for dinner, the patient felt a tightness in his chest, palpitations, and difficulty breathing, as if an invisible hand was covering his mouth and nose.
Later, the patient began to cough and even coughed up blood.
At this time, his family realized that the situation was not good and took him to the local health center for treatment.
Because it was night when we went there, the doctor on duty made a simple diagnosis and asked the patient to be hospitalized first, and planned to do a chest X-ray on the patient after work the next day.
The patient was worried about spending money and felt that nothing was serious, so he refused to be hospitalized and insisted on going home.
After returning home, apart from coughing and chest tightness, there were no other symptoms.
In the end, I just endured it and hoped that I would get better soon.
This dragged on for 27 days, and the patient's condition did not improve, but his chest tightness became worse. In severe cases, he could not breathe and had chest pain.
Yesterday, the patient suddenly fainted at home. His family members were worried that something had happened to him, so they sent him to the hospital.
The local health center did not dare to admit the patient and suggested sending him to a large hospital for treatment.
After many twists and turns, the family finally brought the patient to Tuya Hospital.
After the emergency department received the patient, they felt that they could not handle the situation, so they transferred the patient to the cardiothoracic surgery department for further examination and diagnosis.
Director Hu Kan received a report from the doctors below that the patient's condition was very bad. A chest X-ray was performed on the patient, which showed a right-sided hydropneumothorax with the right lung compressed by more than 80%.
The patient then underwent a thoracentesis and a small amount of uncoagulated blood was drawn out.
The final initial diagnosis was hemothorax.
Because the situation was urgent, Director Hu Kan decided to perform a thoracotomy on the patient.
Based on his experience in diagnosis and treatment, he was certain that the patient had internal injuries from the fall. This type of hemothorax is very difficult to treat, especially since the patient waited so long to come for treatment.
Generally speaking, it is easier to find bleeding points and injured areas when checking right after a fall.
When the patient is examined again nearly a month later, many of the original lesions have disappeared or have turned into latent lesions, which will definitely greatly increase the difficulty of diagnosis and treatment.
Thoracotomy should be performed under general anesthesia.
About twenty minutes before anesthesia, Dr. Guan injected scopolamine into the patient via intramuscular injection.
The use of this medicine can effectively slow down the patient's intestinal motility and reduce the secretion of respiratory mucus.
Unexpectedly, just after the patient was connected to the life monitoring equipment and before the general anesthesia operation could be performed, the patient suddenly began to show symptoms such as irritability, cold limbs, and cyanosis of the lips.
Director Hu Kan remained calm in the face of this sudden situation. He immediately performed local anesthesia on the patient and then performed closed chest drainage from the mid-axillary line of the sixth intercostal space on the right side.
In the end, nearly 1000 ml of blood was drained from the drainage bottle.
Director Hu Kan then gave the patient an intramuscular injection of 12 ml of 2.5% sodium thiopental and 100 mg of succinylcholine.
Next, a endotracheal tube is inserted into the patient.
About two minutes later, the patient resumed spontaneous breathing.
However, the good times did not last long. It was soon discovered that the patient's respiratory resistance had increased. After consulting with the anesthesiologist Dr. Guan, Director Hu Kan gave the patient an intravenous injection of fentanyl and had the patient inhale enflurane.
But the situation did not improve at all.
After a while, I found that there were no bubbles or boiling in the drainage bottle, and the water column in the glass tube did not fluctuate.
Director Hu Kan squeezed the drainage tube with his hands but still no blisters came out.
At this point, the patient's heart stops beating.
Director Hu Kan decisively ordered cardiac compression to rescue the patient.
The thoracotomy was performed between the ribs. When the pleura was cut, bubbles and blood gushed out from the incision.
When Director Hu Kan saw this situation, he said in a sad voice, "Continue cardiac compression, intravenous and intracardiac injections..." Before he could finish his words, he fainted on the ground.
Director Hu Kan is known for his steadiest scalpel, having never failed before.
Only last time when he risked his life to perform surgery on a thymoma patient, something almost went wrong. At that time, Director Hu had a heart attack. It was Zhou Can who carried him around and tried to find a way to save him, and that’s how he was saved.
It is precisely because of this relationship that Director Hu Kan still has a very close relationship with Zhou Can.
Unexpectedly, less than a year later, Director Hu Kan got into trouble again.
And this incident was a bit unfair.
The person who should be held most responsible should be the anesthesiologist, Dr. Guan. Director Hu Kan just happened to be involved in this matter. He fainted in the operating room, and he must have known that it would be difficult to save the patient.
The title of the steadiest scalpel that he had worked hard to maintain his entire life was destroyed in an instant.
The stimulation was too great and he fainted.
After Director Hu Kan fainted, he was rushed to the hospital. Director Xueyan took over Director Hu Kan's position as the chief surgeon and continued to rescue the patient together with Doctor Guan.
Under her command, the patient was given emergency treatment with intravenous and intracardiac injections of epinephrine and lidocaine.
The patient's heart starts beating again with the help of these drugs, which can make the heart beat again.
Unfortunately, it only lasted less than a minute before the patient's heart stopped again.
Since then, they have been working hard to continue rescuing the patient.
After Zhou Can quickly understood what had happened, he had a general understanding of the patient's cause and condition.
When I reached out my hand, I found that the patient had no pulse, his body was cold, and his skin was clammy.
It doesn't have the body temperature that a normal person should have.
"What could have gone wrong?"
Zhou Can forced himself to stay calm. The patient currently had no heartbeat or breathing on his own, and was relying entirely on artificial cardiopulmonary resuscitation to maintain the most basic blood-oxygen exchange. Every second counts in the rescue.
Most of the patient's body was in the gates of hell.
Many chief physicians and deputy chief physicians from the Department of Cardiothoracic Surgery were present to help with the rescue. Liu Xiangqing, director of the Department of Critical Care Medicine, was also invited.
However, faced with the fact that the patient was almost dead, they were all helpless.
At this moment, Zhou Can's emergency medical skills played a huge role.
His mind was exceptionally calm, and his ideas on diagnosis and treatment became stronger and clearer than ever before.
"Cut off three of the patient's ribs and expand the chest cavity by opening a window! The problem is most likely that there is a blood clot in the chest cavity itself, and the closed chest drainage tube is very likely to be blocked by the blood clot."
Zhou Can spoke out his diagnosis.
After quickly going over it in his mind twice, he thought that this was the only possibility.
If the patient already had serious heart problems, he would have died when he fell and would not have survived until now.
Since a large amount of blood has been drawn out from the patient's chest cavity, even though it is uncoagulated blood, it does not mean that no blood clots will be produced.
After the intramuscular injection of scopolamine, the patient became restless and had cyanotic lips, which was probably related to the blood clot that seriously affected the lungs, because the patient's right lung was compressed by nearly 80%.
After sorting out his thoughts, Zhou Can became more certain of his guess.
[Pathological diagnosis experience +1, first aid wisdom experience +1. ]
[During the rescue, you sorted out your thoughts and found the cause of the disease at the fastest speed, and your application of medical knowledge and clinical experience reached a new level. Reward pathology diagnosis experience +100, first aid wisdom experience +100. ]
After Zhou Can received the experience points reward, he became more certain that his diagnosis was correct.
The rescue workers did not listen to him, but looked at Director Xueyan who was in charge of the scene.
"Do what Dr. Zhou Can said immediately and expand the chest opening."
Director Xueyan did not hesitate at all, which showed her absolute trust in Zhou Can.
The patient's condition at this time does not allow for any indecision.
Death has loomed over the patient.
The situation was so serious that these chief doctors had never encountered such a dangerous situation in their lives.
Now, rescuing patients is actually more of a rescue duty for medical staff, and its symbolic significance is greater than its actual rescue significance.
At this critical moment, Zhou Can proposed a rescue idea that no one had thought of, or perhaps thought of but did not dare to implement, which was a last-ditch effort.
The patient's chest window enlarges, which means that cardiac compressions need to be interrupted for a moment.
This is also the reason why the doctors involved, including Director Liu from the Department of Critical Care Medicine, did not dare to follow Zhou Can's command.
Director Liu of the Critical Care Medicine Department has a deep understanding of Zhou Can's abilities. He has taught Zhou Can for nearly three months. The two also have a very good personal relationship.
But when rescuing a patient, personal relationships are nothing, and the patient's life is the most important.
Director Xueyan trusted Zhou Can so much that she decisively followed Zhou Can's advice to further open the chest, which surprised Director Liu.
In fact, it is just that the conditions do not allow it and the time is too tight.
Otherwise, according to Zhou Can's idea, it would be best to saw the sternum in the middle and then expand it.
This is the most common frontal thoracotomy.
But the patient has no heartbeat or breathing. If we really do this, the medicine will be useless.
"I'll do it!"
Zhou Can found that the doctors in the cardiothoracic surgery department inherited the steady pace of Director Hu Kan, and as the saying goes, slow work produces fine work. Their speed was really too slow.
In desperation, Zhou Can had to do it himself.
Many cardiothoracic surgeons are aware of his surgical abilities.
No one raised any objection.
After he took over the surgery, his speed immediately increased from walking to flying a plane.
Swish, swish, swish!
The operation was as fierce as a tiger, leaving Zhou Can's medical staff stunned.
It was really scary to watch Dr. Zhou perform surgery.
Many people thought to themselves, even if the patient’s heart has stopped beating, they cannot perform surgery as roughly as if they were an animal, right?
After a patient dies, as long as the family raises questions, the forensic doctor will definitely intervene.
When the forensic doctor performs the autopsy and sees that the surgical wounds were caused by rough operation, there will definitely be bad comments.
It was only when Zhou Can really completed the expansion of the chest window that everyone discovered that although his operation speed was fast, the surgical incision was not rough. It was even neater than the wounds carefully cut by cardiothoracic surgeons.
"The tube is used to drain the blood from the chest cavity."
There was still some blood inside.
After the blood was drawn out, blood clots were immediately found, and there was more than one.
It can be clearly seen that the chest drainage tube has been blocked by blood clots.
This was the main reason why the patient's breathing and heartbeat stopped completely. It was also the main reason why Director Hu Kan's rescue measures had just taken effect, but lasted for less than a minute before his heart stopped beating again.
" The patient appeared to have a severe tumor in the right upper lung, which had ruptured and bled."
Zhou Can said.
"It should be that the cavitary respiration after anesthesia and intubation caused the lung lobe to expand, and the blood clot moved and blocked the drainage tube, eventually causing tension hemothorax and causing cardiac arrest."
After the thoracotomy, the root cause of the problem was found, and no one thought Zhou Can was fooling around anymore.
On the contrary, they all admired Zhou Can's diagnostic ability and rescue ideas from the bottom of their hearts.
In this case, it takes great courage and determination to insist on further thoracotomy. It also requires a deep and comprehensive understanding of the patient's cause and condition before making such a decision.
"Perform pericardial compression immediately! Transfuse blood to save lives."
Zhou Can gave orders again.
In this kind of emergency rescue situation, every second is extremely precious. He really has no way of asking Director Xueyan first and then giving orders through her.
If you do that, it will be a very face-saving project, but it will just be too time-consuming.
It is also extremely unfavorable for rescue.
In medicine, there is a saying that there are three golden minutes for rescuing cardiac arrest.
At this moment, it has actually exceeded three minutes.
Zhou Can quickly cleared the blood clot in the drainage tube.
"It is safer to use double-lumen endobronchial intubation after closed chest drainage for anesthesia during surgery."
The accident that happened to this patient was both accidental and inevitable.
Dr. Hu Kan may have considered the urgency of the situation and only used a single-lumen intubation.
Eventually, a blood clot blocked the single-lumen tube, causing the patient's breathing and heartbeat to stop again, resulting in the failure of the first rescue.
Another real reason that caused the patient to be on the verge of death was the rupture of the lung tumor causing massive bleeding.
The bleeding is still being seen.
As soon as the blood in the chest cavity was drained out, a lot of blood soon appeared again.
Zhou Can's all-around advantage was fully revealed at this moment.
He quickly determined the location of the patient's pulmonary bleeding, and then used a combination of methods including clamping, ligation, and electrocoagulation to successfully stop the bleeding for the patient.
Originally, if conditions allowed, the patient's lung tumor should be removed. It might even be necessary to remove the entire right lung.
Who dares to do that now?
Even if he had three guts he wouldn't dare to do this.
Otherwise, you will only get yourself into trouble.
It could also be a huge trouble.
After a series of effective rescue measures, the patient's heartbeat recovered, and after a large amount of blood transfusion, his blood pressure slowly rose.
Because the bleeding has stopped, there is no need to worry about the transfused blood escaping, and the effect of the rescue is almost immediate.
"It was a close call, it almost cost a life!"
Doctor Guan is usually a very calm man, but when the accident happened just now, his face was extremely pale and he didn't say a word.
I guess he was scared half to death.
"We have saved the patient's life. However, he has a tumor in his right lung, and the possibility of it being malignant is high. How can we solve this problem?"
Zhou Can asked Director Xue and others for their opinions.
Inside the operating room, the atmosphere was not as tense as before as the patient's vital signs gradually stabilized.
Zhou Can, a small trainee, has undoubtedly become the core of the operating room.
This is how it is in the operating room: whoever can save the patient's life, has the best surgical skills, and has great diagnostic ideas is the boss.
Even if you are just an intern, you will be the chief surgeon, and other senior doctors will naturally put you in a high position.
"What do you mean?"
Director Xueyan asked him.
When she looked at Zhou Can, her eyes shone with a special light. This brother was really awesome. After arriving at the scene, he managed to turn the tide and save the patient from death.
Just now, she was already filled with despair.
I thought the patient could not be saved.
Unexpectedly, a medical miracle happened. After Zhou Can boldly proposed to enlarge the chest incision, the cause of the disease was successfully found and the patient was successfully rescued.
