I can see the status bar

Chapter 392 Intervention Section

From the perspective of treating gastric bleeding alone, it can be seen how different and different the current medical education system and practical application are.The only correct solution to hemostasis of gastric bleeding, which is regarded as the golden rule in textbooks, is to use a three-chamber two-capsule tube.After the three-chamber two-capsule tube is placed in the patient's stomach, air is injected into the tube through a syringe to inflate the gastric bladder to achieve the purpose of compression and hemostasis.

Theoretically speaking, the three-chamber two-capsule catheter has few side effects, and the equipment is cheap, and the operation is not too difficult.It is ideal for the treatment of gastric bleeding and hemostasis.But the reality is that the scope of use of the three-chamber two-capsule tube is severely limited, because it requires the cooperation of the patient. In actual use, it is far less effective than using a hemostatic agent under a gastroscope or cauterization to stop bleeding.In the face of more serious gastric bleeding, doctors will choose to embolize the gastric artery through interventional surgery to relieve bleeding symptoms when gastroscopic hemostasis is ineffective.

However, Dean Wu Youqian directly decided to use interventional therapy instead of gastroscopy to stop bleeding. The thinking process is actually very similar to Sun Lien's "reasonable diagnosis".

In the case of severe infection, sudden severe gastric bleeding when the patient does not eat or drink may indicate the occurrence of DIC.

There are five main causes of DIC, the most common being a severe systemic infection.This is followed by massive depletion of coagulation factors by trauma, organ damage, neoplasms and obstetric disasters, among other causes.

A patient with severe systemic infection with an unknown medical history suddenly suffers from moderate or severe gastric bleeding without gastric ulcer triggers. As a doctor, the first thing that should come to mind is definitely not the common clinical bleeding caused by ulcers, but the first stage of DIC. Spontaneous bleeding symptoms.

For the treatment of patients with such serious conditions, doctors must always maintain a high degree of vigilance.Try to rule out the most serious possibility as soon as possible.This is also the main reason why Dean Wu Youqian directly decided to carry out embolization treatment - if it is DIC, gastroscopic hemostasis will not only be ineffective, but will also lead to further aggravation of DIC due to the consumption of coagulation factors.And if not, embolization therapy can also play a role, and patients themselves will not face more risks.

In the medical industry, experience has always been part of strength.

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Standing outside the clean room, Sun Li'en breathed a sigh of relief after hearing Dean Wu's arrangement.The old dean is indeed a ruthless man who was able to decisively stop bleeding with bare hands in the French operating room. His judgment on the patient's condition was almost as good as that on the status bar. Saw status prompts for (mild DIC).At the same time, Dean Wu has already begun to arrange transfusions of frozen plasma and whole blood to supplement coagulation factors and blood lost by patients.After vomiting blood for the second time, Dean Wu Youqian directly decided to embolize Hou Huiying to stop the bleeding.This should be because it has been judged that the patient has DIC symptoms, so he chose such a firm hemostasis method-it was a quick, accurate and ruthless decision.

Sun Li'en began to think of others, and began to reflect on whether his usual medical activities would affect the timeliness of rescue if he paid too much attention to testing evidence.However, after some deliberation, Sun Li'en found to his dismay that he couldn't learn this set of techniques from President Wu at all.

Carrying out high-risk treatment based only on some indirect evidence is probably something that a director-level expert like Wu Youqian would dare to do.They have seen hundreds of times more patients than the girls Sun Lien has seen.Other medical staff will not raise any objections to Dean Wu's judgment.But Sun Li'en couldn't, even though he already had some fame in the hospital, he was still a trained doctor who needed to use other people's prescription rights.Rather than grabbing a little time for treatment by astonishing the world, it is better to complete the examination as quickly as possible, and then use tangible evidence to prove your own diagnosis plan.This is better than encountering objections from other doctors during the diagnosis, and then having to spend time convincing them to come.

After spending a while thinking about it, I found that I couldn't copy the other party's more effective approach.After understanding this fact, what followed was depression and depression that could hardly be resolved.While Sun Li'en himself was depressed, he suddenly understood the thoughts of Xu Yourong, Yuan Ping'an, and even Dr. Pascal.

It was such a frustrating thing to clearly see a road, but not be able to walk on it at all.

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"Embolization of bleeding veins?" In the interventional operating room, several young doctors looked at each other. They gathered together for a discussion, then shook their heads and said, "President Wu, this operation is too difficult for us to do."

The patient's condition has been clarified by preliminary angiography. Hou Huiying herself did have symptoms of gastric ulcer. Since no obvious abnormalities were found in arteriography, it is certain that the bleeding site is not an artery, but her gastric fundus vein.Although common gastric ulcer bleeding mainly causes arterial bleeding, but because Hou Huiying's ulcer is deep and she is likely to suffer from liver cirrhosis, Hou Huiying's gastric bleeding is actually more troublesome gastric venous bleeding .

The hemostasis of the gastric fundus vein through interventional surgery is two levels more difficult than the arterial interventional embolization of the gastroduodenal artery.First of all, venous embolization needs to let the main medium guide wire of the interventional operation pass through the venous valve, pass through the liver, pass through the portal vein and then go up into the gastric fundus vein for embolization without injuring the venous valve.In the actual operation, it is already very difficult to get the guide wire to reach this position.It is more troublesome to place the embolism later.Human veins are generally wider than arteries.It is extremely difficult to embolize the gastric fundus vein with conventional platinum rings, and gelatin sponge particles must be used to assist embolization.

And the interventional department of the fourth hospital... at least the second-line doctors on duty don't have this ability.

"We really don't have the confidence to do this operation in an emergency situation." The doctors in the fourth hospital can say nothing else. Anyway, with Dean Song around, they dare to do anything to save lives as long as the means and purpose are correct.But the premise of boldness is to be careful. The second-line doctors on duty must clearly raise difficulties to the old director, "If you can't wait, I can do it. In fact, the gastric fundus vein is bleeding, and the effect of ligation with a gastroscope is also very good. ?”

"The patient has signs of DIC, and the hemostatic strength of gastroscopic ligation is not enough." Dean Wu Youqian certainly knows that gastroscopic ligation is easier and more convenient, but the patient has already shown signs of bleeding. Different from drinking poison to quench thirst.What's more, severe bleeding and renal dysfunction are also contraindications for venous ligation under gastroscope.

"I've already called Director Xiong. He'll be here in 10 minutes." Outside the operating room, Song Wen pressed the intercom and said to everyone in the room, "Ms. Wu, let's maintain the patient's vital signs first. Director Xiong will be here soon."

(End of this chapter)