world famous doctor

Chapter 238 Aortic Injury

After Zhou Chen had just consulted several patients, the phone in his pocket rang.

I took it out and saw that it was Dr. Zhang Jian from the emergency department of the municipal hospital.

Press the answer key.

Dr. Zhang Jian's very urgent voice came from the receiver.

"Dr. Xiao Zhou, where are you now? Can you come to the hospital?"

Zhou Chen frowned, and asked, "What's wrong?"

"A patient just came in from the emergency department of the hospital. He fell from a high place on the construction site and was pierced by a steel bar in his left abdomen. He lost a lot of blood and is in critical condition. I'm afraid only you can save him!"

Human life is at stake, Zhou Chen didn't hesitate at all.

He stood up, said a few words casually, and immediately drove to the municipal hospital.

Doctor Zhang Jian has the most contact with Zhou Chen, and he also knows Zhou Chen's medical skills best.

In Zhang Jian's view, even if such a serious patient is transferred to a higher-level hospital, it probably won't help.

What's more, the upper-level hospital is in the provincial capital, hundreds of kilometers away from Jiangzhou, and it takes at least a few hours to drive.

In this way, wouldn't the best time to rescue the injured be delayed even more?
Therefore, Zhang Jian believed that calling Zhou Chen to the hospital was the most correct decision.

Several female nurses in the emergency department of the hospital were also frightened when they saw such a seriously injured patient.

Before Zhou Chen arrived, Zhang Jian led several nurses to rescue him with anxiety and apprehension.

Nurse Bai Ting shouted:
"No, his blood pressure has dropped dramatically!"

"How much?" Zhang Jian asked.

"5.9/0.9kpa." Bai Ting replied.

"Immediately pressurize blood transfusion to resist shock, and prepare for laparotomy!"

As Zhang Jian spoke, he turned back and looked outside the door.

Zhou Chen's figure was not seen for a long time.

He had no choice but to perform an open abdomen for the wounded first.

After opening the abdominal cavity, more than 3900 ml of blood in the abdominal cavity was seen.

The liver is intact, the spleen is ruptured, and the stomach wall is penetrating in the front and back.

The middle part of the pancreas is stabbed on the lower edge.

The diameter is 1.2 cm and the depth is approximately 1.0 cm.

At this time, there was a sound of hurried footsteps in the corridor behind him.

Zhang Jian turned his head and saw Zhou Chen appearing, his eyes lit up.

Other medical staff had the same reaction when they saw Zhou Chen.

It was as if they saw the patient's savior appear.

Zhou Chen walked quickly to the operating table in the emergency room, and lowered his head to observe the patient's abdomen.

"Doctor Xiao Zhou, you're here... You see how serious his injuries are, I think you're still going to be the surgeon."

With that said, Dr. Zhang Jian handed the medical equipment in his hand to Zhou Chen.

Before Zhou Chen entered the emergency room, he had already put on the surgical gown.

It's just that the connection belt on the back of the surgical gown is too late to connect.

A nurse hurriedly came behind Zhou Chen and tied the knot for him.

Zhou Chen took over the surgical instruments, and Dr. Zhang Jian reminded him:
"The injured person's stomach, spleen, and pancreas were all injured..."

Zhou Chen didn't discuss the surgery decision with him too much.

The patient was in a critical condition, and Zhou Chen's face showed a bit of anxiety.

At this moment, as a medical staff, he deeply understands a truth-every minute and every second seems to be competing with death.

Zhou Chen didn't dare to be negligent in the slightest, so he didn't reply.

He remained silent, and immediately opened the western medical surgery column of the famous doctor system in the sea of ​​knowledge.

The famous medical system also gave timely precautions on the rescue of the injured.

When dealing with abdominal trauma, high vigilance should be exercised for the possibility of aortic injury in the following situations:
A large amount of blood loss occurs in a short period of time, excluding substantial organ damage such as the liver, spleen, and kidney, and the amount of blood loss does not match the amount of blood loss caused by damage to other organs.

When a huge hematoma or blood source in the middle of the retroperitoneum is found except for pancreas, duodenum, and kidney injuries.

After active anti-shock treatment and treatment of damaged organs, blood pressure still does not rise and drops sharply.

In case of hemorrhage from aortic trunk and branches, do not blindly clamp or tear blood vessels or tissues to avoid iatrogenic injury. You can compress the abdominal aorta proximal to the breach toward the spine to block or reduce blood flow, in order to Reveal the breach.

If the breach is small, try to open the arterial sheath while blocking the breach, dissect the blood vessel, place Sardinian forceps to partially block the blood flow and repair the breach.

If the breach is large, or the strong blood flow of the abdominal aorta causes the breach to continue to expand when the breach is pressed hard, the incision should be extended decisively into the chest, and the thoracic aorta plus the distal end of the abdominal aorta should be blocked for rapid detection. For the breach, the blood vessels were dissected under direct vision and repaired securely.

When conditions permit, extracorporeal circulation can be used to solve the problem of blood supply to the distal organs and lower extremities when the flow is cut off.

Strictly control the time limit of aortic occlusion, preferably no more than 30 minutes at a time.

Intermittent occlusion of blood flow as necessary to complete revision surgery.

Pay attention to prevent ischemic injury of important organs, intraoperative sudden hypertension, postoperative abdominal infection and other complications.

Zhou Chen nodded secretly, and immediately performed gastric repair, pancreas repair and splenectomy for the injured man.

At this moment, he suddenly discovered that there was a large amount of blood flowing out near the celiac artery trunk on the back wall of the injured stomach.

Zhou Chen looked back at the blood pressure monitor.

The injured person's blood pressure is still around 5.9kpa, which is maintained by booster drugs.

Seeing this, Doctor Zhang Jian's face suddenly became more serious.

"Oops, the aorta is damaged!"

That's right, he judged the same as Zhou Chen.

The injured person showed signs of aortic injury.

Right now, the most important and critical thing is to expose the aorta first.

Zhou Chen immediately used surgical instruments to try to dissect and expose the abdominal aorta.

But the blood was too fast, gushing out, so it was difficult to reveal it.

"gauze!"

Zhou Chen turned around and gave instructions to a nurse.

The nurse didn't dare to neglect, and hastily handed over the gauze.

Zhou Chen immediately used gauze to strongly compress the injured abdominal aorta toward the spine, and at the same time extended the incision to the left chest, and cut the diaphragm circularly along the attachment of the sternum.

After several minutes, the thoracic aorta was finally isolated.

Then, Zhou Chen blocked the thoracic aorta with a rubber restraint band.

With his other hand, he used a Sardinian clamp to block the abdominal aorta distal to the breach.

Every step of Zhou Chen is extremely careful.

This is not to be sloppy, and there must be no omissions and mistakes.

His hand decided the patient's life at this moment.

But even though they worked so hard and carefully, the operation was still not as smooth as they imagined.

Even wearing a mask, everyone can still smell the strong smell of blood.

Zhou Chen's gloves were already dyed bright red.

The white gauze just now was also dyed red.

The bleeding has not stopped until now.

"No, this gap is still expanding!"

Doctor Zhang Jian's voice trembled a little.

In the emergency room, there was the alarm sound of various instruments such as the ventilator and ECG monitoring.

All the medical staff present were in a mess.

(End of this chapter)