My medical skills are a billion points

Only then did Xiao Chu explain to Wang Li and how the patient fell into a coma.

"The patient's head did not have any trauma, and the pupils were dilated and had normal reflexes, so coma caused by head trauma was basically ruled out."

"Looking at his right chest again, there is a crepitus to the touch, which is a manifestation of subcutaneous emphysema, indicating that the patient has a rib fracture on the right side.

And there is a drum sound on percussion, but no breath sound on auscultation. What does this mean?This patient has a pneumothorax. "

"And his sudden coma was caused by tension pneumothorax!"

Speaking of this, Xiao Chu glanced at Wang Li and Liu Qing.

"Tension pneumothorax, you know?"

Liu Qing secretly glanced at Xiao Chu and remained silent.

Wang Li blinked and said, "Tension pneumothorax is also called hypertensive pneumothorax.

Commonly seen in the rupture of larger alveoli, or in larger and deeper lung lacerations or bronchial ruptures.

The opening communicates with the pleural cavity and forms a valve, so air can enter the pleural cavity through the opening when inhaling.

When exhaling, the valve closes, preventing the air in the cavity from returning to the airway to be discharged. "

"In this way, the accumulation of air in the pleural cavity continues to increase, and the pressure continues to rise, compressing the injured lung and causing it to gradually collapse.

And push the mediastinum to the healthy side, squeezing the lung of the healthy side, resulting in serious obstacles to breathing and circulation. "

"Sometimes the high-pressure gas in the pleural cavity is squeezed into the mediastinum and spreads to the subcutaneous tissue, forming subcutaneous emphysema in the neck, face, chest, etc.

Xiao Chu nodded slightly, then shook his head again.

"The definition of tension pneumothorax is relatively clear. But the clinical experience is too lacking."

"You meet this kind of patient, but you don't know how to deal with it. No matter how good the definition is, what's the use?"

Chapter 247 Critical patients, wave after wave

Wang Li lowered her head.

She is really good at theory.

However, when actually encountering a patient, he is unable to judge and is at a loss.

But she is just an intern, she only learns theoretical knowledge in school, and has never been in the clinic.

It is also excusable to be unclear about the condition.

But these emergency patients are valuable learning experiences for her.

That's why Xiao Chu said these words.

It is to impress Wang Li and the two, so that they will not be helpless when they meet similar patients in the future.

The patient had just improved, and the ambulance brought another patient with an open comminuted fracture of the left thigh.

His left thigh was a bloody mess, and his left lower limb had been bent at a strange angle.

"This patient injured the femoral artery, and he is bleeding very badly now, please come and rescue him quickly."

The first responder, who was pushing the patient, yelled.

Now every doctor has patients.

Xiao Chu happened to have some free time, so he asked Wang Li and Liu Qing to watch the patient with tension pneumothorax just now.

He sees patients with massive bleeding.

The patient's injuries were serious, but he didn't cry out in pain. He was obviously in shock, and the bleeding must be stopped as soon as possible, and then a blood transfusion should be given.

Xiao Chu gently picked up a cotton pad pressed on the wound, and checked the wound.

A blood arrow shot out immediately.

Xiao Chu quickly suppressed it again.

"He injured his femoral artery and has to be operated on ASAP!"

The first responder said quickly.

In this patient's case, the entire left thigh was comminuted.

And skin, muscle, blood vessel and nerve damage are particularly serious.

His femoral artery was directly broken.

If only the general bandage hemostasis method is used, the femoral artery bleeding cannot be stopped at all.

Either go to the operating table immediately and give him surgery.

But judging from the current situation, it is unrealistic to immediately go to the operating table for surgery.

Because there are not enough people, everyone is busy.

Even now, no medical staff is idle.

But ambulances are still coming here, bringing patients here.

How can we spare personnel to go to the operating table for surgery?

Generally, it can only be dealt with briefly temporarily.

Once it involves major surgery that requires more than two medical staff, it is possible to wait until all trauma patients are completely stable.

Certainly not right now.

Wanting to stop the bleeding of this traumatized patient with a ruptured femoral artery as soon as possible, Xiao Chu thought of a way.

He wants to do REBOA for the patient!

REBOA stands for resuscitating balloon occlusion of the aorta.

When Xiao Chu went back to his hometown, he met a patient who was injured in a car accident, so he did this operation on the spot.

Looks like it's time to do it again.

At present, this is the only way to prevent femoral artery bleeding.

"I need catheter, 14 gauge needle, arterial blockage occlusion balloon. 20ml saline, quick."

After thinking about the countermeasures, Xiao Chu hurriedly said what he needed.

Nurse Wang Jing hurriedly brought all these things over.

Xiao Chu was at the root of the patient's left thigh, and after disinfection, he was preparing to puncture the femoral artery.

"What are you doing?"

The emergency doctor who helped was pressing the patient's wound.

He couldn't understand Xiao Chu's operation, so he asked suspiciously.

"I want to perform resuscitative aortic balloon occlusion for him. Only in this way can he completely stop the bleeding. There is no ready-made thing now, so I can only do a simple one."

Xiao Chu stopped talking nonsense.

The puncture needle was directly inserted into the common femoral artery at once.

It stands to reason that resuscitative aortic balloon occlusion requires ultrasound guidance to be performed accurately.

But now the situation is urgent, it is impossible to push the patient to do a color Doppler ultrasound.

Besides, with Xiao Chu's ability, there is no need for color ultrasound guidance at all.

Because the patient's blood vessels will be fully displayed in front of Xiao Chu's eyes.

Xiao Chu inserted the puncture needle into the common femoral artery without any difficulty, and then implanted the catheter sheath.

A catheter with a balloon is placed, extending up to the abdominal aorta, and the balloon is inflated to hold it in place.

It's that simple!

Only then did Xiao Chu say: "You can let go."

The emergency doctor and Wang Jing looked at Xiao Chu in disbelief.

They were still tightly pressing the patient's left thigh, not daring to let go.

Hearing Xiao Chu said that it was all right, they let go of their hands suspiciously.

Looking at the patient's femoral artery stump, no more blood flowed out at this time.

"Successful, amazing, Director Xiao."

Wang Jing praised sincerely.

The emergency doctor also cast admiring gazes at Xiao Chu.

In the ambulance, he pressed the patient all the way, and the bleeding continued.

As a result, Xiao Chu completely stopped the bleeding in a few minutes, and he looked like a master.

Gao Yingjun was in the next bed, rescuing a patient with craniocerebral injury.

But he witnessed the whole process, Xiao Chu performed resuscitative aortic balloon occlusion.

I felt a sigh of relief for Xiao Chu's operation in my heart.

This operation, but he has always wanted to do it, but dare not do it.

But Xiao Chu completed the operation blindly without the guidance of ultrasound.

Xiao Chu's medical skills are really outstanding, leaving them all too far away.

The patient's femoral artery bleeding was temporarily stopped.

But his severely damaged left thigh still needs early surgery.

Xiao Chu simply bandaged the open wound with sterile gauze, and pushed him into the ward to stabilize his vital signs.

Once all the patients are settled, operate on him in time.

Before Xiao Chu took a breath, a nurse ran over and shouted: "Director Xiao, this patient has trouble breathing, please see what's going on with him."

All the doctors on the scene were busy, only Xiao Chu was free, so he hurried over.

The patient was a middle-aged man in his forties with extensive abrasions on his front chest.

He sucked in oxygen, but opened his mouth wide, and still felt very difficult to breathe.

Xiao Chu glanced at him and knew what was going on.

Of course he took out his stethoscope and listened, and then he percussed again.

"Doctor, I used to have coronary heart disease, but now I am injured, is it possible that the coronary heart disease has recurred?"

The patient opened his mouth wide and asked reluctantly.

Xiao Chu shook his head.

"Your current symptoms are indeed caused by trauma, and they also belong to the range of heart disease, but it is not your coronary heart attack."

Xiao Chu said, looking at Wang Jing.

"He has cardiac tamponade, hurry up and get a puncture bag, he has to do a pericardiocentesis!"

The patient in charge of Gao Yingjun next to him was in a stable condition. Hearing that Xiao Chu was about to perform pericardial puncture on the patient, he hurriedly asked:

"Xiao Chu, why don't you give him a pericardiocentesis without the guidance of an echocardiogram?"

Xiao Chu waved his hand.

"No need at all!"

For Xiao Chu, pericardial puncture is a simple operation that cannot be simpler!

Where do you use color Doppler ultrasound to guide it!

He has done several cases before.

Now even with his eyes closed, the puncture needle can accurately penetrate the pericardium without hurting the heart.

Soon Wang Jing brought the puncture bag.

Xiao Chu put the patient in a semi-recumbent position, exposing the chest and upper abdomen.

Gao Yingjun was on the side, watching his movements without blinking.