Start From Emergency Doctor

Chapter 41

He Jian smiled and said, “I’m relieved with your words!”

“Teacher, shall I start?” Zhou Yuan asked.

“let’s start.”

“General anesthesia.” Zhou Yuan said.

When the anesthesia took effect, Zhou Yuan glanced at the time and announced: “The operation begins!”

The ocean has already pushed EEG.

The intraoperative use of EEG is to monitor the occurrence of cerebral ischemia. If there is a manifestation of cerebral ischemia, a bypass tube must be used to temporarily divert blood during the operation to ensure cerebral blood supply.

Otherwise, the patient will die due to cerebral ischemia even after carotid endarterectomy.

“Intravenous heparin.”

Heparin is mainly found in the liver and is a kind of polysaccharide sulfate. It is an anticoagulant substance that can strengthen the function of antithrombin and inhibit the adhesion of platelets.

The prerequisite for carotid endarterectomy is systemic heparinization.

“Heparinization is complete.” He Jianyi said after a glance at the indicator.

While performing surgery, Zhou Yuan said: “Report the patient’s bilateral arterial pressure, cervical vascular stenosis, cerebral collateral circulation, and basic organ functions.”

“The arterial pressure is mmHg, the degree of vascular stenosis is 67%, part of the cerebral collateral circulation is blocked, there is obstruction, and the liver and kidney functions are impaired.”

Zhou Yuan’s expression became serious.

Fortunately, the obstruction of cerebral collateral circulation is the most deadly here.

Once cerebrovascular ischemia occurs, brain cells will die in clusters, and the brain cells that have died of ischemia will not be saved anyway!

Zhou Yuan’s complexion became even worse after the operation exposed the stenosis of the carotid artery.

The so-called carotid artery stenosis refers to the atherosclerotic plaque that occurs in the carotid artery compressing the carotid artery. The cause is that under the influence of risk factors such as hypertension, hyperlipidemia, unreasonable exercise habits and eating habits, smoking and drinking, emotional stress and other risk factors, lipids are deposited on the inner wall of blood vessels to form “squamous” hardened plaques. As the disease progresses, some plaques gradually enter the lumen, resulting in narrowing of the lumen.

But it was the first time that Zhou Yuan encountered such a narrow situation as this old man.(Read more @ wuxiax.com)

No wonder the director of neurology, neurosurgery, and Jiang Xiaoqi all said they couldn’t do it.

He Jianyi and others were also shocked when they saw the condition of the inner wall of the carotid artery.

“Go on.” Zhou Yuan said calmly.

After blocking the common carotid artery, internal carotid artery and external carotid artery, Zhou Yuan carefully opened the blood vessel.

This step needs to be especially careful. The surgical technique is very demanding. A slightly stronger knife will break the blood vessel, and if it is a little bit smaller, it will not be able to cut the blood vessel.

Moreover, because the elderly are very old, there are also high blood pressure, hyperlipidemia, etc., the blood vessel condition is not optimistic, and it is very easy to cause irreversible situations.

Simply, what the master suture technique gives Zhou Yuan is not only the skill of suture, but also the ingenuity.

Ten minutes later, sections of carotid arteries were exposed.

“Oops, the position of the operating table is wrong.”

At this time, Zhou Yuan, who was about to start cleaning the carotid artery plaque, was taken aback.

Originally the position was just right, but everyone has overlooked one point. When cleaning the carotid artery plaque, it needs a low position!

He Jianyi’s expression changed: “Who adjusted the operating bed! I wonder if the operating bed should be lower!”

Now that the operation has started, it is impossible to raise or lower the operating bed, otherwise it will cause secondary harm to the patient.

But at this position, no matter what posture Zhou Yuan uses, there will be blind spots when holding the scalpel, unable to take care of it, and very uncomfortable.

It’s okay if the operating bed is high, it’s a big deal to put something under the foot of the surgeon, but now the operating bed is too low!

The cleaning process takes tens of minutes. If the location is not suitable, it is not a good thing for the surgeon or the patient.

He Jianyi was thinking about how to solve this problem when he suddenly saw Zhou Yuan kneel down!

“Zhou Yuan, you…”

Zhou Yuan’s complexion remained unchanged, ignoring the opinions of others present, and directly lying on the operating table in a kneeling position.

This position is just right for surgery!

Facing the side eyes of other people in the operating room, Zhou Yuan slowly said: “It doesn’t matter what posture you use. In my opinion, as long as you can save people, it doesn’t matter if you kneel.”

While speaking, Zhou Yuan’s speed in his hands did not slow down at all.

“Sure enough…” Zhou Yuan said lightly.

He cleaned up the plaque carefully. These plaques are the cause of cerebral infarction and transient cerebral ischemia.

Plaque buildup can make the carotid artery stiff and narrow, and plaque deposits can rupture and rupture, causing damage and leading to thrombosis. The clot and plaque will separate with the blood flow and migrate to the smaller arteries in the brain, resulting in a large area of ​​cerebral infarction.

As long as the intima of the artery affected by the plaque is peeled off and blood supply is restored, there is basically no problem.

Just as Zhou Yuan concentrated on cleaning up, the ocean, which had been monitoring the data of various instruments such as the electrocardiogram, suddenly turned white.

“The patient has had cerebral ischemia!”

——

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