When doctors have a simulated operating room

The patient was diagnosed with leukemia.

The skin on the right side of the patient's upper body is gone, from below the clavicle to the seventh rib.

All subcutaneous tissue and muscle are exposed, as well as a lot of fat.

Human skin has many functions, such as protection, sensory function, absorption function, secretion and excretion function, temperature regulation function, metabolic function, immune function, etc.

Why is the protection function ranked first?

Because the skin is the natural barrier of the human body.

It is also the largest organ in the human body, which can prevent the loss of water, electrolytes and nutrients in the body. It can also protect the organs and tissues in the body from external mechanical, physical, chemical and microbial harmful factors, and maintain the stability of the body's internal environment.

Now, more than half of the skin on the upper body of this patient is gone.

It means that her natural barrier is gone.

The body is very vulnerable to external microorganisms.

Once infected, the situation is very dangerous.

Debridement as soon as possible is one aspect, and anti-inflammatory and anti-infection are also the primary measures for rescue.

And the debridement must be cleaned very cleanly.

All the fascia and fat that have been contaminated by dust must be cut off.

A large amount of saline or hydrogen peroxide must be used for flushing.

The aunt said it was unfortunate, but fortunately, that she was shoved under the car by the engineering vehicle.

Because only half of it was shoveled, the entire right hand was disabled, and the lower body and the left side were fine.

There was no fracture or anything, but the entire right arm and the skin were torn off.

The scene still looked very tragic.

After about three hours of flushing and cleaning, the patient came out of the emergency operating room.

As soon as he came out, he was immediately sent to the emergency intensive care unit.

Waiting outside the door were the family members of the aunt.

An old man in his fifties and two young girls.

"Doctor, how is my mom? Is she okay?"

"Doctor, how is my mom?!"

Wang Yufei took off his mask and explained:

"The situation is not good. The entire right arm, chest and skin have been destroyed.

We have already performed a debridement operation to remove the contaminated fat and some necrotic tissue.

However, it is not necessarily guaranteed that she can recover completely. There is still a possibility of infection.

And her blood pressure is also very low now, and it rises very slowly after taking the medicine.

In this case, if an infection occurs, given her current condition... I suggest you prepare for the worst.

We doctors can only try our best to help her control the infection. We can't guarantee whether she can bear it in the end."

"Ah? Wuuwuwu... Mom... Wuuwu..."

"What should we do? Doctor, please find a way to help me..."

The two young girls cried and pinned their hopes on the doctor.

The uncle standing next to them also looked unhappy, with red eyes and a look of trying hard.

He looked at Wang Yufei and Chen Fang and said:

"Thank you, doctor. You've worked hard. Can we... go in and see her later?"

"Sure. I'll call you after they've arranged everything."

"Okay, okay. Thank you, doctor."

The man is the head of the family, and he's the only man in the family.

He can't cry or fall down. What if his two daughters fall down?

That's why he looks relatively calm.

Alas!

In fact, men keep their sufferings in their hearts.

...

The ICU of the emergency department is right next to the emergency room.

They're separated by a wall, but the supporting facilities are similar.

The emergency room on duty usually also takes care of the patients in the ICU.

Medical resources are insufficient, and it's common for one doctor to take care of more than a dozen patients.

After a while, Wang Yufei called the family members in.

On the bed, the old lady was also full of tubes.

Oxygen tubes, urinary catheters, and transparent infusion tubes.

The hair was neither long nor short, but because of the fear that the messy hair would cause infection, it was shaved completely.

Of course, the most shocking part was the entire half of the chest.

Although the wound had been completely wrapped after the debridement, the family members still couldn't hide their sadness when they saw such a large area.

The two daughters squatted beside the bed and started crying.

At this time, the old lady was not conscious. She sometimes responded and sometimes didn't respond when her name was called. She sometimes cried in pain and sometimes ignored people. She had some symptoms of delirium.

In addition to low blood pressure, it seems that she is still not out of danger.

"Doctor, you must save my mother, I beg you... Please...

Please!"

The two daughters of the family members look very similar. At this time, one of them knelt beside the bed and cried, and the other grabbed Wang Yufei and talked.

Wang Yufei also wanted to help the patient out of danger.

But the doctor has done everything he should do. Just now, Wang Yufei even asked the blood bank to send another 200 ml of platelets and red blood cells to the old lady.

Platelets also play a coagulation role in the blood and can stop bleeding.

Large-area skin tearing must have caused blood loss. Add some red blood cells to restore some blood, and hope that blood pressure can rise as soon as possible.

It also includes anti-infection drugs and analgesics. Wang Yufei has done everything he should do.

Now, he can only wait like this.

See if the patient's condition will improve.

If it can improve, everyone will be happy. If not... then the family members can only mourn.

"We are doctors and we will definitely try our best. ”

There is no way to give a definite answer to the family members. The most common answer from the doctor is "We will try our best".

Time always passes so slowly in the agonizing wait.

Three hours later.

Blood was transfused, medicine was used, and debridement was done.

The old lady finally showed a little sign of improvement.

The blood pressure rose from more than 80 to nearly 100.

She woke up, and the first thing she said when she woke up was to cry out in pain.

Wang Yufei and Chen Fang came together to examine the old lady.

Including whether the hand and leg functions are impaired, whether the conversation and consciousness are clear, and whether the entire right wound has discolored or necrotic.

The examination lasted more than half an hour, and the old lady cried out in pain while checking.

She screamed in pain, and it felt like she was finally getting better when she heard the sound.

Otherwise, how could she have the strength to shout so loudly?

Chen Fang was relieved now.

He is on night shift tonight...

Pray that nothing will happen to the patient at night, and that there is nothing critical or urgent Patients come to the emergency room.

Pray and pray~

Amitabha~

In the afternoon, the police came to the hospital.

They brought the engineering truck driver with them.

They should be discussing compensation with the family, but how much compensation should be paid? It depends on the follow-up situation of this old lady.

If she can survive, it means that she has saved her life. Compared with how much compensation, her family must hope that she can live.

But if she dies...

The driver will also have to pay a huge amount of compensation.

Oh!

In the hospital, it is really a bleak thing.

...

I don’t know if the Buddha didn’t hear Chen Fang’s wish, or Jesus ignored Chen Fang’s prayer.

It was more than eight o’clock in the evening.

This old lady suddenly died again!

——Supplement

Dr. Chen who worked during the day had all gone off work during this period.

There were only four doctors on duty in the group, two of whom were in the emergency clinic at night, and two were guarding the emergency room.

When the nurse came to find Chen Fang, her face was extremely panicked!

"Doctor Chen! Wei Xiaojuan in bed 3 has lowered her blood pressure again, and she is getting irritable! She is almost pulling the gauze off her chest!" Chen Fang sighed inwardly when he heard this. Oh my God! Didn't you hear my prayer?! I was so sincere that I hoped that this patient's condition would not be serious... But you... Oh! Forget it! Doctors are actually afraid that a patient's condition will suddenly get worse during their shift. Because worsening means that they need to be rescued, and rescue is indeed laborious, mental and physical. And the rescue records after rescue are also very troublesome. Usually after doctors finish their clinical work, they have to sit in front of the computer for most of the day to make up the rescue records and some daily diagnosis and treatment records. However, the most worrying and fearful thing is that the patient will die in their hands. Every doctor doesn't want to, but every doctor has to experience it. Chen Fang didn't hesitate, and came to the patient quickly after a long sigh. At a glance, wow! The blood pressure has dropped again. 90!

The gauze was also loosened by her.

When she changed shifts at 6pm, her blood pressure was still fine.

In just two hours, she was not right? !

Chen Fang immediately put on gloves and opened the gauze to check, and immediately, his eyebrows twisted!

This... this is not right!

Why did the color become so strange?

It stands to reason that the subcutaneous tissue after cleaning should be bright red or dark red with blood.

But now... why did the color become lighter? And a little pink?

Something is wrong!

The color is very strange!

When Chen Fang cut the gauze, the old lady was also very agitated, and she was agitated when she was not conscious.

Many patients with shock or delirium will have this kind of unconscious agitation.

If necessary, the doctor can fix the patient's limbs to prevent the patient from being injured unconsciously.

Himself.

After fixing the patient's left hand, Chen Fang stared at the wound for a while.

A bad premonition also popped up in his mind, and he almost blurted it out.

After thinking about it, Chen Fang took out the flashlight in his bag and decided to check it again with strong light.

The strong light shone on the wound on the entire right chest of the patient.

The whole skin was torn off, and the large area of ​​subcutaneous tissue that should have been mixed with blood became lighter in color.

The blood red turned into pink?

No, this... seems to be a little grayish pink, and some places are a little yellowish!

And there is exudate under some of the skin!

Damn! !

Gray and yellow! There is also exudate!

The wound didn't look like this two hours ago!

How come it suddenly became serious two hours later!

This is an infection!

No matter how much you take precautions, you still can't prevent infection!

At this time, eight hours have passed since the antibiotic infusion in the morning.

You can use antibiotics again!

"Go get a cotton swab to take the secretions around the wound and send them for examination. Tell the laboratory that this is an urgent test and that they should be the first to do it!"

"Send another set of blood routine tests and remember to tell them that this is an urgent test!"

"Also, first send another set of cefotaxime mixed with 100 ml of normal saline!

"Add another set of electrolytes!"

"What about the urine volume? How much was the urine volume just now? ”

Usually, patients with more serious conditions or coma will use a urinary catheter.

The nurse will test the urine volume in the urine bag to see if the patient's urine volume changes after a large amount of fluid is infused.

If the urine volume is proportional to the infused fluid, it means that the person's kidney function is fine.

If the infusion is more, the urine will naturally be more.

But if the infusion is too much, for example, one or two thousand milliliters of fluid is infused, and the patient does not urinate for a long time, or only 100 milliliters of urine are produced, then there is a problem.

Why is there a term in clinical practice called "replenish potassium when urine is seen"?

The patient can only replenish potassium when he can urinate, otherwise the potassium supplement cannot be excreted, which is equivalent to sending him to the west one step earlier.

"About 50 milliliters per hour."

"50 milliliters? ”

A normal person’s urine output in an hour is about 40-80 ml, but the aunt in front of me is receiving an IV, and there is a 500 ml bag of vitamins hanging on the shelf.

With so much fluid, 50 ml in an hour?

After thinking for a while, Chen Fang continued:

“When drawing blood, add an electrolyte and renal function test to check whether the electrolytes are disordered, and do a urine test.”

Infected patients, especially those with low immunity, must strictly prevent infectious shock and electrolyte disorders.

Electrolytes may seem insignificant in the human body.

Some patients think that it is useless to see that they are receiving vitamins or electrolytes during the IV, and some people think that the doctor is deliberately cheating them to spend more money.

But in fact, these trace elements also play a vital role in the body.

Potassium, calcium, sodium, magnesium, etc. are all trace elements needed by the human body.

It looks ordinary, but people will get sick without them.

Potassium is needless to say. Without it, you will die, but too much will also kill you.

Calcium. People who lack calcium are prone to numbness, convulsions, and even epilepsy in their limbs. Children who lack calcium are also prone to not growing tall.

Sodium, which can also be understood as salt, will cause dizziness, weakness in the limbs, and edema if you lack it, and high blood pressure if you have too much.

Magnesium. Magnesium and calcium are closely related. Magnesium ions can promote blood circulation and form bones and teeth. It has a very similar function to calcium, and the symptoms of magnesium deficiency are generally similar to those of calcium deficiency.

Therefore, when the hospital is admitted for examination, electrolytes are a must-have option for blood tests.

"Okay! I'll go right away!"

Now it can be confirmed that the patient has been infected.

But it is still unknown what bacteria caused the infection, and we have to wait for the results from the laboratory.

The corresponding bacteria must be treated with the corresponding antibiotics.

Otherwise, there is no effect at all.

"Tell Mao Xiaoyuan that I have to go to the operating room to clean up this patient again, and let him watch outside. Xiao He? Xiao He, come with me to the operating room to help! "

"Oh... OK!"

Xiao He was another nurse on duty.

She immediately went to prepare for the operation after hearing the call.

Mao Xiaoyuan, who was in the clinic, frowned after receiving the news:

"What? That woman is infected? Oh, that's terrible! Infection in this situation is not... Forget it, I'll go talk to the family members. "

Outside the emergency room, the three family members were still waiting outside.

After seeing Mao Xiaoyuan, the three of them were immediately startled and stood up.

Because, just based on the serious expression on Mao Xiaoyuan's face, they couldn't stay calm at all...