Start as an Emergency Physician

Zhou Yuan quickly ran over.

Lying on the hospital bed was a traffic policeman with only a few obvious blood stains on his body, and he looked fine.

"The patient is unconscious!" Zhang Ling hurriedly said.

Zhou Yuan stepped forward and immediately checked the wounded's mouth and nose.

Sure enough, the airway was blocked.

"Zhang Ling, quickly cut the clothes of the wounded!"

This is to prevent the clothing from affecting the casualty's breathing.

The reason why clothes are cut is to avoid moving the body of the wounded, and any movement of the wounded at this time may bring fatal hazards.

Zhou Yuan opened the wounded's mouth, put his gloved hand into the patient's mouth, and pulled out the vomit.

"There is a high probability that the wounded had internal bleeding!" Zhou Yuan's face changed.

Internal bleeding is one of the most difficult to judge among car accident casualties.

After a car accident, many times the doctors in the emergency department will pay special attention to those who have been in a car accident but are alive and well, and even help organize rescue.

These people often have a high probability of internal bleeding, and they can't see anything at first, and the injured only feel a little unwell, but it doesn't seem to be anything compared to the big car accident and other bleeding patients they have just experienced, so they don't care.

However, by the time they do feel particularly uncomfortable, it may be late by then.

There was a car accident in the hospital where the injured person was bleeding internally, and all the doctors were busy saving the injured people, and no one thought that there was anything abnormal about this enthusiastic person who helped the doctors and nurses push the hospital bed, and more than an hour later, he fainted directly in the emergency department and died on the spot.

The cause of death was internal bleeding.

If internal bleeding occurs, it can be manifested as progressive decrease in blood pressure, weak pulse, weakness, paleness, progressive anemia, gradual decrease in hematocrit, gradual shock, the most common rupture and bleeding of the liver, spleen and kidney, symptoms are abdominal pain, abdominal enlargement and low blood pressure, etc.

Now the patient has entered a coma and cannot judge according to the complaint, so he can only rely on Zhou Yuan's experience.

Zhou Yuan needs to determine the cause of the patient's loss of consciousness first, if it is hemorrhagic shock and there is no obvious external large wound, it is very likely to be hemorrhagic shock.

The consequences of hemorrhagic shock are extremely severe.

When volume depletion exceeds compensatory function, shock syndrome is present. Manifestations include decreased cardiac output, constriction of peripheral blood vessels, and a drop in blood pressure. Decreased tissue perfusion promotes anaerobic metabolism, resulting in elevated blood lactate levels and metabolic acidosis.

At this time, further constriction of blood vessels can lead to cellular damage. Damage to vascular endothelial cells leads to fluid and protein loss, exacerbates hypovolemia, and eventually multi-organ failure.

Zhou Yuan took off his gloves and touched the patient's skin.

The typical symptoms of hemorrhagic shock are pale, cold, and clammy. Tachycardia or severe bradycardia may also be present.

These can be diagnosed directly on the body.

After a while, Zhou Yuan felt the cold touch on the traffic policeman Mao An's body, and it was accompanied by sweat, causing Mao An's entire body to appear clammy and cold.

"Hemorrhagic shock! The patient had a blood and was immediately rescued! Zhou Yuan said categorically.

"It's him! This traffic policeman saved a lot of children, and if he hadn't blocked the Mercedes and warned the children, more people would have been injured! "

Several family members of patients passed by the emergency room and saw the traffic police lying on the bed, and their faces were immediately full of gratitude.

"Doctor, you must save him! He was a good guy and saved a lot of children! "

"Must be saved!"

Zhang Ling turned his head and said: "Don't crowd here, we will do our best, we will block the rescue of other medical staff here, and affect the rescue!" "

The family members nodded and hurried away.

Zhou Yuan quickly arranged first aid.

"Open the intravenous access immediately, and give fluids to the wounded at any time! In addition, hurry up and get the blood group report of the wounded, and go to the blood bank to get the blood! At least 2000cc! "

What frightened Zhou Yuan was that the patient also had pneumothorax...

Obviously, Mao An had a pneumothorax before the car accident, and the car accident caused Mao An to have a pneumothorax attack.

"Treat the patient with pneumothorax, do thoracentesis and drainage, and prepare a ventilator, once the condition is serious, immediately put on a ventilator to maintain the patient's breathing!"

Zhou Yuan closely observed the patient's signs and symptoms.

"Disposable syringes."

Zhou Yuan hurriedly drew a tube of blood.

Mao An developed a pneumothorax and restricted breathing, requiring arterial blood to be drawn for blood gas analysis.

Zhang Ling and others performed sinus rhythm recovery, while Zhou Yuan quickly thought about countermeasures.

Generally speaking, there are only two ways to solve the problem of major bleeding: minimally invasive and surgical.

Minimally invasive is the use of laparoscopy for intervention. This method is suitable for non-urgent internal bleeding and is relatively small and easy to manage.

Mao An's condition is obviously an emergency internal hemorrhage, and it has only been about 20 minutes since he was sent over, and severe hemorrhagic shock has already occurred, and the area of internal bleeding is definitely not small.

At this time, there is a possibility that the organs will be broken, and an open abdomen must be performed to enter the abdominal cavity to directly block the bleeding blood vessels, and if necessary, the organs need to be removed.

Zhou Yuan quickly said: "Push to the operating room and immediately perform open surgery!" Establish another intravenous channel, give a large amount of rapid fluids, and quickly infuse two liters of isotonic balanced salt solution to restore blood volume! "

The blood type has not come out yet, Mao An can't wait anymore, Zhou Yuan pondered for a moment, and said calmly: "Immediately take the concentrated red blood cells of type O and enter the wounded through another intravenous channel!" "

Blood type O is a universal blood supply, and now the situation is critical, after the application of balanced salt solution to restore blood volume, concentrated red blood cells should be transfused to make hemoglobin reach more than 10g/d1 to ensure the patient's blood circulation.

Soon, the patient was wheeled into the operating room.

At this moment, several operating rooms were all full, and He Jianyi, Jiang Xiaoqi and others were all in the operating room for rescue.

Without a shadow waiting, Zhou Yuan picked up the scalpel.

"The anesthesia is complete." The anesthesiologist said immediately.

Zhou Yuan nodded, quickly cut in the place marked on Mao An's abdomen, dissected the abdominal cavity, and exposed the abdominal cavity.

"Extracorporeal drains!"

Because of the lack of manpower, there was only one nurse, instrument nurse and anesthesiologist for this operation.

Anesthesiologists are still the kind of anesthesiologists who run to other operating rooms immediately after completing anesthesia.

Although Zhang Ling has participated in few surgeries, it can be seen from the suture bags in her bedroom that she usually works hard.

Therefore, Zhang Ling's movements were very neat, and he soon inserted a drainage tube into Mao An's abdominal cavity and began to drain the blood in the peritoneum.

Zhou Yuan hurriedly looked for the bleeding point.

After more than ten seconds, a situation that made Zhou Yuan a little desperate appeared. _

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