Start as an Emergency Physician

If you were any other person, I am afraid that they would make the same choice as Zhou Yuan.

"Got it done?"

In the operating room, He Jianyi looked at Zhou Yuan, who had finished the preoperative preparations in the back, and breathed a sigh of relief.

Zhao Han's situation is only better than Duan Hongwei's, but it is also enough to be labeled as a black—endangered patient.

He Jianyi and the ocean are nervous.

Craniotomy is not something that an emergency doctor can do, it is a high-precision technology, and the two of them can only wait for Zhou Yuan to come.

"Let's get ready for surgery."

Zhou Yuan sorted out his mood, put on a surgical gown with the help of the nurse, and came to the operating table.

Zhao Han's eyes were closed at this time, his expression was very painful, although he was still in a coma, but after He Jianyi and Haiyang's rescue, his heart rate and blood pressure had stabilized.

"Heart rate 40, blood pressure 131/69!" The anesthesiologist reported.

The normal heart rate is 60~100 per minute, and less than 60 can already be judged as bradycardia. The blood pressure of normal people is 120~139 and the low pressure is 80~89, which of Zhao Han is in danger, but at least temporarily out of danger.

In the case of massive blood loss, skull injury, and spinal injury, it is impossible for Zhao Han to maintain a normal heart rate and blood pressure.

"We have checked the preoperative skin test and allergy drug history, and there is no problem. The family also signed it. Ocean said.

Zhou Yuan nodded reassuringly.

"Anesthesiologist, start anesthesia!"

For posterior fossa craniotomy, the anesthesia method is generally endotracheal intubation and general anesthesia.

Of course, local infiltration anesthesia can also be used when nerve root severance and neurovascular decompression are performed, which can facilitate the observation of efficacy during surgery.

The anesthesiologist chooses general anesthesia with endotracheal intubation.

Because, Zhao Han not only performed a craniotomy of the posterior cranial fossa, but also repaired the spine on He Jianyi's side.

"Lateral position."

After Zhou Yuan finished speaking, he and He Jianyi, Haiyang and others turned Zhao Han over.

The movements of the trio were very light, for fear that the sudden movement would cause the displaced spine to contusion other tissues, leading to more serious sequelae.

After the lateral decubitus position and anesthesia were completed, Zhou Yuan and He Jianyi glanced at each other, and Zhou Yuan said, "Start the operation!" "

As he spoke, Zhou Yuan picked up the marker and chose to make an incision.

The posterior fossa is small in size, and important structures such as the brainstem, posterior cranial nerves, and vertebrobasilar arteries are located, and if the opening is improper, damage or excessive traction may occur during surgery.

Therefore, the design of the incision during craniotomy is very important, and the surgical approach must be accurately positioned and designed before surgery to meet the needs of surgical operations.

Zhou Yuan's face was very serious.

Skull injuries, terrible not fractures of the skull itself.

The skull is a spherical bone. It is used to protect and contain the contents of the cranial cavity - mainly to protect the human brain.

There are very few vascular nerves on the skull, just a few bones that are combined, but once the skull is fractured, it will often lead to damage to the contents of the cranial cavity.

Depressed or comminuted skull fractures are the most severe and can damage the meninges and brain, and can also lead to rupture of cerebral blood vessels and cranial nerves. ，

Therefore, the skull injury is not harmful in itself, and the secondary damage caused by the fracture is much more serious than the fracture itself!

This is the reason why Zhou Yuan is cautious.

"Senior Brother Ocean, puncture into the posterior corner of the lateral ventricle and place a drain!"

After speaking, Zhou Yuan picked up the scalpel and prepared to open the skull.

Due to the injury in Zhao Han's skull, it is likely to be accompanied by significant intracranial pressure and obstructive hydrocephalus, which will affect the exposure and operation of the surgical site, so a drainage tube needs to be placed to drain the fluid in the brain.

In order to save time, Zhou Yuan planned to puncture while opening his skull.

The ocean nodded, and immediately ran over to start the piercing.

Zhou Yuan chose the midline incision, and after marking the incision line with gentian violet, Zhou Yuan quickly carried out routine disinfection, and then spread the single towel and fixed the single towel on the skin with incision film.

"0.25%~0.5% procaine with added adrenaline!" Zhou Yuan said in a deep voice.

Procaine is a local anesthetic, after adding epinephrine, infiltrate the tissues of each layer with procaine along the incision line, and inject 5~10ml of procaine at equal distances on both sides of the incision line, which can reduce intraoperative bleeding and facilitate muscle separation.

Zhou Yuan picked up the needle and pierced the long needle into Zhao Han's skull, which had already been haircut, and injected it on both sides of the incision until the lamina of the first and second cervical vertebrae did not stop.

"The puncture is complete, the drain placement is complete!"

Sure enough, a small amount of reddish stagnant water was drawn from the drain.

Zhou Yuan nodded, took the scalpel, cut the skin and subcutaneous tissue in the middle, and then quickly ligated the bleeding point to prevent excessive bleeding.

After cutting the skin and subcutaneous tissue on the surface of the skull, Zhou Yuan made an incision of the periosteum above the external occipital carina, which extended downward, bypassing the extraoccipital carina, leaving the diamond-shaped fascia at the carina, which was convenient for postoperative alignment suturing of the periosteum.

"Periosteal stripper."

Craniotomy cannot be performed with a scalpel, but requires special instruments, which is why Zhou Yuan emphasized the need to prepare tools for craniotomy.

Zhou Yuan took the periosteal stripper and peeled off the muscles and tendons attached to the occipital bone to both sides, pushing them to both sides.

"Automatic retractor."

Zhou Yuan placed an automatic retractor at the incision, and at the same time electrocoagulated the muscles next to him to stop bleeding.

An automatic retractor is a type of retractor that is used to retract tissue. The surgical instrument that reveals the scope of the operation is actually a retractor, and the automatic retractor can save the assistant and reduce the burden on the main knife.

Soon, the small incision was propped open by the retractor.

Once the incision is complete, the next step is to perform a skull fenestration.

A small incision cannot provide surgical vision and good operating space, and a bone window must be opened.

"Drill." Zhou Yuan said succinctly.

Because Zhao Han was in a lateral decubitus position, the drill bit could not drill vertically into the surface of the skull, so Zhou Yuan placed a bone pry underneath to prevent the drill from sliding down and causing damage to other parts of the skull, which would cause the drill to shave off the scalp, where skin and hair could no longer grow.

Soon, Zhou Yuan drilled a hole in the occipital scales on Zhao Han's left side, and the fine skull powder fell down, which was extremely infiltrating.

The bony window extends to the inferior border of the extraterranic tuberosity and the transverse sinus of the skull, to the left and right to the posterior border of the mastoid process, and below to the posterior border of the foramen magnum.

"That's it?"

The ocean was a little surprised.

Zhou Yuankai's bone window is not large, and if it is replaced by other brain surgeons, it will not be able to operate at all!

He Jianyi raised his head and was also shocked.

However, before he could speak, a soft sound suddenly sounded on Zhao Han's severed back.

It's the sound of bones popping...

Zhou Yuan, He Jianyi and others' faces changed greatly.

"Teacher, what's wrong?!" Zhou Yuan asked with a pale face.

Did He Jianyi make a mistake? _

Feilu reminds you: there are three things to read - collection, recommendation, and points