Start as an Emergency Physician

Zhou Yuan did not answer, but carefully examined it.

Indeed, the patient's condition is very bad, and the biggest difficulty is the diagnosis and repair of the endometrial rupture.

If this problem is not addressed, the patient's life is in danger at any time.

After two seconds of silence, Zhou Yuan raised his head: "Repair the artery first." "

The first priority is to repair the arteries and restore the blood supply.

Because of the fire, some blood vessels have been damaged, and if they are not repaired in time, the blood circulation will not be able to support the tissues at the end, which will cause great irreversible losses at that time.

"It's a bit difficult to repair," the chief physician whispered.

After saying that, he regretted it.

Who is this saying that it is difficult...

This is Zhou Yuan!

Stitching itself is Zhou Yuan's famous stunt, and the chief physician actually told him that it was difficult!

"Let's start, let's get started," said the chief thoracic surgeon.

"Vascular clamps. Zhou Yuan directly entered the state.

Surgical forceps, tissue scissors, blocking forceps, curved forceps.

One instrument after another was sent to Zhou Yuan.

Zhou Yuan's speed was very fast, and the instrument was swimming in his hand.

Both the director and Ichisuke have the illusion that it's not the human hand that controls the instrument, but that the instrument and the hand are together... The instrument is an extension of Zhou Yuan's hand!

It's a very difficult state to achieve, and one that all surgeons aspire to.

"Even if you don't work as a doctor, you'll have something to eat as a tailor in the future," Ichisuke muttered subconsciously.

The director looked up and stared at Ichisuke: "What are you talking nonsense?"

Ichisuke quickly shut his mouth obediently.

Ten minutes is a moment for surgery.

"It's done. Begin to establish cardiopulmonary bypass. Zhou Yuan said in a low voice.

Stanford-A aortic dissection surgery is definitely performed under cardiopulmonary bypass.

The chief physician and Ichisuke cooperated very well, and Zhou Yuan ordered it, and the two immediately chose the left side with a good femoral pulse for femoral artery cannulation.

"The venous drain should be cannulated in the upper and lower vena cava. Zhou Yuan said while dealing with the sternal incision.

The reason why the chief physician did not choose the conventional venous drainage catheter was that the patient's condition was already very poor, and the upper and lower vena cava cannulation could be changed to the cryogenic arrest technique at any time according to the patient's condition during the operation.

The incision is mainly used to create a familiar surgical field.

Surgeons have their own habits, habitual incisions, habitual surgical field positions, etc., and any change may affect their performance.

Although Zhou Yuan will not be affected too much, he must avoid all the factors that increase the risk of surgery as much as possible.

"Cardiopulmonary bypass was established. The chief physician immediately said.

Zhou Yuan nodded, dropped the scalpel, ascended the aorta, etc., and then made an incision in the left and right coronary arteries, and said, "Cardiac arrest fluid perfusion." "

Cardiac arrest fluid can be preserved. This step is crucial in Stanford-A aortic dissection surgery.

The first dose of cardiac arrest fluid perfusion is generally incised and ascending aortic dissection followed by direct perfusion through the left and right coronary artery openings, which is the perfusion method adopted by Zhou Yuan.

The subsequent dose is continuous reverse perfusion through the coronary sinus or intermittent perfusion through the left and right coronary artery ostiums.

This step is also different from the previous pacemaker placement surgery to perfuse cardiac arrest fluid, which cannot be directly perfused through the aortic root because of the presence of a false lumen in the aortic dissection, which will cause cardiac arrest difficulties once the atrophopause fluid enters the false lumen.

"Cardiac arrest fluid perfusion is complete. "

Zhou Yuan nodded and picked up the scalpel again.

There are three basic surgical methods for thoracic aortic dissection, ascending aorta replacement, ascending aorta and ascending aortic arch replacement, and the more commonly used elephant trunk surgery.

The three surgical methods are different, the difficulty is different, and the applicable scenarios are naturally different.

For example, simple ascending aortic replacement is suitable for acute Aortic dissection, and the main purpose is to correct and prevent serious complications of aortic regurgitation or acute rupture.

For Zhao Mingshi, the most suitable method is actually to do the second and third at the same time, that is, to do elephant trunk surgery at the same time as the ascending aorta and ascending aortic arch surgery.

However, because his current condition is very dangerous, the operation must be completed as soon as possible, and the elephant trunk surgery can only be done until the second stage of surgery.

Again, in the eyes of doctors, life preservation is always the most important thing.

"Hypothermia circulatory arrest, superior vena cava retrograde cerebral perfusion. Zhou Yuan glanced at the instrument.

The patient's vital signs were not good, his heart rate was only about 40, and his blood pressure was well below the normal range.

The cryogenic stop cycle begins.

Zhou Yuan stared at the thermometer in the nasopharynx.

When the temperature dropped to 30 degrees Celsius, Zhou Yuan blocked the ascending aorta from a distance of three centimeters from the beginning of the innominate artery.

"Scalpel. "

He made an incision in the artery and reperfused cardioaponic fluid through the left and right coronary arteries.

"Switch to continuous reverse perfusion to protect the myocardium. Zhou Yuandao.

The chief physician stepped forward to maintain the perfusion state.

Without squinting, Zhou began to trim the dissection at the proximal end, extending to about 1.5 cm above the left and right coronary artery openings.

"The dissection has involved the aortic junction..."

Zhou Yuan was silent for two seconds.

This is not a good thing, the wider the scope of aortic dissection, the more dangerous Zhao Mingshi is, and the more difficult the operation will naturally be.

"Needle forceps. "

Zhou Yuan said, and began to stitch and reinforce the place.

When the junction is reinforced, the damage caused by the dissection can be prevented as much as possible, and it will generally not rupture unless the blood impact is very strong.

"Felt strips. "

After completing the sutures, Zhou Yuan added a circle of felt strips to the aortic intima and the adventitia part.

The main purpose of this thing is to seal and prevent the blood from leaking.

After the 4-0 polypropylene thread was reinforced and sutured, Zhou Yuan took the artificial blood vessel that had been prepared before, and used the 3-0 polypropylene thread to continuously suture the artificial blood vessel and the aortic root.

Under the action of cryogenic cessation, the temperature of the nasopharynx has been reduced to 18 degrees.

"Doctor Zhou, the temperature has arrived. The anesthesiologist alerted the doctor.

Zhou Yuan nodded, "Stop cardiopulmonary bypass." "

"Adjust the patient's position and take a 30-degree head down. Zhou Yuandao.

After completing the suture, Zhou Yuan opened the aortic blocking forceps, and built the distal dissection to the proximal blood vessel of the innominate artery, and again took the felt strip and placed it on the intima and adventitia side of the aorta, reinforced the suture with 4-0 polypropylene thread, and continuously sutured the artificial blood vessel and the aortic root with 3-0 polypropylene thread...

Finally, Zhou Yuan began to perfuse and exhaust the femoral artery to prevent various problems after the blood supply was restored due to the presence of air in the blood vessels.

Soon, the exhaust was completed, and Zhou Yuan looked at the instrument next to him again. _

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