Start as an Emergency Physician

Zhou Yuan smiled.

They really guessed correctly, what can be solved with technology is not a problem in the face of Zhou Yuan's master-level pacemaker placement surgery.

"In addition, the postoperative complications you are afraid of, such as hematoma, pneumothorax or something, are also technical problems..."

Zhou Yuan couldn't bear to continue.

If you continue to talk about it, you will be pretending.

Lu Chenxi had long been accustomed to being Zhou Yuanxiu, so he bowed his head silently, and shouted a big guy in his heart.

He Jing suddenly brightened, staring at Zhou Yuan as if a little girl saw an idol.

When Wei Lili saw He Jing's expression, her face suddenly froze.

"He Jing, forget Zhou Yuan's words for me! Don't learn it!" Wei Lili said sternly.

He Jing is a good seedling, he can't let Zhou Yuan's bad thoughts be polluted!

Stability is the most important!

Under the gaze of everyone, Zhou Yuan soon began to puncture the subclavian vein.

Zhou Yuan chose the subclavian vein puncture FAKE method, the puncture point is the junction point of the midpoint of the sternal angle and the middle third of the coracoid process line, and the direction of the puncture is the direction of the junction point between the needle insertion point and the middle and inner third of the clavicle.

The needle insertion point is easy to find, but the difficulty is to control the puncture direction, which must be parallel to the clavicle, once there is a deviation, the wire cannot be placed smoothly, and there is a risk of being squeezed by the lower border of the clavicle, which means that the operation is highly likely to be declared a failure.

But...... Again, it's a matter of technology.

"Puncture needle. Zhou Yuan said in a deep voice.

"The direction of the puncture needle should be as low as possible, if it is too high, the slightest mistake will lead the wire into the internal jugular vein, and then it will be an accident. "

Zhou Yuan reminded Lu Chenxi while guiding the puncture needle into the subclavian vein.

Lu Chenxi naturally knew Zhou Yuan's intentions, and nodded in his heart.

"Expansion tube. "

Zhou Yuan said.

Zhou Yuan left a space between the clavicle and the first rib that was large enough to allow the dilator tube to enter.

"Why... Isn't it too big?" asked Lu Chenxi.

The needle is much smaller than the dilator tube, so there is no need to leave so much space at all.

Zhou Yuan shook his head and said: "The reason why subclavian vein puncture is very difficult is because it is difficult to adjust the direction of the puncture, once the puncture needle and wire are inserted, it can only pass in one direction..."

"In that case, why not leave a little more space so that the needle has plenty of room under the collarbone to adjust the direction of the puncture?"

Lu Chenxi's eyes widened in surprise.

Follow Zhou Yuan... You can really learn a lot of things that are not in textbooks!

"Sheath. Zhou Yuan ignored Lu Chenxi's starry eyes and said.

Zhou Yuan quickly completed the puncture, leaving enough space between the collarbone and the first rib to adjust the direction of the puncture needle freely.

Sure enough, it was more than twice as fast as the cephalic vein.

Wei Lili thinks that even if she dares to get started, she will never be so fast... Because the stakes are too great, she has to be cautious at every step.

Therefore, he looked at Zhou Yuan's gaze.

Zhou Yuan carefully guided the first wire with the piercing sheath, entering through the small opening that could just accommodate the piercing sheath to pass through.

Because of the particularity of human physiological structure, the piercing from the right side requires two curvatures in the chest cavity, while there is only one bend on the left side, so Zhou Yuan chose the left puncture.

Zhou Yuan had enough space at the time of puncture, so when the puncture sheath and wire reached the lower edge of the clavicle, there was no squeezing.

Once squeezed, the wire will bend, resulting in the weakening of metal conductivity, and in serious cases, the wire will even break, and it can only be taken out with the chest open.

Zhou Yuan stared at the perspective image next to him while adjusting the position of the puncture sheath, and soon, he successfully reached the ventricular area.

At this point, everyone was nervous again.

The introduction of ventricular leads has always been a major problem in pacemaker placement surgery, due to the complex structure of the atrium, the atrial comb muscle, tricuspid valve, tricuspid valve tendon cord and other parts will hinder the smooth entry of the leads.

During this period, Zhou Yuan did encounter a tricuspid valve that blocked the wire forward, but he only turned it around, then withdrew backwards, and crossed the wire through the valve.

Seeing this scene, Lu Chenxi and the others were directly dumbfounded.

What the hell can this still be turned?

Zhou Yuandao: "Now I understand the importance of reserving space for rotation? If you don't leave a little space, you can only stab forward when you get here, either stab it, or try your luck to see if you can slide through." "

Lu Chenxi and He Jing blushed a little and nodded.

Wei Lili stared at Zhou Yuan incredulously: "How do you feel that you are so scheming... Who taught you this?"

Zhou Yuanzhi smiled.

"Okay, done, let's put the wires and test the parameters. "

"It's also optimistic here..."Zhou Yuan reminded Lu Chenxi.

Lu Chenxi's eyes immediately widened obediently.

At this time, the lead electrode has been sent by Zhou Yuan to the top of the opening of the tricuspid valve in the right atrium.

In the perspective image, Zhou Yuan was seen rotating the guide wire, causing the electrode to deviate from its original position intermittently.

"Why don't you just push the electrodes from here to the right ventricle!"

As soon as Lu Chenxi finished speaking, he saw Zhou Yuan gently push on the side of Sun Lele's spine, and suddenly, the electrode was sent to the blood flow next to him by this thrust, and along the blood, the electrode easily entered the right ventricle.

Lu Chenxi was stunned.

Zhou Yuan didn't want to use the piercing sheath to guide... Instead, it is driven directly by the blood flow of the heart!

How did you come up with this...

Lu Chenxi was stupid, and he only felt that the person in front of him who was doing surgery was not a young man, but an old fox.

"What are you doing in a daze, and start the parameter test. "

"Oh oh!" Lu Chenxi hurriedly said, like a little apprentice who made a mistake.

The parameter test is not difficult, the perception is greater than 5mv, the voltage threshold is less than 1v, and the impedance is 300~1500ohm.

After completing the test, Zhou Yuan performed diaphragm stimulation again, and was relieved to see the 10V displayed on the instrument.

"No problem. "

After the ventricular wires were placed, Zhou Yuan began to place the atrial leads.

Except that the electrode parameters of the atria are different from those of the ventricles, the other steps are similar.

Zhou Yuan quickly completed the placement of the atrial leads.

"The wire must be given proper tension and, moreover, must be ligated. Zhou Yuandao.

Lu Chenxi nodded.

"The next step is the embedding of the pacemaker. "

After Zhou Yuan said this, he asked the nurse to wipe her sweat before continuing.

Pacemaker embedding is simpler than wire placement.

Zhou Yuan made an incision in Sun Lele's chest, and then buried the pacemaker in front of the fascia of the pectoralis major muscle, and the electrode wires at this time were just behind the pacemaker.

"Stitches. "

The Zhou Yuan fixed wire uses soluble sutures. After completing the suture fixation, he tried to pull, and the wire shook slightly, but did not shift.

Zhou Yuan breathed a sigh of relief.

"Why don't you fix it directly..."Lu Chenxi didn't understand again.

At this point, she had the impression that she wanted to ensure that the wire was reliable! But Zhou Yuan's sutured and fixed wire was obviously shaking!_

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