When doctors have a simulated operating room

The emergency department.

Chen Fang and Zhang Yi had just returned to the office after rounds when they heard the nurse say that the ambulance was coming soon.

"What patient?" Zhang Yi asked.

"The call said gastric bleeding, I don't know if it's portal hypertension."

Zhang Yi nodded and went to the emergency door with Chen Fang.

An ambulance from the emergency center just stopped.

A male patient with a pale face and blood flowing from the corner of his mouth was carried down.

He didn't respond to calls, had night sweats, and was irritable.

The patient even had some symptoms of hemi-shock.

"What's going on?"

"Gastric bleeding. He vomited twice in the car, about 300 ml! He also vomited once at home, but I don't know the exact amount. His family said he had a history of hepatitis B, and it was initially suspected to be caused by cirrhosis."

The emergency doctor hurriedly explained.

Several people worked together to quickly push the patient into the emergency room.

The patient had a history of hepatitis B, so it was highly suspected that it was gastric venous bleeding caused by portal hypertension due to cirrhosis.

Draw blood, CTA (CT scan after injection of contrast agent), and take him to an emergency checkup immediately.

The family members followed behind, crying and saying:

"Wow...what happened to him, doctor...please save him! Our son is only in high school...can't live without a father, please save him!"

Chen Fang glanced at the family members: "Calm down first, don't cry! Tell me clearly when he started vomiting blood, did he have any underlying diseases before?"

"Wow...vomiting blood two hours ago, underlying diseases? It seems that there are diabetes and hepatitis B."

While Chen Fang asked about the medical history, Zhang Yi also saw the problem of this male patient.

It is indeed portal hypertension caused by liver cirrhosis, which caused the rupture and bleeding of gastric varicose veins.

And there is a large amount of free fluid in the entire abdominal cavity.

But what Zhang Yi is most worried about now is not the ascites.

But the patient's stomach has accumulated a lot of blood again!

"Hurry up and bring a bag over! He may vomit blood again!"

Zhang Yi just finished speaking.

The semi-conscious patient on the bed vomited with a vomiting sound!

In an instant, the entire bed sheet and pillowcase were stained red with blood.

The patient's gray short-sleeved shirt and entire cheeks were also all red.

A bloody smell spread everywhere, making people frown.

"Quick, quick, quick! Clean the nasal cavity to avoid suffocation! Also, ask the blood bank to send 400 ml of plasma first!"

"Okay!"

After Zhang Yi gave the order, the nurse immediately went to do it.

When gastric varicose veins rupture and bleed, the blood vessel pressure is very high.

In most cases, the amount of bleeding can reach 1,500 ml per hour.

It is very likely that the bleeding will not stop in time, and the person is about to die.

So the first measure at the moment is to transfuse blood first to stabilize the blood pressure.

However, for hepatitis B patients, medical staff should still be careful of occupational exposure.

Chen Fang asked all the doctors and nurses in charge to wear gloves.

The family members next to her cried again in fear when they saw this scene.

She kept begging the doctor to save her husband.

The nurse comforted her and took her out of the emergency room.

Now the emergency room was quiet.

Soon, the nurse established an intravenous access and infused fluids before the blood came.

A large amount of saline and electrolytes were transfused into the blood vessels.

After a while, the patient's full set of test results came out.

Zhang Yi saw that the hemoglobin was only 4.5g/dl!

The normal value is about 120.

This person is ridiculously low!

Look at the CTA again:

A: Cirrhosis with a large amount of ascites.

B: Thrombosis of the main portal vein.

This report can be completely diagnosed.

It is cirrhosis of the liver with ascites and gastric varicose bleeding.

"Is the blood here? Transfuse blood quickly! If there is no blood, replace it with plasma first!"

"Here it comes! The blood is here!"

As soon as Zhang Yi shouted, the nurse ran over with two bags of plasma.

The blood just taken out of the blood bank was ice, but there was no time to put it at room temperature.

Zhang Yi took a squeezer and pushed the plasma into the blood vessels.

After a bag of transfusion, the blood pressure rose a little, to 98/63mmhg.

"Nurse Li, bring the three-chamber two-balloon tube over here." Zhang Yi said.

The three-chamber two-balloon tube is the primary emergency hemostatic device for gastric venous bleeding.

It is similar to a nasogastric feeding tube.

It is inserted from the nostril through the esophagus to the stomach, and then physiological saline is injected to make the balloon expand.

The principle of hemostasis is similar to compression hemostasis.

But

The process is very painful.

The three-chamber two-balloon tube is thicker than the general nasogastric tube.

It has to be inserted from the nostrils and then extended into the stomach. Most people cannot bear this kind of pain.

In many cases, doctors and nurses hold down the patient's limbs and force the insertion to stop the bleeding.

For example, the patient in front of him.

He is in his forties and looks quite strong.

When Zhang Yi inserted the three-chamber two-balloon tube into him, he was still in a semi-comatose and irritable state.

As a result, he suddenly opened his eyes and grabbed the catheter in Zhang Yi's hand and threw it far away.

He was still mumbling: "I don't want it! Don't touch me!"

Zhang Yi was stunned: "Hey? You still feel pain when you are unconscious?"

Zhang Yi glanced at Chen Fang and called two male doctors.

If soft methods don't work, you can only use hard methods.

This is not abuse, this is saving people.

If the hemostatic tube is not inserted, the blood just now will be lost.

Three people held down the patient's body.

Zhang Yi changed the catheter and applied paraffin oil to it, and started to insert it again.

As soon as the catheter was inserted into the nasal cavity, the patient began to struggle violently.

"It hurts! It hurts so much!"

Zhang Yi did not stop and continued to insert it.

As a result, the catheter actually came out of the patient's mouth...

"Don't move, we are saving you!" Chen Fang leaned close to the patient's ear and said.

I hope the patient can listen to it.

But obviously not.

Zhang Yi pulled the catheter back a little and then extended it downwards.

The patient began to struggle violently again!

The explosive power of people when they are trying to survive should not be underestimated.

With a wave of his hand, Chen Fang was almost knocked down.

Everyone was shocked. Is this the same patient who almost went into shock just now? !

"Forget it, Mr. Chen, I think it's difficult to insert this catheter. Why don't we just do a venous ligation."

Chen Fang panted and looked at the patient. This guy is really strong!

But...

Do a vascular ligation at this time?

The stomach fundus was full of blood, and the surgical field was not clear at all. It was difficult to suture while suctioning.

But if it was delayed like this, the patient would vomit again once the blood in the stomach came out.

In this case, no matter how much plasma was transfused, it would be useless.

The venous bleeding still had to be stopped at the source.

Looking at Chen Fang's tangled expression, Zhang Yi knew what he was thinking.

Zhang Yi said, "Let me do it, I can do it."

Chen Fang looked up in surprise, but the shock in his eyes flashed away.

Forget it, he was already used to it.

Doesn't Zhang Yi know enough?

Just get used to it~

Soon, the family signed a series of signatures such as the informed consent form, critical illness notice, and surgical consent form.

The patient was pushed into the emergency operating room.

Lateral position, propofol intravenous anesthesia.

The patient fell asleep quietly.

In the operating room, all the interns in the emergency department came to learn.

Chen Fang held the endoscope for Zhang Yi.

Zhang Yi took a 50-centimeter-long needle holder to find the bleeding point.

The surgical environment was not good.

As soon as the suction was over, the blood came out again.

However, this was nothing to Zhang Yi.

Even if there was a stone in front of him, he could still see the bleeding point of the blood vessel.

Insert the needle, thread the thread, ligate, overlap, and insert the needle again.

Thirty seconds.

End.

Chen Fang didn't even have time to suction...

He saw that the bleeding in the surgical field had stopped? !

Looking again, a row of neat sutures tied the blood vessels tightly! !