"The skin is incised, blunt separation. "The fat white man who is in charge of the surgeon seems to be a surgeon with a teaching background. His technique is extremely skillful, but because he doesn't have a mask, he has to turn his head sideways every time he explains the situation. "If you cut the fascia of the internal oblique muscle, the incision will be larger. ”

Sun Lien stood in the distance, shocked by this scene, came back to his senses, and conscientiously performed his duties. He stared closely at Li Fengmin's status bar, for fear that the long list of states would suddenly become the word "dead".

"Cut the internal oblique abdominis muscle, note the separation. "The other veteran experts who helped with the operation were very tacitly disinfected with alcohol, and the separated muscle and fascial tissue were dragged by the meat fork that deliberately bent their heads.

"The incision is satisfying, and the transverse abdominis muscle is cut. "The white fat man's technique is very old-fashioned, using the reverse knife method to cut the transverse abdominis muscle, and the blade cuts the transverse abdominis muscle tissue from the inside to the outside to prevent injury to the deep organs and tissues.

"Continue the separation. The old man tilted his head sideways and whispered, "Wipe your sweat." ”

The shriveled old man, who was acting as the second assistant on the side, took out a cut white bath towel from the bag and wiped the sweat on the white fat man's head. "Lose weight Lao Chen, look at this bath towel, it's all oily. ”

Dr. Chan ignored the second assistant and continued to cut. After separating the transverse abdominis muscle tissue, what is exposed is the peritoneum and the veins and arteries of the thoracic and abdominal wall attached to it. Dr. Chan chose a good incision that avoided the ventral ramus of the C4 subcostal spinal nerve and the T4 spinal nerve. After separating the carotid artery in the thoracoabdominal wall with the handle of the scalpel, Dr. Chan again made a reverse provocation incision on Li Fengmin's peritoneum.

A large amount of blood quickly gushed out of the bulging abdominal cavity.

"There is a large amount of blood in the abdominal cavity, estimated to be at least around 1500 ml. "There was no surgical suction device, and a large amount of blood immediately blocked all the surgical fields for Dr. Chen to continue the operation. In desperation, he could only use the sterilized curved disc to directly take blood out of the wound. The blood was poured into the trash can beside him again and again.

"To prepare the patch, I used Takeda's TachoSil. While pouring blood out, Dr. Chen instructed Hu Jia, "Just prepare the patch, and we'll talk about the size later...... Pull the tourniquet a little tighter!"

The two security guards, who were originally preparing to hold Li Fengmin in case he was struggling in pain during the operation, glanced at each other, endured the discomfort, and pulled the two ties tied to the base of Li Fengmin's thighs a little tighter.

"If there is a decrease in the amount of bleeding, it should be the femoral vein or the external iliac vein. Dr. Chen, who was observing the intra-abdominal bleeding, continued to chatter, and then began to put down the scalpel and directly put his hand into Li Fengmin's stomach and groped.

The other doctors on the operating table all looked surprised, and even Hu Jia didn't show anything special. On the contrary, Sun Lien in the audience was even more shocked.

The state of "internal bleeding" on Li Fengmin's head has faded.

In Sun Lien's experience, a weakening of a state means that the state has been controlled. Dr. Chen's seemingly rough movements actually had an effect.

"The left external iliac vein was torn longitudinally, and the tear was about a centimeter. Dr. Chen put half of his arm in Li Fengmin's stomach, but his mouth was still muttering, "Cut me a patch, it will be one by three size." ”

Hu Jia lowered his head and began to cut the patch. During the operation, it is often necessary to trim some consumables, and there will definitely not be a ruler for the medical staff to cut during the operation. It all depends on the doctor's estimate. However, every emergency physician and every instrument nurse in the operating room is a man of God with his own measurement tools. Saying that three centimeters is three centimeters, cut into a maximum size of 3.2 centimeters, the deviation is definitely not too large. To put it bluntly, I still do a lot of work and exercise skills.

The dry and thin second assistant opened his mouth again, "Lao Chen, you hold down his iliac artery first, it will be dangerous to bleed again." ”

"Shall I use you to teach?" Dr. Chen unceremoniously squirted back, "You Wu Qihua must have had surgery ten years ago, right?" he paused and continued, "I have already blocked the tear, I hope Lao Li's blood vessels will break this one place." If there is any other place that is broken...... That's trouble. ”

Sun Lien watched the performance on stage, and he himself fell into deep thought. Li Fengmin's longitudinal tear in the external iliac vein is actually a very rare condition. It is important to know that most patients with this symptom have suffered severe trauma. Penetrating abdominal injuries, or simply open wounds, can cause injuries to the external iliac veins hidden deep behind the ligaments of the sigmoid colon and inguinal saga. But Li Fengmin, who was soaking in the pool, could not have been hit by such a strong external force - there was no nuclear submarine in the pool!

When all factors are excluded, no matter how absurd the explanations remain, it is the answer. Sun Lien opened his eyes, but this speculation was indeed a little too absurd, and he still didn't dare to confirm it - he needed some medical technical support.

"Hey, Doctor Yuan?" Sun Lien took out the phone in the waterproof bag tied to his arm and called Yuan Ping'an directly in Ningyuan. "I have an emergency case here, have you heard of spontaneous rupture of the external iliac vein?"

Yuan Ping'an on the other end of the phone was eating a completely cold dinner, and as soon as he heard Sun Lien's words, he realized that the leader of his treatment team had encountered a very tricky matter.

"I've seen reports of this, but it's very rare, probably no more than 50 cases reported. The last time there was a record in the country was in 09. Yuan Ping'an was quite impressed by the information he had read, and he could even immediately report the time of the record. "The General Hospital of the Army of the Jincheng Military Region recorded a case of spontaneous rupture of the left external iliac vein to form a hematoma. However, it should have been misdiagnosed as deep vein thrombosis first. ”

"How many ruptures are there?"

"It's rare to be able to rupture spontaneously, and there are no records that break several places in one go. ”

"That's fine. Sun Lien gained confidence, and did not continue to say anything to Yuan Ping'an, he shouted directly to Dr. Chen, who was talking on the stage, "Dr. Chen, the patient should have a spontaneous external iliac vein rupture, and there was only one vein rupture in the previous case reports!"

Dr. Chen asked the second assistant to wipe the sweat on his head again, "Spontaneous rupture?

"No more than 50 cases, the last time there was a report in China was in '09!" replied Sun Lien.

Dr. Chen tilted his lips, "The statistics are too small, and the confidence level is too low. He sighed, stood up straight, and rotated the arm that had been stretched into Li Fengmin's stomach slightly, revealing as much space as possible to himself. Then he put his other hand into his stomach as well.

It was a few minutes before he withdrew his hand, "At least there's only one breach in the iliac vein." ”

The surgeon's approach to finding and solving the problem is so straightforward – of course, it can also be said to be simple and crude.

As long as it can save lives, no matter how brutal the means are, they are good means.