From the perspective of treating gastric bleeding alone, it can be seen how different and different there is between the current medical education system and practical application. In textbooks, the only correct solution to gastric bleeding and hemostasis is the use of a three-lumen two-capsule tube. After the three-lumen two-capsule tube is placed into the patient's stomach, air is injected into the tube through a syringe to inflate the gastric pouch to achieve the purpose of compression and hemostasis.

Theoretically, the side effects of the three-lumen two-capsule tube are small, and the equipment is cheap, and the operation is not too difficult. It is ideal for the treatment of gastric bleeding to stop bleeding. However, the reality is that the scope of use of three-lumen and two-capsule tubes is seriously limited, because it requires the cooperation of patients, and it is far less effective than the use of hemostatic agents under gastroscopy or cauterization to stop bleeding in actual use. In the face of more severe gastric bleeding, doctors will choose to embolize the gastric artery through interventional surgery to alleviate the bleeding symptoms when the gastroscopy hemostasis is ineffective.

However, Dean Wu Youqian directly decided to use interventional treatment, rather than the thinking process of gastroscopy to stop bleeding, which is actually very similar to Sun Lien's "reasoning diagnosis".

In the case of severe infection, the patient has sudden severe gastric bleeding without eating or drinking, which may indicate the development of DIC.

There are five main causes of DIC, the most common of which is severe systemic infection. This is followed by trauma, organ damage, oncology and obstetric disasters, and the high consumption of coagulation factors from other causes.

As a doctor, the first thing that should come to mind for a patient with a severe systemic infection with an unknown history of severe systemic bleeding and sudden moderate or higher gastric bleeding without a gastric ulcer trigger is not the bleeding caused by the common clinical ulcer, but the first stage manifestation of DIC, which is the symptom of spontaneous bleeding.

Doctors must always be on high alert in the treatment of such serious patients. Try to rule out the most serious possibility as soon as possible. This is also the main reason why Dean Wu Youqian directly decided to carry out embolization treatment - if it is DIC, gastroscopy hemostasis will not only not be effective, but will also further aggravate DIC due to the consumption of coagulation factors. If not, embolization therapy can also be effective, and the patient himself is not exposed to more risks.

In the medical industry, experience has always been part of strength.

·

·

·

Sun Lien stood outside the clean room, and after hearing Dean Wu's arrangement, he breathed a sigh of relief. The old dean is worthy of being a ruthless person who can decisively stop bleeding with his bare hands in the operating room in France, and his judgment of the patient's condition is simply a fight with the status bar - after the patient spits out the first mouthful of blood, Sun Lien saw the status prompt (mild DIC) from the status bar. At the same time, Dr. Wu has already begun to arrange transfusions of frozen plasma and whole blood to replenish clotting factors and the blood lost by the patient. After vomiting blood for the second time, Dean Wu Youqian directly decided to embolize Hou Huiying to stop the bleeding. This should be that the patient has been judged to have DIC symptoms, so he will choose such a resolute means to stop the bleeding - it is really a quick and accurate decision.

Sun Lien began to think together, and began to reflect on whether he paid too much attention to the detection of evidence in his usual medical activities, whether it would affect the timeliness of rescue. However, after some careful consideration, Sun Lien was a little frustrated to find that he couldn't learn this set of techniques from Dean Wu at all.

Carrying out high-risk treatment based on only some circumstantial evidence is probably what a dean-level bull like Wu Youqian dares to do. The patients people have seen are probably hundreds of times more than the girls Sun Lien has seen. Nor did the other medical staff raise any objections to Dr. Wu's judgment. But Sun Lien can't, even if he already has some fame in the hospital, but after all, he is still a regular doctor who needs to use other people's prescription rights. Rather than relying on shocking the world to grab a little time to treat, it is better to complete the examination as quickly as possible, and then prove your diagnosis with tangible evidence. It's better than having to convince other doctors to oppose the diagnosis and then take the time to convince them.

It took me a while to think about it, and it turned out that I couldn't replicate the more effective approach of the other party. After understanding this fact, it was followed by an almost inextricable depression and frustration. While Sun Lien himself was depressed, he suddenly understood the thoughts of Xu Yourong, Yuan Ping'an, and even Dr. Pascal.

I obviously saw a road, but I couldn't walk it at all, it turned out to be such a frustrating thing.

·

·

·

"Embolization of bleeding veins?" In the interventional operating room, several doctors who were not too old looked at each other, they got together to discuss it, and then shook their heads and said, "Dean Wu, this operation is too difficult for us to do." ”

The patient's condition has been confirmed under the preliminary imaging, Hou Huiying herself does have symptoms of gastric ulcers, and since the arteriography has no obvious abnormalities, it is certain that the bleeding site is not an artery, but her gastric fundus vein. Although the common bleeding of gastric ulcers is mainly caused by arterial bleeding, due to the deep location of Hou Huiying's ulcer and the fact that she is also likely to suffer from liver cirrhosis, Hou Huiying's gastric bleeding is actually a more troublesome gastric fundus vein bleeding.

However, gastric vein hemostasis through interventional surgery is two levels more difficult than arterial interventional embolization of gastroduodenal artery. First, venous embolization requires the main mediator of the interventional procedure, the guidewire, to pass through the venous valve, through the liver, through the portal vein, and then up into the gastric fundus vein without injuring the venous valve. In practice, it is already difficult to get the guidewire to this position. After that, it is more cumbersome to place the embolus. Human veins are generally thicker than arteries. Conventional platinum rings are extremely difficult to embolize the gastric veins and must be assisted by gelatin sponge particles.

The interventional department of the four hospitals...... At least the second-line doctors on duty do not have this ability.

"We really weren't sure we were going to do this surgery in an emergency situation. "The doctors of the Fourth Hospital are okay to say otherwise, anyway, with Dean Song here, in order to treat the disease and save people, as long as there are no problems with the means and purposes, they dare to do anything. But the premise of being bold is to be careful, and the second-line doctor who is currently on duty must clearly raise the difficulty to the old dean, "If I can't wait, I can go." In fact, for fundic venous bleeding, isn't it good to use a gastroscope to tie it?"

"The patient had a precursor to DIC, and the hemostatic strength of the gastroscopic banding was not enough. Of course, Dean Wu Youqian knows that gastroscopic banding is simpler and more convenient, but the patient has already shown signs of bleeding, and taking bandage with relatively low hemostatic intensity under this condition is tantamount to drinking water to quench thirst. What's more, severe bleeding and renal dysfunction are also contraindications to gastroscopic venous ligation.

"I've already called Director Xiong to come. He had ten minutes to go. Outside the operating room, Song Wen pressed the intercom and said to everyone in the intervention room, "Teacher Wu, let's maintain the patient's vital signs first, Director Xiong will be here soon." ”