What are the chances of surviving a patient who has had brain herniation?

In the case of foramen magnum, the chance of survival is almost equal to 0. In the case of tentorial herniation, the chance of survival is about 50% if treated within two hours. Other cases of herniation have a slightly lower mortality rate, but it is still a disease that can be fatal in minutes.

The last thing every doctor wants is when the patient he or she is responsible for is showing symptoms of dying. But if it really happens, there is no good way for anyone except to fight hard to block the water and cover the earth.

For Zhang Junyi now, what he needs most is a neurosurgery. Removing a large number of skull flaps releases intracranial pressure and prevents brain tissue from being squeezed into other pores of the brain.

120 ambulances have mannitol on them. If it can be infused in time, it can slightly reduce the risk of Zhang Junyi's brain herniation. But in the bumpy car, looking at Zhang Junyi, whose limbs were tightly tied to stop the bleeding, the pre-hospital first responder was a little difficult - he could not complete the difficult operation of deep vein catheterization in the car alone.

"Give me the needle. Dr. Brunn saw the pre-hospital first responder's embarrassment, he stopped sending WeChat messages through his mobile phone, took out a pair of clean latex gloves from the car and put them on his hands, "I'll do the injection, you disinfect - don't wipe your neck!" He glared at the front of the hospital, "Tie the jugular vein in the car, do you think he died fast enough?

"Huh?" looked really nervous in front of the hospital, and he was about to disinfect Zhang Junyi's right arm, but was stopped by Brunn.

"The right arm is about to twist into a twist, so you still disinfect the right side?" Dr. Brunn glared at the front of the hospital dissatisfied, then shook his head. After tearing open the syringe package, he completed the infusion preparation with great skill. And in the swinging car, the intravenous injection began - to the point, and the effect was not like a doctor.

It's like a senior nurse.

"When I used to do medical tours in the Caribbean, I didn't have a nurse to help me. "After the needle insertion, Dr. Bruun seemed to have some of his own means. After he muttered like this, he turned his head to Sun Lien and said solemnly, "You must not tell the nurses in our hospital this...... When the time comes, I ask them to do the work on my own, and I can't stand it. ”

The ambulance had stopped at the entrance of the hospital while Sun Lien and Bruen were talking. The doctors, who had received the 120 forecast five minutes in advance and had been notified by Sun Lien and Bruen more than a minute earlier, were already waiting at the door. Zhang Junyi, a person who fell from a high altitude, must have to go through the green channel.

The biggest benefit of the green channel is that it eliminates all other unnecessary processes. Zhang Junyi is like the most important person in the entire hospital, and cutting in line everywhere is the basic operation. The CT room, which received the notice, has stopped the examination of other patients in order to wait for Zhang Junyi. Although most of the patients were dissatisfied and incomprehensible at first, after seeing Zhang Junyi lying on the bed, all the dissatisfaction suddenly disappeared.

He was really hurt...... It's a little too heavy. Even if the average person can't see his brain herniation and vertebral fractures, just look at the deep bony wounds on his limbs and twisted arms, you can tell that this person is seriously injured.

Before the examination in the CT room, the doctors in the emergency department had already put up vital signs monitoring equipment for Zhang Junyi during the transport. He also had a more appropriate emergency treatment for his open pneumothorax - replacing the plastic sheeting with a gauze sheet soaked in petroleum jelly.

A CT scan is usually done within a few minutes. But in the current situation, the doctors still need to hurry up to snatch Zhang Junyi back from Lord Yama. Every second of delay may be the cause of Zhang Junyi's death, but every second of examination may win Zhang Junyi more chances of life. It's a dilemma about how to balance the time spent on the examination with the time wasted before emergency surgery – a very difficult choice for any doctor.

"After the CT scan, I was sent to the operating room immediately. Liu Tangchun, who rushed to the scene, probably glanced at the CT image, and then decisively gave an order. "The middle seam is already off, and it will be too late if there is no surgery. ”

As a result, the CT scan was forcibly stopped. None of the doctors at the scene had an opinion on Liu Tangchun's judgment. For Zhang Junyi now, brain herniation is the most likely cause of his death. In contrast, heavy bleeding and the like are not even the first of their minds.

"The patient has a significant bulge in the abdomen and may have very severe internal bleeding. Sun Lien reminded on the side, "If you have emergency surgery, do you have to invite doctors other than hepatobiliary to do so?"

"That's for sure. Liu Tangchun nodded and agreed with his apprentice's judgment. Zhang Junyi's current blood pressure is not very high, and the monitor shows 125/95mmHg. This is not the same as the average person with a cerebral hemorrhage.

The average patient with intracerebral hemorrhage either has chronic hypertension. Either because of cerebral hemorrhage, the abnormal activation of the neuroendocrine system such as the sympathetic nervous system, the renin-angiotensin system and the corticosteroid system, and the level of bioactive substances such as catecholamines and brain natriuretic peptides in the circulatory system increases, resulting in a sudden increase in blood pressure. Or, because intracranial pressure is increased beyond the tolerance of the brain's autonomic regulatory function, it is necessary to increase peripheral blood pressure to maintain cerebral perfusion pressure, resulting in a Cushing-Kocher response, that is, a brainstem compression response.

All in all, the vast majority of patients will have severe symptoms of hypertension, regardless of whether it is due to spontaneous or external impact. And now Zhang Junyi's blood pressure is only slightly higher than normal. This basically shows a very serious reality, his blood volume is seriously depleted.

Although the injuries on the limbs are serious, a veteran like Liu Tangchun can see at a glance that these injuries basically did not hurt the arteries. Moreover, the right side of Zhang Junyi's body has obviously more and deeper scars than the left side, which should be caused by the body's self-protection mechanism when falling.

When the human body protects itself, it will subconsciously protect the favorable side. In many trauma patients, this self-protection manifests itself as a clear difference in the size of the injuries between the two bodies.

Since it is not a limb injury that causes volume depletion, it can only be internal bleeding. According to the "abdominal distention" mentioned by Sun Lien, Liu Tangchun estimated that either the patient had a ruptured liver or a ruptured spleen.

From Zhang Junyi's current blood pressure level and heart rate estimates, Liu Tangchun is more inclined to liver rupture. If it had been a ruptured spleen that caused the abdomen to distend, he would probably be dead by now.

From being pushed into the CT room to Zhang Junyi being sent to the operating room on the fourth floor, it took only four minutes and 17 seconds for the doctors of the four hospitals.