In the early years of 2000, let alone in the border areas, even when I was talking on the phone in the city, I had to shake my head from time to time to look for a mobile signal.

It seems that after the Olympics, or a year before the Olympics, all of a sudden, the country's network has become more powerful. Mobile phone signals are getting stronger.

Even in mountainous areas, there is a strong signal. The network has also begun to spread to towns and villages. In this township where there are not many people, China Mobile Unicom Telecom is still either next door or door-to-door confrontation.

The development of the Internet is also of great help to medical care. With the rise of online consultation, diseases that cannot be diagnosed in towns and villages can be directly contacted by higher-level hospitals through the platform of the health system, and experts can consult through the Internet, 30 yuan for a consultation!

General chronic diseases can still be dealt with through online consultation, but there is still no good way to deal with this kind of emergency, especially life-threatening diseases, if there is no medical team tonight. Tusun Khan Jiang has to go to the county seat hundreds of kilometers away, and life or death depends on his life.

There are doctors in rural health centers, but after several years of siphoning in the medical system, it doesn't take a few years for the township health centers to shrink quite badly. Doctors with a little bit of skill went to the county seats, and the doctors in the county towns, the doctors who were a little more powerful or a little younger, either went to the city or to the south. The small township can't support the surgeon anymore. As a result, the township health center became a pharmacy.

There is no way, it can't stop the loss of talent. In the end, medical care in small places can only be solved by going to the countryside and going to the countryside regularly. When there is no doctor in the countryside, once there is an emergency, it is a very troublesome thing. Then, the ripple effect is that people are converging towards the city more quickly. When it comes to why they want to go to the city, most people will say: for the education of their children, for the medical care of the elderly.

Maybe it's urbanization!

Once bleeding from the abdominal organs is considered, it is necessary to quickly locate the bleeding organs and stop the bleeding. After the abdominal organs are hit, they are particularly prone to bleeding from some substantial organs, such as the liver, kidneys, and spleen.

These organs, first of all, are relatively fixed, and they are all very brittle, the fresher they are, the softer and brittle. When a car accident occurs in the city, the speed is not high, and after hitting someone, there is no external injury, but the person has already gone into shock, which often causes damage to the abdominal organs, resulting in massive bleeding.

Huaguo's surgical car, in the early years, was all imitation of German goods, as if it was made by a designated automobile factory, and the price was super expensive back then.

Later, the policy was opened, and Yutong Automobile was the latecomer. I don't know why, they didn't learn from Germany, and they took over the technology of Maruki, and after a few years of development, they surpassed other car factories in China in the field of medical professional vehicles in a few years. Almost all of these professional vehicles are contracted by them, except for a few specified, of course.

Where the fart of the ball country is big, it can't be on the macro. But in this kind of small means, small platform, I really have to admire others, what they do is quite powerful, everything is very easy and reasonable, almost perfect.

The midline of the abdomen is incised, and it is not a straight line. You have to avoid your navel. Because this place is a depression, it is a place where dirt and dirt are hidden, and it is not easy to recover after surgery, not to mention, it is also easy to get infected. Abdominal surgery, this place is the focus of disinfection.

When you open the skin, it looks like a thin piece of brown paper. The skin is incised, followed by the superficial fascia. What exactly is this thing, in fact, it is white fat and some loose hoof tissue, which is mainly walking superficial blood vessels and cutaneous nerves.

This is the advanced nature of human evolution, as long as there are a large number of blood vessels or nerves out of shape, almost all of them have this soft fat and slightly harder hoof tissue as a protective layer. If there is no such organization, maybe a casual slap can hit the other party's face with blood.

"Electric knife, gauze. After entering the superficial fascia, the bleeding began to increase, Zhang Fan said softly. Baoyin passed on the things that Zhang Fan needed, and he had to be extra careful when passing things on the surgical car, because after all, this platform was used for emergency use, and all the things were almost single.

After stopping the bleeding, continue to enter. "If you move faster, your blood pressure won't get up. Dr. Liu Yaowen from the anesthesiology department looked at the monitor and gave Zhang Fan a reply.

"Good. Zhang Fan's already fast speed has improved one step further, although it must be fast, but it can't ignore the level, the abdominal structure is too complicated.

Not to mention the internal organs, first of all, the abdominal muscle layer is very complex, the abdominal organs are too important, and the muscle layer of the abdomen is layered. In layman's terms, this abdominal musculature is like two doors, which are divided into two doors from the navel to the midline.

Many people think that when they open their muscles, they can see the abdominal organs clearly, but they don't. To put it simply, the muscles are the door, and when the door is opened, there is also the door curtain and the internal wall, and the so-called door curtain is the omentum.

So when you enter the muscle layer, you can only see a small part of the organs, such as the liver, a small part of the stomach, and a small part of the large intestine, a part of the small intestine. Other organs are not visible.

The anesthesiologist has reminded that the blood pressure cannot go up, so the hemostasis of the muscle layer is very simple, gauze compression. After the internal organs have been treated, go back and deal with them again.

Lift the curtain of the door, and it's the wall. This so-called wall is a film derived from the abdominal wall, which is the belly, like a double layer of plastic.

This thing is like a wall that separates and separates the various organs, this peritoneum is double-layered, there is a small amount of fluid in it, it has many functions, the most important is to prevent friction and cushioning between the abdominal organs.

If there is no such structure, people cannot move vigorously, because once the activity is intense, the abdominal organs will be strongly rubbed against each other, and the organs as thin as cicada's wings may be worn out, and then there will be either blood in the stomach or a stomach of stool!

Opening the peritoneum, a large amount of bruising appeared, Zhang Fan looked at it and said, "The bleeding is on the upper left side." It's not the liver, it's the spleen. Then I opened the bottom of my stomach and began to look for the spleen.

The spleen, because it is a small organ, was not studied much in the early years, but it was simply thought to be a hematopoietic organ in childhood and fetal period, and in adulthood, it is an organ that degenerates like the appendix.

With the deepening of research, it was slowly discovered that this organ is a very important immune organ, and once it was found that the spleen was a little problematic, it was directly removed. However, with the development of evidence-based medicine, the medical community has defined this organ as the largest immune organ in the human body. It has many functions, such as hematopoiesis, blood storage, blood filtration, and most importantly, immune function.

The spleen, in the shape of an enlarged broad bean, is almost identical, hidden under the 10th and 11th costal arches on the left side. The upper part is covered with the stomach corpus, and next to it is the pancreas.

This thing is still wearing a thin coat on the surface, and there are a lot of spleen trauma, and when it was first injured, there were no symptoms at all. It is because of this thin outer garment that when the bleeding breaks through this layer of clothing, it is the time of shock.

After Zhang Fan confirmed the bleeding, he said to Baoyin: "Scalpel!" Because the position of the spleen is relatively high, Zhang Fan's incision is relatively low, and the incision must be extended upward. In general, in this case, it must be opened under the xiphoid process.

"Full cut?" Just as Zhang Fan was extending the knife edge upward, Lu Shuyan asked.

"Let's see, if you can keep it, you can keep it, if you can't keep it all, it's better to do a partial excision. Zhang Fan said as he quickly extended the knife edge.

"Gauze!"

"Dr. Zhang, my blood pressure has dropped so much. When Zhang Fan opened his stomach and cut the peritoneum, the pressure around the wound suddenly decreased, the amount of bleeding increased, and the patient's blood pressure dropped significantly and rapidly.

"The volume of intravenous fluid has increased. Epinephrine and dopamine combined with intravenous push to prepare for blood transfusion. Zhang Fan, who originally had goosebumps on his body, sweated down. The operation was not difficult, but because of the delay, the patient was bleeding too much.

"Dr. Zhang, the effect is not good, and the blood pressure continues to drop. The anesthesiologist's tone was so rapid that he couldn't slurred words.

"Blood transfusions. Use O-type RBCs directly. Zhang Fan is really dual-minded, while quickly processing the tissues under his hands, and entering the spleen area with refueling, he is still giving oral medical orders.

In general, even in the hospital, blood transfusions cannot be easily carried out. Today's situation is even more troublesome, first of all, I don't know the blood type of the patient, and it's too late to test, not a technician in the laboratory department, and the speed under the general staff is even less.

This kind of life-saving moment, time is urgent, and there is no room for delay, it is all up to the doctor to weigh it, to weigh it boldly. If you weigh it well, it can save your life, and if you don't weigh it well, you may be killed directly!

In general, in large hospitals, there is a store of blood, blood that has been examined. But in the event of an emergency, where can I take care of it, fortunately, the surgical vehicle is equipped with type O plasma, otherwise, there would only be a doctor or nurse on the spot. In this kind of place, there are few people who know their blood type, only doctors and nurses know their blood type. Even if other people know their blood type, they are not warriors, not policemen, and Zhang Fan dare not use it!

This is also why, at a critical moment, when the hospital is short of blood, it is directly the army or the police force that drives into the hospital! Moreover, this is an order, a non-negotiable military order. Truly, for these people, the state owes them, and the people owe them.

Don't think that blood transfusion is saving lives, in fact, blood transfusion is not small, even if there are many blood problems of the same type, so in general, if you can avoid transfusion, try not to transfuse.

"Left venous access to enlarge hydroxyethyl starch. Give me fifteen minutes, just fifteen minutes. Hurry!" Zhang Fan said loudly.

"Gauze, tamponade!" Inside the operating car, there was only Zhang Fan's order.

"Three bent pliers. Look! Is the urine coming out!" Zhang Fan's words at this time can be regarded as verbal medical orders, and both nurses and anesthesiologists must implement them, unconditionally, because at this time, the person who knows the condition best is the surgeon.

"No urine found!" said the itinerant nurse, Liso.

"Quick, scissors!" Whether the spleen is completely removed or partially removed, the spleen must be completely free because the tissue here is too complex.

The stomach, pancreas, and intestines are all in this area, and the vasculature here communicate with each other and accompany each other, which is very rich.

Moreover, the upper pole of the spleen is the spleen and stomach ligament, this ligament is too short, and the short arteries and short veins of the stomach are out of shape, and the separation is not clear, and the two vasculature will be broken by a slight stretch.

"Hold your spleen with gauze, pay attention to the ligaments here, move gently, don't stretch. After the spleen was free and gently held up with gauze, Zhang Fan deliberately explained to Lu Shuyan.

The spleen is shaped like a broad bean, and it has a door, which is where it bends on the inside, and this is where the broad bean sprouts. It's the same in the spleen, which has a medial curve where the splenic hilum is located, and it is shaped by arteries and veins.

Beginning to clamp one by one, the bleeding is significantly reduced as the clamping of the curved forceps stops. At this time, it was slightly better than the previous ten minutes. This can be regarded as a disguised hemostasis.

"Dr. Zhang, your blood pressure has risen, and 9 minutes have passed!" the anesthesiologist said deliberately.

"Hmm!" Zhang Fan responded, not in a hurry at this time. How much does the spleen have to be cut to preserve its immune function? There is currently no clear definition in the medical community. However, at least more than two-thirds, otherwise it will be meaningless.

All the solid organs, their blood vessels are like two big trees. At the door, it is a thick trunk, and then after entering the inside of the organ, it begins to branch and scatter, and then at the very end of the artery and vein form a connected capillary network, one in and one out.

The arteries of the spleen are generally divided into two or three parts at the hilum of the spleen, and then divided into two or three levels to enter the parenchyma of the spleen, and the venous arteries of the spleen are like two brothers, holding hands and walking together.

The longest spleen of Chinese men is about 14cm, but the blood vessels and arteries inside the spleen of ordinary people are 15cm.

After Tusun Khanjiang's lower spleen was violently hit by the stag, it directly opened a hole the size of popcorn. The spleen is too brittle, and the strength of the stag is also great. There was no chance of suturing, only partial excision.

This partial excision is not to cut along the wound along this piece, but to look at the blood vessels. Zhang Fan carefully distinguished which was the lower pole artery and which was the lower pole vein, and slowly ligated them one by one.

"I tie the knot!" In normal surgery, after the surgeon uses a needle holder to send the thread in, the assistant grabs the back thread and ties the knot. But Zhang Fan didn't worry about Lu Shuyan. This is a knot of blood vessels, and if you have less strength, you will strangle the blood vessels, and if you have less strength, the blood vessels will not be ligated.

Lu Shuyan stained the blood with gauze while helping Zhang Fan to support the needle holder, no one will refute or be dissatisfied at this moment, the chief surgeon will do whatever he wants, this is the minimum professional ethics of a surgeon.

The blood vessels to be ligated were ligated one by one, and Zhang Fan breathed a sigh of relief. "Wipe my sweat for me. "I was so nervous, Zhang Fan felt that his eyelids were sweating!

This is the time to wait, waiting for the boundary between the area of the spleen that has blood supply on the surface of the spleen and the area that does not have blood supply after ligation. As long as the ligation is passed, within a few minutes, the areas of the spleen with and without blood will be particularly distinct.

One side is still red or pink, while the bloodless area on the other side is noticeably pale.

"Scalpel. "After three or four minutes, the line is clear. In order to ensure the vitality of the preserved spleen, Zhang Fan used a scalpel to cut the outer coat of the spleen one centimeter away from the junction line, and then used the handle to cut into the spleen parenchyma.

The spleen is particularly brittle, and it is easy to injure blood vessels with a knife blade, although it is blunt with a knife handle, it is safe. Slowly, a V-shaped incision is made on the anterior and posterior edges of the spleen, extending inward little by little.

While cutting, Zhang Fan's left thumb and index finger are always holding and compressing the edge of the spleen, which is to fix the spleen. This can effectively control and reduce bleeding in the book.

It's easy to say, but it's actually very difficult to operate. To put it simply, it is to wear plastic gloves with grease on them. Then hold the round soap that has been stained with water or oil, not too strong, and make sure the soap is in place.

This is the work of the surgeon, without more than ten years of exercise, let alone surgery, a simple grip can't be done.

Little by little, there is a small amount of oozing blood on the surface of the spleen, which is the residual blood in the capillary network. "Dip!" Zhang Fan said softly to Lu Shuyan.

Although this kind of bleeding does not need special treatment, it must be removed, otherwise it will affect the surgical field, and this kind of wound can not be rubbed, it should be dipped and gently dipped in gauze, a wipe will not only damage the organs, but also change the position of the spleen.

"Ligate, it's a small artery. Be careful not to tie slippery knots. Zhang Fan held the spleen with one hand and a scalpel in the other, and found a small artery, he couldn't tie the knot, so he asked Lu Shuyan to tie the knot, and Zhang Fan gave a special explanation before tying the knot.

"Hmm!" After Lu Shuyan replied, she began to tie the knot, and Zhang Fan's eyes looked motionless, for fear that there would be a slipknot or a hole in the spleen. The spleen is more brittle than the kidneys, and if you don't use the right force a little, it's a mouth. This is also the reason why the spleen is prone to rupture.

Finally, the damaged part of the spleen was removed. After Lu Shuyan took the removed spleen and put it in the tissue bag, she often breathed a sigh of relief.

This operation was too nervous, and Zhang Fan's tone on the operating table was too harsh, and she was terrified. At this time, if you look at the spleen from under the spleen, it is like a V-shaped duck's beak, with a large mouth and a small inside.

This shape is for later stitching. The spleen is very brittle, and the shape was made in this shape to make it easy to suture. So a good surgeon constructs a well-established surgical process in the brain before the operation.

"I'll stitch it, I'll tie the knot, Dr. Lu, you cut the stitches. Zhang Fan said to Lu Shuyan.

"Okay. ”

Lu Shuyan didn't dare to tie the knot, this kind of very brittle tissue, knotting is real kung fu, just like pulling a thread on another piece of paper, if you don't pull it well, it's a tear.

And this suture cannot be done with small needles and fine threads. Because the small needles and fine threads can cause the capillaries to be unable to crawl, resulting in avascular necrosis. Therefore, the general foreign surgeon of this suture does not dare to guarantee that he can sew well.

"Liver needle! thick thread!" Baoyin neatly threaded the needle and thread and handed it to Zhang Fan. It's not wrong to say that there is a specialization in the art industry.,In the past, a simple thread seemed to be a very simple thing.。

Not necessarily on the operating table. First of all, wear gloves, and when the bleeding is stopped quickly, the hands must be fast, one needle and thread in three seconds, and one needle and thread in three seconds. Therefore, the surgical nurse will not be able to do it if she is a little older, and her eyes will not work in the first place.

This kind of kung fu is also a movement that nurses become proficient in after practicing countless times under the operating table on weekdays. If you don't endure hardship, you can't do it at all.

The liver needle thick line horizontal mattress suture combined with intermittent suture finally closed the incision. Originally, a broad bean became cone-shaped. After the stitches were completed, Zhang Fan used adhesive foam on the wound to stop the bleeding.

"It's finally done!" When Lu Shuyan watched Zhang Fan cover the omentum in her spleen, the girl was relieved. Zhang Fan on the operating table is too brutal, the more dangerous it is, the more brutal it is. But the more responsible she is, the more she looks at Zhang Fan, her eyes are full of flowers!

"When the arterioles were knotted, if I tore my spleen at that time, would you beat me?" Lu Shuyan saw that the operation was over, and she didn't speak through her brain.

"What are you going to do, do you want aseptic operation!" Zhang Fan rolled his eyes at Lu Shuyan.

"Hit the chest, that place is sterile!" Liu Yaowen, an old man from anesthesiologist, took a stubble. At this time, the atmosphere is lively, although everyone says things that are out of tune, but the heart seems to be filled with a sense of achievement, I don't want to be proud and don't want to be complacent, but it's really uncomfortable not to release, so ~~, this feeling is really beautiful!

"Hooligans!" Bao Yin and Lu Shuyan scolded together.

"Hey, hey!" the old man laughed obscenely.

The surgery is over!

Outside the operation car, as the operation began, the people of the Tusun Khan Jiang tribe, as well as the relatives of Tusun Khan Jiang's wife, also learned the news.

Riding a horse and carrying a lantern, they began to gather outside the operating car from all directions. There are more and more people, comforting Tusun Hanjiang's wife, and caring about the operation.

The township chief also came, "Everyone quietly, don't affect the doctors in the car to do the operation." Lead the horses a little farther away. ”

Because before the operation, Zhang Fan asked Zhang Yanfeng from the Department of Respiratory Medicine to inform Tusun Hanjiang's family that the situation was very dangerous. So Tusun Khan Jiang's fierce wife was already crying into tears, sitting softly under the wheels of the operating car.

No matter how fierce she is, she is a woman, and no matter how fierce she is, she is also a wife. Her mouth kept babbling and pleading.

"Isn't it, let people go home. If there is an accident~~" Doctor Zhang Yanfeng looked at the growing crowd and said to the township chief with a little worry.

"It's okay, don't worry. Adaxi, if it weren't for you, Tusun Khan Jiang would have died a long time ago, we are all reasonable, you can rest assured, there is nothing to do. Every spring, there are people who are kicked to death by animals, and he is considered fateful. Bless you!"

After the township chief finished speaking, he stood in the crowd and said: "The doctors operated overnight, this is a benefactor, no matter what the situation is, if anyone is nonsense, I will be a horsewhip!"