"Are you going to have bronchial artery embolization?" Wei Haiyang was stunned and looked at Ruan Bin in surprise.

This is a tertiary surgery, or an interventional operation. Generally, only people from the respiratory and interventional departments will. Of course, the three directors of their emergency department will certainly do the same. After all, if you can become the director of the emergency department, there will be a lot of surgeries in many other departments.

But Ruan Bin, you shouldn't be right!

"Of course I will! This tertiary surgery is nothing, I have done all the fourth-degree surgeries. Ruan Bin said as a matter of course.

At this time, Wei Haiyang remembered that yesterday it seemed that Ruan Bin had a coronary stent implantation with zero contrast in the interventional department, which was a fourth-level operation! Yesterday, it was a lot of news in the emergency department.

It seems that people will have a tertiary surgery now, and it is not impossible?

In fact, he didn't know bronchial artery embolization at all, but there was no one in the emergency department who could do this surgery at all, and he felt that it was time for him to step up and be the backbone of the heart!

"Is it a big deal? The patient is now allergic to contrast media, and he will definitely not be able to perform contrast surgery after interventional surgery. Wei Haiyang said worriedly. That is to say, wait a minute, there is also zero contrast intervention! And there is no contrast map to provide reference.

At present, the bleeding point can only be based on tomography or CT scan to determine the location and extent of the lesion. However, it can only determine the approximate range, and it is not possible to accurately compare the details and precision. In the end, only the imaging is the most accurate to determine the precise location of the bleeding point!

However, it is not possible to have imaging now, so the surgery can only roughly know where the bleeding point is through tomography or CT scan, but it cannot confirm the exact location of the bleeding point in the bronchial artery!

This is undoubtedly a huge challenge to plug bleeding points with gelatin sponges. Sometimes you deviate by a few millimeters and the bleeding will not be successful.

It's still a blind exercise!

Ruan Bin knew that the difficulty was even a little higher than yesterday's coronary stent implantation operation.

Because the coronary arteries are narrowed, you need to put a stent, and you can feel a little bit through the catheter. But how do you feel about the bleeding point?

I can't feel the blood leaking when I control the catheter!

"Hold it!" Ruan Bin said lightly.

"Ninety percent again?" Wei Haiyang's face twitched slightly. How does he feel that Ruan Bin is ninety percent sure of the operation every time he says it!

"Hmm~"

The next step is for the patient's family to communicate with each other before the surgery. In this crisis situation, surgery is necessary immediately.

Of course, Zhao Quan's son signed happily!

"System!"

[System Points]: 1300

[Bronchial artery embolization] - not started+

"Charge 17,000 to go in!" Ruan Bin said proudly. After rushing 17,000, he still has 30,000.

"Level up!"

"Ding-dong...... Deduct 3000 points, [Bronchial Artery Embolization] - Beginner+!"

"Ding-dong...... Deduct 6000 points, [Bronchial Artery Embolization] - Proficiency +!"

"Ding-dong...... Deduct 9000 points, [Bronchial Artery Embolization] - Director Level +!"

[System Points]: 300

When this surgical skill was upgraded to the director level, Ruan Bin had already judged in his heart that it was enough to complete this operation.

"If hemoptysis is simply treated to stop bleeding, it only needs to completely block the target blood vessels!" Ruan Bin said.

"So you just need to find the target blood vessel and then completely block it?" Wei Haiyang said with his eyes lit up. This eliminates the need for precise positioning to stop the bleeding. Just plug this target blood vessel.

"That's right, let's start the operation, you can be my assistant, no problem, right?" Ruan Bin looked at Wei Haiyang.

"Do I still have a choice?" Wei Haiyang smiled and spread his hands.

To be honest, he should be a senior doctor, and now that a resident doctor has become the backbone of the emergency department tonight, he feels a little embarrassed.

No way, who calls people have a high level?

The operation was carried out immediately, and the anesthesia was effective.

Ruan Bin inserted a catheter through femoral artery puncture, and sent the catheter to the level of chest 6 to look for the bronchial artery opening.

At this point, resuscitation capsular occlusion again played a huge role. The ability to manipulate the space of blood vessels is as simple as drinking water.

Soon Ruan Bin felt an incarceration sensation in the catheter head, and he knew that the catheter might have been inserted into the bronchial artery!

If it is a routine procedure, the next step should be to inject 3 ml of contrast medium to confirm that it has entered the bronchial artery.

But at present, it is impossible to imaging, and you can only rely on yourself to judge whether the catheter has entered the bronchial artery!

"Did you enter the bronchial artery?" Wei Haiyang, who was watching from the side, saw Ruan Bin pause slightly, and hurriedly asked.

"Well, it's in. Although there was no angiography, Ruan Bin felt that the catheter had definitely entered the bronchial artery!

"Now it's time to look for the target blood vessels!" Ruan Bin's eyes were intent, and the blood vessel diagram of the entire bronchial artery suddenly appeared in his mind.

He's judging the approximate location of the target vessel!

"It should be from this direction, turn right!"

"Turn left again!"

"A little further down. ”

It's still relying on blind exercises!

"It should be here!" Ruan Bin's clinical experience in his mind and the experience of thousands of bronchial artery embolization surgeries told him, give him a judgment, this is the place!

It's starting to embolize!

He inserted the catheter deep into the target blood vessel, then placed a gelatin sponge of granular embolism into a 5ml syringe and slowly injected it through the catheter under television monitoring until the target blood vessel was completely blocked!

"Whether it succeeds or not depends on this time. Ruan Bin said secretly in his heart.

The next step is to closely observe the blockage of blood flow.

Generally, angiography is repeated after embolization to understand the embolization, extubation is performed after satisfaction, and the puncture site is compressed to stop bleeding, and compression is bandaged.

But now it is impossible to imaging, and it is impossible to observe whether the hemostasis is successful!

The most intuitive view is to look at blood pressure!

"Is your blood pressure still dropping?" asked Ruan Bin to the nurse next to him.

"Still declining slightly!"

"I'll see in five minutes!" Ruan Bin's face was also solemn. Although he was opened, he couldn't be 100% successful in this operation!

He's not a god after all!

Five minutes later.

"The blood pressure hasn't dropped anymore, it's still coming up!"

"Whew...... It should have been successful in stopping the bleeding. Ruan Bin breathed a sigh of relief. Extubation is initiated, the puncture site is compressed to stop bleeding, and the bandaging is compressed......

"Interventional surgery is easy to use!" Seeing this, Wei Haiyang sighed.

Interventional surgery avoids surgery, and has a huge advantage for bleeding first aid, fast!

"I also have to learn about emergency interventional surgery when I have time!" Wei Haiyang said.

Although there are many interventional procedures, emergency interventional procedures are of great help to their emergency department.

He will train here for three years in the future, and he will be sorry for himself if he doesn't learn some and go back. The main thing is that he was envious when he saw Ruan Bin's operation!

Heartbeat!

：。 : I want to talk about "Krypton Doctor" with more like-minded people, pay attention to "excellent reading literature" on WeChat, talk about life, and find confidants~