After brushing her hands, the female Pearson stood outside the operating room and hesitated for a long time, in the end, this matter is still her own fault first, if she can remember that the acute epidural hematoma can not be lumbar puncture, it will not be a foreign appearance, so the female Pearson's complaint to Yi Sheng is much lighter.

It's rare to have the opportunity to participate in the operation, anyway, someone is thundering, and I must give me this opportunity.

The female resident Pearson took a deep breath, and when she entered the operating room, she saw Yi Sheng and Su Jin standing on the side, talking and laughing, and a rather young doctor holding a skin preparation in his hand tremblingly shaving the patient lying on the operating table.

"I said can you hurry up, it's hard to prepare a skin. Su Jin said with a look of disgust: "You didn't prepare skins for rabbits at school, what are you panicking about!"

"You know it's a rabbit!" Tao Qian carefully cleaned the hair in the patient's operating area. In the past, when I was in school, I used to prepare skins for rabbits, but at that time, tissue scissors were used. Tao Qian has never prepared skins since he went abroad, even when he was doing experiments at the Mayo headquarters, there were special operators to prepare skins, and Tao Qian only needed to wear latex gloves to carry out experiments. After returning to China, he even had to prepare the skin himself, or prepare the skin for others, and there was no one.

After cleaning up the patient's hair, Tao Qian gently washed away the patient's remaining hair in the surgical area with clean water, and took alcohol to disinfect it, before putting down the skin preparation device and returning to his position, glancing at the data on the monitoring instrument and saying, "It's time for surgery." ”

"Disinfect, spread the towel. Yi Sheng nodded at Su Jin, glanced at the intracranial pressure detector, and then turned to the heroine Pearson who was standing at the door of the operating room and said: "Intracranial pressure is 2.78kpa, open up intravenous channels, 20% mannitol intravenous infusion, mannitol input speed 13ml/min, tracheal intubation." ”

After everything was in order, Yi Sheng put on a surgical gown with the assistance of Su Jin, checked the instruments in the instrument bag, and then took a deep breath and said solemnly: "I am repeating the last time, this operation was carried out without the permission of the hospital, and I am responsible, but I don't guarantee that the hospital will not punish everyone present, so before the operation begins, please leave the operating room if you choose to quit." ”

Su Jin and the female resident Pearson both shook their heads firmly, and Tao Qian's handsome head poked out from behind the monitoring equipment, shook the mobile phone in his hand and said, "I was ordering takeout just now, what are you talking about?"

"Just do what you have to do. Su Jin gave him a blank slap.

"Oh. Tao Qian hurriedly shrank his head.

Yi Sheng glanced at the CT again, determined the location of the hematoma, and said: "Record the operation time, it is now 1:27 in the morning, and the operation begins." ”

Taking the scalpel handed over by Su Jin, Yi Sheng was ready to cut the skin along the previously set incision starting from the midpoint of the zygomatic arch, around the auricle, and from the posterior segment to the junction of the middle and outer 1/3 of the transverse sinus.

"Dry gauze, scalp clamps. Yi Sheng said with both hands.

After laying both sides of the surgical incision with gauze, Yi Sheng gently cut the patient's skin, subcutaneous and cap-shaped aponeurosis with an arch, and with the movement of the scalpel, let the heroine Pearson spread dry gauze on both sides of the incision and clamp the scalp with scalp clamps to stop the bleeding.

"Bipolar coagulation forceps. ”

Use bipolar electrocoagulation forceps to stop the bleeding point of the loose tissue layer under the cap aponeurosis that Yi Sheng had previously bluntly separated, and wet the inside and outside of the base of the gauze pad, so that the first part of the operation is completed.

Yi Sheng didn't know what level of the "epidural hematoma removal" taught by the system was, Xiao Hulu didn't explain, and Yi Sheng forgot to ask, but judging from the fluency of the operation just now, his avoidance of subcutaneous blood vessels and nerves, the "epidural hematoma removal" taught by the system was at least expert.

Yi Sheng glanced up at the female resident Pearson and asked in a low voice: "When the flap is turned over in a while, immediately prepare wet gauze to cover the inside of the flap for protection." ”

The female resident Pearson nodded and asked, "Why did you choose to start intravenous mannitol before the operation just now?"

"Because the lowest intracranial pressure is half an hour after mannitol instillation, the craniotomy can cause minimal damage to the patient during this time. Moreover, if mannitol is instilled in advance, excessive mannitol will cause some damage to the patient's kidney function. After speaking, Yi Sheng said to Su Jin, who was sorting out the instruments on the side: "Wipe the bipolar electrocoagulation forceps and prepare to turn the flap." ”

"Large round needle, straight pliers, 7# thread. ”

Yi Sheng held a straight forceps to clamp the large round needle into the 7# line to suspend the patient's flap, and then fixed the patient's flap on the tray with a rubber band.

It was the first time for Yi Sheng to see the episteum of a living person, and compared with the general teacher in the dissection room and the episteopia specimens in the exhibition room, the episteum of the living person was even more shocking.

Yi Sheng used bipolar electrocoagulation forceps to gently stop bleeding at several bleeding points, and then asked Su Jin to set up a craniocerebral electric drill and a periosteal dissectioner.

"Periosteal stripper. ”

"Cranial drill. ”

"Wire saws. ”

Yi Sheng carefully peeled off the patient's episteum, drilled 6 holes with a cranial electric drill, then sawed the skull with a wire saw, and then used the peeling ions to open the skull and dura, and after peeling off the exposed bones, a large hematoma on the dura mater came into Yi Sheng's eyes.

"Wet gauze, rongeurs. Yi Sheng said, in the general operating room, the skull bone flap is handed by the chief knife, and the skull bone flap is wrapped in wet gauze after being taken by a suke, but seeing that the hand of the heroine Pearson pulling the hook is trembling, Yi Sheng has to deal with the bone flap by himself, for fear that she will miss and fall to the ground when handing it to the heroine Pearson.

"Bone rongeurs. ”

Su Jin handed the rongeurs to Yi Sheng, and Yi Sheng took the rongeurs to bite the edge of the bone window, and then used bone wax to stop the bleeding.

At this time, Tao Qian, who was behind the monitoring equipment, suddenly stood up and said: "The patient's ABP is transiently reduced to 70/35mmHg, and HR165 times/min. ”

"Intracranial hemorrhage!" "The heroine Pearson was startled and hurriedly said.

The operating room was eerily quiet, only the sound of ECG monitoring "dripping", and if it was an intracranial hemorrhage, it would be very troublesome. One of the complications of acute epidural hematoma is intracranial hemorrhage, once intracranial hemorrhage occurs, if not treated in time, the rupture of intracranial blood vessels will occupy the intracranial space in a very short time, compress other blood vessels and brain tissue, and cause brain herniation, which is life-threatening.

Tao Qian glanced at Yi Sheng and didn't say anything.

Yi Sheng carefully examined it and said: "It's not intracranial hemorrhage, it should be caused by the mannitol injected intravenously before and the dilation of blood vessels when the flap was opened just now." 2ml of nail removal and ephedrine combined with intravenous infusion of alamine to increase the volume of fluids. ”

After speaking, Yi Sheng glanced at the panicked heroine Pearson and said, "Don't be surprised. ”

Tao Qian on the side nodded slightly, and then returned to his position.

After five minutes, the patient's blood pressure rose to 140/90 mmHg, and the HR stabilized at 90 beats per minute.

For the choice of hematoma removal, for Yi Sheng, the two ways of using ionization stripping or cerebral pressure plate free hematoma or using a suction device to suck out the hematoma are the same, Yi Sheng chose a more convenient and fast suction device, although the use of ionization stripping or cerebral pressure plate free hematoma is more testing the level of a chief surgeon, but Yi Sheng feels that there is no need to show off his skills, and the other point is that it is now half past two in the morning, and Yi Sheng is a little hungry.

After the hematoma was suctioned, the small blood vessels on the surface of the dura mater had a certain degree of bleeding, and after Yi Sheng stopped the bleeding one by one with a bipolar electrocoagulant, he observed that there was no trace of further bleeding on the dura mater, and Yi Sheng breathed a sigh of relief and said: "Start suturing." ”

"6*14 round needle, 1# silk thread. ”

Yi Sheng sutures the dura mater and periosteum every 2-3cm along the bone window, and the slight bleeding during the suture process was placed between the dura mater and the inner plate of the skull with hemostatic gauze to stop the bleeding.

After counting the amount of equipment and gauze, Yi Sheng took out the bone flap wrapped in wet gauze, sutured the periosteum, cap aponeurosis and skin, Yi Sheng sutured it with ease, wiped the wound with an alcohol cotton ball, covered the incision with a dressing and bandaged the patient's knife edge.

It was recorded that the patient underwent "epidural hematoma removal" at 1:24 a.m., the end time of the operation was 3:05, the operation time was 98 minutes, the patient's vital signs were stable, blood pressure was 135/88mmHg, and heart rate was 87 beats per minute. Intraoperative infusion of 1000ml, nail removal 2ml, ephedrine and alamine two vials, the patient's vital signs were stable after surgery, and he was sent to the ICU for observation and first-level nursing. ”