Time: 9:46 a.m

Location: Municipal People's Hospital

Incident: The hospital receives an emergency patient who is in critical condition and requires immediate resuscitation measures.

Rescued: Lu Dongming

Age of the rescued: 26 years old

Physician in charge of rescue: George (Vice President)

Rescuers: Ouyang Weiming (Attending Doctor of Brain Medicine), Jiang Dongcheng (Attending Doctor of Orthopedics), Li Xiaoli (Assistant), Zhou Qian, Shen Jing (Nurse)

Time: 9:49 a.m

"Please report the cause of the person being rescued." The vice dean looked a little anxious, but remained calm.

In fact, he is the one who knows the rescued person best, but the rescue process needs to be documented in detail.

This includes the identity information of the rescued person, the people involved in the rescue, and the basic condition of the rescue process.

"The patient's left hand bone has undergone qualitative changes, and the preliminary judgment does not rule out the possibility of necrosis." Jiang Dongcheng report.

"The patient's brain tissue was severely damaged, but the specific cause is unknown, and there is no bleeding." Ouyang Weiming reported.

"The patient is sitting upright and recumbent." Nurse Zhou Qian reported.

"The patient is sweating profusely, has an apathetic expression, and has begun to have difficulty breathing." Nurse Shen Jing reported.

There are many reasons for bone deteriosis and necrosis, and although the vice president is Lu Dongming's attending doctor, the cause is still uncertain.

The crux of this problem is that Lu Dongming himself does not know when his body began to appear.

According to the vice president, long-term observation found that the cause was most likely present when he was a child.

But Lu Dongming's hand bones are in line with most conditions, so this situation is special and it is not easy to infer at all.

The causes of osteonecrosis of Lu Dongming's left hand may be due to these conditions:

First, it may be caused by trauma

This situation is the most common manifestation in clinical practice, and the causes of bone necrosis caused by trauma are actually divided into several categories, and at this time, as Lu Dongming's attending doctor, he has to consider a few points.

1. Due to the trauma of Lu Dongming's left hand bone, the bone damage is more serious, so the bone does not have the function of regeneration because of inactivation, so it will cause bone necrosis at this time.

2. Due to the trauma of Lu Dongming's left hand bone, it was complicated by some serious pollution or infection, which caused direct necrosis of the hand bone.

3. Due to the trauma of Lu Dongming's left hand bone, the blood supply function around the hand bone was very seriously damaged, resulting in avascular necrosis of the bone.

When the vice president treated Lu Dongming's hand bones, he learned that Lu Dongming would often drink heavily due to brain tissue lesions, and the pain was unbearable at the onset of the disease, so he made a bold guess.

Second, it may be caused by alcoholism.

The vice president guessed that from the perspective of the structure of brain tissue lesions, most of Lu Dongming's onset period should be between 8 o'clock in the evening and 2 o'clock in the morning.

Imagine a person on the night of an illness, with no one to accompany him or comfort him, and he can only relieve his pain by drinking a lot of alcohol, but he does not know that doing so is likely to lead to direct necrosis of the hand bones.

From a long time, in the conversation with Lu Dongming, the vice president learned that he is a person who loves diving, so he has to consider that there is such a reason.

Third, it may be caused by decompression sickness.

The vice president learned that Lu Dongming usually likes to do diving, and guessed that in the process of diving and floating, some tiny gas embolus will be produced in the blood vessels around the bones, and if too much is generated, the blood supply to the bones will be cut off, and then the bones will be necrosis.

However, according to observation, Lu Dongming's bones in other parts except for the hand bones have not undergone obvious qualitative changes for the time being, so this possibility is not very valid and should be decisively ruled out.

In the process of brain tissue treatment, Lu Dongming had to use some glucocorticoid drugs such as hydrocortisone, dexamethasone and other similar glucocorticoids because of repeated shocks, so this possibility cannot be ruled out.

Fourth, it may be caused by glucocorticoids.

Drugs such as glucocorticoids, if used in large amounts over a long period of time, may also directly cause bone necrosis.

Time: 9:50 a.m

"Please ask the assistant to immediately give the patient ECG and blood pressure monitoring, pressurized oxygen, establish venous access, and have an oxygen saturation of 58%!" The Vice-President has confirmed the implementation.

Time: 9:55 a.m

Lu Dongming suddenly went into shock, and in this case did not consider the impact of the drug on the bone of his left hand.

"Ask the nurse to immediately give dexamethasone 5 mg intravenously, and five minutes later, use a scalpel to check the osteonecrosis of the patient's left hand, and give morphine 3 mg subcutaneous injection." The Vice-President has confirmed the implementation of the programme.

"Roger." Nurse Zhou Qian followed the doctor's instructions to implement the intravenous push and morphine injection program.

"Roger." Zhang Dongcheng, the attending doctor of the Department of Orthopedics, followed the instructions of the responsible physician to execute the surgical plan five minutes later.

Five minutes later.

Zhang Dongcheng, the attending doctor of orthopedics, used a scalpel to observe that the patient's hand bones had been completely necrotic.

Time: 10:02 a.m.

"The patient has lost consciousness and cannot breathe, and observes an isolarge pupil, no reflex in the left pupil, a sluggish reflex in the right pupil, and a heart rate of 46 beats per minute." Assistant Li Xiaoli reported to the vice president.

"Ask the nurse to immediately give the patient 1 mg of epinephrine and 1 mg of atropine intravenously, and the assistant will continue chest compressions and balloon assisted ventilation." The Vice-President has confirmed the implementation of the programme.

"Roger." Nurse Shen Jing followed the doctor's instructions to implement the intravenous promotion plan of epinephrine and atropine.

"Roger." The assistant Li Xiaoli followed the doctor's instructions to implement compressions and ventilation programs.

Time: 10:05 a.m

"The patient's heart rate has dropped to 39 beats per minute, and his blood pressure cannot be measured." Assistant Li Xiaoli reported.

"Ask the nurse to give it immediately, epinephrine 2 mg intravenously." The Vice-President has confirmed the implementation of the programme.

"Roger." Nurse Shen Jing followed the doctor's instructions to implement the adrenaline intravenous plan.

Nearly half an hour has passed since the entire rescue process has been carried out so far, and each of them, whether it is a doctor or a nurse, has a serious look in their eyes, and the cold tone atmosphere of the operating room makes people feel suffocated.

Lu Dongming is an orphan, and the vice president has no children, so many times the vice president treats Lu Dongming as his own child, and it can be said that he is the one who is most worried about this kind of thing.

Beads of sweat the size of beans slid down his forehead and slowly flowed to the corners of his eyes, and the vice dean's eyes blinked.

The nurse holds a towel to wipe off sweat, and every two minutes she wipes the sweat for the vice dean.

The current situation is very bad, Lu Dongming's heart rate may become a straight line at any time, maybe death is only a matter of time for him.

Time: Morning, 10:01 a.m

"The patient's heart rate is 42 times per minute, and he has no ability to breathe on his own." Assistant Li Xiaoli reported.

Although he is no longer able to breathe, this does not mean that there is no value for treatment, and the vice president observed Lu Dongming and found that this was due to respiratory depression caused by type 2 respiratory failure and a significant increase in the partial pressure of carbon dioxide, which means that this person can continue to be treated.

"Ask the assistant to immediately intubate the intubation and connect it to the non-invasive ventilator to assist the breathing trachea, and the intubation is 22 centimeters built." The Vice-President has confirmed the implementation of the programme.

"Roger." The assistant Li Xiaoli, who followed the doctor's instructions to implement the intubation plan, should have been too nervous, resulting in a serious mistake during intubation, and the intubation was built into 26 cm.

"No bleeding was found in the patient's lungs." The vice president glared at the assistant fiercely, his tone was a little not so calm, "Please go out, and then I will personally treat the patient, and the attending doctor of the brain department, Ouyang, will pay attention to the patient's condition and make a report at any time, no matter what the patient's result is, I will be fully responsible." ”

The vice president didn't blame the assistant too much, no matter who was in this situation, he would be nervous.

Even he himself is the same, but he is calmer than others, but as a doctor, he must always be so calm.

In general, if there is a serious mistake during surgery, a replacement is usually arranged.

However, if a mistake occurs, the person who made the mistake is likely to undergo psychological changes, and at this time, there will be negative emotions such as weakness, self-doubt, and being at a loss due to excessive tension, and if the person who makes the mistake continues to treat the patient, it is likely that the patient will be in danger in the following process.

And once a mistake occurs, it is usually impossible to continue to stay in the rescue room, because the mistakes will also affect other rescuers.

Time: Morning, 10:08 a.m.

"The intubation is built-in, it has been moved to 22 centimeters, the blood oxygen saturation is 46%, and the patient's condition was observed again with continuous chest compressions, and it was found that the patient's pupils were dilated, the left pupil had no reflex, and the right pupil was dull anyway, and the blood pressure could not be measured after attempts." Report by the Vice-President.

This means that the probability of Lu Dongming being treated at the moment is almost only a 10% possibility, and he will soon lose his heartbeat, but as long as the patient has not lost his heartbeat, it is still a fresh life for doctors.

Time: 10:25 a.m

"The patient's heart rate was observed again, 47 beats per minute, and the blood pressure could not be measured after trying, and the patient was tried to use atropine 1 mg intravenously." Report by the Vice-President.

"Atropine 1 mg intravenous push is allowed." Brain attending physician Ouyang Weiming agrees with the implementation of the program.

"Roger, execute the program immediately." Nurse Zhou Qian followed the doctor's instructions to perform an atropine intravenous thrust program on the patient.

Time: 10:35 a.m

"Continued chest compressions, after trying, blood pressure could not be measured." Report by the Vice-President.

The vice president continued chest compressions......

Time: 10:50 a.m

"The patient's ECG oscilloscope is straight, the fluctuations in the aortic arteries disappear, and the patient does not breathe spontaneously." Zhang Dongcheng reported.

Continuous chest compressions......

"The patient has lost vital signs and requests that a declaration of death be given." Ouyang Weiming, the attending doctor of the Department of Brain, reported.

"Request that the body be disposed of." Orthopedic attending doctor Zhang Dongcheng reported.

Time: Morning, 11:09 a.m

Continuous chest compressions......

Time: Morning, 11:20 a.m

Continuous chest compressions......

Continuous chest compressions......