Extubation!

Inject 500 ml of laxative, 60 ml of magnesium sulfate, and 250 ml of mannitol into the patient's stomach!

Repeatedly wash the patient's mouth with 0.9% sodium chloride solution!

The patient is sent back to the ward, fasted for 24 hours, after which he can eat some liquids, and after 3 to 5 days, he can eat some semi-liquids, and then return to his normal diet after the body has recovered.

Pay attention to the cleanliness of the diet, because the gastric mucosa is damaged to a certain extent after gastric lavage, so it is necessary to avoid being stimulated.

The diet should be easy to digest and clear.

Do not eat raw, cold and coarse food, it will scratch the stomach cavity and cause bleeding.

Fasting some stimulating, cold, sour and spicy foods, and eating more foods that nourish the stomach and protect the stomach.

Also be careful not to overeat, some people will feel very hungry after 24 hours of eating, and they will eat more, which is not appropriate.

After gastric lavage, after repeated irrigation of the gastric cavity, the gastric acid becomes less, the digestive function becomes poor, and eating too much will be difficult to digest and absorb, which will increase the burden on the stomach and intestines.

Another is to avoid fatigue, the body is weak after gastric lavage, so it is said to take proper rest and not be too tired.

After explaining the precautions for post-gastric lavage care, Li Xiyang said to Huang Ping, "I suspect that the patient's poisoning is related to the long-term use of digitalis drugs, and when the patient is sober, you should carefully understand it to avoid this happening in the future."

Digitalis medicine?

Huang Ping was stunned, why didn't he think of it.

"Thank you so much, Xiao Li!"

"It's okay!"

After chatting with Huang Ping for a few more words, Li Xiyang left the gastric lavage room.

……

As soon as he arrived at the hall on the first floor, Qian Min hurried over.

"Doctor Li, why did you go, I won't answer your call!"

"Did you call me?"

Li Xiyang took out the mobile phone in his pocket, and sure enough, there were 5 missed calls.

He smiled and said, "I was in the gastric lavage room just now, and I didn't hear it."

"What's wrong?"

Qian Min said, "Go to the emergency room and take a look, there's a seriously injured patient!"

Seriously injured?

Let's go, take me there!

Following behind Qian Min, the two quickly arrived at the No. 4 rescue room.

On the way, Li Xiyang had learned that the patient's skull was pierced by a steel wire and caused internal bleeding, which was very dangerous.

Even if I was mentally prepared, I was still shocked to see a wire stuck in the woman's temple with my own eyes.

In addition, Li Xiyang also noticed that the latter had multiple bruises on his limbs and minor fractures.

This doesn't seem to be an ordinary accident.

The screen flickered.

[Brain: What kind of thing is this, it almost scares my major artery, it's just two inches]

[Heart: Woo woo, they are so ruthless, I used them as cattle and horses, and they beat me so ruthlessly]

[Leg bones: Life is hard, I've broken three times in the past six months, I'm afraid I won't be able to walk normally anymore]

[Eyes: Sisters, don't say anything, blame me, blame me for being blind, I found such a ruthless man]

Seeing the dialogue of the organs clearly, Li Xiyang instantly understood.

This is domestic violence!

The position where the wire pierced is very dangerous, and if you miss a little bit, you will be gone.

Gotta get to the operating room quickly!

Li Xiyang turned his head and asked, "Did you take a brain CT?"

The wound on the patient's body can be put aside for the time being, but the wire in the head must be removed immediately.

Qian Min nodded, the report should come out in a while.

But

Qian Min hesitated for a moment and said, "Because I couldn't find you just now, and the patient's injury was urgent, so I called the neurology department, and the person should be here soon!"

Li Xiyang nodded, it's okay.

Patient this feeling

In this special case, it will be safer to have a doctor from the neurology department discuss the surgical plan together.

"You send the patient to the operating room first, pay attention to be careful when placing it, and do not swing the head too much, otherwise it will cause the wire to go deeper twice." Li Xiyang instructed the little nurse in the rescue room.

"Okay Dr. Lee!"

The little nurse pushed the patient away, Qian Min was a little unoptimistic, "Doctor Li, the chance of intracranial hemorrhage being cured is not very high, you must inform the family in advance, this operation is extremely risky, otherwise it may be very troublesome if something happens later.

And even if the surgery can be successfully successful, there will be many possibilities of sequelae if there are no accidents along the way."

Li Xiyang said, "Don't be so pessimistic, the patient is still young, and with good recuperation after surgery, there is a certain probability of recovering to 60 or 70 percent of the preoperative level.

But you're right, you do need to inform your family in advance.

By the way, what about the family, why haven't you seen it?"

Qian Min said, "I've been contacted, and I'm still on the way!"

Li Xiyang nodded.

But now that the patient is in a dangerous condition, we can't just wait.

"You go and urge the inspection report!"

"Good!"

……

Five minutes later, Qian Min came back with the report.

"Dr. Li, the patient's brain CT scan showed a high-density area of intracerebral hematoma, and the diagnosis was intracranial hemorrhage."

Li Xiyang stretched out his hand to take the light sheet and looked at it carefully.

I couldn't help frowning.

Not only did the wire cause intracranial hemorrhage, but it was so close to the temple that it made the operation extremely difficult.

Just then, the door to the emergency room was pushed open.

"Hehe, Dr. Li is also there!"

The person who came was Wang Tianyi, deputy director of the Department of Neurology.

He received a call from the emergency room and rushed over after getting off the operating table.

"Director Wang!"

Li Xiyang and Qian Min waved hello.

Wang Tian nodded, and then said, "What about the patient? How's it going?"

Li Xiyang said, "The patient's condition is serious, and I have already asked people to be pushed to the operating room to prepare, this is the patient's brain CT!"

Director Wang took the CT and looked at it carefully for a while.

Oh no!

CT scan confirmed intracranial hemorrhage and partial fracture of the brain, the key is that the puncture position of this wire is very unsatisfactory, only about one cm from the temple, and the operation is very difficult.

"Dr. Li, I don't recommend surgery, it's better to rely on medication to control it, it may be safer!"

Wang Tianyi gave his opinion, but Li Xiyang did not agree.

"Intracranial hemorrhage causes high blood pressure, and it will not be very effective to lower blood pressure with drugs alone."

Wang Tianyi naturally knew that this would not have much effect, but...

"Conservative treatment may allow the patient to live for a longer period of time, and if he goes directly to surgery, he may die on the stage!"

Wang Tianyi proceeds from the safety of the patient's life and does not recommend taking risks.

Li Xiyang frowned, do you want the patient to wait for a tightrope to live?

The point is that the intracranial hematoma is not cleared and the patient is simply unable to live a normal life.

Wang Tianyi sighed lightly, "You are still young, it is a good thing to dare to challenge, but you can't gamble with the patient's life."

In fact, Wang Tianyi is a well-known conservative in the Department of Neurology, his medical style is steady, not aggressive, and he is accustomed to considering the most beneficial plan for the patient's life from multiple perspectives.

Li Xiyang shook his head, "Director Wang, I'm not gambling with the patient's life, I just think that we, as doctors, should give advice to patients and their families, as well as analyze the pros and cons.

We don't have the right to decide the final plan for the patient, but at the moment the patient's family is not present, the patient has fallen into a deep coma, you look at this film, if you don't have a craniotomy immediately, it may really not be what you expected, the patient may only have two or three days to live.

In that case, why not try

Try it!"

Wang Tianyi frowned, but he also knew that what Li Xiyang said was indeed fine.

In the patient's current condition, if the wire is not pulled, it can last for two or three days at most.

However, surgery should not be done rashly.

Wang Tianyi groaned and said, "In this case, let's have a meeting first to discuss how to do the surgery, if there is no feasible surgical plan, I will still insist on my own opinion!"

Li Xiyang nodded, "Okay!"

……

in the office.

Wang Tianyi put down the light film in his hand and said first, "If surgery is necessary, I recommend injecting glycerol fructose and glycerin sodium chloride into the patient before the operation to lower blood pressure in the brain as much as possible.

At the same time, find ways to reduce the likelihood of blood spatting during the craniotomy.

Otherwise, the patient is very likely to have sudden cerebral death during the operation!"

Li Xiyang nodded, "Director Wang's suggestion is very good, I think that in addition to drug support, intracranial blood pressure lowering is also essential.

In addition, it is not enough to increase the likelihood of a successful surgery by simply decompressing.

If you look closely at the CT of the patient's brain, the white dots around the black *** domain indicate that the patient has signs of skull fracture.

The damaged part of the fracture must be removed."

Wang Tian nodded, "I have no objection to this, just according to what Dr. Li said, after opening the patient's craniotomy, first use the bone flap to decompress the operation to reduce the difficulty of the operation.

The fracture fragments are then removed.

But

Wang Tianyi groaned and said, "Actually, these are not the biggest problems, the difficulty coefficient of bone valve decompression is not high, the patient is still very young, and in terms of the patient's physical condition, it is not too difficult to complete this operation.

The main thing is that this is very unfriendly to the position of the wire!

If you want to take out the wire completely, it is simply a life of death.

In addition, whether the cerebral hematoma can be cleared will also have a great impact on the patient's postoperative recovery."

Li Xiyang nodded, how to safely remove the steel wire is indeed the key to the success of this operation.

At this time, Qian Min on the side suddenly spoke, "I don't know much about craniotomy, but I know about small bone bed craniotomy hematoma removal, bone puncture hematoma fragmentation, endoscopic hematoma removal, and minimally invasive puncture hematoma removal."

Wang Tianyi nodded with satisfaction at Qian Min, "I didn't expect the intern doctor in the emergency department to understand brain surgery, it's rare."

Qian Min was praised by Director Wang and was flattered.

"However, there are pros and cons to each of these procedures, and none of them are suitable for the current patient!" Wang Tianyi shook his head.

"That's it!" Qian Min sneered.

At this time, Li Xiyang said, "I have another idea!"

Wang Tianyi looked at it, "Tell me about it!"

Li Xiyang said, "We can use small bone bed fibrohematoma removal and large bone flap craniotomy hematoma removal at the same time."

Wang Tianyi was stunned for a moment, "This is what you think?"

Two types of surgery in one operation?

Isn't this nonsense?

Do you think it's a 1+1>2 operation?

In the face of Wang Tianyi's questioning, Li Xiyang said calmly, "Since the approach surgery has been finalized for bone flap decompression, if the small bone flap in the original surgical plan is changed to a large bone flap, then the difficulty of the operation can not only be reduced, but also easier to control brain hemorrhage."

After Li Xiyang finished speaking, Wang Tianyi's eyes flashed.

If you think about it carefully, it seems to be really feasible!

But

At present, craniotomy hematoma removal of large bone flap is rarely used, and the entire medical environment is tending to micro-clearance treatment.

Because of the poor clearance and decompression effect of large bone hematoma, it is prone to rebleeding and increased chance of intracranial infection."

Wang Tianyi felt that although Li Xiyang's proposal had a certain degree of feasibility, no one had operated it after all.

As for the actual operation process,

Whether there is really no problem or not, no one dares to guarantee it now.

Moreover, there is a risk of brain tissue collapse after the large bone flap is removed, which makes it difficult to remove the hematoma and causes unnecessary damage to the brain tissue.

Li Xiyang said, "This is actually very easy to solve, as long as the patient's bone bed is enlarged to 4 cm x 5 cm during the operation. The cortical incision is enlarged by 2 cm, allowing the hematoma to be removed more completely both with the naked eye and under the operating microscope.

At the same time, the cerebral pressure plate can also be used to help reduce the traction of the brain tissue and avoid causing damage to the brain tissue."

After Li Xiyang finished speaking, Wang Tianyi was silent.

Thinking about it carefully, Wang Tianyi felt that Li Xiyang's analysis was reasonable, and it was very in place.

However, if it is really practiced, it will be a great test for the artist's skills.

Even Wang Tianyi himself didn't dare to say that he was sure to complete it.

"Can you really do it?"

It's good for young people to have ideas, but all high-rise buildings need to be built on solid foundations.

He has heard all kinds of rumors about Li Xiyang, and he has also seen some difficult cases he has completed.

However, this craniotomy is no different, the brain is a tissue that is more fragile than the heart.

Li Xiyang smiled, "I can't say I'm 100% sure, but I can really try it."

Looking at the confident smile on the other party's face, Wang Tian was stunned.

After a moment, he nodded, "Then try it!"

Seeing that Director Wang agreed to the operation, Li Xiyang and Qian Min both looked at each other and smiled.

Just as he was about to get up and go to the operating room, the nurse in the emergency room ran in.

"Director Wang, Dr. Li, the patient's family has arrived!"

Li Xiyang nodded, "Has the situation been clarified?"

The little nurse nodded, the patient's situation was explained to the family, but...

"The family members won't sign it!"

Li Xiyang and the three of them were stunned, "Are you saying that the family members do not agree to the patient's surgery?"

"Don't they know about the patient?"

The little nurse said helplessly, "I have made the patient's situation very clear, but they just don't agree to the operation."

Wang Tianyi asked, "What is the reason?"

The little nurse recalled the conversation she had just had with the family members, and her face showed disdain.

"They said that since surgery may not be able to save them, it is better not to spend this unjust money!"

Hearing this, everyone frowned.

This co-author is reluctant to make money!

Isn't the life of a family as important as money?

Wang Tianyi has been in Renhe for almost 30 years, and it is really the first time he has encountered such a family member.

Li Xiyang has been silent because he thinks of the wound on the woman's body.

So he said in a calm voice, "Let's go, take me to see the family!"

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