"Doctor Zhao?"

Wang Li, a nurse in the emergency department, stood beside her, waiting for Zhao Heng's instructions.

As a nurse in the emergency department, it can be said that this kind of scene has to be played out several times a day.

"4 units of nitroprusside, esmolol load 0.5 static push for 1 minute, maintain for 10 minutes."

Seeing the dazzling red blood pressure number on the life monitor, Zhao Heng quickly made a decision.

This nitroprusside, the drug of choice for hypertensive crisis, is a short-acting antihypertensive drug whose nitroso genes break down to produce NO, causing vasodilation, which can dilate arteries and veins at the same time.

As for esmolol, as a selective β receptor blocker, it is mainly used during anesthesia induction, during the endotracheal intubation process, during surgery, during anesthesia recovery and postoperative tachycardia, as well as hypertension.

The reason why Zhao Heng chose the combination of nitroprusside and esmolol is to quickly lower blood pressure, and on the other hand, to stabilize the patient's heart rate and prevent arrhythmia.

It can be said that if it were not for the senior emergency doctors who have worked in the emergency department for decades, they would not have been able to think of such a perfect emergency blood pressure reduction plan.

"Okay, Dr. Zhao."

Hearing Zhao Heng's order, Wang Li immediately responded.

However, at this moment, in Zhao Heng's body, Wang Li actually saw a kind of calm bearing that can only be found in the chief doctor.

After a while, Wang Li prepared two drugs and began to inject the patient.

As soon as the drug enters the patient's vein, it works.

230/120

200/100

。

After three minutes, the blood pressure dropped to 140/80mmHg, which is borderline hypertension and is out of hypertensive crisis.

"Senior, it's time to start operating."

Seeing that his blood pressure had dropped steadily and safely, Zhao Heng couldn't help but breathe a sigh of relief and said to Liu Ziang.

"yes, okay."

Liu Ziang nodded.

Liu Ziang never doubted Zhao Heng's ability to deal with this aspect urgently.

Every time, Zhao Heng would not let him down.

"Let's get started."

Liu Ziang said to Li Yang and the two little fire brothers.

Next, Li Yang wrapped the two ends of the steel bar with a towel, and then he and Liu Ziang respectively held the two ends of the steel bar with both hands.

And the two firefighters, one firefighter fixed one end of the steel bar with hydraulic demolition pliers, and the other firefighter held an angle grinder, cutting the steel bar with an angle grinder little by little, constantly emitting sparks and buzzing sounds.

After a while, the exposed part of the steel bar on the head of the migrant worker uncle was cut off.

This process looks very thrilling.

As the part of the steel bar that exposed the head was cut, the migrant worker uncle was immediately sent to the CT examination room to prepare for a brain examination.

Ten minutes later.

CT examination room operating table.

At this moment, the migrant worker uncle was already wrapped in thick gauze on his head and was lying on the examination table, ready to perform a brain CT examination.

Zhao Heng and Liu Ziang stood behind the console, looking at the real-time brain images that appeared on the electronic screen.

"Director Liu, this patient is very lucky, the steel bar is only 0.5mm away from the middle cerebral artery."

Xu Jin, the attending doctor of the imaging department, looked at the brain CT image displayed on the electronic screen and said with some amazement.

"Of course I'm lucky, otherwise I wouldn't have been able to wait to be sent to the hospital."

Liu Ziang nodded and said.

In fact, every year, there are many accidents on the construction site, and it is not uncommon for workers to be penetrated by steel bars.

There are always a few lucky people who survive being pierced through the abdomen, chest and even head by steel bars.

At this moment, Zhao Heng found that something was wrong with the image on the electronic screen.

"Teacher Xu, can you enhance this piece?"

Zhao Heng pointed to a place on the screen where the density of the brain tissue area was significantly reduced.

"This one?"

Xu Jin was a little puzzled, and then looked in the direction of Zhao Hengzhi.

"This.

This is where the brainstem is located. ”

Just a little glance, Xu Jin, who has a lot of experience in imaging diagnosis, was a little surprised.

The function of the brainstem is mainly to maintain the life of an individual, and a series of important physiological functions, including heartbeat, breathing, and digestion, are related to the brainstem.

So, in general, lesions rarely occur in the brainstem.

And once the lesion occurs, then the situation will be extremely serious.

"However, with this kind of low-density shadow, sometimes brainstem degeneration can also occur, which is not necessarily clinically significant."

Xu Jin thought about it and said.

"No, it's not brainstem degeneration, it's brainstem glioma!"

Liu Ziang looked at the place Zhao Heng pointed to, and said with a very solemn face.

"It wouldn't be, would it?"

Xu Jin was a little surprised by Liu Ziang's judgment, this brainstem gliocytoma is very rare.

"Most likely, the worker who brought the patient said that the patient fell from a two-metre-high scaffold, which is not a very high height for an experienced worker. Therefore, it is very likely that the patient will fall down after a sudden dizziness. What's more, in the later stage of brainstem glioma, cranial nerve palsy, gait instability and ataxia will also appear, which may be the cause of the patient's direct fall. ”

Zhao Heng thought for a while and said.

Just now in the emergency department, Zhao Heng was a little surprised by the injury of this migrant uncle.

For those who work on construction sites for a long time, two meters is not a dangerous height.

Many operations are carried out at a height of several meters or even tens of meters.

The height of two meters can only be said to be very ordinary, and at such a height, once the person is unstable due to an accident, he himself has a certain emergency response ability, and he will not fall down like a green onion in a daze, and be inserted into the head by the steel bar.

“。

。 ”

At this moment, Xu Jin is already a little down.

The head was injured and sent to the hospital, which is already a life.

And now brainstem gliocytoma has been discovered!

Brainstem tumors were previously considered "no-no" for surgery because the brainstem is a small area with many nerve nuclei, conduction tracts, and reticular structures.

Brainstem tumors are mostly glioblastomas that grow invasively, so they are difficult to operate, easy to cause damage to important structures in the brainstem, and have high surgical disability and mortality rates, and have a poor prognosis.

These two are combined, and Xu Jin doesn't know how to do this surgery.

"Junior brother, are you sure about anesthesia?"

Liu Ziang said to Zhao Heng with a solemn expression.

In this patient's case, how to safely remove the rebar from the head is tricky enough.

Not to mention, the tumor at the brainstem site will also be removed at the same time.

What's more tricky is that the brainstem is an important part of controlling the heartbeat of human breathing, and if the brain stem is operated on, the patient will have respiratory and cardiac arrest at any time, in this case, it is difficult to anesthetize the patient and maintain the patient's normal vital signs.