The first thing to do is to look for large blood vessels that have been punctured by sharp objects.

It must be said that when a ruptured blood vessel is large enough, whether an artery or a vein, it is enough to pose a fatal threat to human life.

It's just that the blood pressure in the veins is lower, and the bleeding is not as fierce as in the arteries.

In contrast, a ruptured vein is easier to stop bleeding.

The nurse had a total of eight wounds in her chest and abdomen, and the knives were extremely ferocious, all of which went deep into the cavity.

"A ruptured abdominal aorta was found!"

After the hemoperitoneum is cleared, the source of the large bleeding can be seen more clearly.

This kind of massive bleeding in the form of a jet is extremely terrifying, and can cause a sharp drop in the patient's blood volume in a very short period of time, and eventually go into shock and die from blood loss.

"It should be the superior mesenteric artery in the upper abdominal cavity, which can only be ligated and repaired first,"

While looking for it, Zhou Can gave a hemostatic plan in his own words.

"Hemostat!"

"Give!"

Qiao Yu quickly handed the hemostat to him.

Zhou Can found the vascular end near the heart of the bleeding point, and then clamped it with a hemostat.

"Yang Zhi, help me hold the hemostat, the force can't be too big, and it can't be too small."

This deep artery in the abdominal cavity is pinched during hemostasis and can easily form a thrombus or rupture. The probability of necrosis is low, but there is still a possibility.

Hemostasis is definitely a technical job.

Zhou Can was looking for the proximal end of the blood vessel just now, and it seemed that it was done in a few seconds. That's because his hemostasis has reached an extremely high level.

He has a great understanding of the anatomy of the human body, coupled with rich experience in hemostasis, so he can be so powerful.

Otherwise, if you change someone to operate, you will already be flustered and trembling your hands and feet just by looking at the blood that is constantly spraying.

After Yang Zhi freed up one hand to hold the hemostat, Zhou Can began emergency debridement.

The repair of arterial blood vessels is far more difficult than you think.

In fact, there are so many deep wounds in the patient's chest and abdomen, and there must be more bleeding points than this.

But Zhou Can can only take it step by step.

First repair the superior mesenteric artery that can be seen and bleed the most ferociously.

"Doctor Zhou, the patient's blood pressure is still dropping, his heart rate is also dropping, and there is blood foam in his nostrils when he breathes, see if there is any trauma to his lungs?" The anesthesiologist reminded Zhou Can.

"Okay!"

Zhou Can now opens the abdominal cavity, and if he wants to move his lungs, the best way is to open his chest.

In the patient's current situation, he did not dare to open his chest at all.

It is estimated that before he finished opening his chest, the person was already gone.

Definitely not kidding, with such a serious injury, the patient's life has become very fragile.

"Damn, the door vein was punctured too! What does this make people do? ”

After examination, he soon found a large bleeding spot.

The intestines were also punctured, and the intestinal contents had overflowed directly, contaminating the abdominal cavity. At this moment, Zhou Can especially hopes to have two or three chief surgeons to operate on He Juan together.

He is alone, no matter how strong the surgical ability is, no matter how fast the speed is, it is limited after all.

A deep sense of powerlessness constantly hit his heart.

"Immediately ask Director Xue Yan of the Department of Cardiothoracic Surgery to bring a surgical team to help save people, just say what I said, the sooner the better."

In order to save people, Zhou Can directly used his connections.

The emergency department asked the cardiothoracic surgery department to send someone to rescue the patient, and the cardiothoracic surgery department would not refuse. But it's okay to do business.

If Zhou Can personally asked them to come over to help, the treatment would be completely different.

The rescue continues.

He Juan's mouth and nostrils were foaming with blood, and her blood pressure couldn't go up.

Four bags of blood have been used up in a short period of time.

A bag of 250ml, and 1000ml of blood has also been transfused.

"It's hard to get a broken artery in the lungs! These blood vessels and intestines in the abdominal cavity, as long as I give a little time, can be repaired one by one, but the lungs are very troublesome. Now I don't know what the bleeding is. ”

Zhou Can quickly repaired the blood vessels while introducing the situation.

The anesthesiologist is responsible for stabilizing the patient's life, while Zhou Can is responsible for the surgical repair of blood vessels, intestines, and so on.

Now I can't care about the broken intestine at all, I can only let it leak.

Repairing blood vessels first is the right way.

Not long after, Director Xueyan really rushed over with a whole surgical team. This is Zhou Can's energy. Just mention his name, and you can ask Director Xueyan to help.

"I've heard about family members who have stabbed multiple health care workers in your emergency department with knives. It's infuriating. ”

As soon as Xue Yan came in, she sympathized with what was going on in the emergency department.

"She's spitting blood, it's ...... Did your lungs hurt? ”

"Sister Yan, I just want to ask you to help me see if the patient can open his chest? The wound is on the right chest, in this position. With experience and feeling, it should be an oblique stabbing wound. ”

Zhou Can pointed to the patient's right chest.

It can be seen that the chest has been broken. However, because of the bra and the special body structure of the woman, the depth of the wound should not be particularly deep.

"Her situation is almost certain to die. I suggest opening two small windows for endoscopic surgery, maybe there will be a chance of survival. ”

Deputy Director He of the Department of Cardiothoracic Surgery also rushed over.

He owes Zhou Can a lot of favors, and now that Zhou Can has a call, he will definitely come over and return a favor.

When it comes to thoracic surgery, Deputy Director He should be the most experienced of all the people present.

"Anesthesia, can her condition be transferred to the endoscopic operating room?"

Zhou Can asked the anesthesiologist directly.

"If you don't turn around, you will die, and if you turn around, there is still a glimmer of life, so let's give it a try."

After the anesthesiologist felt that Zhou Can was desperate to save people, she was also deeply moved. also decided to accompany Zhou Can to fight together.

Adventure is definitely needed.

"Can I repair her portal vein and superior mesenteric artery before leaving?"

"I can only try. These two important blood paths have been truncated, and they definitely can't. The anesthesiologist's brow furrowed, and he hesitated for a moment before replying.

The patient's condition is actually terrible.

The injuries were too severe.

"Sister Yan, is it okay to transfer people directly to the endoscopic operating room of the cardiac surgery?"

"No problem, I'll arrange it right away."

Director Xue Yan was very simple, and all kinds of medical resources were released for Zhou Can.

Rescuing such seriously injured patients requires close cooperation from all sides.

Zhou Can began to quickly repair the superior mesoanal artery.

Just now only debridement and trimming have been done, and now all that needs to be done is anastomosis of the blood vessels.

One thing is quite advantageous, only a little bit is removed during vascular repair, and there is no need to consider the problem of shortening blood vessels, and it is necessary to use artificial blood vessels to lengthen. However, this kind of vascular anastomosis is also a great test of the doctor's skills.

Especially large arterial vessels.

In addition, in practice, blood vessels tend to shrink in a short period of time after they are broken.

In medical terms, this is called vascular collapse.

If the blood vessels are not anastomosed and blood vascularization is restored, the difficulty of anastomosis will increase exponentially.

Zhou Can went all out and began to quickly anastomoses the arteries and blood vessels.

[Stitching +1, XP bonus +100.] 】

[Stitching +1, XP bonus +100.] 】

The sixth-level suture technique helped Zhou Can a lot at this critical moment. His stitching speed is also getting faster and faster.

And the phenomenon of being able to feel life through stitching has reappeared.

Each stitch is rewarded with 100 XP points.

This shows that his state at the moment is the same as when he opened his stomach before, and he has entered a wonderful realm. That is, when doing something, devote yourself wholeheartedly, without any distractions, and the belief in your heart is extremely firm and highly focused.

"That's it!"

The vascular anastomosis of the entire superior artery took a total of three minutes and six seconds, which is definitely a record.

[Anastomosis experience +1, the first time to achieve a perfect anastomosis, reward experience +10000.] Heart of Kindness XP +100. 】

Zhou Can was stunned.

Directly rewarding 10,000 XP, definitely for the first time.

He didn't know what a perfect anastomosis was, he only knew that when he had anastomosis just now, there was divine help. How to operate each step is like a rehearsal countless times. The whole matching animation will naturally appear in my mind. It's like setting up a program, step by step, and every step of the operation doesn't need to be considered at all, just implement it directly.

It's a feeling that's so magical that it's hard to describe in words.

If I have to describe it, the anastomosis is like a rehearsal in the brain countless times, and it is so familiar that it can't be more familiar.

Zhou Can knew very well in his heart that the anastomosis of each blood vessel was different. It can only be adapted according to the actual situation, and there is no way to rehearse it at all.

The reason why I have the kind of animation that seems to have been rehearsed countless times in my mind is probably a bit similar to practice makes perfect, plus a blessing to the heart. This kind of wonderful surgical ability has only been seen in this rescue process.

This time, when rescuing patients, the rewards of various medical experience points were soft, and the minimum was 100, and the most this time was as high as 10,000 experience points. Does it have something to do with the special medical skills of benevolence?

Usually, Zhou Can rarely pays attention to this special medical skill.

Its experience also rarely increases.

This is the first time that 100 XP points have been directly increased.

It wasn't the time to study that, and a lot of ideas were just flashing through his head. He had given up his distractions and began to debride, trim, and anastomosis the rupture of the portal vein.

The whole operation is still smooth, fast to the extreme, and the technical points in all aspects are also close to perfection.

Including the details of blood vessel dredging before anastomosis, air discharge, etc., he did it very well.

Five minutes later, the portal vein was repaired.

The patient's blood pressure is still dropping, and the sixth bag of plasma has been hung up. Rehydration is ongoing.

After the portal vein anastomosis was successful, he was rewarded with a high amount of 1000 experience points.

Although it was not as exciting as the last 10,000 experience point reward, this ultra-high amount of reward still allowed his anastomosis to grow rapidly.

It is already approaching the sixth level anastomosis at an alarming rate.

Try to loosen the ligature of the vein and restore blood vessels.

"Hey, that's good! The patient's blood pressure has gone up a little! However, she seems to have a little exhalation, and she has to quickly solve the lung wound, and the most feared thing is that the fluid in the lungs is too serious, which will directly lead to respiratory arrest. ”

Bleeding persists in the lungs and cannot be excreted entirely through the bronchi.

At this point, a severe effusion is inevitable.

The respiration of the lungs relies on the contraction and expansion of countless alveoli to complete the inhalation of air and the expulsion of exhaust gases. When fluid accumulates in the lungs, it is equivalent to being submerged.

If there is only a slight effusion, or if there is an effusion in one side of the left or right lung, the patient will only feel stuffy and have difficulty breathing.

If the whole lung effusion is severe, it is not much better than being choked by the neck.

The patient has respiratory failure, which is a very bad sign.

"Why don't you puncture and drain first! I'm afraid she won't be able to make it to the moment she enters the endoscopy room. ”

Zhou Can glanced at the patient's vital signs monitoring data.

The instrument kept alarming, but there was no way to correct it right away. Little by little, the broken important blood vessels in the patient's body can only be repaired first.

This is also Zhou Can's main operation to rescue patients.

If it were another doctor, it would be difficult to reach Zhou Can's level in terms of surgical experience and speed.

"I think it's wise to drain traffic first."

Director Xue Yan has been on the side to help carry out the rescue, including Deputy Director He.

At the same time, let the two directors and deputy directors of the cardiothoracic surgery department help rescue together, this row is quite large.

The two of them divide their own work, and one first ligates the ruptured intestine to prevent continuous leakage. Then try to clean it up to reduce the potential risk of abdominal and wound contamination.

In the other case, some small bleeding spots were electrocoagulated to stop the bleeding and ligated.

It was with the cooperation of several people that the patient's condition began to improve.

Thoracic drainage is also a technical job, which is risky and difficult.

Many trainees may barely grasp the technical points of chest piercing until the end of the regular training.

For new doctors, inserting urinary catheters and four major punctures are very challenging jobs.

For example, inserting a urinary catheter and encountering elderly patients, especially those with diabetes, can definitely make novice doctors cry. Even some senior residents are also scared when they complete the operation of this special patient.

In older male patients, the problem of prostatic hypertrophy is common.

This can make urinary catheter placement more difficult.

If a patient also suffers from syphilis, acute eczema, etc., it can be even more devastating for doctors.

Zhou Can's injection is currently level 5, that is, the level of deputy chief physician.

Making a chest piercing is a piece of cake for him.

After he found the right position and pierced the puncture needle into the patient's chest, dark red blood quickly flowed out of the catheter.

"The effusion has flooded half of the lungs."

He is very particular about the part of the piercing.

Based on the rate of drainage, as well as the puncture site and the depth of the puncture, an experienced doctor can infer the fluid accumulation in the lungs.

It's important to mention that fluid in the lungs doesn't have to be blood.

Sometimes it can be bodily fluids, or even a viscous fluid such as purulent sputum.

For example, in the early days of new crown infection, the lungs were all that sticky and thick fluid, and the whole lung became as hard as a stone. This is the main cause of their deaths.

My lungs became as hard as a stone, and I couldn't breathe at all.

It could no longer shrink or open.

……

In the endoscopic operating room of the Department of Cardiothoracic Surgery, Zhou Can has chosen to discuss with Deputy Director He, Director Xueyan and others to lock down the location of the pulmonary artery that may be damaged. Then three small windows were opened and endoendoscopic exploration began.

"Lobar injury, pulmonary artery blood vessels in two places, one of the most severe."

Zhou Can's endoscopic surgery ability is also top-notch.

Under his control, the bleeding in the lungs was quickly detected.

The next step is to complete hemostasis and vascular repair. Unlike open surgery in the abdominal cavity, hemostasis and vascular repair of the lungs can only be performed endoscopically. It is done in a small thoracic cavity.

"The blood volume must be insufficient again, the blood pressure is starting to drop again, how many bags of plasma are left?"

"There's only one bag left."

"Contact the blood bank and ask them to think of a way, it is estimated that to support the completion of the entire rescue operation, and blood transfusion will definitely be needed."

The anesthesiologist frowned as he watched the patient's signs go down.

Zhou Can's forehead continued to ooze sweat, and the clothes inside were already soaked with sweat. He didn't care about these, he only had one belief in his heart, he must do his best to save He Juan.

Her one-year-old child is still waiting for her mother to come home.

Her husband, parents, and relatives knew that she was injured like this by her family in the hospital, and they didn't know how distressed she would be.

Nearly half an hour later, Zhou Can finally completed the work of hemostasis in the lungs, vascular repair anastomosis, and wound suturing.

Try to restore blood circulation to the lungs.

Perfect.

The blood flow is smooth, and there is no congestion, thrombosis and other phenomena.

Her breathing seemed to be restoring, and her blood oxygen levels were rising little by little. Dr. Chow, you're amazing! ”

Anesthesiologist Qu Zi's brows opened for the first time, and there was excitement, relief, and a smile in his eyes.

The patient's blood pressure is also rising little by little.

The rescue work is not over, because a total of eight stabs were stabbed, and there are too many injured parts.

Only a few of the most serious and life-threatening areas of hemorrhage have been addressed. There is a lot of work to be done in the repair of the intestine, the debridement and cleaning of the abdominal cavity, and the hemostasis and suturing of other wounded parts.

Zhou Can didn't care about the exhaustion and a lot of physical exertion, and quickly continued the rescue work with Director Xueyan and others.

Deputy Director He knew that his work was sloppy and slow, so he gave up his position to Zhou Can.

(End of chapter)