Hypotension is a special case.

In general, there is physiological and pathological hypotension.

And if there is primary hypotension...... Chen Gong felt that the patient's vital signs were not very similar.

The patient is obese and not tall, if physiological...... He should know.

Thinking of this, Chen Gong couldn't help but ask, "Did you have low blood pressure?" ”

The patient was lying on the bed, tears of pain coming out.

Hearing Chen Gong's words, he hurriedly shook his head: "No, absolutely not!" ”

"I'm usually pretty healthy."

"Except for some fear of heights, there is no normal case of low blood pressure."

"We usually have a physical examination in our unit, but I have only been less than half a month, and there is no low blood pressure!"

"Moreover, except for a little fatty liver and myocardial ischemia, there are no other diseases."

When Qin Xuehai heard the sound at this time, he also frowned slightly, and raised his head and couldn't help but look at Chen Gong.

When Chen Gong heard this, he fell silent again.

The pathogenesis of primary hypotension is still unknown, and most scholars believe that it may be related to central nervous system dystonia.

Due to the imbalance of the excitatory and inhibitory processes of the central nervous system, the inhibitory process of the vasomotor center is strengthened, the dynamic balance of vasoconstriction and diastolic is impaired, and vasodilation is dominant, which ultimately leads to a decrease in arterial blood pressure.

There is a high probability that the patient has a problem with the central nervous system!

But...... There is no way to detect this thing.

The car sped down the road.

"How's your blood pressure now?"

Chen Gong hurriedly asked the staff who were linking ECG monitoring.

Hearing Chen Gong's words, the staff on the side hurriedly watched.

It didn't take long for the values to appear.

“90/55mmHg！”

Chen Gong looked at this blood pressure, and suddenly frowned, and he couldn't help but raise his hand and press the patient's waist.

With a ghost crying wolf howl, the sound sounded.

The patient's blood pressure has dropped again!

The high pressure is only 85 and it seems to be still falling!

In this way...... Chen Gong's face became more and more solemn.

Patients are likely to have central nervous system blood pressure fluctuations.

Moreover, this fluctuation, along with the patient's mood, will still change.

Seeing this, Qin Xuehai's eyes widened suddenly.

This...... What a strange blood pressure?

Qin Xuehai couldn't help but look at Chen Gong: "Xiao Chen, what do you think?" ”

Chen Gong suddenly said with a solemn face: "The situation may be more complicated than we imagined. ”

"The patient's pelvic fracture is more severe."

"But...... The most troublesome thing is, how do you choose surgery. ”

When Qin Xuehai heard this, he was suddenly stunned for a moment, and then suddenly thought of something, he hurriedly looked at Chen Gong with wide eyes:

"You mean...... Anesthesia Problems for Surgery? ”

Chen Gong nodded!

"The cause of low blood pressure is difficult to detect."

"However, I have a doubt!

First, if neuraxial anesthesia is used during the operation, there is a big problem that he has obvious trauma to the back.

Neuraxial anesthesia is an invasive procedure that involves puncturing the skin on the back and injecting a local anesthetic into the subarachnoid or epidural space through a needle or catheter.

Performing the above procedures on the surface of the spinal cord carries a significant risk of bacterial infection, so back boils or skin infections are contraindications to neuraxial anesthesia. ”

At this time......

Qin Xuehai couldn't help but ask: "What if it's general anesthesia?" ”

Chen Gong shook his head again!

During this time, his knowledge of the discipline of anesthesia had reached a professional level.

Although there is still a big gap compared to those powerful anesthesiologists.

But......

He still knows a lot of anesthesia knowledge and common problems.

The so-called general anesthesia actually refers to the inhale of anesthetics through the respiratory tract and intravenous or intramuscular injection into the body, resulting in temporary reversible inhibition of the central nervous system.

The clinical manifestations are loss of consciousness, loss of general pain, reflex inhibition, and skeletal muscle relaxation.

This doesn't seem like a problem.

Although the effect is accurate and reliable.

But...... Respiratory depression, circulatory and central nervous system complications such as asphyxia, airway obstruction, pneumonia and hypoxemia, atelectasis, hypotension may occur.

General anesthesia is not recommended if the patient already has a severe lung disease prior to surgery.

The patient did not have any obvious serious lung disease.

But......

This hypotension will become the main factor causing complications during the operation.

In many cases, there is no single risk factor.

There is often a risk factor that may lead to a cascade of reactions.

Therefore, the anesthesiologist must have strict requirements for the vital signs before performing surgery on the patient.

Don't underestimate an anesthesiologist.

It can even be said that the anesthesiologist is the key to the safety of the operation!

Without an anesthesiologist, surgery may not be possible.

They play a decisive role in whether the operation can be carried out.

Chen Gong took a deep breath and said:

"General anesthesia...... Too risky! ”

"In the case of general anesthesia, although the patient's muscles and nerves will relax, the function of the body will be limited!

The patient's hypotension belongs to the central nervous system type of hypotension, which is very rare, but ...... But it's also dangerous.

Emotional agitation and nerve grafting can trigger changes in blood pressure!

Maybe...... Surgery can also cause hemodynamic changes, which can cause adverse effects such as urinary retention, nausea and vomiting or respiratory depression, and most importantly, changes in blood pressure, which can cause serious complications!

Negatively affect their recovery! ”

Hearing Chen Gong's words, Qin Xuehai had no doubts.

He didn't think about where Chen Gong's anesthesiology knowledge was learned.

His only concern now is the patient's condition and how to carry out the operation!

After listening to Chen Gong's words, Qin Xuehai was also silent.

At this time, the patient was lying in bed, his spirit became more and more excited, and his blood pressure began to change unsteadily.

"Oops...... It hurts, it hurts! ”

"Lao Qin, you have to save me."

"I can't die yet, my son is only 7 years old......"

"Lao Qin, you have to save me......"

"Hurt ......"

……

The man's voice echoed in the carriage, making the dullness of the moment not too monotonous.

But Qin Xuehai's pressure has not decreased in the slightest.

As Chen Gong said, the patient's current surgery is likely to encounter some problems.

Now we can only hope that the situation of the other side is not so serious.

Elective surgery is possible!

During this time, it is also possible to adjust blood pressure.

Otherwise...... The operation could not be carried out at all.

And all this, he can't call the shots.

The so-called medicine, modern medicine, is actually more like a robot walking in a box.

It is not so random, just like the diagnosis of the disease, it needs to be completely matched before it can begin.

Surgery can only be performed after the conditions for surgery are met.

The purpose of first aid is to save lives.

The purpose of surgery is to live a better life.

The car sped away, leaving only a warrior crying wolf, perhaps...... He should be glad that the thick fat on his body gave him enough cushioning and did not cause damage to his internal organs, even his ribs...... can be safe.

But the heaviness of the body also crushed the pelvis that was already overwhelmed.

Raw is fat, and defeat is fat!

……

……

Soon, the car was inside the hospital.

Qin Xuehai urgently arranged an examination in the radiology department to scan the patient's pelvis.

As it turned out, luck was impossible.

Falling from a height of seven or eight meters, even if the fat is cushioned to the ground, the huge weight base does not have the slightest attachment to the pelvis, and the pelvis is directly fractured.

Even......

Qin Xuehai looked at the film and said to Chen Gong:

"It's serious!"

"I still need to rush to surgery."

"I suspect hemorrhage."

"Over time, pelvis aside, bleeding will become a risk factor."

Hearing Qin Xuehai's words, Chen Gong couldn't cry or laugh!

Director Qin...... You're too tactful. ”

"Is this serious?"

"You see, the pelvis itself is a strong ring of bones made up of the sacrum, coccyx, and the hip bones on both sides (ilium, ischium, and pubis).

You see, these two sides of the ilium and sacrum make up the sacroiliac joint.

But...... This fall can basically be said to be torn apart!

You just can't do it without surgery!

But...... It has to be said that the pelvis is the bridge between the spine and the lower limbs, and the gravity of the trunk is transmitted to the lower limbs through the pelvis, and the concussions of the lower limbs also reach the spine through the pelvis. The pelvis also protects the vital organs in the pelvis. ”

"This patient's pelvis fell like this, and the organs are really fine...... It's a miracle too! ”

Qin Xuehai wiped his face and sighed with a headache: "It's not without harm to be fat!" ”

"However, this pelvis has fallen like this, and it needs to be operated on urgently!"

"In this case, I'll go find Director Zheng first and talk to him."

Director Zheng is the director of the anesthesiologist, named Zheng Chusheng, and has a good relationship with Chen Gong.

Even, Zheng Chusheng admires Chen Gong very much.

Seeing Chen Gong grow up day by day, Zheng Chusheng was also very happy.

After seeing Chen Gong and Qin Xuehai, Zheng Chusheng laughed.

"Little one, is this a frequent home visit?"

Zheng Chusheng shook hands with Chen Gong with a smile, patted him on the shoulder, and said with a smile.

"I've heard, you're doing a good job in the emergency center!"

"Well done!"

"By the way, what are you looking for me today?"

Qin Xuehai sighed helplessly: "Lao Zheng, there is really something wrong, you can see what to do about the patient's situation!" ”

"Can I perform anesthesia and surgery?"

While speaking, Qin Xuehai took out the medical record book and showed the patient's situation.

Zheng Chusheng frowned while watching!

After a while, he said directly with a solemn face: "Difficult!" ”

"It's a little hard......"

"Lao Qin, you may not understand, this kind of central hypotension, I have seen it several times in my clinical practice, and it is simply my nightmare."

"I almost walked off the operating table."

"You see, the patient's pelvic situation, vertebral anesthesia is obviously unrealistic, anesthesia here is a contraindication, and the injury to the back is infected, you see...... This area, badly damaged......"

"Moreover, even if it is vertebral anesthesia, I think the anesthesia effect on the femoral nerve and this area is enough."

"If you have a general anesthesia, you can do it, but ...... Do you know how high a central nervous system transplant is for risk factors for central nervous system hypotension? ”

"Let's put it this way!"

"For this operation, few people in the province dare to give you anesthesia."

"Even I'm nervous!"

"Pressure-boosting drugs can be used, but ...... Vasopressors also respond to the heart, and at this time, the heart is also transplanted......"

"How to say it, it can be understood that general anesthesia is a state with a very high risk factor, second only to shock!"

"Let me ask you, in a state of shock, do you dare to lower blood pressure?"

"Isn't this looking for death?"

"There is no doubt that at this time, general anesthesia is also looking for death!"

Hearing Zheng Chusheng's words, Qin Xuehai also realized the seriousness of the situation.

What can I do without surgery now?

The patient is now in the pelvic area, how long can the palliative time last?

"I really can't help it?"

Qin Xuehai couldn't help but sigh and asked.

Zheng Chusheng's face was solemn: "Old Qin, do you think I'm joking with you?" ”

"If there's a way, I'm willing to try it for you, but ...... Lao Qin, you know better than me what the consequences will be if there is a problem with the anesthesia effect during the operation! ”

"If we can really find a new method of anesthesia, it will be a great contribution to medicine!"

After saying a few words, the scene suddenly fell silent.

Zheng Chusheng said at this time: "Actually...... You watch medicine move so fast......"

"But, in fact, not as fast as you think."

"It's just an assumption brought about by the development of science and technology."

"The development of orthopedics is based on the vigorous development of modern imaging and the replacement of new instruments."

"You are an orthopedic expert, and you also know that the surgical procedures we use have changed for so many years, and how many revolutionary changes have been made?"

"The same goes for anesthesia!"

"Anesthesiology is growing fast, but it's actually ...... Anesthetic drugs are changing. ”

"But the real anesthetic means, the manoeuvres, and the techniques ...... These changes are slow. ”

"There are very few new methods that we can really use in the clinic!"

"Of course, it's not that the surgery can't be done at all, I'm just talking about the risk, and the risk is probable."

"As long as the patient's family or myself is willing to take the risk, my side ...... It's not that it's inoperable! ”

Hearing this, Qin Xuehai shook his head directly.

The silence at the scene made the atmosphere much more solemn.

At this time, Chen Gong, who was standing aside and had not spoken much, suddenly said:

"Teacher Zheng!"

"I actually have an idea here, but ...... I didn't dare to try. ”

Zheng Chusheng heard the sound and looked at Chen Gong with a smile: "You say!" ”

At this time, Chen Gong took out a piece of paper and quickly drew on it.

It didn't take long for a fascia iliaca space to appear on the paper.

Chen Gong said: "I think this is an anesthesia site. ”

"You see, this is fascia iliaca, and there are two nerves that go in and out of here, the femoral nerve and the lateral femoral cutaneous nerve.

Theoretically, it can be confirmed that it can block two nerves of the lumbar plexus: the femoral nerve and the lateral femoral cutaneous nerve. ”

"Even the obturator nerve has some effect."

"Although spinal anesthesia cannot be performed, and general anesthesia carries a significant risk."

"So...... I think that it is possible to perform anesthesia for pelvic surgery by triggering it from the fascia iliaca. ”

"You see, the pelvic area is here, if fascia iliaca anesthesia is done...... The femoral nerve is the largest branch of the lumbar plexus and originates from the L2, 3, and 4 nerves......"

"Then came the lateral femoral cutaneous nerve ......"

"When anesthesia is done here, I think it will work well."

"The use of clinical anesthetic drugs or opioids in surgery reduces the stress response.

Among them, ropivacaine has a definite role in pain block, but it has a shorter and poor effect on motor nerve block, and is mostly used for local anesthesia.

Dexmedetomidine has significant analgesic, sedative, antisympathetic and hypnotic effects, and there is no risk of respiratory depression, so it has many clinical applications. ”

"If in this area, the effect of carine mixed with dexmedetomidine fascia iliaca space block anesthesia."

"Maybe the effect will be significant......"

"Of course, I don't know a lot about anesthesia, it's just my immature opinion."

The voice fell, and the scene was silent.

Originally, there were people in the anesthesiology room, and after hearing Chen Gong's words, a few people immediately gathered around.

Zheng Chusheng listened to Chen Gong's words even more, his face was solemn, and his eyes were staring directly at the fascia iliaca area.

After listening to Chen Gong's words, Zheng Chusheng's eyes suddenly widened!

"This ...... This is what you came up with? ”

Chen Gong coughed: "As you know, I have been conducting research on interstitial medicine. ”

"The fascia iliaca space is one of my research interests."

"I didn't see the effect of this gap in the first place, but ...... I think it's an area worth looking into from an anesthesiology perspective! ”

Hearing Chen Gong's words, the room suddenly exploded.

Several deputy directors were already standing aside and discussing frantically.

"I think it's doable!"

"This fully satisfies the theoretical support of anesthesiology!"

"That's right, here, the most important thing is that it is very safe, you see, the protective tissue of the fascia iliaca area can perfectly avoid the bypass of blood vessels, and the absorption speed of anesthetic drugs is not inferior to spinal anesthesia!"

"Awesome!"

"It's amazing!"

"Are you also involved in anesthesia?"

"Genius ideas and creativity! This is a completely new direction in the field of anesthesiology. ”

"That's amazing!"

……

Listening to the remarks of his subordinates on the side, Zheng Chusheng's breathing became rapid at this time.

Because Chen Gong, this is not an immature assumption at all.

It is a feasible new direction of anesthesia with theoretical basis.

This is definitely an innovation in the field of anesthesiology!

Perhaps, there are many anesthesia methods at present, but ...... This fascia iliaca anesthesia can really make up for a lot of deficiencies.

Moreover, Chen Gong has even made the choice of medicine.

How awesome is that?

Xiao Chen...... Do you know anesthesia? ”

Chen Gong scratched his head and smiled: "Understood...... A little bit. ”

"Not much!"

"I hope Mr. Zheng won't laugh at my unprofessionalism."

"Recently, I've had to study other areas of medicine in order to study intermittent medicine and translational medicine."

"I think these gaps can be analyzed and studied from multiple angles."

"Banmen has an axe, I hope you will forgive me!"

It's not that Chen Gong is modest, but Zheng Chusheng himself is the vice president of the Shanhe Provincial Anesthesiologist Association.

His words are authoritative!

Chen Gong's suggestion directly made him excited.

This made Zheng Chusheng couldn't help but stare at Chen Gong.

Boy!

Talented!

He really underestimated Chen Gong.

This is an all-rounder!

Anesthesia will be!

You know, anesthesiology and clinical medicine are 108,000 miles apart.

The distance is obvious to all.

The clinician will also have an infiltration anesthesia and will use lidocaine.

And what about Chen Gong?

It's simply ...... That's awesome!

Zheng Chusheng stared at Chen Gong, how did he think that this kid was not like a demon.

Being stared at by Zheng Chusheng and feeling a little numb, Chen Gong couldn't help but ask:

"Mr. Zheng, what do you think...... Is it feasible? ”

Zheng Chusheng suddenly smiled: "What's more feasible? ”

"To me, it's a genius idea and a creative idea!"

"This fascia iliaca anesthesia technique is really more powerful than you imagined!"

"Do you know that your seemingly casual remark may cause a riot in the narcotic circle?"

Zheng Chusheng's words were supported by a group of subordinates around him.

"It's not just a riot!"

"This is definitely a new direction in the field of global anesthesia."

"You're amazing!"

"I don't think it's a problem at all, and I can try it because there's no danger here!"

"Yes!"

Zheng Chusheng took a deep breath and said to Qin Xuehai:

"Let's get ready for surgery!"

"I'll anesthetize this operation!"

"Hurry up!"

"To be honest, I'm getting itchy hands!"

"After a while, you guys, follow me to the operating room to evaluate and test the patient's vital signs and anesthesia effect!"

"I want every piece of data!"

Hearing Zheng Chusheng's words, several colleagues around him laughed: "Okay! ”

"No problem!"

"Boss, this subject ...... Can you put me in the top 10? ”

"Boss, I also witnessed it!"

……

Qin Xuehai froze in place at this time, looking at Chen Gong with some disbelief.

He never imagined that this would be the case today.

It turned out to be Chen Gong...... Solved the problem of anesthesiology?

He even felt a little incredulous when he said it.

However, at this time, Zheng Chusheng hurriedly said, "By the way, Director Yang, you go with Director Qin." ”

"You go and talk to the patients and their families."

"Explain the anesthesia situation and ask the other party to sign it, saying that this anesthesia is our original and has a certain risk......"

After Zheng Chusheng finished settling down, he then looked at Chen Gong.

There was anticipation in his eyes.

"Chen Gong!"

"Shibei three days, it really impresses me."

"You've really improved too much."

"Stay with you, I want to talk to you."

"Can we work on this topic together?"

"Of course, you can be the first person in charge of the project."

"Is that okay?!"

"You have to let me do it, please!"

Chen Gong looked at Zheng Chusheng's excited appearance and couldn't help but say, "Director Zheng, is it really feasible?" ”

Zheng Chusheng smiled slightly: "You really underestimated your strength!" ”

"Your ability is far more terrifying than you imagined!"

"I really can't imagine what your future holds!"

"This topic, I promise, is at least a topic of the first prize of the National Science and Technology Progress Award!"

"Even, if you have the qualifications, you can be guaranteed to be an academician!"

"It's not too much."

"It's not an exaggeration!"

After Chen Gong listened, his heart was also beating wildly.

He really didn't expect that there would be such a big influence.

Originally, Chen Gong just felt that this was a new anesthesia site.

But......

In Zheng Chusheng's eyes, this is obviously a technical supplement in the field of anesthesiology.

"Don't worry, I'll raise funds for this project, and I'll write the project application."

"You don't have to do anything!"

"Just wait."

"There is a lot to be done on this subject."

"I'll give you three places, even if it's the third person in charge, and you invite you to come in and cooperate with this project."

"How?"

Chen Gong pondered Zheng Chusheng's words, this ...... Isn't that the rhythm of lying down to win?

Accidentally, translational medicine seems to be one step closer!

……

The surgery began soon.

Are there any reasons for the patient's family to refuse?

Even if it's a new means of anesthesia, what about it?

After all, there is no way for patients to have surgery now......

So yes, it didn't take long for the surgery to begin.

Chen Gong stood in the room nervously.

watched everyone carry out the operation in full swing.

Several anesthesiologists evaluate the patient's signs and the effectiveness of the anesthesia.

The operating room was silent.

As an experienced anesthesiologist, Zheng Chusheng is also cautious.

After all, it was the first time this anesthetic had been used.

Time passes minute by minute.

Chen Gong's eyes were also firmly fixed on the indicators on the ECG monitor, breathing, heart rate...... The atmosphere does not dare to come out.

After a long time!

As the news of the successful operation sounded, the office applauded continuously.

Qin Xuehai was also sweating profusely, but ...... When he looked at the stable values on the ECG monitor, he couldn't help but breathe a sigh of relief.

It worked!

Qin Xuehai hurriedly looked at Chen Gong and couldn't help but say, "You kid! ”

"It really makes me feel unbelievable!"

Chen Gong smiled slightly and did not speak.

Look at the surgical involvement.

Not low!

Surgery contributed 50 percent.

This made Chen Gong a little more sure in his heart.

That's ...... Surgical contributions are not just about how much you are involved in.

It's about how much you contribute!

This operation, without myself, will never be able to be carried out satisfactorily.

Without his new ideas of anesthesia, there is absolutely no way to carry it out, and no one can estimate the follow-up of the patient.

Looking at the diamond treasure chest he obtained, Chen Gong was overjoyed.

Today's trip, blood earns!

Not only has fascia iliaca space anesthesia been validated.

And I got a problem, and I finally got a diamond chest.

After coming out of the operating room, Zheng Chusheng told an anesthesiologist to observe the patient's postoperative signs, recovery, and record carefully!

Obviously, at this time, he has entered the state of experimentation.

And Zheng Chusheng himself pulled Chen Gong to the office and said straight to the point.

"See?"

"That's your credit!"

"You used your means to save a person."

"Are you ready for a new project?"

Chen Gong smiled slightly: "Happy cooperation!" ”

Zheng Chusheng's face was excited, he really didn't expect it, Chen Gong made his originally silent heart ripple again.

Future......

Who knows what it looks like?

Maybe you can fight for it!

The more he thought about it, the more excited Zheng Chusheng became.

Looking at Chen Gong's eyes, there was also a little more excitement and joy.

While speaking, Zheng Chusheng stood up excitedly and hugged Chen Gong:

"Thank you!"

"Xiao Chen, you may have given me a new dream!"

"It's so precious!"

"If you have a place to find me in the future, you can speak at any time."

"Any!"

After finishing speaking, Zheng Chusheng pressed his arm and hugged Chen Gong tightly.

He was so excited!

Who would have thought that he, who is about to retire, can usher in such a dawn?

……

ps: It's the end of the month, ask for a monthly pass, to be honest...... I'm sorry, this month's update, pulled the crotch.

However, thank you all for your support.

(End of chapter)