"Director Qiu, what is the situation with this patient?"

Associate Professor Qiu of the Department of Anesthesiology is also the deputy chief physician of the department, but the director of the Department of Anesthesiology still calls him Director Qiu with more face.

"Director Zeng, when I was sent to the emergency department, I considered a traumatic hemorrhagic hypotension, and there was no indication for shock at that time."

"After the official opening, although there was still bleeding, due to blood transfusion, I barely maintained the stability of blood pressure."

"But now, the trauma surgeons have completed the debridement and exploratory surgery, and no active bleeding has been found, and the patient's blood pressure has not risen...... "Associate Professor Qiu hurriedly reported to the director of the anesthesiology department to explain the situation.

Associate Professor Qiu's figure is difficult to describe as absolutely fat and thin, if you only look at the belly, he should be a big fat man, but if you look at places other than the belly, he should be a good man with a strong body.

When Associate Professor Qiu explained, the director of the Department of Anesthesiology, who was tall and strong, had a wide skeleton, and his muscles were obviously better than Associate Professor Qiu's, and his brows were instantly furrowed.

looked at the two little ones on the operating table and asked, "Since this shock is not under the control of the orthopedics, what are the two of them doing?" ”

Zeng Quanming has a Chinese face, a serious expression and eyes, as if he has experienced many life and death experiences.

The tone was calm and slightly sarcastic.

Associate Professor Qiu's eyes under Hua Juan's hat darkened: "Director Zeng, other surgical personnel have already consulted, and they all say that shock has nothing to do with the disease in their department. ”

"All that's left is the orthopedic open injury."

"And now, the orthopedic surgery has been done, isn't it just going to be a shock chain."

"What is the patient's current blood pressure? It's a good situation. Qiu Yuxuan glanced at the current monitor, although he trusted his own technology, Qiu Yuxuan was also in a panic now.

In the operating room, the patient on the operating table, there is a patient with an unclear diagnosis and unstopped shock, he knows how troublesome it will be.

When Director Zeng and Associate Professor Qiu of the anesthesiology department looked at each other there, finally the head nurse of the operating department also walked in from outside, but she didn't dare to ask about the trouble of the anesthesiology department, but yelled.

"You surgeons haven't figured out the cause, what surgery did you send? Do you think it's going to end now? The grumbling voice that entered the door betrayed her age as a tigress in her forties.

Hearing this, Fang Ziye glanced up but didn't speak, but motioned to his junior brother Jiehan to continue stitching.

may be seeing that Fang Ziye is more honest, the head nurse came again: "Why don't you call your superiors quickly?" ”

"What the hell is going on here?"

When he heard this, Fang Ziye said: "Why don't you signal, teacher, how will we deal with it in the future?" ”

"I'm not a doctor, why are you asking me? You ask me if it's useful, so why do you need a doctor? The woman spoke very frankly, without a trace of guilt, but with mockery.

Fang Ziye lowered his head and whispered, "I thought you were here for consultation and guidance on the indications for surgery?" ”

"What?" The middle-aged woman, who has always been scared of the air, and even the professor of surgery rarely gives face, flashed disbelief in her tone.

"Nothing! ~" Fang Ziye bowed his head and continued to close his wound with Jiehan.

Hearing this, the director of the anesthesiology department helped: "Head nurse, open injury is the indication for surgery, surgery is a large department, and the surgical indication of orthopedics is orthopedic, or it cannot be generalized." ”

The woman nagged: "Director Zeng, you are still too accustomed to these people in surgery, we are all parallel departments, why do they ......?"

When the woman was teasing her voice, the door of the operating room opened, and then a young man came in, wearing black-rimmed glasses, and after stepping through the door, he wanted to rush to the computer of the anesthesiology department to read the film again.

Seeing this, Zeng Quanming glanced at the other party up and down: "Which subject are you the teacher?" ”

The young man shuddered for a moment when he heard this, and then said, "Director Zeng, it's me, the vascular surgeon." ”

Zeng Quanming seemed to have recognized the other party a long time ago: "You are the person from your vascular surgery, right?" ”

"Director Zeng, when you just called, Director Wu of our department really couldn't leave, abdominal aorta and femoral artery replacement! Except for Director Wu, no one in our group can top it. The youth hurriedly explained.

Knowing that he came secretly, he was arrested, and he is only the attending treatment now, in fact, he is not qualified to respond to the consultation call of Zeng Quanming, a director of a large department.

"Shock Chain, your vascular surgery task is the heaviest, you have to think about it yourself!"

"I just looked at the medical records, and when the patient was in the emergency department, the neurosurgery, gastrointestinal surgery, thoracic surgery, hepatobiliary surgery, and thoracic surgery consultation were already in attendance." Zeng Quanming reminded young people to recognize the reality clearly.

"Hey, thank you, Mr. Zeng, I'll be very cautious." The hearts of young people are not particularly panicked.

The Department of Thoracic Surgery and Cardiac Surgery of Zhongnan Hospital are combined, and the Department of Vascular Surgery is actually in charge of other aortic injuries other than the thoracic aorta.

Some other arteriole injuries are actually blamed on various subspecialties.

In addition, there are some thrombosis treatments, which are under the vascular surgical tube.

If it is a hemorrhagic injury of an organ, this kind of local hemostasis is not within the scope of vascular surgery, at least not in Zhongnan Hospital.

Specialized treatment does not mean that vascular surgery needs to give you hemostasis for hemorrhoidal blood vessels.

What the young man could think of, Zeng Quanming could also think of, so he scolded in a low voice.

"Wu Yong, this dog thing."

When the young man heard this, his eyelids raised, although he clearly heard Zeng Quanming scolding his own department director and his own group leader, he still didn't dare to fight back.

The young man honestly began to read the films, re-diagnosed, and then read the previous medical records, looking at the physical examination records written by others to guess the true diagnosis......

Now the patient is already on the operating table, and it is impossible to get him down for another physical examination, and the current trauma surgery is not yet nearing completion.

No one can go against the principles of sterility.

Now it is necessary to find other hidden bleeding points other than open limb injuries, which is the real task of emergency consultation.

……

Consultations from other departments are also coming one after another.

Although the people from some departments are professors, and the people from some departments are associate professors, Zeng Quanming does not have any temper.

Different departments actually have sub-specialties.

As a professor, you don't necessarily have the best at it.

The attendance requirements for the general consultation of the whole hospital are the deputy high and above, what else can he say.

Of course, just when everyone was arguing, Fang Ziye and Jiehan were sewing very calmly.

It's not that the two of them deliberately delay time, it's just that they don't dare to deal with it at will, so in terms of suturing, they are also full of firepower, and they take the fast and several words to the extreme.

Neurosurgery consultations have not yet arrived, and may not even come.

Fang Ziye had already finished the operation, and after covering the sterile dressing, he said to the anesthesiologist: "Mr. Qiu, the emergency surgery of our orthopedic department has been completed, and if the patient's vital signs are stable, he can be sent directly to the ward." ”

"But if your blood pressure is unstable, you should still be transferred to the ICU."

"As for the communication work of the patient's family, I just heard that the teachers have put a lot of effort into it, so I ......" Fang Ziye explained so, and sent Jiehan away.

Fang Ziye, who had just experienced being beaten by Master Yuan Weihong in the morning, was naturally not good at yo-yo again under non-emergency tasks.

This patient is going to cause medical disputes and human life.

Fang Ziye will definitely not leave halfway, he will be present throughout the whole process, even when people from other departments are doing surgery, even if Fang Ziye has dealt with all the orthopedic matters, he still insists on being present.

Seeing Fang Ziye on the side, calm and cautious like a king.

Many people's anger doesn't come to one place.

This kind of qi is not only the prudence of the gas side industry at the moment, but also the gas side industry does not rule out the goal of eating melons with a cautious attitude.

Even more angry, the people in emergency surgery have to put the orthopedic department together, and put the orthopedic people in the last place to ask for emergency consultation.

Now it's okay, Fang Ziye is a pure honest person.

didn't put forward a refutation at the first time, didn't avoid the tasks and business scope of his department, and directly pulled into the operating room before telling others that shock has nothing to do with orthopedics.

The hospital implements the first diagnosis responsibility system.

The emergency department is the first department to be diagnosed.

Therefore, during the emergency department, it is the power of the emergency department to which departments to invite for consultation and which departments not to invite for consultation.

It is also the right of the emergency department to invite consultations with which departments to be invited for consultation.

Fang Ziye thought that after the consultation of other departments in the emergency department, he would come for a consultation again, so he naturally had to undertake the work of exploring and stopping the bleeding of the traumatic injury.

There are some differences from Fang Ziye's indifference that Deng Zhi is a little panicked now.

Although he has fulfilled the duties of the general inpatient of the emergency department, he has sent the patient to the specialist.

However, Fang Ziye has now sent the patient from the specialist to the anesthesiology department, and the anesthesiology department has to send the patient back to the emergency department.

How can it be the task of the anesthesiology department to consult and troubleshoot the matter of specialist diagnosis?

Therefore, Deng Zhi's hair is no longer flowing.

At this moment, his brows were furrowed, and while he was making a wider range of calls, even the administrative director of the emergency department came over to help end the game.

The current situation is like this.

All the consultations requested by the emergency department have been dealt with, but the real cause of shock has not been found.

In other words, the emergency department does not have the right department to consult.

The patient has not yet reached the orthopedic ward.

Therefore, the patient is either placed in the anesthesiology department or sent to the emergency surgery department for emergency surgery.

Trauma surgery and orthopedics must be regardless of matters such as consultations.

Because of Fang Ziye's consultation opinion, it is written that the diagnosis of open injury of the lower limb is clear, there are indications for emergency surgical exploration and treatment, and if there is vascular injury, hemostasis will be treated.

At present, the amount of blood loss from open injuries is not large, and the direct cause of non-hemorrhagic shock is considered. It is recommended to consult other specialists to assist in diagnosis and treatment.

Fang Ziye only said that he would stop bleeding and explore, but did not say that he would correct the shock.

It seems that Fang Ziye had expected something in advance, but Fang Ziye was not good at guiding and suggesting what specialist to consult in emergency surgery.

Moreover, although Fang Ziye came at the end, these opinions had to be written, but the emergency department had already done it in advance, so he didn't take it seriously.

But if you take it seriously or not, the program is right.

……

Jiehan left, went to the real operating room of trauma surgery.

After Fang Ziye finished his own operation, he continued to stay in the operating room, listening and watching.

Of course, what I heard was basically the movements and voices of a group of associate professors and attending professors shaking their heads and waving their heads.

"That's weird, right?"

"According to the current CT scan, there is no bleeding in the chest and abdomen?"

"Isn't it hemorrhagic shock?"

"How could it not be hemorrhagic shock? The essence of all shock is hemorrhagic ......" someone began to teach and learn.

But no one refutes that there can be no problem in theory if the title can go this far, and some basic theories are immersed in one or two decades, how can they be wrong.

Shock is defined as absolute or relative hypovolemia.

CT did not show bleeding spots, but?

Shock is still there.

Seeing that it had been five minutes since the end of his operation, everyone was inconclusive.

Fang Ziye was also very helpless, after all, he didn't want to cause trouble for things.

The role of knowledge points is to use.

It can be used on any patient, because the end result is to improve one's skill level and proficiency.

Therefore, Fang Ziye can only improve the level of his CT reading technique by one level.

Immediately, the CT reading technique reached level 5 proficiency.

Then, Fang Ziye was at the computer again, looking at an unknown associate professor, where he was looking at the results of the patient's CT scan over and over again.

Roughly speaking, there is no bleeding foci.

No matter how closely I looked, there was still no bleeding foci.

Looking at the lumen of the blood vessels between the various organs in detail, the shape is actually fine, and there are no symptoms such as rupture.

So?

Is it really not hemorrhagic shock?

But if it weren't for hemorrhagic shock, why would the patient's blood pressure be so low?

The level of oxygen in the blood is also not high.

Is there no problem with the amount of heart pumping? The patient has undergone ultrasound monitoring of the heart during the operation.

Then, in such a case, there can only be other problems.

What kind of problem is that?

After a while, when Fang Ziye examined his abdomen again, Fang Ziye finally came to his senses.

Well, so it was.

It's dark all over TM.

Everyone only noticed that the bleeding had gone and did not take much into the relative volume depletion.

Not to mention the extremely low probability.

Possibility of re-arterial dissection after CT.

Fang Ziye then suggested: "Brother Deng Zhi, do you want to let the vascular surgery teacher try to probe the abdomen carefully?" ”

"What?" Deng Zhi's mind was in turmoil at the moment, and he didn't hear what Fang Ziye was talking about at all.

"I said, or, let's do another bedside CT scan or another abdominal vascular ultrasound." Fang Ziye gave a more direct and simple suggestion.

"It is difficult to operate bedside CT in the operating room, but color ultrasound is not difficult, what do you guess is the diagnosis?"

"It was only after the patient fell into a coma that he encountered an arterial dissection."

"Or traumatic, delayed arterial dissection." Fang Ziye suggested.

"It can't be! ~”

"How can a dissection not be diagnosed, people in vascular surgery have seen it many times."

"We also often see imaging of dissections, not to mention, patients also have CTAs." Deng Zhi almost immediately refuted Fang Ziye's suggestion.

"Then make a color ultrasound, anyway, there's nothing to do now." Fang Ziye simply took a step back.

The surgery is over, and there is no need to care about the principle of sterility.

Therefore, Associate Professor Qiu Yuxuan of the Department of Anesthesiology also really explored the patient's abdomen, and then as soon as the ultrasound probe probed up, he found that the diameter of the blood vessel was not quite right......

On the spot, almost everyone was dumbfounded.

Then when I looked at Fang Ziye, who made this suggestion, Fang Ziye had already stepped on the induction door and left the operating room, leaving only an honest back.

(End of chapter)