The matter of marriage leave is put aside for now, and people are being saved in the operating room.

Neurosurgeons have removed the first bone flap. Some yellowed skulls were placed on the side of the surgical tray, and many neurosurgeons came to observe the wounds. Now is the best stage to determine the level of intracranial pressure in Zhang Junyi.

When confronted with patients with signs of herniation, doctors can tell that the patient's intracranial pressure level is not available at all. Ordinary people can also get a relatively accurate intracranial pressure value by puncturing the lumbar pool. The doctors had to roughly judge Zhang Junyi's intracranial pressure without directly priing his head open in accordance with the process...... Then we can only get a rough estimate by pressing his eyeballs.

In the absence of clarity about the patient's intracranial pressure, the anesthesiologist struggled to keep his vital signs within a range that could be operated on. After the skull was removed, the job seemed to go a lot smoother.

From Sun Lien's angle, it can also be seen that after taking out a skull about 14 centimeters long, the whitish dura that was almost about to swell out.

A bulging dura means that the patient's intracranial pressure is dangerously high. But now, his luck is not bad - if he didn't die from brain herniation at this point, he would have basically eliminated the danger of brain herniation.

Although the dura has not been completely cut to relieve the pressure, at least the dura itself is much more malleable than the skull - the human skull does not deform due to internal pressure.

Neurosurgeons are preparing to cut the dura to release intracranial pressure, and abdominal surgery has been performed to cut the rectus abdominis muscle.

The abdomen is not a single or double layer of flat skin and muscles. In this operation, for example, the hepatobiliary surgeon selected the right side of the rectus abdominis muscle for laparotomy. The doctors first cut open the skin of Zhang's abdomen, and then separated the subcutaneous fat from the abdomen. An incision is then made in the external oblique muscle and fixed with a retractor.

After the external oblique muscle is separated, the rectus abdominis muscle and part of the internal oblique muscle are exposed to the surgical field. Underneath these two muscles is a larger transverse abdominis muscle.

After disintegrating the protection of the four layers of muscles, the peritoneum and omentum can be seen.

The peritoneum is a thin, smooth serous membrane with a translucent interior. This layer is very sensitive to pain and other sensations because it has 7~11 pairs of intercostal nerves, subcostal nerves, and lumbar nerves. Once symptoms such as severe inflammation and tracheal perforation occur in the abdomen, inflammatory substances and irritants can cause peritoneal irritation. Symptoms include abdominal tenderness, rebound tenderness, and abdominal muscle tension.

The omentum below the peritoneum looks like a yellowish layer of loose fat. In adults, the omentum heals together with the peritoneum most of the time. This ligament structure is specifically designed to fix the relative position of the gastrointestinal tract in the human body, and also performs the role of immune defense in the abdominal cavity - the omentum is rich in fat and phagocytic cells, which is an important part of the body's immune system in the abdomen.

After separating the peritoneum from the omentum, the surgical field progresses to the intestinal part. From here, the doctors of hepatobiliary surgery probably have a general understanding of Zhang Junyi's liver rupture.

"There was a lot of bleeding, which was at least 800 millilitres. The hepatobiliary surgeon who was in charge of the operation stopped what he was doing and asked Hu Jia on the side to help wipe the sweat from his forehead. He motioned to the assistants on the side to pull the puller in their hands wider, and at the same time asked the blood transfusion doctor on the side, "Is there enough blood?"

"If you can use your own body, you should use your own body. "The doctors in the blood transfusion department pushed in the autologous blood recovery machine and put it in a position that didn't interfere with the surgeons' work so much. "But his bleeding is not small, and he has to add some platelets and fresh blood. ”

The autologous blood salvage machine is an important tool to reduce the amount of blood transfused during surgery. Although the application of autologous blood recovery machine is difficult to be fully rolled out due to the insufficient number of domestic blood transfusion professionals, it is still an important means to solve the shortage of blood in blood banks.

The patient's bleeding during surgery was originally just medical waste that needed to be discarded. Before the advent of autologous blood recovery machines, there were only two options for addressing bleeding – reducing bleeding or transfusing allogeneic blood products.

Reducing bleeding can reduce intraoperative blood loss in some patients, but this strategy is of little significance for patients with massive intra-abdominal bleeding such as hepatosplenic rupture. Allogeneic blood transfusions are limited by a common problem across the healthcare system – insufficient unpaid blood donations.

Unpaid blood donation is a noble act of donation. Although this behavior can avoid the occurrence of blood sales and disorderly blood collection to a certain extent, we must admit that it is difficult for unpaid blood donation to fully cover the blood demand of hospitals.

This contradiction is particularly prominent when there are emergency patients with severe bleeding such as liver and spleen rupture. If allogeneic blood is used alone, taking Zhang Junyi as an example, the total amount of blood transfusion he needs is at least 3000cc. This is all the blood that 8 unpaid blood donors can donate in a single blood donation cycle.

According to the current regulations of the Blood Transfusion Department of the Fourth Hospital, the four blood types of ABO and AB are reserved according to the ratio of 2.5:2.5:4:1. The minimum stock requirement for each blood type is 5 U, and the required safe storage capacity must be one week's supply. But in practice, the blood transfusion department of the Fourth Hospital has never been so wealthy. Even if a blood supply linkage contract was signed with the Provincial Blood Center, the blood transfusion department of the Fourth Hospital had never seen 5 units of AB suspension red blood cells. The largest storage of O-type suspension red blood cells is only 6 units.

In order to ensure that Zhang Junyi's surgery for blood type A was carried out, the hematology department of the Fourth Hospital gritted his teeth and took out 8 units of blood type A and 6 units of blood type O - a total of 2800cc of suspended red blood cells. This is already the limit of the minimum storage conditions currently maintained by the four hospitals.

More than 1,300 cc of this batch of suspension red had been infused preoperatively, and the remaining 1,500 cc had to be used to complete the operation, which was an extremely difficult task without an autologous blood recovery machine.

As a general rule of thumb, a ruptured liver alone will cost another 3,000cc of blood in the two hours from entering the operating room to the completion of the operation. The amount of plasma left is not enough for half of the loss, and if there is no autologous blood recovery, the doctors of the hematology department of the four hospitals will have to jump into the ambulance and go to the provincial blood center to rob the blood bank.

With this expensive machine, which requires a dedicated transfusion doctor and a transfusion technician to operate, the demand for blood in this part of the world is reduced a lot.

According to general estimates, autologous blood recovery can complete about 60% of blood loss. The amount of blood lost at 1200cc can be compensated for by the remaining plasma, at least numerically.

Maybe after the operation, I can return a bag of unprescribed O blood to the blood transfusion department.

Sun Lien looked upstairs at the busy doctors in the operating room, and felt a little emotional.