By the time the pre-hospital emergency doctor in the ambulance jumped out of the car and rushed to the conference room, Li Fengmin's operation had basically reached the final stage.

Dr. Chan first clamped the distal end of the external iliac vein with his left index and middle fingers, and with the assistance of a tourniquet at the base of his thigh, he completed a venous blockade without a hemostat to stop the bleeding. Then he carefully pasted Hu Jia's cut hemostatic patch on the vertical tear of the external iliac vein. It's like putting a rubber patch on a perforated bicycle tire, except that you don't need to apply any strange adhesive to the contact surface between the patch and the blood vessel, and you don't have to polish the outside of the blood vessel that needs to be repaired in advance.

According to the operation requirements of the Takeda TachoSil patch, Dr. Chen stuck his hands in Li Fengmin's stomach and did not let go - according to the instructions, it took about one minute for the patch to activate the clotting substance after it came into contact with the blood until the clotting substance was enough to stick to the patch. There were not enough conditions at the scene for Dr. Chen to make a visual judgment when the surgical field was sufficient, so for the sake of safety, Dr. Chen simply stuffed his two hands into Li Fengmin's stomach together. The left hand presses the patch against the broken blood vessel and exerts continuous pressure, while the right hand continues to maintain the position of "blocking" the external iliac vein, only occasionally loosening the finger and then pinching it back immediately - this is to prevent the blocking effect from being too good, so that the patch does not reach enough blood to adhere to the blood vessel.

Li Fengmin's condition is actually very dangerous, and bleeding of more than 1,500 ml is undoubtedly the primary danger. If it is in a well-equipped operating room, about one-third of the blood in the peritoneum that Dr. Chen uses a curved disc to contain can actually be returned to Li Fengmin's body after being recovered and purified by the corresponding equipment, and with the support of plasma and crystalloid fluid, these risks can be overcome.

Not long after Dr. Chan announced that the patches were working well and that the external iliac vein bleeding had been effectively stopped, the pre-hospital emergency doctor rushed into the conference room. Then he was frightened by the scene in front of him, and ran out again with the first aid kit in his hand.

"Come back!" Dr. Chen waved his hand to the door with a smile, "Do you have any high-concentration sodium chloride injection or 706?"

706 generation plasma, that is, hydroxyethyl starch injection with a concentration of 6%, is a commonly used blood volume expansion fluid in clinical practice. It is mainly used to reduce the need for intraoperative blood transfusion and emergency rehydration in cases such as burns. You know, there is definitely no blood transfusion device in the ambulance, and there is no blood backup. For Li Fengmin, who has already developed symptoms of hemorrhagic shock, if he can expand his blood volume now, of course, it will be more conducive to recovery later - there is no plasma, and it is not bad to have some crystalloid and colloid. A certain amount of highly permeable crystalloid can mobilize blood stored in organs into the circulatory system, and Plasma 706 can further increase blood volume, which helps to ensure that there is enough fluid in Li Fengmin's circulatory system. This has a positive effect on maintaining brain perfusion.

"706 does not, but sodium chloride injection has a concentration of 7.5%. "The pre-hospital emergency was originally two trembling and almost wanting to go first, but when I heard the other party's tone, the feeling was not that some cannibals were feasting, but a group of peers were saving people.

"Yes, let's bring it first. Dr. Chan slowly withdrew his hands, waited for a while, and then turned the slightly obstructive sigmoid colon a little to make sure that there was no other bleeding before releasing a little. "Don't worry about closing the abdominal cavity first, close part of it, and you may have to deal with it again when you get to the hospital. ”

Surgery is not as simple as sewing the belly of a person after the operation is over. Generally speaking, how to cut it, you have to sew it back. After cutting the skin, fascia, and muscles, you have to sew the muscles, fascia, and skin back together one by one. And you can't just use one style to sew it from beginning to end. The muscles need to be closed with strong sutures to prevent cracking during exercise, and the fascia needs to be closed with strong continuous seam sutures. Depending on the need, different techniques and different thickness of sutures are used to suture, which is a necessary ability for a qualified surgeon.

Dr. Chen, who dared to perform exploratory laparotomy surgery in this environment, has naturally far exceeded the limit of the word "qualified". With more than 35 years of surgical experience and many years of experience in dealing with difficult and critical patients, he is able to subconsciously allocate all resources during the operation. And this ability told him that in the current situation, it is impossible to complete a "qualified" "belly pass".

The sutures that Hu Jia found were pre-packaged synthetic sutures with skin needles, but there were only two models, 4-0 and 0, the length of the 4-0 line was only 45CM, and although the 0 line was longer, it was only 60CM. Not only is the length not enough to close the abdomen, but the thread is either too thick or too thin, and it can't be used at all.

And most importantly, this is not the operating room of the First Affiliated Hospital of Yunhe Tongde Medical College, and there is no surgical team that Chen Tianyang is accustomed to working with. This is the meeting room of a five-star hotel in Sanya, and under the spotlights, Chen Tianyang can even see some hairy pollutants floating in the air.

Even if he used the existing resources to close his abdomen, after sending Li Fengmin to the hospital in Sanya, the doctors here would still have to reopen his abdomen for abdominal lavage and sterilization. It's better to save some effort, just use line 0 to connect the skin around the stomach first, and when the province is carried, one accidentally dangles the intestines of Comrade Lao Li out.

Sun Lien diagnosed the cause of Li Fengmin, while Chen Tianyang was the chief surgeon of the operation, and Hu Jia was the person in charge of providing the intraoperative instruments. The three of them had to follow the ambulance to the hospital, while the other veteran specialists involved in the operation went to the bathroom to clean the blood stains on their bodies, led by the hotel director.

"You're so bold. In the slightly crowded ambulance, the pre-hospital emergency doctor, who had finally calmed down, said to the three people in front of him, "Without anesthesia and circulatory support, you dare to have open surgery?"

"If he didn't have this surgery, he would be dead. Chen Tianyang is the chief surgeon, and he glared at the pre-hospital emergency doctor very dissatisfied, "If you wait for your car to drive to the place, Lao Li will have to braids even if he has blood transfusion support." ”

"But under that kind of conditions, you are not afraid of postoperative infection?" The pre-hospital doctor also knew that the patient's condition was urgent, but he always felt that the behavior of the three of them was a bit overrun. "That place is not a hospital, so it must not be in line with your medical license, right? Even if you are all doctors, you may be held accountable for illegally practicing medicine. ”

"Post-operative infection? You have to be alive to get infected. Chen Tianyang spread his hands disdainfully, "As for the operation, anyway, I am the chief surgeon, even if the certificate is revoked, I will be hung alone-and, who said that we are practicing medicine?"

The pre-hospital emergency physician choked on the last rhetorical question.

"We are just a group of righteous and courageous people with the corresponding professional ability. Chen Tianyang smiled very slyly, "See righteousness and courage for you, right?"