Suffering from gains and losses is because care is chaos. At least for the vast majority of family members, they tend to be stuck in a cycle of death because they care about their loved ones – they want their loved ones to survive, and they want their loved ones to be "safe and sound".

Only by immediately making the family aware of the conflict between these two options can help them break out of this loop.

Only the dead do not have to worry about whether to save their limbs or their lives. The biggest difference between work in the emergency department and in the outpatient clinic is that there is room to discuss and treat the patient.

Sun Lien's words were very heavy, but the effect was really good. Zheng Xin's wife only hesitated for a few seconds before making a decision, "Intercept it, it's important to save your life!"

Sun Lien nodded secretly and handed the consent form to the young woman in front of him. Then, as quickly as possible, the consent form was sent back to the rescue room.

The family agreed. Sun Lien said to Dr. Cao Yanhua, "The orthopedic department has come to the operating room, right?"

"They've arrived. Dr. Cao Yanhua nodded after a quick glance at the consent form, and said to the nurses on the side, "The blood transfusion speed is a little faster—Lien, you go and get two more tourniquets." ”

Now that the decision has been made to amputate the limb, it is possible to use tougher methods to stop the bleeding. Sun Lien took several tourniquets from the cart on the side, and tightly tied Zheng Xin's arm with a very "savage" technique. After the three tourniquets were tied, Sun Lien also locked the tourniquet with a hemostat, and then turned around again.

This level of hemostasis is generally not used in the hospital – excessive hemostasis can lead to avascular necrosis from the distal end of the ligated portion. But now that it has been decided to have Zheng Xin's leg amputated, this kind of problem can not be considered. It's just that the side effects of tough hemostasis are still there - Zheng Xin, who is unconscious, soon developed symptoms of irritability.

Patients who have lost a lot of blood are prone to irritability in addition to being unconscious. Coupled with the fact that the means of stopping the bleeding were indeed painful, his irritability was even more obvious.

"Don't move, we're saving your life!" Hu Jing, the head nurse, slapped Zheng Xin back. But the other party kept struggling, which really hindered the rescue. Zheng Xin had two infusion tubes on his left arm and two on his right foot. If his blood loss was a little larger, he would have to ask the anesthesiologist to perform a central venous catheter for him.

"It can't go on like this. Although Hu Jing, the head nurse, can press the other party to immobilize with a slap, he can't let Hu Jing act as a restraint belt in all the subsequent rescue processes. Sun Lien thought about it, and still tied Zheng Xin with a restraint belt. "He can't delay this situation any longer, and he has to be sent to the operating room quickly. ”

The compression transfusion of four venous channels barely maintained Zheng Xin's vital signs, which is a very serious bleeding situation. No matter how many tourniquets Sun Lien could use to stop the bleeding of Zheng Xin's right arm, he still couldn't completely stop the blood from flowing out of those broken arteries. The only way to stop bleeding once and for all is to cauterize and stop bleeding after amputation, ligating the bleeding arteries and veins.

"The surgery should already be in place. Dr. Cao Yanhua seemed more calm, "I can't send it yet, and I will transfuse another eight units of whole blood." I'll wait until his situation is a little more stable. ”

It took some time to get a patient out of the emergency room and onto the operating table. Even with the hospital process design and architectural design of the four-hospital emergency model, it takes at least 20 minutes to transfer a patient from the emergency room to the operating room, and then send him to the operating table, complete the anesthesia and start the operation.

During these 20 minutes, the patient could not get the same life support as the emergency room. In this process, once the patient's condition deteriorates, it is difficult to deal with it.

In the elevators and corridors of the hospital, where will there be equipment in the emergency room!

With Zheng Xin's current situation, it is really difficult to guarantee that there will be no problems in these twenty minutes. But in the same way, it is not a problem for people to lie in the emergency room all the time for blood transfusions.

"Do you think this will work?" Sun Lien frowned and put forward his idea, "Let's ask the doctor from the anesthesiology department to come over first and anesthetize him before the operation." And then send the person to the operating room?" "Giving preoperative anesthesia ahead of time can save about five to eight minutes of preparation time for surgery.

"That's all there is to it. Sun Lien's proposal was approved by Dr. Cao Yanhua, "I'll contact the doctor in the anesthesiology department, Xiao Sun, you look at the patient's condition." ”

There are many points that need to be paid attention to in large blood transfusions, and the first thing to pay attention to is probably acidosis. In the modern medical system, in order to prevent blood clotting, on the one hand, blood is stored and used, and the blood bank will use appliances coated with sodium citrate on the walls of the tube and bag when collecting blood. When dissolved in the blood, these sodium citrates prevent blood from clotting, thus extending storage time. But as a large amount of blood was injected into Zheng Xin's body, these sodium citrates, which were used to stop blood clotting, also entered his body.

When the amount of blood transfusion is greater than 1000 ml, sodium citrate will be difficult to be oxidized by the body in time, so serious side effects such as bleeding tendency, hypocalcemia and acidosis will occur.

Bleeding tendencies can be countered with drugs such as vitamin K, while hypocalcemia can be improved by intravenous bolus of calcium gluconate, and acidosis is even simpler - 5% sodium bicarbonate injection can be injected intravenously. These problems are not difficult to deal with, but not all doctors can immediately determine whether this is a side effect or the result of disease progression based on the patient's condition.

If the patient has ventricular fibrillation or cardiac arrest, is it due to myocardial ischemia caused by hypovolemia, or is it due to the disturbance of the cardiac electrical signal due to hypocalcium? Is the acidosis exhibited by the patient due to blood transfusion or carbon dioxide retention due to insufficient breathing and ventilation after coma?

The same symptoms can be caused by different causes. Doctors must find the right cause of the symptoms and then respond to them in a race against time. One wrong step can cost the patient's life.

Emergency work is dirty, tiring and bitter.

"Hang a bottle of 5% sodium bicarbonate. With the help of the status bar, Sun Lien quickly discovered the symptoms of metabolic acidosis. He gave the doctor's order directly. And Dr. Cao Yanhua also completed the communication with the anesthesiology department, "They will send someone over immediately." ”

Sun Lien nodded, took two steps back, and continued to observe Zheng Xin's status bar as if he was pretending to observe the monitor.

"120 forecast!" Just as Sun Lien squinted at the stall of the status bar, a new bad news was reported on the duty desk, "Male, about twenty-five years old, had a production safety accident and broke his right leg. ”

"I'll pick it up first. Sun Lien and Cao Yanhua exchanged a look, "After this patient is sent to the operating room, Dr. Cao, you will take over." ”