Li Fengmin's situation has changed, although the five words "slight pulmonary embolism" are still very light, and there is almost a little phantom outline, but the status bar does remind Sun Lien that Li Fengmin's blood is wrong.

And this kind of change, to be honest, was not much unexpected by Sun Lien. In other words, if Li Fengmin did not have this symptom, Sun Lien would still feel a little strange, and at the same time, he was a little glad that this kind of heavy bleeding did not cause blood problems.

There are two possible causes of pulmonary embolism, the first of which is venous thrombosis. Li Fengmin's external iliac vein was torn, and although the bleeding was successfully stopped after the mesh was re-patched on the outside, because the operation was too urgent, the ruptured blood vessels were not trimmed and reconnected, and the tourniquets in the lower limbs actually hindered the return of venous blood in the lower limbs, which is likely to lead to thrombosis. When these blood clots move up the reopened blood vessels into the veins in the lungs, they plug the veins directly, causing pulmonary embolism.

The second reason is even more troublesome, if it is not a pulmonary embolism caused by venous thrombosis, then Li Fengmin may fall into the symptoms of DIC (disseminated intravascular coagulation).

As the ultimate pathway of a variety of blood diseases, the pathogenesis of DIC has been studied over and over again for a long time - when the human body consumes too much coagulation factors for various reasons, the human body may spontaneously develop coagulation disorders. Clotting fibrin is deposited in the blood in small blood vessels, resulting in clotting, while other parts may have a tendency to bleed spontaneously due to the lack of clotting substance. But the exact circumstances under which the body will develop DIC is still a mystery that has not been clarified.

Although there is no clear answer, scientists and doctors have come up with a set of high-risk factors for DIC, and unfortunately, Li Fengmin fits two of them — massive blood loss and post-major surgery.

In fact, the term "major surgery" is a bit wishful thinking, and in the medical field, it is rare to say "large or small", but to judge it by risk. The riskier the surgery, the closer it is to what is commonly understood as "major surgery". The external iliac veins on the left and right sides serve as the main connection of the inferior vena cava, and at the same time, they are deep in the abdominal cavity, which is quite risky to perform surgery even in a well-equipped hospital. And the risk of an emergency hemostasis in the conference room can be imagined.

Although the cause has not yet been determined, the embolism caused by the embolism must be treated immediately. Otherwise, Li Fengmin would never have been able to get off this operating table.

"Didi, Didi!" Just as Sun Lien opened his mouth and was about to speak, the cardiopulmonary monitor suddenly screamed. Everyone in the operating room immediately stopped preparing and looked in the direction of the anesthesiologist.

"Blood oxygen saturation has dropped, 90%!" The anesthesiologist stood up from the stool suddenly, he turned around and walked quickly to Li Fengmin's side, and checked the trachea and ventilator settings that were still inserted in Li Fengmin's throat as quickly as possible, "The ventilator settings are fine, did any of you just meet the patient?"

"I'm disinfecting. The instrument nurse raised the iodophor cotton block in her hand, "I just finished the first sterilization." ”

"It's okay with this. The anesthesiologist continued to investigate according to the prescribed process, "No nail polish, no bright light, I'll try a different probe." He quickly ran to the side of the cardiopulmonary monitor, took out an unopened blood oxygen saturation monitoring probe, opened the package and replaced it.

"Oxygen saturation of 89%, not a fault. The anesthesiologist frowned and walked quickly to the operating table, "It can't be DIC, right?"

It is not the anesthesiologist's duty to administer heparin to the patient, but it is his responsibility to stabilize the patient's vital signs. "I increased the breathing flow a little bit and switched to pure oxygen breathing. He looked at Lin Hua and said, "Doctor Lin, do a B-ultrasound to see the blood flow in the lungs." ”

In general, the gold standard for diagnosing a patient's pulmonary infarction is angiography of the lungs. But Li Fengmin has a ruptured vein, which is a contraindication to the imaging. Even if imaging is to be done, it is not practical to move a patient with an open belly to the intervention room. If you can judge the situation immediately, you can only rely on B-ultrasound imaging.

"Lung ultrasound...... Call and ask Director Guo from the ultrasound department to come over. Lin Hua immediately made a decision, it is not a simple job to use B-ultrasound to judge the blood flow in the lungs. Although the B-ultrasound machine of the Sanya Branch of the General Hospital of the Army is advanced enough, the pulmonary artery is hidden just below the sternum, and this physiological structure determines that it is extremely difficult to detect it with an ultrasound probe. Only extremely skilled doctors will be able to accomplish this task.

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"You've got me a tough job. Director Guo from the ultrasound department walked in with a blue disposable hair cap. He muttered to Lin Hua, "Look at the pulmonary artery with B-ultrasound, why don't you use it to augment?"

"If your stomach is open, you can't do an imaging if you have a ruptured vein. Lin Hua spread his hands and said that he couldn't do anything about it. "Hurry up and see, we're in a desperate situation. ”

Sun Lien watched the state above Li Fengmin's head change from "slight pulmonary embolism" to "moderate pulmonary embolism", if it weren't for the fact that Director Guo had already picked up a small probe and pressed it on Li Fengmin's chest, he really couldn't help but remind him - pulmonary embolism is going to kill someone.

But the condition of the status bar is only a hint after all, and to obtain a real basis for medical decision-making, it is still necessary to rely on testing methods. Fortunately, the cardiopulmonary monitor has been monitoring Li Fengmin's vital signs, and although the situation is getting worse, at least he still has a little time.

"There is regurgitation, about a third. In less than two minutes, Director Guo looked at the images on the ultrasound and made a judgment. "It may be at least a moderate pulmonary embolism, or it may be DIC, and the specific situation is easy to judge, do a coagulation five items to see the results. ”

Lin Hua frowned, it seemed that the operation could only be stopped first. If the pulmonary embolism is already in progress, the embolus must be removed by intervention, and if it is a thrombus, anticoagulation therapy needs to be started as soon as possible, as is the case with DIC. But no matter which outcome it is, there is a great risk for Li Fengmin, who needs to redo the external iliac vein.

The operating room has to coagulate the results of five items, and the laboratory department certainly does not dare to slack off. After making the results as quickly as possible, Lin Hua's brows furrowed even deeper - Li Fengmin's plasma prothrombin time was only 6 seconds, fibrinogen level was 1.5g/L, and D-dimer level was as high as 0.7mg/L. The results of all three examinations showed symptoms of DIC, which met the criteria for the diagnosis of DIC.

"On heparin sodium, 7,000 units of intravenous bolus, and then hang a bottle of 500 heparin sodium, 10,000 units, 30 ml per hour. "Lin Hua has not dealt with DIC once or twice, and he can be said to be familiar with the corresponding treatment methods. But the real difficulty is still to come, after starting anticoagulation therapy, Li Fengmin's coagulation function will be inhibited. At this time, the surgery to amputate and reanastomose a major vein is initiated, and the risk of bleeding during the operation is too great.

Chen Tianyang, who had been a bystander, also guessed what Lin Hua was worried about, and he was about to speak, but suddenly turned to Sun Lien and asked, "Little Sun, do you think you can continue the operation now?"

Chen Tianyang estimated that a doctor like Sun Lien, who was biased towards emergency medicine and diagnosis, might oppose higher-risk surgeries, and he was ready to remind Lin Hua by refuting and educating Sun Lien. But Chen Tianyang forgot that Sun Lien was a freak who dared to suggest emergency laparotomy in the conference room.

"Yes, and it must be done right away. Sun finally found an opportunity to express his opinion, and he quickly said, "The hemostatic patch attached to the patient's external iliac vein itself consumes fibrin, and I think that the operation should be performed immediately before the patient's blood clotting function is suppressed to an unacceptable level." ”

A person dies if he does not breathe, but he dies without blood in his body. There is no point in discussing whether to stop Li Fengmin from breathing or drain his blood. In cases where any one symptom can be fatal, then all potentially fatal symptoms must be dealt with. Sun Lien has been working in the emergency department for more than a year, and he has really done a lot of things to stop the bleeding of patients and unblock the airways at the same time. In Sun Lien's view, Chen Tianyang's question does not need to be considered at all. After the heparin sodium injection takes effect, the hemostatic patch is likely to fail, and if it is delayed until this time, the anastomosed blood vessels may still continue to bleed out even if they are sewn up.

But if you don't care about DIC, it's obviously not realistic. The main function of blood is to transport oxygen to the cells in the body and to transport carbon dioxide from metabolism. The blood vessels are sewn up, but the patient's DIC causes the blood in the lungs to become blood tofu, so how can it transport the oxygen of a fart?

"Insightful. Chen Tianyang gave a thumbs up, turned to Lin Huadao, "Hear?"

"I hear you. Lin Hua nodded, no longer talking, but said to the doctors of the surgical team, "Let's work, and strive to get it done within half an hour." ”

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Sewing blood vessels sounds simple, but in reality, it's not ordinary. In particular, the external iliac vein, which has a large flow and pressure, and is hidden under many organs, is even more difficult.

"Hemostats. "Since it has been decided that the operation will be completed as soon as possible, Lin Hua cannot afford to delay time. Fortunately, Chen Tianyang's cutting edge was perfect, which robbed Lin Hua of a lot of time. After quickly separating the skin and the underlying muscle tissue from the peritoneum, Lin Hua saw the patch that stopped bleeding with a retractor instead of a bent meat fork. And the moment he saw the blood vessels, he reached out and asked the instrument nurse for a hemostat.

"I want to bend my head ......" Hu Jia was a little distracted by Sun Lien, but after hearing this, she subconsciously asked. As a result, she asked three words, and she realized that the doctor was not asking herself. Only then did he quickly cover his mouth.

Sun Lien looked at Hu Jia, hugged her shoulder with some sadness, and gently touched her head with his free hand by the way.

"Get another pair of hemostats. Lin Hua ignored the voice coming from Sun Lien's side. He concentrated on clamping the upper and lower ends of the broken external iliac vein, letting go of the part that was encased in the hemostatic patch, and after confirming that the hemostat was clamped well, he used surgical scissors to cut off the broken vein.

Lin Hua used tweezers to clip out the broken veins that fell in the abdominal cavity, and then began to trim the two ends of the severed blood vessels, "Take the artificial blood vessels, which should be 11mm in diameter and two centimeters long." ”

Yizhu, who had been praised by Chen Tianyang for a few words, quickly brought the pre-packaged artificial blood vessels, cut out a suitable section, and handed it to Lin Hua.

"Vascular staplers. Chen Tianyang didn't say a word, not at all like the usual chatter in the operating room. He needed to concentrate to get the surgery done as quickly as possible, which would have taken nearly two hours to complete. Any distraction of energy is likely to cause his hands to slow down.

If it is slow at this time, it may directly lead to Li Fengmin's death. Although Lin Hua didn't say anything else, the pressure on his shoulders now was unimaginable to outsiders.

Vascular staplers are used to connect thicker veins, which is not very common. After all, the blood vessels can also be sutured with the same needle, and the effect of suturing will not be much worse. But the biggest advantage of the stapler is that it is not too suitable under the current conditions - it is really fast to anastomosis blood vessels with it.

Ordinary hands sew a vein, and it takes about 20 minutes for a veteran like Zheng Guoyou. And Lin Hua's own fastest record is 28 minutes. This eight-minute gap is a concrete embodiment of the gap between him and Zheng Guoguo's more than 20 years of medical and surgical experience.

But if a vascular stapler is used, Lin Hua can complete the suture in five minutes.

An eight-minute gap equals about twenty years of medical experience. The twenty-three minutes of progress in vascular stapler improvement is simply impossible to make up for with individual skills.

Of course, the artificial blood vessel is actually a little better than the real blood vessel, but this also means that it will take Lin Hua about ten minutes to sew the two ends of the two-centimeter-long artificial blood vessel to Li Fengmin's external iliac vein.

Time is of the essence.

In the third minute and 51 seconds, Lin Hua connected the artificial blood vessel and the anastomosis of the distal external iliac vein. After checking that the anastomosis was good, he released the hemostat holding the distal end, and the blood flowed out quickly, and there was no blood leakage at the interface.

In the eighth minute and twelve seconds, Lin Hua completed the anastomosis of the artificial blood vessel and the external iliac veins at both ends in a short enough time to show off. He picked up the stapler with tweezers and looked at the connection underneath with a circular viewing glass, which is commonly used in dentistry. After making sure that the stapler was anastomoses well and that the blood vessels were not visibly twisted and folded, he released the hemostat at the proximal end. Then there was a suffocating silence.

"The vascular anastomosis is good and there is no leakage. After looking at the blood vessels for almost three minutes, Lin Hua announced that the operation was partially successful. "Irrigate the abdominal cavity and strengthen disinfection. When you're done, prepare to close your abdomen. ”

This time, Li Fengmin finally didn't have to reveal his henchmen to others.