First of all, the most critical symptoms must be dealt with. But Sun Lien looked at the bloody woman in front of him, and he didn't know which aspect to deal with first for a while.

The data on the "blood pressure 58/94, heart rate 117" monitor is not optimistic, and a ruptured spleen may cause fatal internal bleeding, but it is also possible to stop the bleeding on its own. Fractures of both leg bones may lead to severe bleeding, periosteal compartment syndrome, pulmonary embolism. This can be fatal just as well. Brainstem hemorrhages can also be fatal – skull fractures are the same as brain contusions.

Five states, almost every one of them can be fatal. Sun Lien was a little panicked, most of the rescue patients he had taken over before were in one or two fatal states, and there was a series of fatal states on top of his head, and almost every one of them might kill Tian Huixin in a short period of time. In this case, which one should be dealt with first?

Sun Lien was silent for a second. In all fairness, he felt that the possibility of Tian Huixin being rescued in the end was not very high, but this was not an excuse for him to be passive and slack off. On the contrary, he was ready to complete the examination of Tian Huixin as soon as possible and immediately send him to the operating room for emergency surgery. That way she still has a slight chance of surviving.

"Push B over, check the abdomen, there may be internal bleeding. Sun Lien quickly ended the conscious judgment of "patting and shouting", and issued his own rescue order. "Let the CT be prepared immediately, and the brain CT should be done as quickly as possible - which neurosurgery teacher is on duty today?"

"Liu Pingchuan is on duty today. Dr. Pascal replied, "Do you need to ask him for a consultation?"

Sun Lien shook his head after thinking about it in his heart, "I'll call." ”

He didn't plan to let Liu Pingchuan come down to consult Tian Huixin, it didn't actually make sense. Liu Pingchuan is the highest level of neurosurgeon in the hospital, and may even be the most capable neurosurgeon in the whole of Song An Province and even the surrounding provinces. If he can't do Tian Huixin's surgery, then no one can do it. In patients with brainstem hemorrhage, if they do not undergo surgery to remove the blood clot immediately, the mortality rate is almost 100%.

Liu Pingchuan must operate on Tian Huixin, otherwise she will die. On this basis, Liu Pingchuan's diagnosis is not important, what he needs to do is to arrive at the operating room as soon as possible and start preoperative preparations.

"Dean Liu, please go to the operating room immediately and wait, we have three patients with head injuries after the explosion who need to be operated on. Sun Lien reported the situation to Liu Pingchuan on the phone at the fastest speed, "There is an adult woman who needs you to do the operation - the family has not been found yet." ”

"Okay, I'll go to the operating room now. Liu Pingchuan replied very simply, Sun Lien called and went to the operating room immediately without saying a word, so you don't need to ask to know that the patient's condition is very serious, "Emergency surgery, right?"

Sun Lien nodded on the other end of the phone, "Yes, this patient's condition is more serious. As soon as she was sent to the hospital, we first gave her a B-ultrasound to see the internal bleeding, and then immediately sent her to the emergency CT, and then she was sent directly to the operating room. ”

"So urgent?" Liu Pingchuan frowned, "If you're in a hurry, let's send it directly to the compound operating room after the B-ultrasound is over." CT scan is also OK during surgery. ”

"I'm afraid not...... Sun Lien sighed, "The accuracy of the CT machine in the compound operating room is not enough, and the patient's condition is not very good, the pupils are constricted, and the breathing is irregular." ”

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The two situations reported by Sun Lien sounded basically no different to the ears of neurosurgeons as "dead". Needle-like miosis is usually seen in poisoning and pontine hemorrhage. Add to that irregular breathing, and the answer is only brainstem hemorrhage – symptoms caused by morphine poisoning that suppress breathing, but don't make it irregular. Irregular breathing and needle-like pupil conservation at the same time can only cause brainstem hemorrhage.

Brainstem hemorrhage, on the other hand, is generally not saved.

The reason why brainstem hemorrhage is more serious than ordinary intracerebral hemorrhage is mainly due to the different responsibilities of the brainstem and the cerebellum. The brain is damaged, and a person's higher neural activity may be affected. For example, memory, certain cognitive abilities and consciousness can be affected. The cerebellum, on the other hand, mainly controls the activity of the body's muscles. Injuries to the brain and cerebellum can be severe, but as long as no one dies, the damage is still in the "bearable" range. It may be painful to be paralyzed, lose memory or lose a few skills, but at least the person is still alive.

But the brainstem doesn't.

The brainstem plays a very important role in mediating the "reflex centers" and "reflex impulses" in the human body.

Without the brainstem to give instructions, the human heart will not be able to beat normally, breathing will not be able to proceed normally, blood pressure, endocrine, digestion, and all kinds of activities that require nerve instructions will not be able to carry out normally. The consequences are very fatal.

This is the main reason and basis for Sun Lien's decision to perform a CT examination immediately after the B-ultrasound examination and send it directly to the operating room.

The internal bleeding of the spleen determines whether Tian Huixin can survive the five-minute journey from the emergency room to the operating room, and the CT examination determines whether Liu Pingchuan can try to break his wrist with death.

As for the bleeding and femur fracture - at least Tian Huixin's heart is still beating, and the blood transfusion has been given. Pulmonary embolism caused by a femur fracture, although also fatal, usually occurs a day or two after the fracture. This kind of problem can be handed over to the orthopedic doctor after Tian Huixin survives today.

The first job credo of emergency physicians has never changed – "save lives first, then heal diseases".

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Liu Pingchuan didn't ask any more questions, he gathered his surgical team as quickly as he could, and entered the operating room to start standby—the only reason he didn't disinfect right away, put on his surgical gown and enter the operating room was because Liu Pingchuan needed to look at the CT images first. This way he can have a rough plan for the surgical process.

Sun Lien and the others almost pushed Tian Huixin out of the CT room with the speed of a charge. The results of the ultrasound examination are not too bad, but they are certainly not optimistic. After the rupture of the spleen, Tian Huixin had about 700 milliliters of blood in her abdominal cavity. But fortunately, under the ultrasound examination, her bleeding did not show a significant trend of activity.

As for the CT examination, there is no difference from the state seen by Sun Lien. There was a hemorrhage in Tian Huixin's pontine part, with a volume of 2 mm * 1 mm * 3 mm.

This is already very close to the limit of 10ml for cerebral hemorrhage.

"The hospital office has authorized it, right?" Liu Pingchuan only asked this sentence when he saw Sun Lien.