bookpower Chapter 144
Chapter 144
Emergency operating room.
The patient's old lady had successfully anesthetized and lay quietly on the operating table.
Lin Feng spent 10 minutes reading the old lady's various examination materials.
Medical record......
Brain CT...
Because the old lady is too old, she checked her heart, blood routine and so on...
After reading the information, I have a general understanding of the condition.
· C7 scan shows obvious brain compression of intracranial hematoma!
Suprateumtorial hematoma heavy rain 30ml, under-the-mizuku hematoma heavy rain 10ml!
And the patient has a severe coma!
Disinfection, dressing, gloves... A series of masterful process moves...
The nurse has shaved the hair on the back of the patient's head ...
And the anesthesiologist has finished anesthesia ...
"Prone position!"
"Craniotomy!"
"General anesthesia, establishment of intravenous access, maintenance of blood supply!"
"Intubation in the trachea!"
Lin Feng commanded while moving his hands.
......
Step 1,
Cut open the brain!
Lin Feng took the disinfectant tongs handed over and disinfected the neck with iodophor gauze, and then the alcohol cotton ball was deiodined.
An incision is made with a surgical file at the base of the patient's skull, at the site of the combination of cartilage and osseo.
"Electric knife!"
Cut subcutaneously.
"Scalp clamps!"
Each layer is cut, scalp clamps are required to stop bleeding on the scalp.
"Mobile bleeding point!"
"Bipolar electrocoagulation to stop bleeding!"
Lin Feng methodically commanded the two assistants, Zhang Yuan and Song Ziming.
The scalp is cut open in pieces.
"Scalpel!"
Lin Feng began to sharply separate the loose tissue layer under the cap aponeurosis.
Use forceps to flip towards the base of the flap.
"Bipolar electrocoagulation to stop bleeding!"
"Saline!"
Place the saline pad on the outside of the base so that the soaked saline pad covers its inner surface.
"Scalpel!"
"Periosteum separator!"
Lin Feng made an incision along the inside of the incision and then peeled off the periosteum.
......
Step 2,
Cut open the braincase.
"Hand crank skull drill!"
"Crunch, crunch..."
A drill hole was drilled into the back neck skull.
Lin Feng used a small curette to carefully scrape out the fragments inside the skull drill hole.
"Wire saw!"
Lin Feng was careful, little by little with a wire saw, sawing open the skull.
Then insert the periosteum separator under the bone flap and forcefully turn the bone flap upwards.
The skull is lifted.
"Bone wax to stop bleeding!"
"Brine gauze!"
Take the saline gauze handed over and wrap the bone flap.
......
Step 3,
Clear the hemorrhage!
"Nerve stripper!"
Lin Feng relied on the nerve peel and gently removed the hematoma visible to the naked eye, piece by piece, from the brain dura.
"Attractor!"
Lin Feng gently used the aspirator to partially remove the free hematoma from the skull.
"Multiple active bleeding spots!"
Song Ziming looked at the data on the microscope probe and reported.
Lin Feng nodded.
There are bleeding points, there are two methods, one is ligation and the other is electrocoagulation.
Although bipolar electrocoagulation to stop bleeding is easy to use, Lin Feng is still accustomed to using silk thread through ligation.
After all, bipolar electrocoagulation to stop bleeding will still cause certain damage to the subcutaneous nerve layer in the skull.
"Tie!"
Lin Feng used the smallest thread to ligate the bleeding point little by little.
"Bone wax!"
Bone wax is used to fill the middle meningeal artery bleeding that travels inside the bone canal.
After doing this,
After waiting for a few minutes, there was no bleeding again.
And all the blood has been removed.
It's time to start closing the braincase.
......
Step 4,
Close the braincase!
"Little round needle!"
Hands manipulate small round needles and suture the dura mater and periosteum every 2-3 cm around the bone window.
"4/0 silk thread!"
The round needle guides the silk thread, constantly piercing and suturing between the periosteum.
Disinfect......
Fixing the bone flap...
Disinfect......
Suture flaps, muscles, subcutaneous...
With the last silk thread being cut ...
End of surgery!!
......
The whole time of the operation, 2 hours and 13 minutes!
Extremely fast!
Zhang Yuan, Song Ziming and others next to them are already accustomed to it.
Base!
Don't cow!
All sitting!
So many surgeries, it seems that as long as it is in Lin Feng's hands, no matter how serious the condition is, it can be solved.
This side has just been carried out of the operating room, and the family members continue to thank each other.
Lin Feng shouted: "Xiaoli, where is my supper?"
Xiaoli: "It's already delivered, in the lounge..."
Lin Feng smiled, his stomach was hungry, it was good to have a supper.
Outcome......
"Beep Beep ~~~~"
Another ambulance, speeding to a speedy stop in front of the emergency room.
A flat cart pushed an elderly man and rushed into the operating room.
Lin Feng: "????"
A look of decay!
Why do I get up for a late night snack?
Doesn't sleep sound?
The nurse quickly understood the condition.
"Very coincidence, fate, this old man quarreled with the old man with cerebral hemorrhage in front, because the quarrel was won, too proud, after going back, the more I thought about it, the more excited I was, and suddenly cerebral infarction!"
The nurse preached helplessly.
Lin Feng: ".................."
Zhang Yuan, Song Ziming, and everyone: ".................."
This year, there are all kinds of cows, ghosts, snakes and gods!!
Quarreled and lost so angry that the brain hemorrhage also said the past, but the mud horse this because of the proud cerebral infarction, what is the thing.
"Cerebral hemorrhage" and "cerebral infarction" are both cerebrovascular diseases.
But there is a fundamental difference in pathogenesis!
The treatment is diametrically opposite!
Cerebral hemorrhage: most of the causes are atherosclerosis caused by hypertension, aneurysm formation, aneurysm rupture, blood overflow from inside the blood vessel to outside the blood vessel, hematoma compresses the brain tissue and brain tissue necrosis, causing symptoms of neurological deficits.
Cerebral infarction: is due to atherosclerosis, resulting in narrowing of the lumen, occlusion of the tube wall or the formation of thrombus in the lumen of the blood vessel to block the blood flow, causing brain tissue ischemia, hypoxia, and necrosis.
......
Zhang Yuan: "Lin Feng, come on..."
Lin Feng: ".................."
I'm a person in obstetrics and gynecology!
(Obstetrics and Gynecology: You know !!)
Lin Feng checked the old man's physical condition.
The heartbeat is so weak that it is negligible
・The patient's pupils are extremely dilated and he loses consciousness.
Lin Feng can basically be judged as "large-scale cerebral infarction"!
In a civilized and harmonious society, we must not solve anything with our hands.
This is good, the noisy lost anger caused a cerebral hemorrhage, and the noisy laughter caused cerebral infarction.
The price is not small!
So, if you are not happy, just do it.
If it's a knock and a little skin, it's good to put on a medicine (manual funny)!
Lin Feng said to the family: "The patient is judged to have a large-scale cerebral infarction, so craniotomy is required!"
If it is only a small cerebral infarction, and within the window period, it only needs to be degraded by thrombolytic drugs.
However, if there is a large cerebral infarction, it must be counted as craniotomy.
The patient's family happened to see the other old lady coming out of the operating room at this time, and knew that the operation was successful, so they still trusted Lin Feng.
"Send it to the CT and take a quick CT..."
"Xiaoli, let the family sign a letter of critical condition..."
......
10 minutes later...
CT results come out,
Large flaky low-density foci can be seen in the right frontotemporal lobe and basal nucleus area, and irregular patchy high density can be seen inside. The right lateral ventricle is compressed and narrowed. High-density foci are seen in the posterior corner of both ventricles. The midline structure is slightly displaced to the left.
Obviously, a large cerebral infarction!
The subsequent CT results showed that although the cerebral infarction was blocked, the blood pressure continued to increase, and a state of intensiveness appeared, which would lead to arterial blood vessel rupture and cause cerebral hemorrhage...
Plus diagnosis: intracranial pressurization!
Emergency operating room...
Lin Feng commanded, and a group of people busily started.
"ECG blood pressure monitoring!"
"Closely observe changes in the patient's consciousness, pupils, and vital signs!"
"Anesthesia!"
"Establish double venous access!"
Lin Feng ordered the preoperative preparations as usual.
After 5 minutes,
Surgery ready...
After anesthesia...
......
Lin Feng stood on the operating table and used a scalpel to cut the scalp on the underside of the patient's left ear.
Open your brain!
"Hand crank skull drill!"
After cutting the dura mater, a drill hole is drilled.
The intracranial pressure was immediately relieved, but the value remained above the critical point.
But there is still danger, and Lin Feng uses a wire saw to cut a bone window in the skull.
"Wire saw!"
Lin Feng manipulated the wire saw, cut off the bone flap in the patient's skull, clamped it out with tweezers, and put it in the tray.
"The intracranial pressure is still above the critical point!"
Song Ziming said with a worried face.
It stands to reason that intracranial pressure, after craniotomy and decompression, will definitely fall to the critical point.
It is somewhat difficult to continuously raise the intracranial pressure.
"Intravenous hypertonic dehydrating agent!"
"Push in 50ml of diuretics!"
Lin Feng commanded on the side.
And the index finger constantly tapped on the operating table, silently reciting the time in his heart.
......
Twenty minutes later...
Song Ziming reported data:
"The intracranial pressure is infinitely approaching the high critical point and falling off a cliff!"
Lin Feng was relieved, thrombolytic drugs still have a certain effect on degrading thrombus and reducing intracranial pressure.
Right now, Lin Feng has to make a choice:
One: Excise the severely damaged part of the brain tissue.
Two: choose conservative treatment and resuscitate brain tissue through drugs.
The former is once and for all, but once it recurs, the case fatality rate and disability rate are much higher than the second drug control rate.
Lin Feng: "Go and ask the family members to decide and sign..."
Zhang Yuan: "I'll go." "
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ps: 4600+3300+3100=11100 words
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