Chapter 31 Pulmonary embolism again! This resident doctor is a bit tricky
Meng Yingan quickly looked at the monitor.
The patient's heart rate suddenly soared.
The body temperature was also slowly rising!
This operation was originally performed with the assistance of an extracorporeal oxygenator.
And the low temperature environment was controlled to reduce the patient's metabolism as much as possible...
Logically, in this case, the patient's heart rate, breathing and other vital signs would be lower than normal.
The rise at this time must be an unexpected major accident!
If it is not immediately checked, the patient will have to give up limb preservation and terminate the operation!
"The heart rate has risen to 170!" The instrument nurse was pale and reminded.
Meng Yingan had a gloomy face.
He quickly stopped the operation and began to check the entire surgical area.
And Xu Qiu stared at the monitor.
Within a few dozen seconds, the patient's ventilation resistance continued to increase, and the blood oxygen saturation had dropped to about 75%.
This is an indicator of hypoxia in the body.
Normal people are between 95% and 99%.
However, Meng Yingan still did not find the problem.
There were no bleeding points in the surgical area.
He wiped it with gauze, and there was only a faint trace of blood on it.
"No, it doesn't look like bleeding."
Meng Ying'an's face was as heavy as iron, and his tone became more solemn.
Xu Qiu looked at the gauze that Meng Ying'an threw into the tray, but his eyes lit up.
"Blood?!"
Xu Qiu suddenly said, "Mr. Meng, did you use too much adrenaline?"
"What's the point of adrenaline at this time..."
Meng Ying'an's words hadn't been cursed out yet, but his expression suddenly froze.
He stared at the patient's wound with very little bleeding.
During the operation, in order to achieve a bloodless surgical area, doctors will inject adrenaline to penetrate the mucous membrane and other parts to stop bleeding.
Could it be... a problem with adrenaline?
At this moment, the patient's blood oxygen saturation suddenly dropped again!
Meng Ying'an was still a little dazed.
But Xu Qiu shouted at this time: "Anesthesiologist, check the tracheal intubation!"
The anesthesiologist sitting in the back, who was fully focused on the operating table, suddenly woke up.
He hurried over to check, and found that the patient's trachea was already filled with pink endotracheal tubes...
Suffocation!
Pulmonary congestion caused pink foam secretions, which eventually led to airway obstruction!
The anesthesiologist quickly sucked out the secretions.
But the patient's blood oxygen saturation only slightly recovered, and he was still in a state of extreme hypoxia.
Everyone in the operating room became nervous.
If it is not corrected as soon as possible, it will not be a matter of losing a hand.
The patient will not be able to leave alive!
"Pulmonary... pulmonary embolism..."
Meng Yingan is experienced after all.
At this point, he has seen the crux of the problem.
In short, the patient has a blood clot in his right upper limb.
During the operation, due to excessive adrenaline, the patient's heart rate was too fast and the blood flow was turbulent.
The blood clot on the right upper limb was washed down!
Finally, it was brought to the narrow pulmonary blood vessels and blocked here...
Pulmonary embolism is a critical illness with a very high mortality rate.
"Quick, please consult the cardiology department!" Meng Ying'an supported himself on the stage with both hands, and his physical strength was exhausted.
His hands began to tremble uncontrollably.
"It's too late, too late, by the time the cardiology department comes, the person will be dead!"
At this time, Xu Qiu's voice suddenly broke the silence.
He grabbed the ultrasound machine next to him and signaled the instrument nurse to apply coupling agent.
Meng Ying'an was stunned. He said, "Can you do it? Are you kidding your career?"
He was thinking about loving talents and couldn't bear Xu Qiu to make mistakes.
A resident doctor,
At this juncture, without waiting for the cardiology department to consult, it would be a violation of regulations to perform a pulmonary embolism operation without authorization.
Once the patient died on the stage, Xu Qiu might have to say goodbye to the medical profession!
At this moment, Wang Ping stood up and said, "Mr. Meng, I am Wang Ping, I guarantee that he can do pulmonary embolism!"
"Wang Ping?"
Meng Ying'an was delighted.
Of course he had heard of this name. He was a mainstay of emergency medicine, and was particularly good at treating various acute and severe respiratory diseases, including pulmonary embolism.
"Guarantee what the hell! You don't go, and let the younger generation take the blame? Save people quickly!" Meng Ying'an cursed angrily.
Wang Ping moved over, and felt his steps were extremely heavy.
His expression was particularly strange.
Mr. Meng, you overestimate me...
In the past 30 years, I have saved the lives of six patients with pulmonary embolism.
The treatment rate is zero percent.
The only one was saved by Xu Qiu a week ago...
"Apply the coupling agent!"
Wang Ping had no choice but to bite the bullet.
He winked at Xu Qiu.
I will assist you and listen to your orders.
You, understand?
Xu Qiu nodded and immediately ordered:
"Turn off N2O and ventilate with 100% pure oxygen!"
"Adjust to semi-recumbent position and place a urinary catheter!"
"Give furosemide 20mg, dexamethasone 8mg, hydrocortisone 100mg!"
Instructions were given one after another.
But everyone stood still and no one dared to move.
Meng Ying'an's face trembled a few times, he raised his head and saw Xu Qiu's calm eyes.
At this moment, an idea suddenly popped up in his mind.
The other party, it seems that he can really do it?
The next moment, Meng Ying'an's face sank and said, "Why are you in a daze? Xu Qiu has the final say!"
As soon as the voice fell,
The stagnant operating room immediately started to move, and instantly ran at the highest speed.
On the other side, Xu Qiu also completed the transthoracic echocardiogram.
The ultrasound showed:
Local ventricular wall motion was reduced, and the ejection fraction (EF) was 20%!
Cardiogenic pulmonary edema!
Combined with pulmonary embolism!
Xu Qiu's voice also sounded:
"Test TT, PT, and APTT immediately."
"Give urokinase!"
"..."
"Heparin!"
"..."
"Digoxin injection 0.5mg intravenous push!"
"Dopamine 7ug per minute body weight!"
Xu Qiu quickly glanced at the monitor and shouted at the same time: "Systolic blood pressure must be maintained above 90!"
A large amount of drugs was injected into the patient's body without regard for his life.
This is the rescue process.
Crazy fluid and blood volume replenishment can bring a glimmer of hope for the patient.
Finally,
After three long minutes, the nurse's surprised voice rang out:
"Stable! SBP (systolic blood pressure) is maintained at around 100!"
The blood oxygen saturation also rose to 98%.
Xu Qiu: "Stop using dopamine and switch to dobutamine. The unit dose is reduced to 5ug."
After saying this, Xu Qiu breathed a sigh of relief.
There were already fine beads of sweat on his forehead.
"Xu, Doctor Xu, wipe the sweat!"
The nurse stretched out her hand and wiped Xu Qiu shyly.
The next moment, the whole operating room burst into cheers.
"Good!"
"It's back. Doctor Xu is the direct disciple of some cardiology boss, right?"
At this time, the director of the cardiology department finally arrived late.
Hearing the enthusiastic cheers, he was a little confused. There was no need to welcome himself like this, right?
Just when he wanted to get close to the operating table, he was told that the person was back and he could go back.
Director of the cardiology department: ? ? ?
...
Next to the operating table
As the patient's vital signs stabilized and the danger was lifted, everyone was in high spirits.
"Mr. Meng, we can continue the operation!" someone said.
Meng Ying'an didn't say anything.
Xu Qiu tilted his head to take a look, and his heart suddenly skipped a beat.
