Chapter 454: The drug of choice? Wrong medication!
Family members who have a lot of questions during the preoperative conversation actually mean that they really listened to the doctor. After an accident, these family members are unlikely to make trouble for no reason.
But those who don't ask any questions and keep saying "Save my husband" and "Save my son" are the most likely to cause disputes.
But Xu Qiu has no psychological burden.
The situation of Lv Guilan before was not much better than the current one. The other party didn't even have the signature of the family members, but Xu Qiu dared to perform the operation anyway.
Later, after the operation was successful, Lv Guilan sold her house and car to pay the compensation for the victim who was hit and killed by her son. These days, she has also been sending money to Linyi to repay the cost of the operation at that time.
No matter how dangerous the operation is or how unruly the family members are, as long as the operation is so good that people can't find fault with it, it will not be a problem.
Obviously, for Xu Qiu, although the patient with full-thickness tear is a life-or-death situation, it is not without confidence.
The improved SUN operation can also reduce the mortality rate of aortic dissection surgery to less than 5% by further increasing the contact area between the artificial blood vessel and the aortic wall!
With the observation of world-famous doctors such as Joseph and Saito, Xu Qiu can trigger [popularity], and the success rate of the operation can be greatly improved.
In this sense, Joseph and others are not useless, at least they can be used as mascots...
After the conversation, Xu Qiu sorted out the documents signed by the family members and said: "The initial estimated cost is 300,000, prepare the money."
Judging from the family members' conversation and dress, 300,000 should not be a problem for them.
"Okay, doctor, you must save my son, we are willing to pay any amount!" The middle-aged woman with jewels wiped her eyes, as if she had grabbed a life-saving straw, and held Xu Qiu's hand tightly.
...
The last check before the operation, the situation is still not optimistic.
In the emergency room, everyone's face is very ugly.
After a while, Xu Qiu came back from the conference room with his people. He just finished talking and glanced at the emergency room and asked, "How is the blood pressure under control?"
The anesthesiologist looked grim: "Doctor Xu, it can't be lowered! And the patient's condition is getting more and more critical. Just now, another cardiac arrest occurred!"
The pupils of Joseph, He Hai and others contracted.
Since admission to the hospital, the patient has had four cardiac arrests. Can such a body really undergo surgery? !
"Can't control the blood pressure?" Xu Qiu was puzzled.
It's okay if the blood pressure can't be lowered, why is the situation getting worse...
He quickly did a quick physical examination.
No obvious abnormalities were found.
However, judging from the expression, the patient's pain was obviously more severe than before, and he almost fainted several times due to the pain.
This is still under the condition of using morphine for analgesia!
Seeing this scene, Xu Qiu suddenly remembered something and immediately asked, "What antihypertensive drugs are used?"
"Antihypertensive drugs? At first, we used metoprolol to reduce heart rate, but the effect was not good, so we changed to the commonly used sodium nitroprusside..."
"That's the problem!"
Xu Qiu interrupted the anesthesiologist, his face changed several times, "Change to other antihypertensive drugs, verapamil!"
"Okay... okay!" The anesthesiologist and Wang Fan and others looked confused, but they immediately followed Xu Qiu's arrangement.
Soon, as the new antihypertensive drug was pumped into the patient's body, everyone's eyes were focused on the life monitor.
Beep, beep--
Beep, beep--
After a short wait, verapamil took effect at an incredible speed, and the patient's systolic blood pressure dropped once a beat, and finally slowly stabilized at around 150.
"What's going on?"
"In the clinical guidelines, the first choice is to use 5mg intravenous intermittent administration and sodium nitroprusside intravenous drip 25-50ug/min to adjust the drip rate... Why is it not as effective as verapamil here?"
"Yes... the first choice is sodium nitroprusside or α-receptor blockers, why is sodium nitroprusside useless!"
Not only the clinical doctors don't understand, Joseph and Saito Ye are also puzzled.
In clinical practice, many patients cannot be saved even with sodium nitroprusside, and their blood pressure is still sky-high, which is normal.
However, the first choice of sodium nitroprusside is useless, and it is replaced with verapamil, and the antihypertensive effect is so significant, which is very abnormal!
Both are antihypertensive drugs, and sodium nitroprusside even has a better antihypertensive effect. Why is one ineffective and the other effective? !
"Get ready for surgery."
After Xu Qiu finished the examination and confirmed that the patient's condition met the minimum requirements for surgery, he said.
He glanced at the eager crowd and gave an explanation: "Sodium nitroprusside is indeed the first choice for lowering blood pressure, and it is even the first choice for hypertension caused by aortic dissection. Generally speaking, the antihypertensive drugs used by patients with aortic dissection are not much different from those used by ordinary people...
But the problem is that the patient does not only have aortic dissection, but a ruptured dissection!
In this case, sodium nitroprusside will cause reflex catecholamine release, leading to left ventricular contraction, which will increase left ventricular contractility and aortic wall shear stress, aggravating the degree and range of rupture!"
Everyone's face changed drastically.
Wang Fan, He Hai and others who were responsible for the rescue almost died.
So...they rescued for so long and had several cardiac arrests, all because of this clinically preferred sodium nitroprusside?
Did sodium nitroprusside aggravate the patient's dissection, aggravate the pain, and even cause multiple cardiac arrests? !
"But why didn't anyone point out this problem before..." He Hai couldn't understand.
Wang Fan glanced at Xu Qiu and said, "Maybe it's because only our hospital can rescue patients with aortic dissection rupture like this."
This remark instantly enlightened everyone.
Even Joseph, a living fossil in cardiac surgery, was helpless with this patient. No one in any hospital in the country could save him. With full-thickness tear + multiple ruptures, the patient's aorta had long been like a sieve. Just go through the process and report the death.
Only Linhai First Hospital, with Xu Qiu as a backup, dared to make a heavy bet to rescue such a patient who was destined to die.
That's why only Linhai Hospital encountered such patients with multiple factors superimposed on each other.
"Is that so?" Joseph was shocked.
He didn't expect that as an authority in cardiac surgery, he would one day feel the gap brought by clinical experience...
At least, Joseph's knowledge was not as deep as Xu Qiu's on the fact that sodium nitroprusside could not be used for patients with aortic dissection rupture.
There is also the modified SUN operation.
There is also total laryngectomy.
There is also heart repair.
And...
"What's wrong with you, Professor Joseph?" Saito looked at Joseph in surprise. The old professor's face suddenly became uglier and uglier, and he became angry.
"Stop talking nonsense and go to the operation!" Joseph snorted coldly, flicked his sleeves and walked towards the operating room.
Saito scratched his head.
Did I provoke you?
Why are you suddenly angry?
