Chapter 453: 10,000 Experience Points Reward, Finally I See Hope
The first thing to do is to look for large blood vessels that have been punctured by a sharp object.
It must be said that when the ruptured blood vessel is large enough, whether it is an artery or a vein, it is enough to pose a fatal threat to human life.
It’s just that the blood pressure in the veins is lower, so the bleeding is not as severe as in the arteries.
Relatively speaking, ruptured veins are easier to stop bleeding.
The nurse had a total of eight wounds in her chest and abdomen. Each wound was extremely brutal and penetrated deep into the cavity.
"A rupture in the abdominal aorta was found!"
After clearing the blood in the abdominal cavity, the large source of bleeding can be seen more clearly.
This type of spurting bleeding is extremely terrifying and can cause the patient's blood volume to drop sharply in a very short period of time, eventually leading to shock and death from blood loss.
"It should be the superior mesenteric artery in the upper abdominal cavity. It can only be ligated first and then repaired."
While searching, Zhou Can muttered to himself a plan to stop the bleeding.
"Hemostat!"
"Give!"
Qiao Yu quickly handed the hemostat to him.
Zhou Can found the end of the blood vessel near the heart where the bleeding occurred, and then clamped it with hemostatic forceps.
"Yang Zhi, help me hold the hemostat. The force should not be too strong or too weak."
This deep artery in the abdominal cavity is easily thrombi or ruptured when it is clamped during hemostasis. The probability of necrosis is low, but there is still a certain possibility.
Stopping bleeding is definitely a technical job.
Zhou Can just found the proximal end of the blood vessel, which seemed simple and only took a few seconds to complete. That was because his hemostasis skills had reached an extremely high level.
He is so good because of his extremely good understanding of human anatomy and rich experience in hemostasis.
Otherwise, if someone else were to operate it, he would become panic-stricken and his hands and feet would tremble just by looking at the blood spurting out.
After Yang Zhi freed one hand to hold the hemostat, Zhou Can began emergency debridement.
Repairing arteries is more difficult than you might think.
In fact, the patient has so many deep wounds in the chest and abdominal cavity, and there must be more than one bleeding point.
But Zhou Can can only take it one step at a time.
First repair the superior mesenteric artery, which is visible and bleeds the most violently.
"Doctor Zhou, the patient's blood pressure is still dropping, his heart rate is also dropping, and there is blood foam in his nostrils when he breathes. Check if there is any trauma to his lungs?" the anesthesiologist reminded Zhou Can.
"OK!"
Zhou Can is now opening the abdominal cavity. If he wants to move the lungs, the best way is to open the chest.
Given the patient's current condition, he didn't even dare to perform a thoracotomy.
I guess the person was dead before he finished opening the chest.
This is absolutely no joke. With such serious injuries, the patient's life has become extremely fragile.
"Damn it, the portal vein has also been punctured! What should I do?"
After examination, he soon discovered another large bleeding spot.
The intestines were also punctured, and the intestinal contents had directly overflowed , contaminating the abdominal cavity. At this moment, Zhou Can especially hoped that there would be two or three surgeons to perform surgery together to rescue He Juan.
No matter how strong his surgical skills are or how fast his speed is, he is limited after all.
A deep feeling of powerlessness continued to hit his heart.
"Immediately ask Director Xueyan of the Cardiothoracic Surgery Department to bring a surgical team to help save the patient. Just tell them what I said, the sooner the better."
In order to save people, Zhou Can directly used his own connections.
If the emergency department asks the cardiothoracic surgery department to send someone to rescue the patient, the cardiothoracic surgery department will not refuse, but it can handle the matter impartially.
If Zhou Can personally invited them to come and help, the treatment would be completely different.
Rescue efforts are still ongoing.
Blood foamed out of He Juan's mouth and nostrils, and her blood pressure remained high.
Four bags of blood had been used up in a short period of time.
250ml per bag, that means 1000ml of blood has been transfused.
"A ruptured pulmonary artery is difficult to deal with! These blood vessels and intestines in the abdominal cavity can be repaired one by one as long as I am given some time, but the lungs are very troublesome. Now I have no idea where the bleeding is."
Zhou Can quickly repaired the blood vessels while explaining the situation.
The anesthesiologist is responsible for stabilizing the patient's life, while Zhou Can is responsible for performing surgery to repair blood vessels, intestines, etc.
Now I can't take care of the ruptured intestines and can only let it leak out.
The right thing to do is to repair the blood vessels first.
Not long after, Director Xueyan really came with a whole surgical team. This was Zhou Can's power. Just mentioning his name would get Director Xueyan to help with all her might.
"I have heard about a family member who attacked your emergency department with a knife and stabbed several medical staff. It is really infuriating."
As soon as Xueyan came in, she expressed sympathy for the emergency department's situation.
"She's spitting blood foam. Is this... a lung injury?"
"Sister Yan, I asked you to come here to ask for your help. Can the patient's chest be opened? The wound is on the right chest, at this position. Based on my experience and feeling, it should be an oblique stab wound."
Zhou Can pointed to the patient's right chest.
You can see that her breasts are broken, but because she is wearing a bra and has a special body structure, the wound should not be very deep.
"Her condition is such that a thoracotomy would almost certainly result in death. I suggest opening two small windows for endoscopic surgery, which may give her a glimmer of hope."
Deputy Director He from the Department of Cardiothoracic Surgery also rushed over.
He owed Zhou Can many favors. Now that Zhou Can summoned him, he would definitely come over to repay the favor.
When it comes to thoracic surgery, Deputy Director He should be the most experienced one among everyone present.
"Anesthesia, can her condition be transferred to the endoscopic operating room?"
Zhou Can asked the anesthesiologist directly.
"If you don't turn, you will die. If you turn, there is still a glimmer of hope. So let's give it a try."
The anesthesiologist was deeply moved when she felt Zhou Can's desperate efforts to save lives, and she also decided to accompany Zhou Can to fight together.
Adventure is definitely needed.
"Would you allow me to repair her portal vein and superior mesenteric artery before leaving?"
"We can only try. It won't work if these two important blood routes are blocked." The anesthesiologist frowned and hesitated for a moment before giving his answer.
The patient's condition is actually very bad.
The injury is too serious.
"Sister Yan, can we transfer the patient directly to the endoscopic operating room of your cardiac surgery department?"
"No problem, I'll arrange it right away."
Director Xueyan was very straightforward and made all medical resources available to Zhou Can.
To rescue such seriously injured patients, close cooperation from all aspects is necessary.
Zhou Can began to quickly repair the superior mesoanal artery.
We have just completed the debridement and repair, and what we need to do now is to anastomose the blood vessels.
One advantage is that only a small amount of blood vessels are removed during the trimming process, so there is no need to worry about shortening the blood vessels and needing to use artificial blood vessels to lengthen them. However, this type of blood vessel anastomosis is also extremely demanding on the doctor's skills.
Especially the large arteries.
Also, in actual operations, blood vessels tend to shrink continuously within a very short period of time after being broken.
This is medically known as vascular collapse.
If the blood vessels are not anastomosed and blood supply is not restored quickly, the difficulty of anastomosis will increase exponentially.
Zhou Can put all his efforts into it and began to anastomose the arteries quickly.
[Suture +1, Experience Points Bonus +100. ]
[Suture +1, Experience Points Bonus +100. ]
The sixth-level suturing technique helped Zhou Can a lot at this critical moment. His suturing speed was also getting faster and faster.
And the phenomenon of being able to feel life through the stitching appeared again.
Each stitch will earn you 100 experience points.
This shows that his current state is the same as when he opened his abdomen before, and he has entered a wonderful state. That is, when doing something, he devotes himself to it wholeheartedly, without any distractions, and his belief in his heart is extremely firm and highly focused.
"alright!"
The entire superior artery vascular anastomosis took a total of three minutes and six seconds, which definitely set a record.
[Anastomosis experience +1, first time to achieve a perfect anastomosis, reward experience +10000. Benevolence experience +100.]
Zhou Can was stunned.
Directly rewarding 10,000 experience points is definitely the first time.
He didn't know what perfect anastomosis meant, but he knew that when he anastomosed the blood vessels just now, it was as if he was assisted by God. He knew how to perform each step, as if he had practiced it countless times. An animation of the entire anastomosis would naturally appear in his mind. It was like a set program, and he didn't need to think about each step, he just had to do it directly.
This feeling is so magical that it is hard to describe in words.
If I have to describe it, anastomosis of blood vessels is like something that has been rehearsed countless times in the brain. It has become so familiar that it cannot be more familiar.
Zhou Can knew very well that the anastomosis of each blood vessel was different. He could only make adjustments based on the actual situation and there was no way to rehearse it.
The reason why the animation scene that seemed to have been rehearsed countless times appeared in my mind was probably a bit like practice makes perfect, plus a sudden inspiration. This wonderful surgical ability only appeared during this rescue process.
This time, when rescuing patients, I got a lot of medical experience points, and the lowest one was 100, and the highest one was 10,000. Could it be related to the special medical skills and benevolence?
Normally, Zhou Can rarely pays attention to this special medical skill.
Its experience points also rarely increase.
This time, 100 experience points were directly added, which was the first time.
Now was not the time to study these things, and many ideas only flashed through his mind. He had already put aside all distracting thoughts and began to clean and repair the ruptured portal vein, and then anastomosed it.
The entire operation is still smooth and extremely fast, and the technical points in all aspects are close to perfection.
He did a very good job in all the details, including clearing blood vessels before anastomosis and removing air.
Five minutes later, the portal vein was repaired.
The patient's blood pressure is still dropping, and the sixth bag of plasma has been put in. Fluid infusion is continuing.
After the portal vein anastomosis was successful, he received a high reward of 1,000 experience points.
Although it was not as exciting as the last reward of 10,000 experience points, this extremely high reward still allowed his anastomosis skills to improve rapidly.
We are currently approaching level 6 anastomosis at an astonishing speed.
Try to loosen the ligature on the portal vein to restore blood flow.
"Oh, that's good! The patient's blood pressure has gone up a bit! But she seems to be in respiratory failure. We need to fix the wound in her lungs as soon as possible. The most worrying thing is that the fluid in her lungs is too severe and will directly cause her to stop breathing."
If the lungs continue to bleed, it is impossible for all of the bleeding to be discharged through the bronchi.
At this time, serious effusion is bound to occur.
The lungs breathe by contracting and expanding countless alveoli to complete the inhalation of air and the expulsion of waste gases. When the lungs accumulate fluid, it is equivalent to being flooded.
If there is only mild effusion, or effusion in one of the left or right lungs, the patient will only feel stuffy and have difficulty breathing.
If the effusion in the lungs is severe, it is not much better than being strangled.
The patient experienced respiratory failure, which is a very bad sign.
"Why don't we do a puncture and drainage first? I'm afraid she won't last until she can get into the endoscopy room."
Zhou Can took a look at the patient's vital signs monitoring data.
The instrument kept giving alarms, but there was no way to correct everything immediately. All they could do was repair the broken blood vessels in the patient's body little by little.
This is Zhou Can performing surgery to save the patient.
If it were another doctor, it would be difficult to reach Zhou Can's level in terms of surgical experience or speed.
“I think it’s wise to drain the water first.”
Director Xueyan was always there to help with the rescue, as was Deputy Director He.
At the same time, the two directors and deputy directors of the cardiothoracic surgery department were asked to help with the rescue. This was quite a grand event.
The two of them divided their work, one first tied the ruptured intestine to prevent continuous leakage, and then tried to clean it up to reduce the potential risks of abdominal cavity and wound contamination.
Another person performed electrocoagulation and ligation on some small bleeding spots.
It was with the concerted efforts of several people that the patient's condition began to improve.
Thoracentesis and drainage is also a technical job with high risks and difficulty.
Many trainees may only barely master the technical points of thoracentesis by the end of their training.
For new doctors, inserting a catheter and performing the four major punctures are tasks that require a lot of skill.
For example, when inserting a urinary catheter on an elderly patient, especially one with diabetes, a novice doctor would definitely cry. Even some senior residents would feel scared when performing the operation on such special patients.
Prostate enlargement is a common problem among elderly male patients.
This can seriously increase the difficulty of catheter insertion.
If the patient also suffers from diseases such as syphilis and genital eczema, it will make the doctor even more frustrated.
Zhou Can’s injection skills are currently at level five, which is the level of associate chief physician.
Getting a chest piercing is a piece of cake for him.
After he found the right position and inserted the puncture needle into the patient's chest cavity, dark red blood quickly flowed out of the catheter.
"The fluid has flooded half of the lungs."
He was very particular about the location of the piercing.
Based on the drainage rate, puncture site, and puncture depth, an experienced doctor can infer the amount of fluid in the lungs.
It should be mentioned that fluid in the lungs is not necessarily blood.
Sometimes it may be body fluids, or even thick liquids such as pus and sputum.
For example, in the early stage of COVID-19 infection, the lungs of patients were filled with sticky and thick liquid, and the entire lungs became as hard as stone. This was the main cause of their death.
My lungs became as hard as stone and I couldn't breathe at all.
It can no longer shrink or expand.
…
In the endoscopic operating room of the cardiothoracic surgery department, Zhou Can had already discussed with Deputy Director He, Director Xueyan and others to locate the possible location of the pulmonary artery damage. Then they opened three small windows and began to perform endoscopic exploration.
"The lung lobe was damaged and the pulmonary artery blood vessels were ruptured in two places, one of which was the most serious."
Zhou Can’s endoscopic surgery skills are also first-class.
Under his control, the bleeding in the lungs was quickly detected.
The next step is to stop bleeding and repair blood vessels. Unlike open surgery in the abdominal cavity, stopping bleeding and repairing blood vessels in the lungs can only be done through endoscopy, which is done in the narrow chest cavity.
"The blood volume must be insufficient again. The blood pressure is starting to drop again. How many bags of plasma are left?"
“There’s only one bag left.”
"Contact the blood bank and ask them to think of a solution. I think blood transfusion will definitely be needed to complete the rescue operation."
The anesthesiologist frowned anxiously as he watched the patient's vital signs decline.
Zhou Can's forehead was sweating, and his clothes were soaked with sweat. He didn't care about these things, he only had one belief in his heart, he must do his best to save He Juan.
Her one-year-old child is still waiting for his mother to come home.
I wonder how heartbroken her husband, parents, and relatives would be when they found out that she was badly injured by her family members in the hospital.
Nearly half an hour later, Zhou Can finally completed the work of stopping the bleeding in the lungs, repairing blood vessels and anastomosis, and suturing the wounds.
Try to restore blood flow to the lungs.
Perfect.
The blood circulation is smooth, and there is no congestion or thrombosis.
"Her breathing seems to be recovering, and her blood oxygen level is rising a little bit. Dr. Zhou, you are great!"
For the first time, anesthesiologist Qu Zi's brows relaxed, and there was excitement, relief and smile in her eyes.
The patient's blood pressure is also rising little by little.
The rescue work is not over yet because he was stabbed eight times in total and the injuries were too many.
We have only dealt with some of the serious and life-threatening bleeding sites. There is still a lot of work to be done, including intestinal repair, abdominal cavity debridement and cleaning, and hemostasis and suturing of other injured sites.
Zhou Can ignored his fatigue and physical exhaustion, and quickly continued the rescue work with Director Xueyan and others.
Deputy Director He knew that he was sloppy and slow in his work, so he stopped and gave his position to Zhou Can.
