Chapter 1408

In the medical industry, when outsiders look at it, it is easy for outsiders to feel low-key, luxurious and connotative. For example, when the director rounds the room, the director stands in the middle of the crowd with some body movements.

Then he kindly said the patient's treatment points to the young doctors around him, and occasionally jumped out a foreign word that he had hardly heard of, especially the middle-aged male director. His thick and low voice really had a charming feeling.

But for the young doctor standing around the director, NIMA said it was easy! For doctors, this thing is definitely not a low-key luxury with connotation, but the real thing is that it can be used at first sight.

For example, cardiac surgery is the most obvious one. In cardiology, the working principle of the heart is pulled out by individuals. It can be said one by one. From electrophysiology to cell threshold, from the entry and exit of sodium ions to the state of heart contraction.

But let's get started. The hospital can't pull out three. They can pat their chest and say, I'm the best for heart puncture! The simplest is the heart puncture among the five puncture operations, which is clearly required by the syllabus of the Ministry of health for interns to master.

But NIMA went to see which medical school in Manchuria dares to let interns do this work. The result is that when this class comes, the students are excited. It seems that they can finally see the long-standing legend of evil ward sword in the Jianghu.

As a result, in class, the teacher said faintly that I won't explain this chapter in detail. Zhennima is very much like the biology class in junior middle school. It's going to have a physiological structure of men and women. The beautiful teacher said that she let the students go home after class and have a look.

Nima, what do I want your teacher for? Did I pay my tuition to study by myself?

In fact, this thing is really difficult. Even if you puncture your abdomen, the worst result is to give a needle to someone else's bladder. At most, it is to let someone urinate blood for a few days, so that the old man with enlarged prostate suddenly has the illusion that he can have a period.

But the heart is not good. One needle is not strong enough. One needle is too deep to pierce the muscle layer of the heart. NIMA is not kidding. She can solve it with a few toilet papers. It can kill people.

In the operating room of the children's Institute, Zhang Fan has separated the child's circulatory system from old man Jiang. How can I say this? It's like a drum washing machine beside the operating table, and NIMA is a double barrel.

Blood into the cardiopulmonary bypass machine, the child is like an alien, covered with wires.

In particular, infants are covered with lines and pipes, and then there is another big blood hole in their chest. Really, the more they see, the more they feel congested.

At this time, Zhang Fan and old man Jiang have no time to stop. Now they have reached the most critical moment.

"We must lower the temperature and then carry out heart and brain perfusion, otherwise the brain will be damaged. The child is too young. We can't even judge whether it is damaged or not. Let's cool down Zhang Fan!" old man Jiang said a word looking at the beaded sweat beads on Zhang Fan's forehead.

To tell the truth, Zhang Fan, who did not open the secondary extracardiac system, can do well in surgery, but Zhang fan can only say that he has a pair of golden hands and lacks a brain that is fatal to heart disease.

His extracardiac surgery and knowledge are not enough.

Cool down, cool down on the operating table. To be honest, this thing is a double-edged sword.

Human brain tissue is extremely sensitive to ischemia and hypoxia. At normal temperature, the time of cerebral ischemia resistance is five minutes, which is the treatment window of cardiopulmonary resuscitation. If it exceeds five minutes, brain injury will definitely occur.

Therefore, when rescuing, people in the non-medical industry, once they find that the heart of the person in need of rescuing doesn't beat, you don't want to take advantage of others and break off others' mouths to blow air. You must first find a way to make the heart beat.

Whether passive or active, as long as you can make your heart jump, this is success. First of all, you have extended the resuscitation treatment window of rescue.

In brain tissue, 40% of oxygen consumption is used to maintain cell integrity and 60% is used for nerve impulse conduction. This is why when the concentration of carbon dioxide is too high, people will have some hallucinations.

Because at this time, the brain is actually the same as the workers with incomplete wages. Looking at work, NIMA is actually fishing.

Now, the operation requires the whole body to stop circulation for ten minutes. If other organs don't say it first, the brain won't want to.

What to do? Reduce the temperature. For every 10 ℃ decrease in the body, the oxygen metabolism of the brain decreases linearly, which is the same as the intersection of the two functions. When the body temperature reaches 13 ℃, the safe phase of disconnection can reach 29 minutes.

Of course, if the body temperature continues to drop, the safe oxygen consumption metabolism will continue to decrease, but the side effects will become more and more serious. First, the brain is willing, but the heart will not. At this temperature, the heart may not be able to sleep or the blood vessels will be blocked.

This is why many old people have cardiovascular diseases when winter comes.

This kind of cooling is very troublesome. There must be corresponding instruments, such as special water bath box. Cooling the patient is not like NIMA buying a piece of meat and throwing it into the refrigerator. It needs to be in a constant water bath.

And it should be carried out after the start of cardiopulmonary bypass. This cooling time is very slow. Sufficient cooling can be maintained for at least 30 minutes. At present, the experimental data clearly confirm that sufficient and uniform cooling takes at least 75 minutes.

When cooling down, the other side also needs to open a hole in the large blood vessels, and retrograde and anterograde input the blood with temperature.

What do you mean? To put it bluntly, while bleeding to cool down, you should also input a little warm blood to ensure that the neurons and internal organs in the body will not be frozen.

This kind of operation is particularly troublesome. While cooling down, we also need to ensure a small amount of body temperature and body temperature. When the temperature is high, the brain is active and excited. When the temperature is low, other internal organs and neurons will die again.

Really, to tell the truth, if you don't tell others, such a cooling and heating up is enough for a doctor to study all his life.

This kind of surgery, not to mention tea, has not been done in the whole northwest.

"What should I do now?" Zhang Fan asked old man Jiang directly without nonsense.

Old man Jiang was slightly stunned and scolded in his head: Club hammer! But he began to say, "do you have a constant temperature water bath?"

"Yes!" the director of the Institute nodded and answered, then directly asked his doctor to push out the water bath box, which is a little similar to the electric incubator for hatching chickens.

"Is there a bedside detector?" old man Jiang swallowed his spit!

"EEG and somatosensory evoked point detection should be available?"

"Yes, do you need European or American standards? We have three sets!"

"It's best to have a jugular vein oxygen detection balloon catheter temperature detector."

"Yes, children's version!"

The more old man Jiang said, the more NIMA was surprised. Finally, he wiped his sweat and asked tentatively, "is there a noninvasive transcranial oxygen saturation detector?"

The detection of blood oxygen saturation usually needs to puncture the artery. Generally, doctors and nurses will take off your pants and pierce a thick needle tube at the root of your thigh. Under normal circumstances, nurses can't start this operation. It is often operated by doctors and assisted by nurses.

The noninvasive detection is actually the infrared ray emitted to the outer cortical layer, just like the electronic thermometer. This device is effective, but this method is relatively novel, so it only appeared in some high-end laboratories first.

As a result, the director of the children's Institute nodded shyly, "yes, but..."

Unexpectedly, NIMA tea vegetarian Institute also has it. Old man Jiang quickly asked, "what's the matter? Is it broken?"

The old man thought the things were too advanced and let these goods play badly.

Unexpectedly, the director of the children's Institute shook his head and said, "it's not bad, it's not bad, but the doctors here don't know how to use it!"

"Come on, push it out!" this almost sent old man Jiang away. NIMA has wanted this instrument for a long time!

When all the equipment is set up, the child is like a small fish with its belly ripped into a water basin.

It's short of onion, ginger and garlic seedlings, otherwise it's really like pickled and delicious.

"DHCA temperature management begins!" Lao Jiang starts roll call one by one.

"Yes, DHCA temperature management begins!" at the same time, Yang Yong of the children's Institute repeated the old man's words, and then turned on the switch of the instrument.

"PH management starts!"

"Yes, pH management begins!"

"Increase the dosage of halothane and isoflurane!" three old men outside the operating table changed the dosage of anesthetic at the same time. When the child entered the water pool and the temperature began to decrease, injection anesthesia gradually turned into inhalation anesthesia.

"Double the hormone! Put it in the pot!"

"Boy, it's up to you now. In twenty minutes, the hole depends on whether you can block it." after old Jiang arranged, he took a deep look at Zhang Fan with his eyes.

"OK, start!"

At this time, it is obvious that all data of EEG and blood oxygen are stable, just like the ticking of patients with prostate, which can no longer be stable.

Under the microscope, Zhang Fan began to operate. When everything is stable, to tell the truth, this hole, the hole big as soybeans, is under Zhang Fan's hands, and NIMA is a brother.

Nima is big in soybeans. She looks down on Zhang Fan. If you have the ability, you can come out with a big broad bean.

Zhang Fan didn't need any help. In one hand, he held a needle holder with absorbable purple suture hanging on it, and in the other hand, he held ophthalmic forceps and directly pulled the edge of the hole in the heart.

It's too easy to sew directly. It's all in vain. I'm sweating white hair.

Up, down, left and right, a cross nodule was stitched out by Zhang Fan, and it was as beautiful as a small chrysanthemum growing on a child's heart. Really, with the peristalsis of muscles, the small chrysanthemum opened and closed, which was so beautiful.

"Rewarming, perfusion!"

The blood is slowly sent into the body from the postural circulator, and the water temperature in the child's bathtub slowly begins to change from cold to white.

The original blue children, like Smurfs, slowly changed from cheeks to pink, then neck, whole body, and finally limbs and lips.

Slowly, it looked like a little devil's baby. At this time, it turned pink. NIMA was sleeping page.

"Heart rate, blood pressure, blood oxygen and respiration are all normal. Zhang Yuan's child has recovered. Looking at the child's EEG is also normal. Zhang Yuan succeeded!"

The director of the children's Institute was so happy that he didn't know what to say.

It's really a surprise that things that had no hope were perfectly successful.

Old man Jiang felt the instruments around him at this time and whispered, "what a good thing, what a good thing!"

Zhang Fan looked at the child's instrument. He was also excited. Really, when the child couldn't operate after cardiopulmonary bypass, his eyes were black. Really.

He looked at the data and took the time to take a look at old man Jiang. He wanted to thank the old man. As a result, he saw that the old man was greedy to death. He smiled.