Chapter 2718

Time is no longer calculated in days or hours, but in seconds.

As time goes by, the patient's invasive arterial blood pressure drops steadily, and the heart rate does not change dramatically when it reaches more than 150 beats / min.

But this kind of tachycardia is already very scary. I don't know when it will be a cliff fall, which can declare the patient dead.

The blood oxygen saturation has dropped to about 66%, and the oxygen is not enough. The anesthesiologist has begun to change to 100% pure oxygen ventilator.

Under the action of pure oxygen, blood oxygen saturation rises briefly and then decreases unswervingly.

"Director Liu, it's a gas embolism." The anesthesiologist was a little flustered. All he could think of was ruled out, leaving only the diagnosis of high mortality.

If there's a gas embolism, you'll fuck. The anesthesiologist's voice trembles when he says this.

Director Liu took a look. Hem-O-lock was placed at the bifurcation of the renal vein and completely clamped the renal vein. There is no possibility of a large amount of carbon dioxide flowing along the vein and entering the blood circulation through the pressure difference when establishing pneumoperitoneum.

He denied the anesthesiologist's statement, but was careful to immediately stop the inflation of carbon dioxide in the abdominal cavity and pull out traroca to relieve pneumoperitoneum?

However, the patient's condition remains unchanged. The rescue medication has been given once, and the vital signs displayed on the monitor are still declining.

"Call director Miao." Director Liu said in a deep voice.

The itinerant nurse was stunned, and the time seemed to return to half a year ago. No matter what happens, you can solve it by calling director Miao.

However, she did not hesitate, nor did she manage that director Miao has retired now, but immediately dialed director Miao's phone.

……

……

Director Miao sat at home, chatting gossip with Zheng Ren and Su Yun.

Chatting all over the place, just not talking about medical treatment. I've worked all my life. At this time, I've been demobilized and returned to the field. Let everything go away from me.

"Director Miao, my mother also dances square dance at home. I don't know what's good. Tell me what the benefits are." Su Yun said, "how can the wind and rain be right? The old man and the old lady are so proud of this thing."

"Let's have fun together." Director Miao said with a smile. He was full of confidence in his voice. He has basically completely recovered. Except that the broken end of the fracture caused a little problem when walking, everything else was fine.

"I have nothing to do at home all day. I'm idle."

"I have a dog in my house. Why don't you help me walk the dog? By the way, catch it. Sunspot's leg broke during the earthquake relief and can't run fast. Don't worry. It's a match with your legs and feet." Su Yun asked with a smile.

Director Miao was about to laugh and scold when the phone rang.

He leaned back on the sofa and picked up his cell phone leisurely. After a look, it was the phone in the operating room. The whole person sat up straight and the smile on his face disappeared, leaving only dignity and solemnity.

"What's the matter, director Miao?" Su Yun asked.

Director Miao waved his hand and didn't answer Su Yun's words, but directly connected the phone.

"What's the matter?" Director Miao asked in a deep voice.

On the other side of the phone, there was a loud voice. Zheng Ren and Su Yun heard some clips.

Uh... The patient is in bad condition during the operation?!

They looked at each other. If they were in 912, they might have rushed to the operating room by now.

But now at director Miao's house, I wait for a car and then rush to the hospital. The cucumber and vegetables are cold.

Urology, there is the operation of nephrectomy under endoscopy in the afternoon. Did you encounter a blood vessel that should not be touched?

"Video, let me see the patient." Director Miao said solemnly after listening to the simple introduction.

When the phone hung up, director Miao saw Zheng Renhe and Su Yun looking directly at themselves, and explained, "when doing nephrectomy under laparoscopy, suddenly the blood pressure and heart rate were unstable, and the blood oxygen saturation decreased rapidly."

That's true!

"Touched a blood vessel?" Su Yun asked.

"No, if you encounter blood vessels to stop bleeding, it's over." Zheng Rendao, "it is estimated that it is inexplicable. Is it caused by vagus nerve reflex?"

Director Miao shook his head slightly. "Cardiac arrest caused by vagal nerve in nephrectomy is rare. It's good to use drugs."

Just now, the voice of wechat video sounded, and director Miao connected the video request.

"Director, patient..." director Liu's voice came from the video. He took his mobile phone and aimed the picture at the laparoscopic TV screen, "there is no bleeding, patient's blood pressure and heart rate..."

"Cardiac arrest! Cardiopulmonary resuscitation!" The anesthesiologist roared loudly.

Zheng Ren and Su Yun quickly gathered around director Miao and looked at the picture.

The heart rate dropped precipitously, the oxygen saturation was 52%, and the alarms on the ventilator and monitor kept ringing. Even if they saw this scene at home, the three people naturally secreted a large amount of dopamine, adrenaline and glucocorticoid.

"The anesthesiologist adjusted the operating table, head low and feet high." Director Miao said.

But the picture is messy. The anesthesiologist is pushing drugs and Yu is always doing cardiac compression. Because the problem has not been found, everyone is in a panic.

"Anesthesiologist! Xiao Liu, adjust the bed, head low and feet high!" Director Miao raised his voice and said without doubt.

Soon the bed adjusted an angle and changed its position as director Miao said.

Adrenaline, isoproterenol and cedilanid, the instructions for intravenous injection, came out in director Miao's mouth, and the doctor's orders were executed on the other side of the video.

It was like an invisible hand turning back the time and returning to the past again. At this time, director Miao stood in the operating room and presided over the rescue.

"Director Miao, what do you think is..."

"Establish pneumoperitoneum, resulting in gas embolism." Director Miao said with certainty.

If Zheng Ren is present, you can use the system panel to judge; Without director Miao, Zheng Ren estimated that it would take some time to determine.

After all, the gas embolism caused by the establishment of pneumoperitoneum is so rare. At least Zheng Ren did not encounter a similar situation when he performed endoscopic surgery in general surgery.

After endoscopic nephrectomy, Zheng Ren quickly looked for similar information in his mind.

Laparoscopic nephrectomy is a minimally invasive, safe and effective surgical treatment for patients with renal diseases, but there is an inevitable risk of air embolism due to the need to establish pneumoperitoneum?

The incidence of gas embolism is very low, about 0.002% ~ 0.02%. Once it occurs, the mortality can be as high as 50%?

Reviewing the literature, so far, only 5 cases of gas embolism in endoscopic renal surgery have been reported?

Jiang is still old and spicy. It is estimated that director Miao has encountered a similar situation. You can know what happened at a glance.

After all, director Miao is the first batch of surgeons to operate with endoscopy in China. He has never encountered any situation.