Chapter 1789： Difficult left and right

“What if there is no signature of the patient’s family?” Su Yun asked.

"Looking for Director Lin." Zheng Rendao.

"Well, the job of the Medical Service is to protect the clinic." Su Yun said: "But it doesn't include you!"

"Emergency first aid, is there any other way?" Zheng Rendao, "Ask Zhao Yunlong, the signature is not finished. After a long time of work, it is estimated that this should be able to sign."

"how do you know?"

"Do a head nuclear magnetic, you have to ponder a day, let alone IABP." Zheng Rendao: "The state is not very good, let the next critical notice, the patient is able to come back."

"..." Su Yun frowned. "Are you sure?"

Zheng Ren sighed and looked at the patient's red blood-dropping system panel, some helpless.

"You may need extracorporeal membrane lung support, will you do it?"

"No problem." Su Yun said with certainty.

ECMO is an extracorporeal circulation technique that goes out of the heart operating room.

The principle is to take the venous blood in the body out of the body, and then inject it into the patient's arterial or venous system through special material artificial cardiopulmonary bypass oxygenation, which can partially replace the cardiopulmonary and maintain the oxygen supply of the human organ tissue.

There is no ECMO in the first house of Haicheng. Zheng Ren saw this thing for the first time after graduation. It is on Dr. Mehar.

Zheng Ren smiled and shook his head. "Do you see nuclear magnetic?"

"The diagnosis of moyamoya disease is very clear." Su Yundao: "If the extracorporeal membrane lungs, a large amount of heparin will enter the circulatory system. Do you think that it will induce aggravation of moyamoya disease, leading to cerebral hemorrhage?"

"Well, the possibility is very big." Zheng Ren said that it is quite polite, just entered the system operating room, he tried to do the operation of extracorporeal membrane lung.

But less than two hours after the completion, the patient died of cerebral hemorrhage.

This is a dilemma.

The contradiction between heparin anticoagulation and hemorrhage, hemolysis, and poor biocompatibility of biomaterials. The road to exploration is long. There are countless dead people on this road, but there are countless people living.

Under the cloud, the extracorporeal membrane lung has no problem in terms of technology.

However, Zheng Ren judged that a large amount of heparin could cause cerebral hemorrhage, and Su Yun hesitated. The use of extracorporeal membrane lungs, not to mention the cost, is technically a very difficult thing.

"Looking for neurosurgery?" Su Yun asked.

"First look for Ringer, right away!" Zheng Rendao, "The operation is done under the heart stop, blood heparinization, it is likely already... Zhao Yunlong has not returned yet?"

"I have a phone call to remind me." Su Yundao.

"Look at you, I will take a look." Zheng Ren packed up the IABP, looked at the patient's vital signs, opened the door, and strode into the corridor of the EICU.

On the face, Zhao Yunlong took a piece of A4 paper and walked back.

"Old Zhao, something is looking for you." Zheng Ren recruited.

"Going back to the IABP, I am worried about a sudden cardiac arrest." Zhao Yunlong said in a hurry.

"It has already been done." Zheng Rendao.

"Do you... finished?" Zhao Yunlong said in amazement, then he lowered his voice and hurried to Zheng Ren's side. "Zheng boss, just did it?"

"Well, the heart is in a sudden situation, I can't do it. Now the state is slightly relieved, but the relief is not great." Zheng Rendao: "I consider using extracorporeal membrane lung for a period of time, but there is a contraindication."

"Smog disease? Can you confirm the diagnosis?" Zhao Yunlong made a difficult decision.

"Yes." Zheng Rendao, "How do you explain to the patient's family before you open the chest?"

"There was no time to explain, the patient was sent to the operating room for surgery under the chest compression." Zhao Yunlong said: "I later explained it to the patient's family before the extracorporeal circulation, suspected of moyamoya disease, blood. Heparinization is likely to cause cerebral hemorrhage."

“How do you say at home?” Zheng Ren is most concerned about this issue.

If the family cooperates, the probability that the patient has at least 30% to half can be saved.

But if the patient's family does not cooperate...

It is better to give up the rescue directly. In that case, medical disputes and contradictions will be much less.

On the extracorporeal membrane lung, it is hard to say that the patient will die. But for the families of patients who are hesitant, the cost during hospitalization has risen sharply.

But if you don't have extracorporeal membrane lungs, the patient will die, the only difference is that you can live for a few more hours.

The heart is so tired, Zheng Ren is not willing to face this situation.

But life is like this, it is impossible to let yourself do whatever it wants in the operating room of the system.

"The patient is married, and her current husband says to give up treatment." Zhao Yunlong said, "But her daughter just came over and insisted on treatment, and signed it very happily."

When Zheng Ren’s heart sank, he rose again.

A complicated family environment, it is no wonder that the first time even MRI has to wait a day.

Being able to go on surgery, alive, Zhao Yunlong has taken the risk of greatness.

"I will go see." Zheng Rendao.

"Zheng Boss, Professor Zhang communicates with the patient's family outside." Zhao Yunlong said: "Let's wait a little longer."

"What is communication?" Zheng Ren heard a bad meaning in Zhao Yunlong's tone.

"To be honest, it is unlikely that patients will be able to live again." Zhao Yunlong said with frustration.

No one can expect patients to live more than the chief surgeon or the bed doctor. This kind of expectation is very complicated and difficult to say a word.

Zheng Ren also knows that after Professor Zhang’s explanation, the family will give up treatment with great probability, and the patient is dead.

As long as the patient's family gave up the rescue, the IABP was withdrawn, and the next time the ventricular rapid pulsation, heart failure, the patient died.

He sighed deeply.

“Is it an economic issue?” Zheng Ren asked.

"Well, the family is not very affluent." Zhao Yunlong said: "The migrant workers have not paid in the social security of their hometown."

"If I..." Zheng Ren said halfway, he stopped.

Zhao Yunlong reluctantly patted Zheng Ren's shoulder did not say anything, silently went back to the ward.

Live emergency rescue, upper and extracorporeal membrane lung?

The success rate of the apricot forest, the success rate is a key factor.

And the patient's own problems, how about the extracorporeal membrane lung? Moyamoya disease, because of heparinization of blood in the body, a small aneurysm rupture and bleeding, you have to live the death of the patient.

For mature business operations, this is totally untenable.

The reputation that Zheng Ren has worked hard to accumulate will also be fatally damaged by the death of the patient.

However, Zheng Ren is not thinking about the extracorporeal membrane lungs, but the moyamoya disease for surgical treatment.

First block the location of the bleeding, other things are better solved.

Zheng Ren judged that if there is support for extracorporeal membrane lungs, there is no problem with bypass surgery, and patients still have the possibility to survive.