Chapter 2171： rescue

"Old Mu is in surgery, what happened?" Su Yun asked lazily.

"The patient's heart beats!" The nurse shouted and turned and ran back.

Uh……

Next door surgery?

Su Yunhuo stood up all the time, across the lead glass, saw Zheng Ren turned around, even the sterile clothes did not tear off, opened the induction of the airtight lead door, strode out.

"Wu old, don't worry, my boss and the past." Su Yun strode away, have not forgotten to explain with Wu Lao.

At the age of Wu Lao, I was really afraid that he would take emergency treatment in the emergency department.

The interventional operating room of the People's Hospital of Pengcheng Development Zone is small, with only 5 operations. The intraoperative airtight lead door with the red light in the operation was closed, and a flustered voice came out of the operation room.

"Push the medicine! Atropine 1mg!"

Zheng Ren walked quickly and saw a pale system panel, the diagnosis on it was blurred. Vaguely seen coronary atherosclerotic heart disease, carotid stenosis and other diagnoses.

The doctor in the Department of Cardiology is doing a heart press, and the nurse is taking medicine and preparing for a bolus.

The surgical screen shows that the carotid intervention site is at the bifurcation of the right internal carotid artery, where the baroreceptor is sensitive, and the reflection adjustment is mainly to respond to the pressure sensing in a short time, within a few seconds.

This is to do the coronary stent, the heart stops when the carotid artery stenosis is opened by the front surgery.

Zheng Ren glanced at the situation and saw the situation directly into the system operating room.

Su Yun hurriedly followed Zheng Ren and saw the speed of the drug taking a little slow. He said: "Lao He!"

Lao He did not respond, but walked directly, silent and firm. He walked over to the rescue vehicle, opened an atropine, pumped it into the syringe, and opened the tee directly into it.

The emergency rescue test is the psychological quality and technical level.

The little nurse is like a new recruit on the battlefield. Hearing the roaring sound of the cannon, he is scared. How can he be skilled in the veterans who have experienced countless battles?

The original technical level is average, and then panic, then there is really nothing left.

"Old congratulations, intubation." Zheng Ren suddenly said, "Road, push the ventilator over. Su Yun, to do heart compression, the intensity and frequency should be increased."

Zheng Ren said that he had torn off the sterile clothes, picked up the sterile gloves, and turned to brush his hands.

Su Yun did not hesitate, went to the side of the surgeon, hit the shoulder, and squeezed the surgeon from the position of the chest outside the heart.

The surgeon is stupid.

However, at this time, there is a doctor who can confidently take over and rescue, she will not stop.

At the beginning of the operation, the balloon was slightly opened and the patient had a cardiac arrest. In this aspect of emergency first aid, it is said that the circular department is very good at it, but after pressing for 30 seconds, I did not see the heart re-jumping, and suddenly panicked.

"You, go and charge the defibrillator." Zheng Ren went to brush his hand, Su Yun took over and directed the rescue command.

He is a good-natured commander, full of the director's style.

One atropine, dopamine, and adrenaline were pushed forward, and the oldest man completed the tracheal intubation at the fastest speed and handed the balloon to the assistant doctor.

Zheng Ren brushed in and wore sterile clothes.

"Boss, what do you do?"

"Neck arterial stenosis is still to be opened, old Mu?" Zheng Ren glanced at it, seeing that Su Yun is doing chest compressions at a frequency of 110 beats / min, the waveform on ECG monitoring has not recovered, and The system is the same in the operating room, and there are some urgency.

"Zheng boss, I am coming." Mu Tao completed the last step of the operation and rushed in.

The doctor of the Department of Cycling saw Mu Tao come in and finally saw the savior. He said: "Professor Mu, the patient has a sudden cardiac arrest..."

"Zheng boss, how to do it?" Mu Tao asked with a frown.

"You go to push the ventilator, I am under the bracket." Zheng Ren stood at the position of the surgeon and took a look at Su Yun.

"You see what I am doing, I didn't wear it without wearing a lead coat, you just do it." Su Yun's arms are straight and he is constantly doing cardiopulmonary resuscitation.

The airtight lead door slowly closed, and Zheng Ren began to step on the line at this time.

The position of the balloon changed slightly. Zheng Ren sent it to the inside to find the place where the carotid artery was narrow. The narrow section was opened and sent to the CRISTALLOideale-SE6-9mm×40mm self-expanding stent.

With the opening of the carotid artery, Su Yun's movements gradually slowed down.

The pulsation fluctuation of the patient's ECG monitoring gradually returned to ventricular tachycardia, and after a few seconds, the sinus rhythm was restored.

Zheng Ren stopped stepping on the line and said: "Take the lead clothes."

Su Yun glanced at the value of the monitor, nodded and turned to wear a lead coat with Laohe.

"..." The surgeon of the circular department stood by his face.

"Little Sun, what happened?" Mu Tao asked.

"The diagnosis of patients is coronary atherosclerotic heart disease, labor-type angina pectoris; arteriosclerosis of both lower extremities; carotid artery stenosis. Originally wanted to solve carotid stenosis first, then the lower bracket, but I did not expect the balloon just went in, the heart stopped It is."

Mu Tao nodded.

Significant carotid stenosis is an important risk factor for perioperative stroke in patients with coronary stents. The incidence of stroke is as high as 3% to 11%, and is positively correlated with the degree of carotid stenosis.

The patient's condition is clear, and there is no problem in preoperative diagnosis and surgical indications.

If the treatment is correct, the surgery should be normal and the carotid artery stenosis should be resolved first. It’s just that the patient’s sudden cardiac arrest is a bit long, and this side is directly paralyzed.

"Zheng boss." Mu Tao asked softly.

"Talk about the surgical procedure." Zheng Rendao, "There should be no big problems, don't be nervous."

"The patient's condition is much better. Do you still use a ventilator?" Mu Tao asked.

"It must be used." Su Yun came back with a lead coat and said with dismay: "The patients with coronary stenosis have a stroke due to carotid stenosis during the perioperative period, and the prognosis is very poor, with a mortality rate of about 50%."

Mu Tao is an interventional doctor, not a doctor in the circular department. If you follow the rescue and do coronary stent surgery, he is no problem. It really involves some more meticulous things, especially the pathological and physiological aspects, and he can't do it.

"Talk about the process." Zheng Ren reminded again.

"Preoperative angiography showed 90% stenosis of the proximal end of the right internal carotid artery. I used the super-sliding guide wire to send the 8FMPAI guide tube to the right common carotid artery, SpiderRX5.0mm to the distal end of the right internal carotid artery, and sent it to the Sapphire 4.0mm × 20mm balloon. Give 15atm. After 5 or 6 seconds, the patient's heartbeat stops."

The surgeon should be the director of the circular department of the People's Hospital of Pengcheng Development Zone. Under the pressure of Zheng Ren, he became a small doctor and began to report the operation.

Emergency first aid, when there is basically no effect, some people come forward, which is undoubtedly a relief for the surgeon.

In the face of sudden cardiac arrest, can you still be so firm and confident in command and rescue, how much higher is the technical level than yourself?

"Hmm squeezed into the carotid pressure sensor." Zheng Rendao, "The heartbeat stops after balloon dilation, followed by ventricular fibrillation malignant arrhythmia is a common complication."

"Zheng boss, I thought I would give up the surgery." Mu Tao said with a sigh of relief.

"No. The cardiovascular activity center in the brain controls the heart and blood vessels through the sympathetic and vagus nerves, keeping the arterial blood pressure at a certain level."

"When the balloon is dilated, the arterial baroreceptor immediately feeds these information back to the cardiovascular center through the afferent nerve, and the cardiovascular center's activity changes accordingly, causing heart rate to slow down, peripheral vasodilation, and blood pressure to decrease. ”

"The pressure inside the balloon rises too fast, the diameter is too large, the pressure is too high, the duration of expansion is too long, and the sensitivity of baroreflex is too strong, which may be the cause of cardiac arrest."

"The surgery will be solved, and it will be restored after a while." Zheng Ren smiled.

"Old Mu, Wu Lao?" Su Yun suddenly asked.

"The teacher looked at the patient during the surgery..." Mu Tao said.

"Also, I am going to prepare for the next operation. This should be solved soon." Zheng Ren smiled.

"The heart stent doesn't need us to go down." Su Yun asked the surgeon.

"No... no, no trouble." The surgeon was whispering.

At this time, it is equivalent to reclaiming the patient, and it is equivalent to recovering himself. The surgeon feels that he cannot express his gratitude.

It’s just that she is still a little embarrassed, still immersed in the nightmare of the patient’s sudden death without slowing down.

vertex

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