v3 Chapter 2722： Last lesson

After a while, Director Liu explained before returning.

He asked Mr. Miao for instructions, then washed his hands again, and started the operation again to finish the unfinished operation.

The operation was very simple. It was just a destructive nephrectomy. Director Liu's technique was delicate. Even if the old director stood behind and looked at him, he still did not show any nervousness. It was completed in less than an hour. The whole process of surgery.

Quilting the skin, the sound of good fortune echoed in the operating room, and Director Liu seemed to relax a little. He asked, "Director, how did you come here?"

"During the operation, the large blood vessels were not damaged. The renal vein, lumbar vein, right iliac vein, and inferior vena cava were intact. Regardless of the injury, gas was quickly absorbed into the circulation. I think it should be the rapid inflation of carbon dioxide through the kidney when the pneumoperitoneum is established The malformed blood vessels of the tumor enter circulation. "

"The patient's blood pressure is not falling fast, I look at the anesthesia record sheet, you have about 11 points to rescue." Director Miao said with a clear back, "Do you remember I scolded you once."

"Remember." Director Liu did not evade the problem, and said frankly, "I had an operation, and the hem-o-lock was placed at the bifurcation of the renal vein, and the renal vein was not completely clamped."

"Well, in that case, a large amount of carbon dioxide will enter the blood circulation with the pressure difference." Director Miao continued, "I estimate that this is the 50% mortality rate. The pneumoperitoneal carbon dioxide entering the large blood vessels will cause An irretrievable death. In this case, a small amount of gas enters the malformed blood vessel and is saved. "

"Carbon dioxide enters the right atrium? Right ventricle? Pulmonary artery through the open vein through the inferior vena cava along the pressure gradient, forming an air plug at the pulmonary artery, causing mechanical obstruction, preventing blood flow from entering the left ventricle, leading to circulatory failure in patients? "

"The amount of gas entered is not much, which is also the fineness of your operation. Some complications that cannot be prevented, just remember how to rescue. Before the operation, be careful and explain a few words."

Director Miao Miao still looked as if she was a big director.

"Director, let the ventilator blow for a few days after the operation." Director Liu asked.

"It can be done in 1-2 days." Director Miao said with confidence: "Recheck the bedside echocardiogram after you go back, and find a good person to do it. If there is no residual gas in the heart, it can be removed in at least 2 days. tube."

After speaking, Director Miao paused and said, "I remember telling the nurse of icu that I was mentally up at night and sucked sputum once an hour. If there is a lot of sputum in the lungs, I'm afraid there will be atelectasis. "

"Director, I stay in ICU to see patients at night." Director Liu said naturally, "You can rest assured."

"Um." Director Miao nodded, all of which seemed to be proper.

"Director, thanks to your experience, I was at that time." Director Liu said frankly. He did not hide his lack of experience, and said it frankly.

"It's good to go through it once." Director Miao said, "Establishment of pneumoperitoneum inevitably involves the risk of air embolism. The incidence of gas embolism is very low, about 0.002% ~ 0.02%. Once it occurs, its fatality rate can be as high 50%? "

"We have had three cases in all these years, plus your case."

主任 Director Liu has some emotions. The 912 urology is very strong, otherwise it is impossible that all the professors in the group think they can compete for the position of director.

It is true that everyone has this qualification no matter from the level of surgery or other aspects. But that was a normal situation. Once encountering such a thing today, Director Liu deeply felt the correctness of the sentence that an old man has a treasure.

Thousands of cases of laparoscopic surgery a year, only three cases have occurred over the years. Listening to the meaning of Director Miao and the understanding of Director Liu, two cases occurred when he did not come.

所以 "So when you are performing laparoscopic surgery, I have to remind you to pay attention to the state of the patient. Quick diagnosis and timely and effective treatment are necessary conditions for success, because air embolism leaves too little time for rescue?"

"It is critical that the management goal of the gas plug is to prevent further gas from entering the circulation and maintain hemodynamic stability."

"In the event of an abnormal situation, stop inflation immediately to reduce pneumoperitoneal pressure. Place the patient in a left-lying position with the head low and feet high so that air bubbles entering the right ventricle gather at the apex to prevent them from entering the pulmonary artery.

"Cardiopulmonary resuscitation and electrical defibrillation should be performed in time for cardiac arrest, while maintaining circulation while also flowing air out of the pulmonary artery."

"He Junjin did a good job, the fastest time to **** out the gas with a central venous catheter."

"I looked at the anesthesia record sheet. He Junjin increased the amount of fluid input after he came. I asked you why?" Director Miao's voice suddenly became cold, like a severe teacher asking a naughty student.

"Is it because the infusion of a large amount of fluid increases the venous pressure and prevents the carbon dioxide gas from further entering the venous system?" Director Liu's basic knowledge is also quite solid, and he answered directly without thinking.

"Well, that's it."

When Director Mi Miao saw the last stitch, he turned around and walked away.

"Director, UU reading . Wait a minute!" Director Liu speeded up his hand, the last needle passed out, patted the needle holder and tweezers on the patient's leg, and turned to catch up with Director Miao.

"Huh?" Director Miao murmured softly.

"Director, I went to see you a few days ago, and you think about what you said." Director Liu said very seriously, "Returning hires, there is nothing too heavy, just take us to check the room for one day. The key is ... The key is that you are not there, I don't know. "

"Promises," Director Miao sneered. "Sooner or later, you have to leave. Don't be afraid to do it because of one or two accidents. Go back and read the book and ask He Junjin. I remember doing gastrointestinal surgery 3 years ago. Gas embolism occurred in a laparoscopic operation. He was anesthetized by that operation. "

When Laohe saw Boss Zheng leaving, he unplugged the USB flash drive, and was busy chopping. Hearing Director Miao mentioned himself, he smiled.

Zheng Ren glanced at Lao He, it was really not easy to live this big.

"Director ..."

"You work hard, I retire is to retire, I will not re-employ." Director Miao said firmly.

After speaking, he turned his back and slowly left the operating room.

Zheng Ren glanced at Director Liu and followed in the footsteps of Director Miao. He knew the meaning of Director Miao's last sentence. Director Miao was still kind.

Uh ...

Uh ...

Note: The case is quoted from the Chinese Journal of Emergency Medicine, Vol. 23, No. 9, September 2014.