Chapter 336: Sweaty eyelids

Chapter 336 Sweating Eyelids
In the first few years of 2000, let alone in the border areas, even when calling in the city, from time to time, you have to shake your head and look for mobile signals.
It seems that after the Olympics, or one year before the Olympics, the country's network suddenly became stronger. The mobile phone signal got worse.
Even in the mountains, there can be relatively strong signals. The network has also begun to spread to the towns. In this town with few people, China Unicom Telecom is either next door or door to door.
The development of the network has also greatly helped medical care. Online consultation is on the rise. For diseases that cannot be diagnosed in towns and villages, directly contact the superior hospital through the platform of the health system, and allow experts to consult through the network. One consultation is 30 yuan!
Common chronic diseases can also be handled through online consultations, but this emergency, especially life-threatening diseases, has no good way. If there is no medical unit tonight. Tusun Khanjiang had to go to the county seat hundreds of kilometers away, depending on his life and death.
There are doctors in rural hospitals, but after several years of siphoning in the medical system, within a few years, township hospitals have shrunk considerably. Slightly more skilled doctors went to the county seat. The doctors in the county seat, slightly better or younger doctors, either went to the city or to the south. Little townships can no longer support surgeons. As a result, the township hospital became a drug store.
There is no way to stop the drain of talent. In the end, only through going to the countryside, and regularly going to the countryside can we solve the medical problems in small places. When there is no doctor going to the countryside, once an emergency occurs, it is a very troublesome thing. Then, the chain reaction is that the crowd gathers towards the city more quickly. When it comes to why you go to the city, most people will say: For the education of children, for the medical treatment of the elderly.
Perhaps this is urbanization!
Once the abdominal organ bleeding is considered, the bleeding organ must be quickly found to stop bleeding. Abdominal organs are particularly vulnerable to bleeding after being hit, such as the liver, kidneys, and spleen.
These organs, first of all, are relatively fixed, and they are very crispy. The fresher they become, the softer and crispier they become. There is a car accident in the city, the speed is not high, after the collision, there is no trauma, but the person has already been in shock. This situation often causes damage to the abdominal organs, resulting in major bleeding.
This surgical car in Huaguo was all imitation German goods in the early years. It seemed to be made by a certain car factory. The price was considered extremely expensive in that year.
Later, the policy was liberalized, and Yutong Automobile came later. I do n’t know why, they did n’t learn German, and they took over the technology of Maruko. After a few years of development, they were in the field of medical professional vehicles, and they surpassed other car factories in China in a few years. Most of these professional vehicles have been contracted by them, of course, except for some designated ones.
Where Maruko fart is big, it doesn't work on a macro scale. But in this small means, small platform, I really have to admire others, doing a pretty good job, everything is very smooth and reasonable, almost perfect.
The abdominal midline is not a straight line. Must escape the navel. Because this place is a depression, it is a place to hide dirt and dirt. It is not easy to recover after surgery. It is also easy to be infected. For abdominal surgery, this place is the focus of disinfection.
Open the skin, the skin is like a thin kraft paper. Cut the skin, followed by a superficial fascia. What exactly is this thing, in fact, it is white fat and some loose knots and hoofs, which are mainly the superficial blood vessels and cutaneous nerves that walk.
This is the advanced nature of human evolution. As long as there are a large number of blood vessels or nerve walks, almost all of this soft fat and slightly harder knots and tissues serve as protective layers. Without this layer of organization, maybe the other person who can slap casually can slap on the face.
"Electric knife, gauze." After entering the superficial fascia, the bleeding began to increase, Zhang Fan said softly. Baoying Lishou passed the things Zhang Fan needed. Be careful when passing things on the operation car, because after all, this platform is for emergency use, and everything is almost single.
After hemostasis is completed, continue to enter. "Move faster, blood pressure can't rise." Dr. Liu Yaowen from the Department of Anesthesia, watching the monitor give Zhang Fan a beep.
"Okay." Zhang Fan already had a fast speed and took another step forward. Although faster, he couldn't help but pay attention to the level. The abdominal structure was too complicated.
Regardless of internal organs, this abdominal muscle layer is very complicated. The abdominal organs are too important. The abdominal muscle layers are layered. Popularly speaking, this abdominal muscle layer is like two doors, divided from the navel to the midline into two sides of the door.
Many people think that when the muscles are opened, the organs in the abdomen can be clearly seen, but in fact they are not. Simply put, the muscle is the door. When you open the door, there are curtains and internal walls. The so-called curtain is the omentum.
Therefore, when entering the muscular layer, only a small part of the organs can be seen, such as a small part of the liver, stomach, and a small section of the large intestine, a part of the small intestine. The other organs are invisible.
The anesthesiologist has reminded that the blood pressure is no longer up, so the hemostasis of the muscle layer is very simple and the gauze is compressed. Wait for the internal organs to be processed before returning to processing.
Opening the curtain is the wall. This so-called wall is derived from the abdominal wall, that is, the double-layer plastic film on the belly.
This thing separates each organ like a wall. This peritoneum is double-layered and contains a small amount of fluid. It has many functions. The most important thing is to prevent friction and buffering between abdominal organs.
Without this structure, people cannot move violently, because once the activity is intense, the abdominal organs are strongly rubbed against each other, and the organs as thin as cicadas may be worn out, and then either the blood of one stomach is the one of the stomach Poop! It's scary.
Opening the peritoneum, a large amount of congestion appeared. Zhang Fan looked at it and said, "The bleeding is on the upper left side. It is not the liver, it is the spleen." Then he opened the bottom of his stomach and looked for the spleen.
The spleen, because it is a small organ, has not been studied much in the early years, but it is simply considered as an organ for hematopoietic in childhood and fetus. In adulthood, it is an organ that degenerates like an appendix.
With the deepening of research, I slowly discovered that this organ is an important immune organ. Once a problem with the spleen was found, it was removed directly. However, with the development of evidence-based medicine, the medical community has defined this organ as the largest immune organ in the human body. It has many functions, such as hematopoietic, blood storage, filtered blood, and most importantly immune function.
The shape of the spleen is an enlarged broad bean, almost identical, hidden under the tenth and eleventh rib arches on the left. The upper part is covered with the stomach body, and the pancreas is next to it.
The surface of this thing is still wearing a thin coat, and many spleen traumas. When it was just injured, there were no symptoms at all. It is because of this thin coat that when the bleeding breaks through this layer of clothing, it is the time of shock.
After confirming the bleeding, Zhang Fanyi said to Baoyin, "The scalpel!" Because the position of the spleen is relatively high, Zhang Fan's incision is relatively low, and the incision must be extended upwards. In this case, you must drive under the xiphoid.
"Full cut?" Just as Zhang Fan stretched his blade upward, Lu Shuyan asked.
"If you look at it, you can keep it. If you can't keep it all, it's best to make a partial cut." Zhang Fan said as he quickly extended the knife edge.
"gauze!"
"Dr. Zhang, the blood pressure is severe." When Zhang Fan opened his stomach and cut the peritoneum, the pressure around the wound suddenly decreased, the amount of bleeding increased, and the patient's blood pressure dropped significantly.
"The amount of fluid in the veins has increased. Epinephrine and dopamine combined with static push, ready for blood transfusion." Zhang Fan, who had goosebumps on the original, sweated down. The operation was not difficult, but because of the delay, the patient suffered too much bleeding.
"Dr. Zhang, the effect is not good, and the blood pressure continues to drop." The anesthesiologist's tone also quickly spit out the words.
"Blood transfusion. Use O-type RBC directly." Zhang Fan is really dual-purpose, quickly processing the tissue under his hand, entering the spleen area while refueling, while still giving an oral medical order.
In general, even in hospitals, blood transfusion cannot be easily done. Today, this situation is even more troublesome. First of all, I don't know the blood type of the patient number, and it is too late to detect. It is not a technician in the laboratory.
This kind of life-saving moment, time is urgent, no delay can be tolerated, all rely on doctors' weighing, bold weighing. The trade-off is good, it can save lives, and the trade-off is not good, maybe it's direct death!
Under normal circumstances, blood is stored and checked in large hospitals. But in emergency rescue, where can I take care of it? Fortunately, there is O-plasma in the operating car. Otherwise, only the doctor or nurse will be available on site. In such places, few people know their blood type, only doctors and nurses know their blood type. Even if other people know their blood type, they are not soldiers, not police, and Zhang Fan dare not use them!
This is why, at a critical moment, when the hospital is ischemic, the army or police force directly entered the hospital! And this is an order, a military order that cannot be negotiated. Really, for these people, the country owes them, and the people owe them.
Do n’t think that blood transfusion is life-saving, in fact, the risk of blood transfusion is not small, even if there are many blood problems of the same type, so in general, try to avoid blood transfusion without transfusion.
"Left venous channel increases hydroxyethyl starch. Give me fifteen minutes, just fifteen minutes. Quick!" Zhang Fan said aloud.
"Gauze, stuffing!" Only Zhang Fan ordered in the operating car.
"Three bending pliers. Look! Urine has come out!" Zhang Fan said at this time, it is considered an oral doctor's order, both the nurse and the anaesthetist must perform it, unconditionally, because the best understanding of the condition at this time is Surgeon.
"No urine!" Said the circuit nurse, Lisuo.
"Quick! Scissors!" Regardless of whether the spleen is completely or partially removed, the spleen must be completely freed because the tissue here is too complicated.
The stomach, pancreas, and intestines are all in this one, and here the vessels communicate with each other and go along with each other, which is very rich. If they are not carefully separated, a mutated blood vessel will come out and a pair of scissors will really make things worse.
And the upper pole of the spleen is the spleen-gastric ligament. This ligament is too short, and the short arteries and short veins of the stomach are in the shape of the spleen.
"Support the spleen with gauze. Pay attention to the ligaments here. Be gentle. Don't pull it." After the spleen was released, gently supporting the spleen with gauze, Zhang Fan specifically explained to Lu Shuyan.
The spleen is shaped like broad beans. It has a door, which is where it bends on the inside. This place is where the broad beans sprout. The same is true for the spleen. The medial curve here is the spleen hilum, which is shaped by arteries and veins.
A handful of curved pliers, beginning to clamp one by one. With the clamps of the curved pliers, the bleeding was significantly reduced until the bleeding stopped. This time is slightly better than the first ten minutes. This can be regarded as a disguised hemostatic.
"Dr. Zhang, the blood pressure has risen. The time has passed 9 minutes!" The anesthesiologist said deliberately.
"Yeah!" Zhang Fan responded a little, and was not in a hurry at this time. How much can the spleen be cut to retain its immune function? There is currently no clear definition in the medical community. However, it must be at least two-thirds, or it would be meaningless.
All the parenchymal organs, their blood vessels are like two big trees. At the doorway, it is a thick trunk, and after entering the organ, it begins to branch and loosen leaves, and then at the end of the arteriovenous, a connected capillary network is formed, one in and one out.
The arteries of the spleen are generally divided into two to three points at the spleen hilum, and then enter the parenchyma of the spleen in two or three grades. The vein arteries of the spleen are shaped like brothers, holding hands and walking together.
The longest spleen of a Chinese male is about 14 cm, but the vascular arteries inside the spleen of an average person are 15 cm. It can be imagined how slender and twisty this gadget is.
After the lower pole of Tu Sunhan's spleen was violently hit by the male deer, he directly opened a mouth the size of popcorn. The spleen is too brittle and the male deer is strong. There is no chance of suture, only partial removal.
This partial resection is not a cut along the piece where the wound is, but a blood vessel. Zhang Fan carefully distinguished which was the lower pole artery and which was the lower pole vein, and then slowly ligated one by one.
"I'm knotting!" In general surgery, after the surgeon uses a needle holder to put the thread in, the assistant will hold the loop and knot it. But Zhang Fan was uneasy about Lu Shuyan. This is a knot in the blood vessel. It will break the blood vessel with less strength, and the blood vessel will not be ligated with less strength.
Lu Shuyan was stained with gauze and blood while helping Zhang Fan to support the needle holder. At this moment, no one would refute or be dissatisfied. Doing what the main knife lets you do is the minimum professional ethics of the surgeon.
The blood vessels to be ligated were ligated one by one, and Zhang Fan just let out a little breath. "Help me sweat." Too nervous, Zhang Fan felt that his eyelids were sweating!
At this time, it is waiting, waiting for the boundary between the area with blood supply on the spleen surface and the area without blood supply after being ligated. As long as the ligation passes, within minutes, the and bloodless areas of the spleen will be particularly clear.
One side is still red or pink, while the other bloodless area is noticeably pale.
"Scalpel." Three or four minutes later, the boundaries were clear. In order to ensure the vitality of the spleen, Zhang Fan cut a spleen coat with a scalpel one centimeter away from the junction line, and then cut into the spleen parenchyma with a knife handle.
The spleen is particularly brittle, and it is easy to hurt the blood vessels with the blade. Although the handle is blunt, it is safe. Slowly form a V-shaped incision at the front and back edges of the spleen, extending little by little to the inside.
One side cut, Zhang Fan's left thumb and forefinger always hold and press the edge of the spleen, this is to fix the spleen. This can effectively control and reduce bleeding in the book.
It's simple to say, but it's actually very difficult to operate. Simply put, it is to wear plastic gloves, and there is grease on the gloves. Then hold the round soap stained with water or oil. This should not be too strong, but also ensure that the soap is fixed.
This is the kung fu under the surgeon's hands. There is no more than a decade of exercise, let alone surgery. It cannot be done with a simple grip.
Going bit by bit, there is a small amount of bleeding on the surface of the spleen, which is the residual blood in the capillary network. "Dip!" Zhang Fan said softly to Lu Shuyan.
Although this kind of bleeding does not require special treatment, it must be removed, otherwise it will affect the surgical field, and this wound cannot be wiped. Dip it, and gently dip it with gauze. A wipe will not only damage the organs, but also change the position of the spleen.
"Ligation, this is an arteriole. Be careful not to slip the knot." Zhang Fan held the spleen in one hand and a scalpel in one hand, and found an arteriole. He couldn't tie it, so Lu Shuyan tied it. Before the knot, Zhang Fan explained specifically.
"Huh!" Lu Shuyan said a word, and then began knotting. Zhang Fan's eyes looked motionless, afraid of a knot or opening his spleen. The spleen is more brittle than the kidneys, and it is a bit of a mouth if it is slightly wrong. This is why the spleen is prone to rupture.
Finally, the injured part of the spleen was excised. Lu Shuyan often took a sigh of relief after holding the excised spleen into a tissue bag.
This operation was too nervous, and Zhang Fan was too harsh on the operating table. She said that she was frightened. At this time, if you look at the spleen from under the spleen, it is like a V-shaped duck mouth with a large mouth and a small mouth.
This shape is for later stitching. The spleen is very brittle, and this shape is made for sutures. So a good surgeon constructs a perfect surgical procedure in the brain before the operation.
"I stitch, I knot, Dr. Lu cut your thread." Zhang Fan said to Lu Shuyan.
"Ok."
Lu Shuyan did not dare to tie knots. This very brittle organization, knotting is really kung fu, just like pulling a piece of paper on a piece of paper. If it is not pulled well, it is a torn mouth.
And this kind of suture cannot use small needles and thin threads. Because small needles and thin threads can cause capillaries to crawl and cause ischemic necrosis. Therefore, this general suture general dare not guarantee that he can sew well.
"Liver needle! Thick thread!" Baoyin Lisuo passed the needle and thread and handed it to Zhang Fan. It is true that there is a speciality in the surgery industry. In the past, a simple needle threading seems to be a very simple thing.
Not necessarily on the operating table. Wear gloves first, and when you stop bleeding quickly, you must keep slickness under your hands, one needle for three seconds and one needle for three seconds. So the surgical nurse can't do it at a little old age, and his eyes can't be done first.
This kind of kung fu is also a skill that the nurses practiced numerous times under the operating table on weekdays. No hard work, no hard work, no work at all.
The liver needle thick horizontal mattress suture combined with intermittent suture finally closed the incision. A broad bean had originally become a cone. After the suture was completed, Zhang Fan used adhesive foam on the wound to stop bleeding.
"Finally done!" The girl was relieved when Lu Shuyan watched Zhang Fan cover the omentum with his spleen. Zhang Fan on the operating table was so cruel, the crises became more cruel. But the more she was responsible, she looked at Zhang Fan with flowers in her eyes!
"When the arterioles were knotted, if I had torn my spleen, would you have hit me?" Lu Shuyan saw the operation was coming to an end, and she could not speak through her brain.
"Where are you? No need for aseptic operation!" Zhang Fan rolled Lü Shuyan's eyes.
"Hit the chest, that place is sterile!" Liu Yaowen, an old man from the anesthesiologist, made a mistake. At this time, the atmosphere became active. Although everyone said something, they seemed to be filled with a sense of accomplishment. I did n’t want to be proud and not content, but it was really uncomfortable not to release. It's up!
"Rogue!" Baoyin and Lu Shuyan scolded together.
"Hey!" The old man smiled warily.
The operation is over!
Outside the operating car, as the operation started, the people of the Tusun Khan River tribe, as well as the relatives of the Tusun Khan River wife, also learned the news.
Riding a horse and holding a lantern, they gathered outside the surgical car from everywhere. More and more people are comforting Tu Hanhan's wife and caring about surgery.
The head of the township also came, "Everyone is quiet, don't interfere with the doctors in the car to perform the operation. Take the horses a bit further."
Because before the operation, Zhang Fan asked Zhang Yanfeng of the Department of Respiratory Medicine to inform the family of Tusun Khanjiang that the situation was very dangerous. Therefore, Tu Sunhan's sturdy wife had already cried, and sat softly under the cymbal of the operating car.
No matter how sturdy she is, she is also a wife. She kept thinking and praying in her mouth.
"Yes, let people go home. If it was an accident ~~" Dr. Zhang Yanfeng said to the head of the township, looking a little worried at the growing crowd.
"It's okay, rest assured. Adasi, if it wasn't for you, Tu Sunjiang would have died a long time ago. We are all justified. You can rest assured that there is nothing. Every spring, some animals are kicked to death. Big. Hu Bless you! "
After speaking, the head of the town stood in the crowd and said, "Doctors have surgery all night. This is a benefactor. If the situation is different, whoever is Hu Heli, I will be a whip! I know it!"
Six thousand words, can be regarded as three chapters, the original medicine is divided into three chapters,
But then there is no coherence,
So it is a big chapter directly
So ask for votes
ticket!
(End of this chapter)