Chapter 18 Intra thoracic cardiac resuscitation

  Liu Yuanyuan's condition changed, and when the nurse informed Tang Xiaofeng, Liu Yuanyuan had already gone into shock. Tang Xiaofeng hastily asked the nurse to call Director Zhu, then told another nurse: "Check her blood pressure." After checking Liu Yuanyuan's pulse, Tang Xiaofeng muttered to himself: "Her pulse is rapid and weak."

  "Real sound." Tang Xiao Feng knocked on Liu Yuanyuan's ribcage and asked, seeing the nurse taking off the blood pressure stethoscope, "How much is the blood pressure?"

  "The nurse replied: '60/40.'"

  "What's going on?" Director Zhu and Director Sun rushed into the ward in a hurry, and as soon as they entered the door, Director Zhu asked.

  "Liu Yuanyuan is having a hemorrhage, the drainage tube has already drained more than 600ml of blood in less than an hour, it's bleeding very fast, needs to open chest immediately to stop the bleeding." Tang Xiaofeng hastily replied.

  The pale complexion, rapid and weak pulse, decreased blood pressure and shock that appeared due to the car accident were all consistent with the previous diagnosis of hemothorax. However, it had only been a short time since the drainage began. Tang Xiao Feng was very certain that in less than an hour, the bleeding had already exceeded 600 milliliters, and the drainage tube in the bottle was still continuously bleeding, which could confirm that Liu Yuanyuan was experiencing progressive bleeding.

  "Arrange the operating room immediately and prepare for surgery, Xiao Tang, you come with me to the operation." Director Zhu instructed the nurse.

  "Alright, I'll arrange it right away."

  "Alright, got it."

  "Teacher Sun, the lung cancer patient is going to be discharged." Zhang Wei hastily ran into the ward and said.

  "Oh! Alright, you let Director Wang go and do some ideological work on them, try to keep them in the hospital, stabilize their condition first before talking." Director Sun looked at Zhang Wei and replied. "Okay, I'll go talk to the head nurse now." He then turned around and ran off.

  In the disinfection room, Director Zhu, Tang Xiao Feng, Zhao Yong and others are washing their hands before surgery. The purpose of hand washing before surgery is to eliminate bacteria on the hands and arms of surgical personnel, so this hand washing is not as simple as ordinary hand washing. It is necessary to roll up both sleeves to one-third of the upper arm, tuck the lower hem into the waistband, and then start cleaning both hands. The most commonly used method in hospitals is iodine scrubbing, first washing with soap and water, then rinsing with clean water, and finally wiping twice with a 5% povidone-iodine swab, which must be washed up to the elbow and 10 cm above the elbow.

  When Tang Xiaofeng put on the sterile gown and gloves with the help of the nurse, Director Zhu called everyone to the operating table and pointed at Liu Yuanyuan, asking Tang Xiaofeng: "Xiaofeng, you come, how should this operation be done?"

  Tang Xiaofeng thought for a moment and simply answered Director Zhu based on his previous surgical experience. Director Zhu's face flashed with a look of surprise at Tang Xiaofeng's answer, which was not limited to theoretical knowledge, but like a doctor sharing his practical experience with others.

  Thoracotomy, also known as thoracic exploration, is usually performed when the location of the intrathoracic lesion cannot be determined after various clinical examinations. Hemothorax is also included in this category. The purpose of performing a thoracotomy on Liu Yuanyuan was to directly observe the bleeding site and provide surgical hemostasis treatment.

  Director Zhu suppressed the surprise in his heart, instructed a few people to take their positions, and prepared to start surgery on Liu Yuanyuan. After disinfecting Liu Yuanyuan, Director Zhu picked up the surgical knife and instructed: "I'll be the lead surgeon, Tang Xiaofeng will assist me."

  Director Zhu first made an incision in the skin, and with a few more cuts, he opened up Liu Yuanyuan's. The several movements were continuous and orderly, fast and proficient, completing the procedure seamlessly, making one involuntarily praise Director Zhu for being truly vigorous and energetic in his old age, with his surgical skills undiminished from his prime years.

  Taking over the thoracostomy instrument, prying open the incision, Director Zhu instructed: "Zhao Yong hold it in place, Tang Xiaofeng prepare to aspirate blood, pay attention to where the bleeding is coming from..."

  As soon as Director Zhu finished speaking, Tang Xiaofeng inserted the electric suction device into Liu Yuanyuan's thoracic cavity and began to aspirate blood. Meanwhile, Director Zhu focused his attention on the incision in the thoracic cavity, trying to locate the source of bleeding at the moment when Tang Xiaofeng was sucking out the blood.

  The suction device was aspirating quickly, but the accumulated blood in the thoracic cavity didn't seem to be decreasing. Director Zhu saw this and before he could instruct the next course of action, a nurse on the side suddenly reported: "Heart rate is slowing down, blood pressure is dropping, it's at 50 now!"

  "Administer adrenaline! Blood transfusion." Director Zhu glanced at the monitor and ordered calmly.

  "It's already lost."

  "Tang Xiaofeng, speed up the suction, the patient is bleeding too fast, can't see the bleeding port." Liu Yuanyuan's blood pressure dropped drastically, and Director Zhu became somewhat impatient.

  "Blood pressure is gone!"

  "Heart stopped!"

  The nurse's consecutive beeps made everyone stop in their tracks. Liu Yuanyuan had lost too much blood, and death was expected, but no one thought it would come so soon. After glancing at the monitor, a deep sigh escaped her lips.

  "Note down the time of death." The hospital had patients dying almost every day, Director Zhu was already used to such existence, calmly instructing the nurse beside him.

  "Wait, there may still be hope..." Tang Xiao Feng called out to the nurse and then instructed her: "Change my gloves." The nurse looked at Tang Xiao Feng in surprise but didn't say anything else, helping him change into a new pair of gloves. When everyone was watching Tang Xiao Feng, not knowing what he was going to do, suddenly he stretched out his right hand and inserted it into Liu Yuanyuan's chest cavity, without seeking the approval of Chief Surgeon Zhu.

  "What does he want to do?" Everyone looked at each other, could it be that he wants...

  He felt Liu Yuanyuan's heart, and Tang Xiaofeng confirmed that Liu Yuanyuan was in cardiac arrest rather than still in ventricular fibrillation. Then he grasped the warm heart with his thumb in front and the other four fingers behind, squeezing it down one by one.

  "Internal cardiac massage?" Director Zhu exclaimed in surprise, this is a kind of cardiopulmonary resuscitation that is rarely used clinically, but Liu Yuanyuan's bleeding was so fast, would this method work?

  As time passed, the entire operating room became tense after Tang Xiaofeng inserted his hand into Liu Yuanyuan's thoracic cavity. Everyone's attention was focused on him, and at this moment, they were thinking of only one question: Could Tang Xiaofeng make her heart beat again?

  "Xiaofeng, stop it, with this kind of bleeding, there's no use." Director Zhu couldn't help but advise Tang Xiaofeng.

  "A teacher's life is precious, can't give up any opportunity or possibility." "Adrenaline, cardiac injection," Tang Xiao Feng turned to the anesthesiologist beside him and said.

  The anesthesiologist looked at Director Zhu, saw him nod, and immediately injected adrenaline into Liu Yuanyuan's left ventricle. Injecting adrenaline into the heart is to promote cardiac resuscitation, increase myocardial tension, and enhance compression effect, but... obviously this adrenaline did not produce the effect Tang Xiaofeng wanted, the monitor still showed no waves. Jump for me! Jump! ~ Tang Xiaofeng shouted in his heart, his entire arm was slightly numb, and the sweat on his forehead was getting more and more. He quickly glanced at the monitor, still no good! Fate has been decided, for this 31-year-old young life, he was powerless to change it!

  Just as Director Zhu wanted to stop Tang Xiaofeng again and let him give up, he heard the nurse's excited cry. "There's a heartbeat!" He subconsciously turned his head towards the monitor, and the data on it confirmed the nurse's excited cry. Director Zhu was overjoyed, Liu Yuanyuan's heartbeat had recovered.

  "Blood pressure has also recovered, good, nurse, add a bag of blood," the result was unexpected by Director Zhu, but it's always good that Liu Yuanyuan's heart can beat again. He straightened his body and said: "Xiaofeng, stop for now, we need to find the source of the bleeding first."

  "It's been found, it's here." Táng Xiǎo Fēng stopped his hand, slowly moved the blood-stained fingers away from the heart, and then removed his thumb to reveal a crack less than one centimeter long.

  "Hemostatic forceps!" Director Zhu ordered, the instrument nurse handed over the hemostatic forceps, he took them and clamped down on the wound on the heart, and the bleeding finally stopped.

  "Suction." The assistant began to suction, this time with a hemostatic clamp clamping the incision, and quickly sucked out the accumulated blood in the thoracic cavity. Director Zhu then wiped away the blood stains on the heart, carefully observed for a while, and only stopped when he confirmed that there was no bleeding elsewhere.

  Liu Yuanyuan's condition has been brought under control, and Director Zhu is no longer anxious. He looks up to see Tang Xiaofeng staring at Liu Yuanyuan's heart and casually asks: "Xiaofeng, who did you learn this CPR from?"

  "...learned from books." Tang Xiao Feng replied, shifting his gaze. "Oh, looking at your movements, it doesn't seem like you're doing it for the first time?" Director Zhu's face was filled with doubt, if he really only learned from books, then he must be a brilliant new star in the medical field! "It's my first time, I practiced with balloons when I had nothing to do." Tang Xiao Feng said, looking at Director Zhu's puzzled face. "First time?" Director Zhu muttered softly without asking further, turning his head towards Zhao Yong: "Zhao Yong, repair the heart opening, you do it?"

  Suturing the heart is much more complicated than suturing other parts, and the difficulty is also quite high. The people present, namely Director Zhu and Doctor Zhao, are the only two who can complete it. Although Tang Xiaofeng gave himself too many surprises and unexpected events, he was also excluded from it.

  "Director, you come." Zhao Yong felt a little uneasy and knew he wasn't suitable for this delicate work at the moment, so he hastily declined. After speaking, he secretly glanced at Tang Xiaofeng again. Did he succeed in restoring the patient's heartbeat on his first try? He had performed CPR six times as a doctor, but the only successful patient still couldn't escape death.

  Director Zhu quickly finished suturing the incision in the heart, and after about thirty minutes, he confirmed that Liu Yuanyuan's vital signs were stable before suturing the incision. He said to Zhao Yong: "Dr. Zhao, the patient is now in your hands. If the vital signs are normal two hours later, arrange for her to be sent to the general ward." "Okay, got it, Director," he replied. After finishing speaking, Director Zhu walked out of the operating room with everyone else.

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