Medical road

In the first few years of 2000, let alone border areas, even when calling in the city, I would shake my head and look for mobile signals from time to time.

It seems that after the end of the Olympics, or a year before the Olympics, suddenly the country's network became more powerful.The mobile phone signal becomes stronger.

Even in the mountains, there is a relatively strong signal.The network has also begun to spread to towns and villages.In this small township, China Mobile Unicom Telecom is still doing confrontation either next door or door to door.

The development of the Internet is also of great help to medical treatment.With the rise of online consultations, for diseases that cannot be diagnosed in towns and villages, directly contact the higher-level hospitals through the platform of the health system, and allow experts to consult through the Internet. A consultation is 30 yuan!

General chronic diseases can be dealt with through online consultations, but this kind of emergency, especially life-threatening diseases, is still no good way, if there is no medical team tonight.Tusunhanjiang had to go to a county a few hundred kilometers away, and his life would depend on his fate.

There are doctors in rural health centers, but after a few years of siphoning in the medical system, the township health centers have shrunk rather severely within a few years.Doctors with a little bit of skill went to the county town, the doctors in the county town, the doctors who were a little bit more powerful or younger, either went to the city or went to the south.The small township cannot feed the surgeon.The final result of the development was that the township health center became a pharmacy.

There is no way to stop the loss of talents.At the end of the development, only by going to the countryside, regular visits to the countryside can solve the medical treatment in small places.When there is no doctor going to the countryside, once an emergency occurs, it is very troublesome.Then, the chain reaction is that the crowd also gathers more quickly toward the city.When talking about why you want to go to the city, most people will say: for the education of children, for the medical care of the elderly.

Maybe this is urbanization!

Once the abdominal organ bleeding is considered, the bleeding organ must be found quickly to stop the bleeding.Abdominal organs, after being hit, are particularly easy to bleed are some substantial organs, such as liver, kidney, spleen.

These organs are relatively fixed at first, and they are all very brittle, the more fresh they are, the softer and crisper they are.There was a car accident in the city. The speed was not high. After hitting a person, there was no trauma, but the person was already in shock. This situation often caused damage to the abdominal organs, leading to heavy bleeding.

In the early years, this surgical car in China was all counterfeit German products. It seemed to be manufactured by a certain auto factory. The price was considered super expensive back then.

Later, the policy was opened up, and Yutong Motors followed suit.I don't know why, they didn't learn German, and they took over the technology of Maruko Country. After a few years of development, they surpassed other automobile factories in China in the field of medical professional vehicles in a few years.Almost all of these professional vehicles are contracted by them, of course, except for some designated ones.

Where the meatballs are big in the country, the macro is not good.But in this kind of small means, small platform, I really have to admire others, what they do is quite powerful, and everything is done smoothly and reasonably, almost perfect.

Surgery on the midline of the abdomen is not a straight line.Must avoid the belly button.Because this place is a depression, it is a place where dirt and dirt are hidden, it is not easy to recover after the operation, and it is also easy to be infected.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 the superficial fascia.What is this thing, in fact, it is white fat and some loose hoof knot tissue, which mainly consists of walking superficial blood vessels and cutaneous nerves.

This is the advanced nature of human evolution. As long as there are a large number of blood vessels or nerves, almost all of this soft fat and slightly harder knot tissue act as a protective layer.Without this layer of organization, maybe the opponent who can slap casually will be bloodied.

"Electric knife, gauze." After entering the superficial fascia, bleeding began to increase, Zhang Fan said softly.Baoyin quickly passed the things Zhang Fan needed. Be careful when passing things on the surgical cart, because after all, this platform is for emergency use, and almost everything is single.

After stopping bleeding, continue to enter."Move faster, blood pressure won't rise." Dr. Liu Yaowen from the Anesthesiology Department gave Zhang Fan a reply while looking at the monitor.

"Okay." Zhang Fan was already fast, and he took another step up. Although he wanted to be fast, he still had to pay attention to the levels. The abdominal structure was too complicated.

Not to mention the internal organs, first of all, the abdominal muscle layer is very complicated, the abdominal organs are too important, and the abdominal muscle layer is considered layered.In layman's terms, this abdominal muscle layer is like two doors, divided into two doors from the belly button to the midline.

Many people think that by opening the muscles, the organs in the abdomen can be clearly seen, but it is not.Simply put, the muscle is the door. When the door is opened, there are also the door curtain and the inner wall. The so-called door curtain is the omentum.

So when you enter the muscle layer, you can only see a small part of the organs, such as a small part of the liver and stomach, a small part of the large intestine, and a part of the small intestine.The other organs are invisible.

The anesthesiologist has warned that the blood pressure cannot go up, so the hemostasis of the muscle layer is very simple, gauze pressure.After the internal organs are processed, go back and process again.

Open the curtain, it is the wall.This so-called wall is a double-layer plastic film derived from the abdominal wall, which is the belly.

This thing separates the various organs like a wall. The peritoneum is double-layered with a small amount of liquid inside. It has many functions. The most important thing is to prevent friction and cushioning between abdominal organs.

Without this structure, people cannot do vigorous activities, because once the activities are vigorous, the abdominal organs will rub against each other strongly, and the organs that are as thin as cicada wings may be worn out, and then it will be either a stomach of blood or a stomach. Poop!It's terrible.

Opening the peritoneum, a large amount of congestion appeared. Zhang Fan took a look and said: "The bleeding is on the upper left side. It is not the liver, but the spleen." Then he turned over the stomach and started looking for the spleen.

The spleen, because it is a small organ, has not been studied much in the early years. It is only considered to be a hematopoietic organ in childhood and fetus. It is an organ that degenerates like the appendix in adulthood.

With the deepening of research, it was gradually discovered that this organ is a very important immune organ. Once a problem with the spleen was discovered, it was simply removed.However, with the development of evidence-based medicine, the medical profession defines this organ as the human body's largest immune organ.It has many functions, such as hematopoiesis, blood storage, blood filtration, and the most important immune function.

The spleen is shaped like an enlarged broad bean, almost exactly the same, hidden under the tenth and eleventh ribs on the left.The stomach is covered on top, and the pancreas is next to it.

This thing is still wearing a thin coat on the surface, many spleen injuries, when first injured, there were no symptoms at all.It's because of this thin coat blocking it, and when the bleeding breaks through this layer of clothing, it is the time of shock.

After confirming the bleeding, Zhang Fan said to Baoyin: "Scalpel!" Because the position of the spleen is relatively high, Zhang Fan's incision is relatively low, and the incision must be extended upward.In this case, you must drive under the xiphoid process.

"All cut?" Lu Shuyan asked as Zhang Fan stretched his knife upward.

"Look at it, let's keep it if you can keep it. If you can't keep it all, it's best to do a partial excision." Zhang Fan said as he stretched the cut quickly.

"gauze!"

"Dr. Zhang, the blood pressure dropped a lot." When Zhang Fan turned the appetizer and opened the peritoneum, the pressure around the wound suddenly decreased, the amount of bleeding increased, and the patient's blood pressure dropped significantly and rapidly.

"The amount of intravenous fluid has increased. Adrenaline and dopamine are combined with intravenous pushes to prepare for blood transfusion." Zhang Fan, who had gotten goose bumps on his body, was sweating.The operation is not difficult, but because of the delay, the patient is bleeding too much.

"Doctor Zhang, the effect is not good, and the blood pressure continues to drop." The anesthetist's tone was also swift and almost slurred.

"Blood transfusion. Use O-type RBC directly." Zhang Fan is really a dual-purpose, he is quickly processing the tissue under his hand, and entering the spleen area with oil, while still giving an oral doctor's order.

Under normal circumstances, even in the hospital, blood transfusion is not easy.Today’s situation is even more troublesome. First of all, I don’t know the blood type of the patient, and it’s too late to be tested. I am not a laboratory technician, and the speed under the hands of ordinary people is even too late.

This life-saving moment is short of time and can not tolerate delay. It depends on the doctors to weigh and boldly weigh.Well-balanced, it can save lives, but if the balance is not good, it may be directly fatal!

Under normal circumstances, blood is stored in large hospitals and blood has been checked.But in the emergency rescue, no one can take care of it. Fortunately, the surgical cart is equipped with O-type plasma. Otherwise, only the doctor or nurse will be picked on the spot.In this kind of place, few people know their blood type, only doctors and nurses know their blood type.Even if other people know their blood type, if they are not soldiers or policemen, Zhang Fan dare not use it!

This is why at a critical moment, when the hospital is ischemic, the army or police force drove into the hospital directly!And this is an order, a military order that cannot be negotiated.Really, for these people, the state owes them and the people owes them.

Don't think that blood transfusion is saving lives. In fact, the danger of blood transfusion is not small. There are many problems with blood of the same type. Therefore, in general, try not to transfusion as much as possible.

"Add hydroxyethyl starch to the left venous channel. Give me fifteen minutes, just fifteen minutes. Quick!" Zhang Fan said loudly.

"Gauze, stuffing!" In the surgical cart, only Zhang Fan ordered.

"Three curved forceps. Look! Has the urine come out!" What Zhang Fan said at this time was considered an oral doctor's order. Both nurses and anesthesiologists must execute them unconditionally, because at this time, the one who understands the condition best is Surgeon doctor.

"No urine!" the itinerant nurse said sharply.

"Quick! Scissors!" Whether you cut the spleen completely or partially, you must completely dissociate the spleen because the organization here is too complicated.

Stomach, pancreas, and intestines are all in this area, and the vessels here communicate with each other and accompany each other. They are very rich. If they are not carefully dissociated, a mutated blood vessel will come out, and the scissors will make it worse.

Moreover, the upper pole of the spleen is the spleen-gastric ligament. This ligament is too short. The short artery and short vein of the stomach are formed inside. The separation is not clear. A slight stretch will break the two vessels.

"Support the spleen with gauze. Pay attention to the ligaments here. Be gentle and don't pull it." After freeing the spleen and gently holding it up with gauze, Zhang Fan specifically confessed to Lu Shuyan.

The spleen is shaped like a broad bean, and it has a door where it turns on the inside, where the broad bean sprouts.The same is true for the spleen, where the spleen is curved on the inside, and it forms arteries and veins.

Curved forceps one by one, start to clamp section by section. With the clamping of the curved forceps, the bleeding is significantly reduced until the bleeding stops.This time is slightly better than the previous ten minutes.This can be regarded as a disguised hemostasis.

"Doctor Zhang, the blood pressure has risen, 9 minutes have passed!" The anesthesiologist said specifically.

"Yeah!" Zhang Fan responded, not in a hurry at this time.How much does the spleen cut to retain its immune function?There is currently no clear definition in the medical community.However, at least more than two-thirds, otherwise it is meaningless.

All physical organs, their blood vessels are like two big trees.At the door, there is a thick trunk, and then after entering the inside of the organ, it begins to branch and disperse leaves, and then form a connected capillary network at the end of the arteries and veins, one in and one out.

The arteries of the spleen are generally divided into two to three parts at the hilum of the spleen, and then into the essence of the spleen after being divided into two or three levels. The venous arteries of the spleen are like the two brothers, holding hands and walking together.

The longest spleen of a Chinese male is about 14 cm, but the blood vessels and arteries inside the spleen of an average person are 15 cm. One can imagine how slender and tortuous this thing is.

After Tusun Hanjiang's spleen was violently hit by the male deer, a popcorn-sized hole was directly opened.The spleen is too brittle, and the male deer has great strength.There is no chance to suture, only partial excision.

This partial resection is not to cut along this piece where the wound is, but to look at the blood vessels.After Zhang Fan carefully distinguished which is the lower pole artery and which was the lower pole vein, he slowly ligated them one by one.

"I'm tying a knot!" In general operations, after the surgeon uses a needle holder to feed the thread in, the assistant grabs the thread back to tie the knot.But Zhang Fan was worried about Lu Shuyan.This is a knotting of blood vessels. If the strength is small, the blood vessels will be strangled. If the strength is small, the blood vessels cannot be ligated.

Lu Shuyan covered the blood with gauze while helping Zhang Fan support the needle holder. At this moment, no one would refute or be dissatisfied. This is the most basic professional ethics of a surgeon.

The blood vessels to be ligated were ligated one by one, and Zhang Fan breathed a sigh of relief."Help me wipe my sweat." Too nervous, Zhang Fan felt that his eyelids were sweating!

This time is to wait, waiting for the boundary between the area with blood supply on the surface of the spleen and the area without blood supply after ligation.As long as the ligation is passed, within a few minutes, the blood and bloodless areas of the spleen will be particularly distinct.

One side is still red or pink, and the bloodless area on the other side is obviously pale.

"Scalpel." Three or four minutes later, the boundaries were clear.In order to keep the vitality of the spleen, Zhang Fan used a scalpel to cut the outer garment of the spleen one centimeter away from the boundary line, and then cut into the spleen substance with a knife handle.

The spleen is very fragile, and it is easy to damage the blood vessels with a knife. Although the handle is a little blunt, it is safe.Slowly make a V-shaped incision on the front and back edges of the spleen, extending inward little by little.

While cutting, Zhang Fan's left thumb and index finger always held and pressed the edge of the spleen in order 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, wear plastic gloves, and there are grease on the gloves.Then go to hold the round soap soaked in water or oil. The force should not be too strong, and the soap should be fixed.

This is the skill under the hands of the surgeon. Without more than ten years of exercise, let alone surgery, you can't do it with a simple grip.

Bit by bit, there is a small amount of blood oozing 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 kind of wound should not be wiped, but should be dipped, gently dipped in gauze. A single wipe will not only damage the organs, but also change the position of the spleen.

"Ligate, this is a small artery. Be careful not to slip the knot." Zhang Fan held the spleen in one hand and a scalpel in the other. He found a small artery. He couldn't knot it, so he let Lu Shuyan knot it. , Zhang Fan gave a special explanation before tying the knot.

"Yeah!" Lu Shuyan replied and began to tie the knot. Zhang Fan watched motionlessly, fearing that there would be a slip knot or a gap in the spleen.The spleen is more fragile than the kidneys, and a little bit of force is wrong, just a hole.This is why the spleen is easily ruptured.

Finally, the damaged part of the spleen was removed.After Lu Shuyan took the excised spleen into the tissue bag, she often breathed a sigh of relief.

This operation was too stressful, and Zhang Fan's tone on the operating table was too harsh, she was frightened to speak.At this time, if you look at the spleen from under the spleen, it is like a V-shaped duck beak with a big mouth and a small inside.

This shape is for later stitching.The spleen is very fragile, and the operation is made into this shape for easy stitching.Therefore, a good surgeon constructs a perfect surgical procedure in his brain before the operation.

"I stitch, I tie the knot, Dr. Lu cut the thread." Zhang Fan said to Lu Shuyan.

"Ok."

Lu Shuyan didn't dare to tie a knot, this kind of very fragile organization, knotting is a real skill, just like pulling a string on another piece of paper, it will be a torn hole if it is not pulled well.

And this kind of stitching cannot use small needles and thin threads.Because the small needle thread will cause the capillary to fail to grow and cause ischemic necrosis.Therefore, the general surgeon who is stitched can not guarantee that he can sew well.

"Liver needle! Thick thread!" Baoyin handed it to Zhang Fan after putting on the needle and thread.There is nothing wrong with the specialization of Shuye. In the past, a simple threading and threading seemed to be a very simple matter.

Not necessarily on the operating table.First of all, wear gloves, and when the bleeding is stopped quickly, you must ensure that the bottom of your hand is sharp, one needle and thread every three seconds, and one needle thread every three seconds.Therefore, the surgical nurses can't do it even when they are a little older, first of all, the look in their eyes will not work.

This kind of kung fu is also a skill that nurses can only practice after countless times under the operating table.If you don't suffer from hardship, you can't do it at all.

The thick horizontal mattress suture of the liver needle combined with the intermittent suture finally closed the incision.A broad bean turned into a cone.After the stitches were completed, Zhang Fan applied adhesive to the wound to stop bleeding.

"Finally done!" The girl was relieved when Lu Shuyan watched Zhang Fan cover the omentum on the spleen.Zhang Fan on the operating table was too cruel, the more the crisis, the more cruel.But the more responsible she was, she looked at Zhang Fan and her eyes were full of flowers!

"When the small arteries were knotted, if I had torn my spleen, would you beat me?" Lu Shuyan saw that the operation was over, and she didn't speak through her brain.

"Hit you? Do you want aseptic operation anymore!" Zhang Fan rolled Lu Shuyan's eyes.

"Beat the chest, that place is considered aseptic!" Liu Yaowen, an old man anesthetist, made trouble.At this time, the atmosphere is active. Although everyone can't speak, it seems to be filled with a sense of accomplishment. I don't want to be proud or self-satisfied, but it is really uncomfortable not to release, so ~~, this feeling is really beautiful Up!

"Rogue!" Baoyin and Lu Shuyan cursed together.

"Hehe!" The old man smiled wretchedly.

The operation is over!

Outside the operating vehicle, as the operation started, people from the Tusun Hanjiang tribe and relatives from Tusun Hanjiang's wife also learned the news.

Riding a horse and carrying a lantern, they gathered outside the surgical cart from around.There are more and more people, comforting his wife, those who care about surgery.

The mayor also came, "Everyone is quiet, don't influence the doctor in the car to perform the operation. Pull the horses away."

Before the operation, Zhang Fan asked Zhang Yanfeng from the Department of Respiratory Medicine to inform Tusun Hanjiang's family members that the situation was dangerous.So Sun Hanjiang's sturdy wife was crying into tears, sitting softly under the wheel of the surgical cart.

No matter how tough is a woman, no matter how tough is a wife.She kept muttering and begging.

"Is it right? Let the people go home. If there is an accident~~" Dr. Zhang Yanfeng said to the mayor with a little worry as he watched the growing crowd.

"It's okay, don't worry. Adasi, if it were not for you, Sun Hanjiang would have been dead. We are all reasonable. Don't worry, there is nothing wrong. Every spring, there are people who are kicked to death by animals. He is considered dead. Big. Bless Hu Da!"

After the mayor finished speaking, he stood in the crowd and said, "The doctors are performing operations overnight. This is a benefactor. I will wait no matter what the situation is. If anyone is crazy, I am a whip! Do you know it!"