When a doctor opened a plug-in

The power that a person explodes when convulsing is still considerable.

Three or four people took a lot of effort to control the old man!

Soon, the role of stability began to play out.

The patient calmed down.

However, this does not mean it is safe.

Here, a doctor from the second group kept explaining the patient's condition.

"Patient, male, 72 years old, recovery period after subtotal gastrectomy, the cause of convulsions is unknown, history of hypertension, diabetes... oral..."

Hearing the patient's words, Hou Rong's face was deep.

The patient has a history of hypertension, but at this time the blood pressure is less than 80mmHg, which means that such a blood pressure is difficult to provide the patient with sufficient blood supply.

The human body has a tolerance function for many situations.

Some people don't feel any discomfort when their blood pressure reaches 1700 or 180, while some people don't see any abnormalities when their blood sugar exceeds 33.3.

This is that the human body has tolerated this abnormal environment.

So at this time, the patient's systolic blood pressure is only after 80, which has brought shock!

Here, after the patient's condition stabilized, Hou Rong hurriedly took the patient to the operating room to complete the esophageal repair operation in time. After all, at this time the esophagus ruptured, and a lot of bleeding would definitely flow into the chest cavity.

Stop bleeding!

Repair the esophagus and trachea.

Clean the blood in the chest cavity to prevent further infections.

This is the best thing to do right now.

And here, Hou Rong is still thinking about a question, why does the patient have epilepsy?

What is the reason?

But now the situation is urgent and time is limited, so there can be no more delay.

The patient had gastric cancer, could it be a brain metastasis?

Thinking of this, Hou Rong couldn't help but feel a headache.

And Chen Cang said at this time: "Director Hou, is it a cerebral hemorrhage?"

In a word, Hou Rong was immediately awakened.

Yes indeed!

The patient has a history of hypertension, is it cerebral hemorrhage?

It must be too late to do CT, and the time to do CT may be dead. In that case... it must be inappropriate.

Thinking of this, Hou Rong performed a meningeal irritation test, and that was true!

Positive!

Of course, positive meningeal irritation does not necessarily mean cerebral hemorrhage, but it is possible.

But now, the patient must have surgery, otherwise, let alone cerebral hemorrhage, the ischemia will be gone!

Here, the blood transfusion department has completed the distribution of blood and delivered it directly.

A group of people pushed the patient directly towards the operating room.

Chen Cang also followed directly.

After all, it's about one's own task, so you can't care about it.

Moreover, Chen Cang felt that this patient seemed not as simple as he imagined.

After the anesthesia, the operation begins.

After passing through the neck opening, the esophagus, trachea, nerves... are all exposed to everyone's field of vision.

However, because of this, everyone looked at the terrible neck condition and it was really shocking!

At this time, the patient's esophagus was damaged in many places, the wound was irregular, and the condition of the entire esophagus was very poor!

Generally speaking, the success or failure of the treatment of esophageal perforation depends on the location of the perforation, the size of the breach, the time of diagnosis and whether the treatment measures are appropriate.

And the situation of this old man is obviously very bad!

Not only are there many cracks, but the damage is still irregular. If it is not sent to the emergency center in a timely manner, once it exceeds 12 hours, there is basically no need for treatment!

Hou Rong also couldn't help feeling a little regretful.

For now, the probability of a patient being cured is low enough.

During the period after the patient's onset, with seizures, oral secretions must have been swallowed into the stomach, so that secretions containing a large number of bacteria enter the mediastinum or chest cavity from the breach, which will aggravate the infection!

"Broad-spectrum antibiotics!"

"Large dose!"

Hou Rong continued to give medical advice. At this time, blood transfusion and fluid replenishment were being performed at the same time, and the electrolyte disorder was being corrected, and the patient's condition was stabilized.

At this moment, what is needed is to separate the esophagus and repair it.

The patient's surgical incision was on the front edge of the left sternocleidomastoid muscle, and in this way, the thyroid gland was also exposed.

Hou Rong carefully cut off the scapula hyoid muscle.

Then free the middle thyroid vein.

Retract the thyroid and common carotid artery sheaths to both sides to free the esophagus!

The perforation is so obvious that it can be seen without looking for it.

Fortunately, there is no damage to the airway, otherwise, the operation will be more troublesome.

The next step is to repair the esophagus.

but!

At this moment, a difficult problem appeared in front of everyone.

The rupture is too many and irregular, so it is definitely not possible to use absorbable thread to suture it directly.

How to fix it?

After the excision, the stump anastomosis

This is simply unrealistic, because the patient has stomach cancer and has undergone a subtotal gastrectomy, and the length of the digestive tract is simply not enough.

It is simply unrealistic to want to suture after removal.

However, it is more dangerous to force an anastomosis without cutting.

After forced anastomosis, reflux esophagitis, anastomotic leakage and so on will occur in most cases.

Seeing the inflammation around the ulcer, Hou Rong hesitated.

How to do?

By this time the operation was carried out, there was no way to proceed.

Hou Rong quickly said to the nurse on the side: "Call Director Yu, and Director Chang, the leader of the three groups."

Director Chang is an expert in thoracic surgery, and Hou Rong can only pin his hopes on them at this time.

The esophagus is ruptured, and there is no surgery, sutures are impossible, and anastomosis is not possible.

At this time, several doctors in the second group were also a little restless.

These situations are often encountered in the emergency department, because the operation is more urgent and there is no time to make adequate preparations. When encountering these emergencies, you need to discuss them on stage!

Yu Yonggang and Chang Xiong arrived in the operating room not long after.

Seeing the patient's condition, the three fell silent for a while.

Hou Rong couldn't help asking: "Is it feasible to replace the esophagus with an autologous colon?"

Abdominal organs such as the stomach and colon are still the most commonly used methods to replace the esophagus.

Chang Xiong shook his head directly: "No!"

"There is a subtotal gastrectomy itself. I watched the film. At the expense of the digestive tract, it hit the patient's digestive system too much, and there were many surgical complications. The patient itself was after gastric cancer. In this case, the quality of the operation is too high. Poor, even... the basic digestive function cannot be maintained."

At this time, Yu Yonggang took the forceps to carefully separate the neck tissues, and suddenly said: "Can I use the cervical platysma flap to reconstruct and repair the cervical esophagus?"

As soon as this sentence came out, the eyes of the people around suddenly lit up!

This is a good way!

However, Chang Xiong carefully looked at the flap of the platysma muscle, and suddenly frowned and said, "It's okay, but... In this way, blood supply is a problem. After a long period of time, scar tissue will definitely form and cause contracture of the esophageal wall There is basically no possibility of success in the next operation!"