Path of Medicine With a System

In the early years of 2000, let alone in the border areas, even when making calls in the city, I had to shake my head and look for mobile signals from time to time.

It seems that after the Olympics, or a year before the Olympics, the country's network suddenly became more powerful. The mobile phone signal is getting worse.

Even in mountainous areas can have a relatively strong signal. The network has also begun to spread to townships in an all-round way. In this small town with few people, China Mobile, China Unicom and China Telecom are still fighting against each other 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 consultation, for diseases that cannot be diagnosed in townships, you can directly contact the higher-level hospital through the platform of the health system, and let experts consult through the Internet. A consultation costs 30 yuan!

General chronic diseases can be treated through online consultation, but there is still no good way for this kind of emergency, especially for life-threatening diseases, if there is no medical team tonight. Tusun Khanjiang had to go to a county town hundreds of kilometers away, and life and death depended on his fate.

There are doctors in the rural health centers, but after a few years of siphoning in the medical system, the township health centers have shrunk considerably in just a few years. Doctors with a little bit of skill went to the county town, and the doctors in the county town, the more powerful or younger doctors, either went to the urban area or went to the south. Small towns can no longer support surgeons. The result of the final development is that the township health center has become a pharmacy.

There is no way to stop the loss of talents. In the end, only by going to the countryside and going to the countryside on a regular basis can the medical care in small places be solved. When there were no doctors sent to the countryside, once an emergency appeared, it was a very troublesome thing. Then, the chain reaction was that the crowd gathered towards the city more quickly. 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.

Perhaps this is urbanization!

Once abdominal visceral bleeding is considered, it is necessary to quickly find the bleeding viscera and stop the bleeding. Abdominal organs, after being hit, are particularly prone to bleeding are some substantive organs, such as the liver, kidney, and spleen.

These organs are relatively fixed first, and they are all very brittle. The fresher they are, the softer and more brittle they are. There was a car accident in the city, the speed was not high, and after hitting someone, there seemed to be no trauma, but the person was already in shock. This kind of situation often caused damage to the abdominal organs, leading to massive bleeding.

The surgery trolley in Huaguo was all imitated German products in the early years. It seemed to be manufactured by a designated automobile factory, and the price was super expensive back then.

Later, the policy was opened up, and Yutong Motor came from behind. I don't know why, they didn't learn from Germany, and took over all the technology from the Maruko country. After a few years of development, they surpassed other auto factories in Huaguo in the field of medical professional vehicles in a few years.

Almost all of these professional vehicles were contracted by them, except for some designated ones, of course.

The place where the meatball country has a big fart is not good at the macro level. 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 very smoothly and reasonably, almost perfect.

Incision on the midline of the abdomen is not a straight line. The navel must be avoided. Because this place is a depression, it can be regarded as a place where dirt is hidden, not to mention that it is not easy to recover after surgery, and it is also prone to infection. Abdominal surgery, this place is the focus of disinfection.

Open the skin, the skin is like a thin kraft paper. The skin is incised, followed by the superficial fascia. What exactly is this thing? In fact, it is white fat and some loose hoof tissue, which mainly contain 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 out of shape, almost all the soft fat and slightly harder hoof tissue act as a protective layer. If there is no such layer of organization, maybe a casual slap can slap the opponent's face with blood.

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

After hemostasis, continue to enter. "Move faster, the blood pressure won't rise." Dr. Liu Yaowen from the anesthesiology department looked at the monitor and reported back to Zhang Fan.

"Okay." Zhang Fan's speed was already very fast, and he raised it one step further. Although he was fast, he had to pay attention to the layers, because 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 can be regarded as layer upon layer. In layman's terms, the abdominal muscle layer is like two doors, which are divided into two doors from the navel as the midline.

Many people think that by opening the muscles, the abdominal organs can be clearly seen, but this is not the case. To put it simply, muscles are the gates, and there are curtains and internal walls to open the gates. The so-called curtains are the omentum.

Therefore, when entering the muscle layer, only a small part of the organs can be seen, such as the liver, a small part of the stomach, a small part of the large intestine, and a part of the small intestine. Other organs cannot be seen.

The anesthesiologist has reminded that the blood pressure cannot go up, so the hemostasis of the muscle layer is very simple, and the gauze is pressed. After dealing with the internal organs, go back and deal with it again.

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

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

Without this structure, people cannot move vigorously, because once the activity is intense, the abdominal organs will rub against each other intensely, and the organs as thin as cicada wings may be worn out, and then the stomach will be full of blood or water. shit! very scary.

When the peritoneum was opened, a large amount of blood appeared. Zhang Fan looked at it and said, "The bleeding is on the upper left side. It's not the liver, it's the spleen." Then he opened the fundus of the stomach and began to look for the spleen.

The spleen, because it is a small organ, was not studied much in the early years. It was simply considered to be an organ for hematopoiesis in childhood and fetus, and it degenerates like the appendix in adulthood.

With the deepening of research, it was gradually discovered that this organ is a very important immune organ. In the past, once a problem with the spleen was found, it was directly removed. However, with the development of evidence-based medicine, the medical profession defined this organ as the largest immune organ in the human body. It has many functions, such as hematopoiesis, blood storage, blood filtration, and the most important immune function.

The spleen, shaped like an enlarged fava bean, is almost exactly the same, hidden under the tenth and eleventh costal arches on the left side. Covering the body of the stomach above, next to it is the pancreas.

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

Once Zhang Fan confirmed the bleeding, he said to Bao Yin, "Scalpel!" Because the spleen is located relatively high, Zhang Fan's incision was relatively low, and the incision had to be extended upwards. Generally, in this case, it must be driven under the xiphoid process.

"Full cut?" Lu Shuyan asked just as Zhang Fan extended the knife edge upwards.

"Let's see. If you can keep it, keep it. If you can't keep it all, it's better to have a partial resection." Zhang Fan said while quickly extending the incision.

"gauze!"

"Doctor Zhang, the blood pressure has dropped dramatically." 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 and rapidly.

"Increase the amount of intravenous fluid. Adrenaline, dopamine combined with intravenous injection, ready for blood transfusion." Zhang Fan, who had goosebumps all over his body, was sweating. The operation was not difficult, but because of the delay, the patient was bleeding too much.

"Doctor Zhang, the effect is not good, and the blood pressure continues to drop." The anesthetist's tone was so rapid that he could hardly speak clearly.

"Blood transfusion. Directly use O-type rb." Zhang Fan really had two purposes at once. While quickly processing the tissues under his hands, he rushed into the spleen area, while still giving verbal doctor's orders.

Under normal circumstances, even in a hospital, blood transfusions cannot be easily performed. Today's situation is even more troublesome. First of all, I don't know the blood type of the patient, and I don't have time to test it. I'm not a technician in the laboratory department, and the speed of ordinary people is even more difficult.

At this life-saving moment, the time is tight and there is no room for delay. It all depends on the doctor's weighing and bold weighing. If the balance is good, it can save lives, if the balance is not good, it may be fatal directly!

Under normal circumstances, there are stored blood and checked blood in large hospitals. But in the case of emergency rescue, there is no way to take care of it. Fortunately, there is type O plasma in the operating vehicle, otherwise, the doctor or nurse would have to draw it 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, Zhang Fan dare not use it if he is not a soldier or a policeman!

That's why at the critical moment, when the hospital is short of blood, the army or police team drove into the hospital directly! And it's an order, a non-negotiable military order. Really, for these people, the country owes them, and the people owe them.

Don't think that blood transfusion is saving lives. In fact, blood transfusion is not small. Even with the same type of blood, there are many problems. Therefore, in general, try not to transfuse if you can.

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

"Gauze, stuff it!" Zhang Fan was the only one in the operating cart who gave the order.

"Three curved forceps. Look! Has the urine come out?" Zhang Fan's words at this time are all oral doctor's orders, and both nurses and anesthesiologists must follow them, unconditionally, because at this time the person who knows the condition best is Chief surgeon.

"No urine!" The itinerant nurse said sharply.

"Quick! Scissors!" Regardless of whether the spleen is completely or partially removed, the spleen must be completely freed, because the tissues here are too complicated.

The stomach, pancreas, and intestines are all in this area, and the blood vessels here communicate with each other and accompany each other, which is very rich. If the dissociation is not careful, a mutated blood vessel will come out, and the scissors will really make the situation worse.

Moreover, the upper pole of the spleen is the splenic-gastric ligament. This ligament is too short, and the short arteries and veins of the stomach are distorted inside.

"Use gauze to support the spleen, pay attention to the ligament here, be gentle and don't pull it." After the spleen was freed and gently supported with gauze, Zhang Fan deliberately explained to Lu Shuyan.

The spleen is shaped like a broad bean, and it has a door, which is the place where the inner side bends, and this place is where the broad bean germinates. The same is true for the spleen, where it bends inwardly and this is the hilum of the spleen, where arteries and veins run.

One by one, the clamps were clamped segment by segment. With the clamping of the clamps, the bleeding was significantly reduced until the bleeding stopped. This time is slightly better than the previous ten minutes. This can be regarded as a disguised form of hemostasis.

"Doctor Zhang, the blood pressure has risen, and it's been 9 minutes!" the anesthetist said deliberately.

"Yeah!" Zhang Fan responded, not in a hurry at this time. How much should the spleen be cut to preserve its immune function? At present, there is no clear definition in the medical field. However, at least more than two-thirds, otherwise it is meaningless.

All solid organs, their blood vessels are like two big trees. It is a thick tree trunk at the door, and then after entering the interior of the organ, it begins to branch and spread leaves, and then forms a connected capillary network at the end of the artery and vein, one in and one out.

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

The longest spleen of Chinese men is only about fourteen, but the blood vessels and arteries inside the spleen of ordinary people have fifteen. One can imagine how slender and tortuous this thing is.

After Tusun Hanjiang's lower pole of spleen was violently hit by the buck, a hole the size of a popcorn was directly shaken open. The spleen is too brittle, and the stag has great strength. There is no chance of suturing, so it can only be partially excised.

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

"I tie a knot!" In general surgery, after the operator sends the end of the thread in with a needle holder, the assistant grabs the back thread to tie the knot. But Zhang Fan was worried about Lu Shuyan. This is the knotting of the blood vessels. If the strength is too small, the blood vessels will be strangled, and if the strength is small, the blood vessels will not be ligated.

While Lu Shuyan stained the blood with gauze, she helped Zhang Fan support the needle holder. At this moment, no one would refute or feel dissatisfied. Do whatever the surgeon tells you to do. This is the minimum professional ethics of a surgeon.

The blood vessels to be ligated were ligated one by one, and Zhang Fan breathed a sigh of relief. "Wipe off my sweat." Zhang Fan was so nervous that his eyelids were sweating!

At this time, it is waiting, 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 bloody and bloodless areas of the spleen will be particularly distinct.

One side is still red or pink, while the bloodless area on the other side is noticeably pale.

"Scalpel." After three or four minutes, the boundaries were clear. In order to ensure the preserved vitality of the spleen, Zhang Fan used a scalpel to incise the outer coat of the spleen at a place one centimeter away from the junction, and then cut into the spleen parenchyma with the handle of the knife.

The spleen is particularly fragile, and it is easy to injure the blood vessels with the blade. Although the handle of the knife is a bit blunt, it is safe. Slowly form a V-shaped incision on the front and back edges of the spleen, and extend to the inside bit by bit.

While cutting, Zhang Fan's left thumb and index finger always hold and compress the edge of the spleen, which is to fix the spleen. This can effectively control and reduce the bleeding in the book.

It sounds simple, but it is actually very difficult to operate. To put it simply, it is wearing plastic gloves, and there is grease on the gloves. Then hold the round soap with water or oil, the strength should not be too strong, and the soap must be fixed.

This is the skill of a surgeon. Without more than ten years of training, let alone an operation, a simple grip can't be done.

Bit by bit, there will be 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 kind of wound cannot be rubbed, but should be dipped, gently dipped with gauze, rubbing 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 tie the knot, so he asked Lu Shuyan to tie the knot. , Zhang Fan made a special statement before tying the knot.

"En!" After Lu Shuyan replied, she began to tie the knot. Zhang Fan watched with his eyes motionless, fearing that there would be a slipknot or his spleen would be opened. The spleen is more fragile than the kidneys, and if you use a little force wrong, there will be a hole. This is why the spleen is prone to rupture.

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

The operation was too tense, and Zhang Fan's tone on the operating table was too severe, which made her terrified. At this time, if you look at the spleen from the bottom of the spleen, it looks like a V-shaped duck mouth with a big mouth and a small inside.

This shape is for later stitching. The spleen is very fragile, and it was made into this shape for easy suturing. Therefore, a good surgeon has built a complete surgical process in his brain before the operation.

"I will sew and I will tie the knot, Dr. Lu, you cut the thread." Zhang Fan said to Lu Shuyan.

"OK."

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

And this kind of suture cannot use small needles and thin threads. Because small needles and thin threads will cause capillaries to fail to grow and lead to ischemic necrosis. Therefore, general surgeons with ordinary sutures can't guarantee that they can suture well.

"Liver needle! Thick thread!" Baoyin threaded the needle neatly and handed it to Zhang Fan. It is true to say that there are specializations in the art industry. In the past, simple threading a needle seems to be a very simple matter.

Not necessarily on the operating table. First of all, wear gloves, and when the bleeding is stopped quickly, the hands must be agile, one needle thread in three seconds, and one needle thread in three seconds. Therefore, surgical nurses will not be able to do it if they are a little older. First of all, their eyesight will not work.

This kind of kung fu is also a movement that nurses have practiced countless times under the operating table on weekdays. If you don't suffer, you can't work hard.

The incision was finally closed by thick horizontal mattress suture with liver needle combined with interrupted suture. What was originally a broad bean became a cone. After suturing, Zhang Fan used adhesive foam on the wound to stop the bleeding.

"Finally finished!" Lu Shuyan felt relieved when she watched Zhang Fan cover the spleen with the greater omentum. Zhang Fan on the operating table was too cruel, the more crisis he faced, the more cruel he became. But the more responsible she was, she looked at Zhang Fan with flowers in her eyes!

"When the arterioles were knotted, if I tore my spleen, would you have hit me?" Lu Shuyan saw that the operation was coming to an end, and she didn't speak out of her head.

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

"Slap the chest, that place is considered sterile!" Liu Yaowen, an old man from the anesthetist, objected. At this time, the atmosphere became active. Although everyone was talking in an incoherent manner, they seemed to be filled with a sense of accomplishment in their hearts. I didn’t want to be proud or complacent, but it was really uncomfortable not to let go, so~~, this feeling is really beautiful up!

"Rogue!" Baoyin and Lu Shuyan cursed together.

"Hey!" The old man smiled wretchedly.

The operation is over!

Outside the operating vehicle, as the operation began, people from the Tusun Khanjiang tribe and relatives of Tusun Khanjiang's wife also got the news.

Riding on horses and carrying lanterns, they gathered outside the operating vehicle from all directions. There are more and more people, comforting Sun Hanjiang's wife and caring about the operation.

The township head also came, "Everyone, be quiet, don't interfere with the doctor in the car performing surgery. Pull the horses away."

Because 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 very dangerous. So the sturdy wife of Tusun Hanjiang was already in tears, sitting limply under the wheels of the operation cart.

No matter how tough she is, she is still a woman, and no matter how tough she is, she is still a wife. She kept muttering and praying.

"Isn't it? Let everyone go home. If there is an accident~~" Dr. Zhang Yanfeng said to the mayor worriedly seeing more and more people.

"It's okay, don't worry. Adasi, if it weren't for you, Tusun Hanjiang would have died a long time ago. 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 fate." Big one. Hu Da bless you!"

After the mayor finished speaking, he stood among the crowd and said, "The doctors performed the operation overnight. This is a benefactor. No matter what the situation is, I will be the horsewhip if anyone behaves foolishly! Do you understand!"