"Find someone to do transesophageal echocardiography!" Chief Miao continued.
Su Yun had already picked up his phone and called Lao He's phone. Lao He was already preparing to get off work. He was humming a little tune as he sat in the duty room and smoked.
When he received Su Yun's call, Lao He did not ask what had happened. He only knew that it was a surgery from the Department of Genitourinary Surgery and that he had to do transesophageal echocardiography immediately.
Lao He's ultrasound skills were quite high. He was one of the few doctors who could use ultrasound to determine pneumothorax. This kind of skill was one of the few skills that could be bragged about in front of Boss Zheng. He did not expect that he would be thought of when he saved the stage.
Pushing the ultrasound machine at the head of the bed, Lao He ran into the operating theater.
The operating theater was a mess. The strange thing was that Lao He did not see Boss Zheng and Brother Yun. Chief Liu of the Department of Genitourinary Surgery held his phone in his hand and kept changing the angle. The voice of Chief Miao commanding the resuscitation came from the phone.
F * ck … Lao He was stunned for a moment before his heart lit up. He immediately realized what had happened.
Chief Surgeon Liu was dumbfounded!
It was a habit formed over the years. After encountering a problem that he could not solve himself, he would immediately look for the chief.
At the moment of life and death, Chief Liu had forgotten that Chief Miao had already retired. He had changed from a frontline clinical chief to an old man who danced in the square every day and leisurely retired.
Chief Miao's voice came from the phone. It was still calm, full of domineering and unquestionable aura.
Where were Boss Zheng and Brother Yun? Lao He pushed the ultrasound machine at the head of the bed to the patient's head and took the opportunity to look around.
No one!
Brother Yun said to do a transesophageal echocardiography.
Lao He quickly sent the transesophageal ultrasound probe into the patient's mouth. He avoided the tracheal intubation and overcame the interference of Chief Yu doing chest compressions. He sent the probe into the esophagus.
"Chief Yu, stop for 20 seconds!" Lao He shouted loudly.
"Xiao Yu, stop for 20 seconds. The anesthesiologist will do an echocardiography." Chief Miao's voice came. The memory contained in Chief Yu's body made him immediately stop the chest compressions.
"Gas is found in the right heart! Gas is also found in the left heart! " Lao He quickly scanned and saw the gas in the heart. After reporting to Chief Miao in the video on his phone, he left an image and took out the probe.
"Put a small sponge pad on the right side!" Chief Miao's voice came. "Continue compressions and interrupt CPR. Central venous catheter … "
"Chief Miao, let me do this." Boss Zheng's voice came from the video.
Lao He's heart was clear, but he did not think too much about why Boss Zheng was at Chief Miao's house. Instead, he quickly pushed the bedside echocardiogram machine to the side, found the central vein puncture kit in the cabinet, and quickly came to the patient's side.
The patient's head had already been squeezed by many people. Lao He did not explain and forcefully knocked open a world. At this moment, his phone rang. Before the puncture, he took out his phone, put it on speaker mode, and put it aside.
"Lao He, do the central venous puncture." Boss Zheng's deep and steady voice was heard.
Lao He's heart calmed down. As he prepared to puncture, he said, "Immediately, 22 seconds!"
He used the improved method of subclavian vein puncture. He found the best puncture point at the intersection of the vertical line of the right clavicle and the horizontal line of the sternoclavicular joint. The needle pointed at the lower edge of the thyroid cartilage.
Once inside, the central venous catheter extended downward into the right heart. Lao He was quite confident in his skills. 22 seconds, not a single bit off.
"There's an airlock effect. You can feel the pressure after you go in and inhale." Boss Zheng's voice came from the phone.
Although what he said was what Lao He knew, his heart felt even more stable for no reason.
"It has already entered the right atrium," Lao He said. "The gas is being pumped."
He kept testing. Because of the airlock effect, the syringe was not pumping smoothly.
The airlock effect was also known as the airlock phenomenon. It was a kind of blocking phenomenon in a flowing liquid caused by different pressures in the liquid. This phenomenon usually occurred at the high points between the pipes. It was the reason why ordinary centrifugal pumps could not pump the liquid.
Lao He tested it bit by bit. Suddenly, the syringe in his hand moved slightly and moved a small distance. It was about 5 ml.
"Boss Zheng, extract 5 ml of gas." Lao He quickly extracted the blood and gas as he reported to Zheng Ren.
"Continue. I just looked at the echocardiogram. There's still gas in the ventricular cavity."
Zheng Ren said as he held his phone.
"Boss, it's normal for the atrium to have gas. I've never understood why there's gas in the ventricle," Su Yun asked as he stood at the side.
Although he was not in the operating theater, he could still feel the aura that was filled with adrenaline and dopamine.
Zheng Ren shook his head and said, "There are too few cases, so I'm not too sure. The existing cases show that most of them are double-chamber pneumatosis, and none of them have a congenital disease of right-to-left shunt. "
Abnormal air embolism was the gas that was absorbed into the venous system and finally entered the arterial system.
It usually occurred in patients with right-to-left shunt of the heart. The gas that accumulated in the right atrium or right ventricle entered the left heart system through the right-to-left channel, causing a coronary artery or cerebral artery embolism.
This was a question. Now that they were in the emergency department, the two of them had a tacit understanding not to continue talking about this question.
Lao He's operation was passable, and it even overflowed a lot. Soon, the gas in the left heart was also extracted, and the problem that caused the cardiac arrest was solved.
After about 20 minutes of continuous chest compressions and intermittent defibrillation, the patient's hemodynamics and respiratory function stabilized.
Chief Miao let out a long breath. He put his phone aside and leaned against the back of the sofa. Zheng Ren looked at his expression. There was no fatigue, only nervousness, excitement, relief, and joy after the emergency treatment.
"Chief Miao, are you tired?"
"I'm not tired," Chief Miao said with a smile. "It's the first time an old man like me has seen someone commanding the rescue through a phone."
"A treasured knife never gets old!" Su Yun gave him a thumbs up and praised.
"I've encountered a laparoscopy causing a gas embolism once before. At that time, I was stunned. I pondered while resuscitating. However, that time was a mistake in my operation. It was very easy for me to think that carbon dioxide would enter the blood vessels. After symptomatic treatment, the patient did not have any complications after the surgery. He was discharged a few days later. "
"How many years ago was it?" Su Yun asked.
"It was the end of the last century," Chief Miao said.
"At that time, laparoscopic surgery had just been started, right? You already encountered a gas embolism? Why didn't you write a case report? "Su Yun asked curiously.
"The case report … was written," Chief Miao said. "I thought that this case should be very rare. I didn't even submit it to a journal with the word" Chinese "in it. I directly looked for the Lancet. Unfortunately, my English is average, and I'm not very clear about the format. In the end, it was left unsettled. "
So that was how it was. Zheng Ren smiled.
"Chief, how are you?" Chief Liu's voice came from the phone.
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