Guan Chuyu was injured in the temporal region. However, this injury was particularly strange. The injury caused by falling is generally a concussive cerebral contusion, which may cause scalp avulsion and facial abrasion. More importantly, Falling from a high place such as stairs cannot only injure the head. Most of the time, the left and right zygomatic arches may have comminuted fractures, and the radial shaft may also have fractures. However—— Except for an injury on the left temporal bone, Guan Chuyu's body is fine. Moreover—— This injury does not look like a contusion!
Instead, it looks more like a blunt object hit! Xu Qiu's face sank. Other doctors around noticed the change in Xu Qiu's eyes, and they also came to check. "What's wrong?" "Doctor Xu, did I not do a good job of debridement... I'm sorry..." There was a sudden sound of footsteps in the corridor. He Hai heard that there was an emergency patient with brain herniation. He finally rushed to the emergency room. He took a look and made a direct judgment: "Blunt injury, what's going on? Call the police!" Everyone was stunned and looked at Guan Chuyu's wound again. They suddenly realized it, and then their faces became ugly. ... "How...how is it possible? Teacher Diao from the cram school said that she fell from the stairs!" Outside the emergency room, the two young parents were shocked and angry. He Hai didn't say much, but said: "If you don't call the police, we will call the police." Whether it is domestic violence or violence by cram schools, extending the poisonous hand to such a young child will not end well. "In addition, the operation is also urgent. It must be performed within an hour. He must perform craniotomy hematoma removal, bone craniectomy decompression, etc.!" He Hai explained again: "Your child's intracranial pressure is very high now, and there is also brain herniation. He may die at any time. It is necessary to open the cranium to remove the hematoma, remove the intracranial hypertension, and relieve the brain herniation!" ... Ten minutes later, a multidisciplinary joint meeting was held urgently. Elite doctors from neurosurgery, respiratory, ultrasound, imaging, anesthesia, emergency department, etc. were present to participate in the plan formulation.
Finally confirmed: intracranial hematoma removal + craniectomy decompression + external ventricular drainage surgery! The surgical steps are also very simple: Craniotomy - dura mater incision - hematoma removal - dura mater suture. "Who will do this operation?" someone asked. Everyone looked at Xu Qiu in unison. "Can Dr. Xu do it?" "He just finished a neuroendoscopic resection of a huge skull base tumor. This operation is a piece of cake!" "But he has finished a day's work today, and he also did two operations in the afternoon. Isn't it too much?" "That's right, it would be too difficult for Dr. Xu to do another operation." Everyone shook their heads. Although I really want to see it, the patient's life always comes first. Director Lin is also a little jealous of Xu Qiu's operation. These days, he has watched the endoscopic resection many times. So much so that he didn't hand in homework to his wife for several nights. It's all Xu Qiu's fault... Director Lin said with some regret: "Xu Qiu, you can go off work, leave this operation to me." Xu Qiu glanced at his daily tasks. Simple task: remove feces for patients General task: complete three operations Difficult task: discover a difficult and complicated disease and cure it In the afternoon, Xu Qiu had the opportunity to do simple tasks. But he gave it to Wang Fan. What if Wang Fan also has a system? As for difficult tasks... Difficult and complicated diseases, just diagnosing them may take months or years. Not to mention curing them. I definitely didn't expect to complete difficult tasks today. However, after this operation, we can complete three operations, and it's not bad to finish today's work with a general task.
After thinking it through, Xu Qiu came back to his senses and said calmly: "I'll do the operation." The conference room was silent for a short time. Immediately, many doctors burst into cheers. Director Lin also smiled evilly: "Okay, there are new films to watch." ... ... At 5:05 pm, I entered the operating room. Chief surgeon: Xu Qiu First assistant: Director Lin Second and third assistants: … At 5:10, general anesthesia was rapidly induced. First, etomidate, sufentanil, and rocuronium were used, and endotracheal intubation was performed. To maintain anesthesia, the anesthesia was switched to intravenous, and the drugs were changed to propofol, sufentanil, and dexmedetomidine. After anesthesia was completed. Under ultrasound guidance, the right internal jugular vein was punctured and cannulated, the central venous infusion route was opened, and the central venous pressure was monitored. "SBP maintained at 100~140mmHg, DBP maintained at Hg, and the heart rate maintained at 85~100 beats/min..." Xu Qiu arranged calmly. He glanced at the BIS (bispectral index). This is an indicator for detecting brain function, and it also directly guides the depth of anesthesia. At this time, Guan Chuyu's BIS value was 51. 100 represents awakeness, 0 represents a state of complete lack of brain electrical activity, and it should be maintained between 40 and 60 during the operation. "Give 150,000 U of ulinastatin." "Inject dexmedetomidine μg (/ kg·h)..." On the other side, the results of the blood gas analysis after anesthesia were also released. ", PaCO2 mmHg, PaO2 201 mmHg, BEL, blood sugar mmol/L, lactic acid mmol/L..." Xu Qiu glanced at it, pH is too low, metabolic acidosis. "Give 5%NaHCO3 125 ml!"
Blood sugar is too high. "Pump regular insulin IU/h." After all preparations are completed, the operation finally begins! Xu Qiu picked up the scalpel and cut open the scalp and muscles in layers. Afterwards, the skull was drilled to remove a bone flap of approximately 4 cm×5 cm. The next step is to cut the dura mater... "Quickly instill 250ml of 20% mannitol and 30mg of furosemide intravenously!" The intradural pressure is too high and must be lowered first. After the administration, Xu Qiucai cut the hanging dura mater crosswise and turned it toward the sagittal sinus. laugh-- Finally, everyone saw the epidural hemorrhage under the surgical field. "Clear the hematoma." While Xu Qiu was speaking, his hands were already moving. The aspirator sucks out the blood. The coagulated blood clot is removed with tumor forceps. slowly, There was something wrong with everyone's expressions. "Why is there so much bleeding!" Look at the blood drawn out and the blood clots pinched out. This amount of bleeding can be found everywhere! Boom! At this moment, part of the brain tissue suddenly bulged, completely blocking the surgical field. "The bleeding was too much and too fast, and there was no room for surgery..." Director Lin's expression changed. He glanced subconsciously at the patient's head. I want to check the condition of her pupils on both sides to determine her condition. However, this is definitely not possible when the patient is covered with sterile drapes. He judged based on experience: "There should be new bleeding lesions in the skull...Xu Qiu, let's do an ultrasound!"
At this time, the bleeding is obvious and it is difficult to stop the bleeding. If the bleeding focus is not found as soon as possible, the operation will be in doubt! Others in the operating room were also sweating. The anesthesiologist closed the chat page of "Little Goblin", took a look at the situation, and said: "Ultrasound exploration is of little significance. There must be a new bleeding focus, but now the operating space is gone, so it is difficult to explore!" The surgical field is completely lost, and it is extremely difficult to advance the operation—— Brain surgery is very experienced in such unexpected situations. The surgeon often chooses to close the skull, cover it with a sterile dressing, and let the anesthesiologist take a portable monitor, a simple ventilator, etc. to the imaging department to do an emergency CT. After confirming the location of the bleeding, immediately return to the operating room, enter the brain from the other side, and restart the hematoma removal. but…… This will inevitably increase risks and is definitely not the optimal solution. "Can't delay it!" At this time, the anesthesiologist urged again. Director Lin didn't speak, he looked at Xu Qiu. Since the chief surgeon was handed over to Xu Qiu, Director Lin would naturally not overstep his responsibilities as first assistant. Xu Qiu has already earned this respect with her strength. He waited quietly. Just when everyone was anxious, Xu Qiu's voice finally sounded. His voice was calm and calm, and he said: "I figured it out, there's no need to go to the imaging department, it's not a new bleeding focus..."
