Section 50
The patient's gray short-sleeved shirt and cheeks were all bright red.
A bloody smell spread everywhere, making people frown.
"Quick, quick, quick! Clean the nasal cavity to avoid suffocation! Also, ask the blood bank to send 400 ml of plasma first!"
"Okay!"
After Zhang Yi gave the order, the nurse immediately went to do it.
When gastric varicose veins rupture and bleed, the blood vessel pressure is very high.
In most cases, the amount of bleeding can reach 1,500 ml per hour.
It is very likely that the bleeding will not stop in time and the person is about to die.
So the first measure at the moment is to transfuse blood first to stabilize the blood pressure.
However, for hepatitis B patients, medical staff should still be careful of occupational exposure.
Chen Fang asked all the doctors and nurses in charge to wear gloves.
The family members next to them were frightened and cried again when they saw this scene.
She kept begging the doctor to save her husband.
The nurse comforted her and took her out of the emergency room.
Now, the emergency room was much quieter.
Soon, the nurse established an intravenous channel and infused fluids before the blood came.
A large amount of saline and electrolytes were transfused into the blood vessels.
After a while, the patient's full set of examination results came out.
Zhang Yi took a look and found that the hemoglobin was only 4.5g/dl!
The normal value is about 120.
This person's hemoglobin is ridiculously low!
Let's look at the CTA:
A: Cirrhosis with a large amount of ascites.
B: Thrombosis of the main trunk of the portal vein.
This report can be completely diagnosed.
It is cirrhosis of the liver with ascites and gastric varicose bleeding.
"If the blood has not arrived, please transfuse it quickly! If there is no plasma, please hold on first!"
"Here it comes! The blood is coming!"
As soon as Zhang Yi shouted, the nurse came running with two bags of plasma.
The blood just taken out of the blood bank was ice, but there was no time to put it at room temperature.
Zhang Yi took a squeezer and pushed the plasma into the blood vessel.
After transfusing a bag, the blood pressure rose a little hg.
"Nurse Li, bring the three-chamber two-balloon." Zhang Yi said.
The three-chamber two-balloon tube is the primary emergency hemostatic device for gastric venous bleeding.
It is similar to a nasogastric tube.
It is inserted from the nostrils through the esophagus to the stomach, and then physiological saline is injected to make the balloon expand.
The principle of hemostasis is similar to compression hemostasis.
But the process is very painful.
The three-chamber two-balloon tube is thicker than the general nasogastric tube.
It has to be inserted from the nostrils and then extended into the stomach. Most people can hardly bear this kind of pain.
Many times, doctors and nurses hold down the patient's limbs together and force the insertion to stop the bleeding.
For example, the patient in front of him.
He is in his forties and looks quite strong.
When Zhang Yi inserted the three-chamber two-balloon tube into him, he was still in a semi-comatose and irritable state.
As a result, he suddenly opened his eyes and grabbed the catheter in Zhang Yi's hand and threw it far away.
He was still mumbling: "I don't want it! Don't touch me!"
Zhang Yi was stunned: "Hey? You still feel pain when you are unconscious?"
Zhang Yi glanced at Chen Fang and called two male doctors.
If soft methods don't work, we have to use hard methods.
This is not torture, this is saving people.
If the hemostatic tube is not inserted, the blood transfusion just now will be in vain.
Three people held down the patient's body.
Zhang Yi changed a catheter and applied paraffin oil, and started to insert it again.
As a result, the patient started to struggle violently as soon as it was inserted into the nasal cavity.
"It hurts! It hurts so much!"
Zhang Yi didn't stop and continued to insert it.
As a result, the catheter actually came out of the patient's mouth...
"Don't move, we are saving you!" Chen Fang leaned close to the patient's ear and said.
I hope this patient can listen to it.
But obviously not.
Zhang Yi pulled the catheter back a little and then extended it down.
The patient started to struggle violently again!
The explosive power of people when they are trying to survive should not be underestimated.
With a wave of his hand, he almost knocked Chen Fang down.
Everyone was shocked. Is this the same patient who almost went into shock just now?
"Forget it, Mr. Chen. I think it's hard to insert the cannula. Why don't we just do a venous ligation?"
Chen Fang panted and looked at the patient. This guy is really strong!
But...
Do a vascular ligation at this time?
The stomach fundus is full of blood, and the surgical field can't be seen clearly. It's difficult to suture while suctioning.
But if it's delayed like this, the patient will vomit the blood in the stomach.
In this case, it will be useless even if more plasma is transfused.
The venous bleeding still needs to be stopped at the source.
Looking at Chen Fang's tangled expression, Zhang Yi knew what he was thinking.
Zhang Yi said, "Let me do it. I can do it."
Chen Fang looked up in surprise, but the shock in his eyes flashed away.
Forget it, he is no longer surprised.
Isn't Zhang Yi good at anything?
Just get used to it~
Soon, the family signed a series of signatures such as the informed consent form, critical illness notice, and surgery consent form.
The patient was pushed into the emergency operating room.
Lateral position, intravenous propofol anesthesia.
The patient fell asleep quietly.
In the operating room, all the interns in the emergency department came to learn.
Chen Fang handed the endoscope to Zhang Yi.
Zhang Yi took a 50-centimeter-long needle holder to find the bleeding point.
The surgical field environment was not good.
As soon as the suction was over, the blood came out again.
However, this was nothing to Zhang Yi.
Even if there was a stone blocking his eyes, he could still see the bleeding point of the blood vessel.