Chapter 180

When they were taking anatomy classes in medical school, they would use air embolism to demonstrate the horror of this disease.

Whether it was the mice used in the experiment or the rabbits used for dissection, the teacher would shave the hair on their ears with a blade to expose the blood vessels inside.

Then use an empty needle that sucks 15ml of air to puncture the exposed blood vessels and inject air.

When the air circulates with the blood and gathers from the superior and inferior vena cava to the right atrium, the heart is blocked by a large amount of gas, resulting in a decrease in ejection volume.

The beating of the heart will further circulate the air that forms large bubbles into the lungs, forming a more serious embolism.

It only takes a dozen seconds for the experimental living creatures to kick their legs and twitch due to lack of oxygen until they die.

This process is very fast, impressive, and very uncomfortable.

Therefore, in their future clinical work, as long as they involve patients who are injected with infusions, they will repeatedly explain to keep an eye on the hanging bottle and don't let it drip empty.

Not to change the bottle privately.

They are afraid that the patient or family members will not pay attention and accidentally inject air into the body, which is a fatal thing.

But now, in the operating room, they are actually experiencing a patient with air embolism.

No one knows how much gas enters the patient's body through blood circulation.

As for how it enters.

Just as Xiao Chenguang said, hydrogen peroxide corrodes the mucosa, and the oxygen produced enters the body through the tiny blood vessels on the greater omentum, resulting in a typical decrease in blood oxygen saturation and blood pressure.

"There is still hope, hurry up, lower the head and raise the feet, and lie on the left side."

After listening to the heart murmur, Xiao Chenguang took the opportunity to auscultate the patient's left and right lung cavities and 18 lung tissues.

There are no obvious wet rales and bubbling sounds of air passing through water, indicating that the patient's embolism has not progressed to the lungs.

This is a blessing in disguise.

It seems that only a small part of the gas produced by hydrogen peroxide has entered the patient's blood.

Otherwise, as long as the amount of gas is larger, even if it is more than a dozen milliliters, the patient would have died long ago and would not have waited for Xiao Chenguang to come for a consultation.

"Don't just stand there, adjust the patient's position quickly so that the air in the patient's heart stays in the right atrium."

A schematic diagram of the entire heart structure instantly appeared in Xiao Chenguang's mind.

Whether it is oxygen or air, the density is lower than that of blood. Lying on the left side with the head down and the feet high will allow the embolic gas to float on the upper layer, away from the tricuspid valve.

Thereby avoiding entering the pulmonary artery and causing severe pulmonary embolism or even lung necrosis.

"Okay, okay, right away!"

Seeing that the patient could still be saved, everyone seemed to have grabbed a life-saving straw and immediately began to adjust the patient's position according to Xiao Chenguang's instructions.

Although Shengli Hospital was established in 1964, the operating room, as the facade of the hospital, has just been upgraded.

The scaffolding and operating table can be adjusted quickly.

This greatly shortens the time for adjusting the position.

Otherwise, it would take at least three to five minutes to reposition a patient under general anesthesia.

Sun Chengwu directly asked for a few large gauze pads moistened with warm saline to cover the abdominal incision to prevent bacterial infection.

Soon, everyone worked together to turn the patient's position, with the left side of the body pressed down and the right side lifted up.

The patient was in a [/] shape, like an onion upside down.

"Is the oxygen concentration given to 100%? Change the ventilator parameters to CPAP mode."

"Okay."

The anesthesia immediately began to readjust the ventilator parameters.

"Patrol, 40mg of methylprednisolone plus 100ml of 0.9% physiological sodium chloride, intravenous drip."

"Another half-dose of dexamethasone injection, open a new intravenous access, and drip 250ml of 20% mannitol at full speed."

Xiao Chenguang's medical instructions came whistling, like an eight-level gale, blowing everyone a little suffocated.

Air embolism, in their view, is a fatal outcome.

And this is indeed the case.

As for how to rescue and what measures to take, everyone is completely in the dark and has no idea.

Now with Xiao Chenguang's instructions, they suddenly feel that the patient seems to be saved.

Anesthesia adjusted the ventilator parameters and took the patient's blood pressure.

It was still very low.

Seeing this, Xiao Chenguang asked the anesthesia to push another dose of epinephrine hydrochloride, and then prepared 200mg of dopamine, which was dripped into the patient's vein in 250ml of saline.

The monitor was still alarming, and the screen was red, like a devil with fangs, staring at everyone.

In particular, the blood oxygen saturation that fell to the bottom deeply stimulated their nerves.

"Xunxuan, go prepare the deep vein kit and puncture kit."

Xiao Chenguang's voice sounded again.

"Director Xiao, do you still need to puncture the deep vein at this time? I have already built three access routes for the patient in advance, and the fluid infusion speed is completely sufficient."

Xunxuan was obviously stunned after hearing Xiao Chenguang's request.

Although the deep vein puncture technology has not really started in the Department of Anesthesiology.

But since Xiao Chenguang's previous two patients had successfully carried out deep vein technology, they really felt the advantages of deep vein catheters in fluid infusion.

Therefore, the head nurse of the anesthesia department has privately trained their nurses.

But now this patient has no problem with the fluid infusion speed, why does Xiao Chenguang still ask for a deep vein kit?

Just as the anesthesia doctor who was guarding the bedside was puzzled and went to get the deep vein kit, he suddenly thought of a possibility.

There was a look of disbelief in his eyes.

Director Xiao, this is to use the deep vein catheter to extract all the air in the patient's right atrium.

But, is this possible?

Anesthesia dared not think about it anymore, but did not stop working. No matter whether Xiao Chenguang succeeded or not, it was better than him groping in the dark.

Skin disinfection, according to Xiao Chenguang's previous puncture habits, with the internal carotid artery as the center, began to gradually spread to the surrounding areas.

At this time, Xiao Chenguang took the disinfection cotton ball from Anesthesia's hand and said.

"No internal jugular this time."

"Ah?"

Anesthesia was completely confused.

If you don't do internal jugular puncture, femoral vein is even more impossible.

Could it be that Xiao Chenguang, in this critical situation, puncture the subclavian vein?

Although this vein is closest to the right atrium, because of the many complications, if it is not properly operated, it is easy to cause subcutaneous emphysema, and in severe cases, even life-threatening hemothorax.

This is why the Department of Anesthesia dare not easily carry out deep vein puncture.

At this time, the circulating nurse had already run back with the deep vein kit.

The patient's blood pressure was still very low, and the veins were shriveled and almost invisible.

Unlike Xiao Chenguang's previous two punctures, the internal jugular and femoral veins had corresponding arterial vessels as references.

But the subclavian vein had to be punctured blindly, relying entirely on rich clinical anatomical knowledge.

The difficulty coefficient was the highest among the three veins.

The risk was also the greatest.

But Xiao Chenguang held the puncture needle in one hand, without a moment's hesitation, he lifted the needle and pierced it directly.

A long puncture needle was nearly halfway into the chest cavity.

Everyone's eyelids jumped when they saw it.