MTL - Live Surgical Broadcast

Because it was in the system operating room, Zheng Ren was not particularly impatient. This is an incomparable advantage of others, and Zheng Ren is used to it. He silently watched the state of the subject deteriorating, and began to measure various values.

Laboratory test values ​​indicate that the subject has symptoms of metabolic acidosis and acute renal failure.

仁 ECMO may have gas embolism during use. This is what Zheng Ren knows. It is estimated that gas embolism has blocked the renal artery, and there have been cases in which the surgery has failed before it is completed.

I can find it just fine, Zheng Ren's mood is stable. The significance of the system operating room is here, the problem is found in advance, and what can be done to avoid this situation.

Determined that there is a problem with the kidney. Zheng Ren ended the lung transplantation operation, but did not leave the system operating room, but performed a renal angiography on the subject.

The final conclusion proves Zheng Ren's judgment-gas embolism.

After ECMO placement, liver and kidney function should be improved because ECMO can improve perfusion of peripheral organs.

Looking for similar information in the journal, there is very little relevant information. Zheng Ren can only make judgments with limited information plus his own imagination.

的 Deterioration of kidney function may be a sign of ECMO failure or may indicate that the patient has had kidney disease before. Zheng Ren tried several methods and discussed with Lao He, and finally decided to use continuous renal replacement therapy as a circuit independent of the ECMO system to avoid air embolism.

The cause of persistent metabolic acidosis may be insufficient perfusion of any organ, tissue necrosis, or distal limb infarction. Oxygenator failure can manifest as massive hemolysis. Distinguishing hematuria, diffuse intravascular coagulation, and hemolysis requires emergency diagnosis and examination. Continuously measuring values ​​during the operation and timely treatment are very important.

One problem after another was solved, Zheng Ren pulled Lao He researching tiredly.

印 Every time he verified and resolved the problem, Zheng Ren found that in addition to renal gas embolism, there is a 15% chance of acute liver failure when using ECMO.

Because the small stone has just completed two liver cancer interventional embolizations, the liver function is poor. Liver failure is also a top priority for surgery. Zheng Ren didn't want to show his skills, and completed a liver transplant at the same time as a lung transplant.

怕 The transplantation of an organ is afraid that the small stones won't stand up, let alone more organs.

Finally, he and Lao He set down to measure liver function every 10 minutes during the operation. If the small stones still progress to a continuous increase in bilirubin or an acute increase in liver enzymes under the conditions of appropriate ECMO flow and blood pressure, it must be Liver dialysis using a molecular adsorbent recycling system.

"Lao He, do we have liver dialysis during surgery?" Zheng Ren asked.

"No, Emperor Capital only has Xiehe and Emperor Hedan gallbladder." Lao He said, "The amount of liver surgery we do is not as good as that, and this situation is not common, so the equipment is temporarily unavailable."

Zheng Zhengren did not hesitate to call Zhou Chunyong with a phone call.

Borrow a piece of equipment to use it, and borrow it well, and pay back, the chief dean of the emperor's liver and gallbladder Bao Longtao will not embarrass himself because of this.

Laohe was particularly helpless. In his opinion, even if there was a problem with liver function, it was too late to get it. But Boss Zheng poses a gesture that must make the operation perfect, so he doesn't say much.

After nearly 10 hours of discussions, brainstorming round after round, Lao He has been completely squeezed out by boss Zheng.

Looking at Zheng Zheng's enthusiasm, he went to the operating table for surgical training. Lao He held 12 A4 paper records in his hands, and slowly closed his eyes.

There are so many details to be aware of when it comes to anesthesia, ECMO, and extracorporeal circulation. What about surgery? It is estimated that there are more points to focus on.

"Lao He, do you want to drink some Red Bull?" Linger's voice came.

"Ah? Lin, how are you here?" Lao He gave a moment's answer, what time is it, why is Linge ... still need to ask, is Lin Lin also preparing to stay in the community hospital for a while and do the logistics? .

In the days of Director Mao, the Department of Medical Science and Education was almost transparent to the clinic, and basically did nothing serious except to ask doctors to take a card. There is a stale smell, and when it comes to science and education, clinicians frown.

This is a sub-office work at Zhe Lin, but Lao He is still not used to it.

He wanted to say hello to Linge, but his eyelids seemed to stand together, and it took a lot of effort to open them.

"If you can't, just go back to sleep." Linge advised. "I think you have too much mental energy. It's probably a waste tonight. It's useless to boil here, but the efficiency is low. It's not a day thing, I see what Mr. Zheng meant. This is a marathon. "

"Well, still Boss Zheng is young, healthy and energetic." Lao He glanced at Zheng Ren who stood in silent operation under the shadowless lamp, and sighed, "My old arm and leg are really not working."

"What did you discuss just now?"

"Boss Zheng took me through the anesthesia operation from beginning to end." Lao He said, "the type of intubation, the depth of intubation, the frequency of the ventilator, the tidal volume, the end-expiratory pressure ... and then During ECMO, there are various things to pay attention to, as well as preparations for kidney and liver dialysis. "

"Usually ..."

"Forest Lin, how high Boss Zheng is." Lao He said, "Hepatobiliary has made several applications and wanted to enter the liver dialysis equipment during surgery ~ www. ~ I haven't come in yet. Boss Zheng manages Didu liver Borrow equipment to be sure. "

"I heard it and was just asking you, would it make sense to borrow this thing?" Linger asked, lowering his voice.

"Of course it makes sense. Once the bilirubin rises during the operation, immediately going to the liver for dialysis is much better than the symptomatic treatment after the operation." Lao He said, "But the meaning is the same thing. If you change someone else It is estimated that it will be enough to deal with this. The surgery will not be delayed for a long time, and it is better to go back for dialysis during the operation. And there are not many people who know that there is renal dialysis during the operation, which is a very advanced treatment. "

"You see what you said." Ringer laughed.

"Lin, it's not a joke." Lao He said very seriously, "I don't believe you ask the clinician, when you say dialysis is kidney, there are not many people who know liver dialysis during surgery."

Linger nodded, and raised the event level up again.

老板 Boss Zheng cares about what he cares about. There is nothing to say. For a problem that may arise, it takes a lot of money to borrow equipment from the emperor's liver and gallbladder. How much effort did Boss Zheng spend?

If it wasn't for the age difference between Boss Zheng and the young patient, Lin Ge even thought that the little patient was the illegitimate son of Boss Zheng. If it weren't for his own son, who would like to spend so much effort to brush his face to prepare for surgery and treatment.

Treating patients as if they are relatives, President Yan will talk about it every time at the hospital weekly meeting. It is true that there are not many doctors who can treat patients like relatives.

Boss Zheng: This ... Linger felt that he had done a little too much.

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