When the sternum was closed, the blood pressure fluctuated abnormally, and rapid ventricular arrhythmia occurred repeatedly with a heart rate of 170 Xun 180 beats per minute.
This was the value that appeared when the sternum was not completely closed. If the sternum was really closed by force, the patient might not even be able to get off the operating table.
“Boss Zheng, was there any judgment before the surgery?” Zhao Yunlong knew that Zheng Ren had made the right choice, so he asked softly.
“The ultrasound showed that the patient’s heart was swollen, but that’s not the main reason. The judgment to delay the closure of the chest was based on past treatments.” Zheng Ren started to make preparations for the delayed chest closure as he explained.
“Boss Zheng, are we going to do the ultrasound now?” Old he asked as he pushed the machine in.
“Alright,” he said.
Old he did not mind that he was brought to the operating room by boss Zheng from home early in the morning just to do a transesophageal ultrasound examination. He did whatever boss Zheng asked him to do and had no complaints.
In a state of general anesthesia, it was also a skill to successfully complete a transesophageal ultrasound examination when there was a ventilator and intubation. Not everyone could do it.
“Please wait a moment.” Old he ran to the computer, plugged in the USB drive, and the lucky song started to play.
“Nowadays, if you don’t listen to this song, you won’t be able to perform surgery.” Old he explained with a smile.
Although the surgery was at the last step, old he still insisted on playing “good luck.”
Stepping on the beat of good luck, old he felt that his body had become lighter, as if he had become an immortal.
The difficult operation became very smooth in his hands. A few minutes later, old he said in a soft voice,””Boss Zheng, SAM’s characteristics are obvious.”
SAM sign was a sign in the diagnosis of M-mode ultrasound.
The main point was the forward movement of the anterior lobe of the meniscus during the contraction period. In the C stage of the contraction period of patients with obstructed coronary heart disease, there was not a slow ascending platform. Instead, there was an abnormal wave that protruded upward, which was in the direction of the intercostal space. This phenomenon was called the forward movement during the contraction period, or the SAM sign for short.
“Give him a small amount of beta-Broner and quickly replenish his blood plasma.” Zheng Ren gave his medical order and started delaying the procedure of chest closure.
“Adjust the dosage of leoximendan to 0.5 μ g/kg/1/min.” As Zheng Ren spoke, Xie Yiren had already handed him a child-sized chest piece.
Zheng Ren changed the adult’s sternum spreader to a smaller child’s one. Then, he observed the blood pressure, central venous pressure, heart rate, cardiac rhythm, cardiac contraction strength, and pulse oxygen saturation level at the same time.
His hand slowly changed the distance of the sternum, looking for the most conducive position for stable blood pressure, no increase or decrease in heart rate, no ventricular arrhythmia, a decrease in MVP, strong cardiac contraction, no heart expansion, and no increase in oxygen saturation.
“Boss, you’re too meticulous.” Su Yun said,”it’s not necessary to perform surgery in millimeters. Cardiothoracic surgery is all about being rough!”
Zheng Ren laughed. Su Yun’s rough words were probably different from what the others understood.
“The more accurate the position, the faster the postoperative recovery. If there are no accidents, the edema will gradually subside in two to three days, and old Zhao will be able to close his chest in about five days. ” Zheng Ren said.
Zhao Yunlong lowered his head, his eyes fixed on the way boss Zheng moved the child-sized chest extension device.
There was a way to explain every angle, every distance, and every action, but Zhao Yunlong knew that this was an instinct formed by his rich surgical experience. He was afraid that even boss Zheng himself would not be able to explain it.
“I’ll look at it carefully and think about it when I get back. If there’s a next opportunity, I’ll try it,” Zhao Yunlong thought.
They placed the cardiac and medicinum drainage tubes, sealed the incision with a transparent, sterile surgical film, and used a retractor.
“Send it to the ICU.” Zheng Ren turned around and got off the stage. He immediately turned around and asked,”old Zhao, do you guys often delay chest closure surgeries?”
“I do it occasionally, very rarely. But the doctors and nurses of the icu are experienced, so don’t worry, boss Zheng. ” Zhao Yunlong knew what Zheng Ren meant by his question and immediately replied.
“Alright, that’s it then.”
Even though the chest closure was delayed, the surgery was completed at 101%, and Zheng Ren was very satisfied with this.
The patient should be fine.
“Boss Zheng, thank you.” Director lang said softly as he took a deep bow.
“You’re welcome,” Zheng Ren said,”I shouldn’t have used IAB. I’m more experienced now, and I won’t make such a mistake next time.”
“Next time …” Director lang muttered.
“What?” Zheng Ren could tell that director lang had a hidden meaning in his words and looked at him in confusion.
However, director lang did not continue. Instead, he asked,”boss Zheng, isn’t the IABP a good match? Every time I encounter a similar situation, I use IABP to solve it. “
“We can’t be too dogmatic.” Zheng Ren said,”after the clinical judgment determines that there are many early symptoms of cardiac tamponade, emergency measures such as cardiac puncture drainage should be carried out immediately to alleviate the symptoms. At this point, there’s no problem with your treatment. You’ve done well. “
Seeing that director lang was not in a good mood, Zheng Ren did not over-stimulate him. Instead, he praised him, which was a rare sight.
“During our intraoperative exploration, we did not see the common situation of cardiac tamponade caused by blood accumulation caused by a coronary perforation. By right, even if it was pericardium puncture drainage, it would still be more or less a case. This situation is too rare.”
“Boss Zheng, it’s caused by the rupture of a small branch, right?” Director Zhang Lin asked.
“It should be. We can also consider that it’s a small rupture. As the pressure in the pericardium increases, the rupture point has already healed.” Zheng Ren said,”his luck is indeed a little bad. Actually, it might have been better if this patient did not do anything.”
“……”
Director lang was speechless. Boss Zheng’s words made him feel ridiculous.
The style of an absurd black comedy and nonsensical words were not suitable for the operating theater, and Department Director lang could not accept it.
“But I think it’s more likely because the patient is older. The main cause of cardiac tamponade is the highly congested swelling of the cardiac muscle, not blood accumulation in the pericardium.” Zheng Ren explained,”according to my analysis, it should be because of the extensive myocardial infarction that caused your heart to swell during the process of your coronary artery removal.”
“In the early stage of myocardial infarction, there was severe myocardial edema, and the advantage of the left crown meant that the scope of myocardial infarction was larger, which led to this special change.”
“In other words, the cardiac tamponade was not caused by a coronary artery rupture or bleeding, but by acute necrosis and tamponade.”
“Under such a rare situation, all the operations that you did after that were wrong, Department Director lang.” In the end, Zheng Ren still told the truth.
“Although the IAB measure reduced the afterload of the patient’s heart, it did not reduce the pressure on the patient’s pericardium in time. Hence, the symptoms became more and more serious.”
“……”
Director lang listened to boss Zheng’s explanation of the patient’s condition, and his judgment of the patient’s condition was not the small coronary artery branch rupture and bleeding as director Zhang Lin had said before, but another kind of complication.
At that moment, Department Director lang was in a daze.
