? 2018 July 2 1 Director Gan Naiyan of the Department of Cardiothoracic and Vascular Surgery of Yulin First People's Hospital is checking the patient's condition as usual. Suddenly, I was informed by the medical department of the hospital that there was a patient with clavicle fracture and subclavian artery bleeding in Tian Liang Health Center of Luchuan County, about 70 kilometers away from our hospital, and his condition was very critical. Director Gan Naiyan, with his professional sensitivity and decades of experience in cardiothoracic and vascular surgery, knows the risk and difficulty of subclavian artery bleeding. He was calm and strategizing, and immediately arranged for experienced Deputy Director Chen Jun and Dr. Lu Kai to visit him and explain the matters needing attention. At the same time, considering the limited conditions in primary hospitals, contact Huang Hailin anesthesiologist and operating room nurse Chen Ou, who has rich anesthesia experience in anesthesiology department, and contact the blood bank to prepare 4U red blood cells and plasma. Everything was ready, and the emergency team arrived at the destination after more than two hours of bumps, and went to work without a sip of water.
Reality is more serious than imagined. Clavicle fracture with subclavian artery rupture, subclavian artery diameter is large, the anatomical position is special, the blood vessels are located under the clavicle, the pressure is high, and it is difficult to expose. The condition is dangerous, and uncontrollable bleeding, shock and even death often occur after rupture. At that time, the patient's hemoglobin was only 59g/L, which belonged to severe anemia. If it is directly transported back to the First People's Hospital, it may bleed to death on the road. What should I do if the local health center is in poor condition after the operation stops bleeding? There is no blood source and blood substitute, and there is no anesthetic for intravenous anesthesia. The anesthetic can only last for three hours, without a ventilator? Clinical rescue must race against time. After reporting to Director Gan Naiyan, Minister Wu of the Medical Department and Vice President Luo, we decided to overcome the difficulties at all costs, stop bleeding by surgery first, and then transport the patients.
Director Chen Jun and Dr. Lu Kai, both backbone experts of cardiothoracic and vascular surgery in the First Hospital of the city, quickly worked out a treatment plan, and then formed an emergency team with anesthesiologist Huang Hailin and operating room nurse Chen Ou, and immediately put them into rescue work. Dr. Huang Hailin quickly performed arterial puncture, and established arterial monitoring and intubation general anesthesia. In the operation group, doctors saw the sternum to expose the left clavicular artery, blocked the posterior clavicle, and exposed and repaired the broken blood vessels. Everything is going on in an orderly way.
Because there is no ventilator in Tian Liang Hospital of Luchuan County, patients can only perform thoracotomy after general anesthesia with tracheal intubation, so simple breathing balloon is used to assist breathing in the whole process.
The patient's vital signs were stable after operation, and the tracheal intubation was removed immediately. No adverse reactions, perfect cooperation. For the safety of patients, after excluding life-threatening factors, they were taken back to the intensive care unit of cardiothoracic and vascular surgery in the First Hospital of the city for treatment. At present, the patient's condition is stable and has been transferred to the general ward.
In the absence of sophisticated equipment and harsh environment, all emergency teams used their rich clinical experience and solid technical foundation to complete the repair of subclavian artery rupture, racing against death, saving time and greatly appreciating the patient's life. ò ? ó? )。
? The cardiothoracic and vascular surgery team in our hospital is a team that can fight hard. They have visited Yulin Orthopedic Hospital many times, and hospitals such as Beiliu, Luchuan, Bobai, Rongxian and Xingye have successfully rescued vascular diseases such as clavicle artery, abdominal aorta and heart. The success of this rescue is the effective organization of medical department and hospital leaders, and the active cooperation of anesthesiology department, operating room, blood bank and 120, which is the embodiment of our hospital's unity and cooperation, kindness to all beings and kindness to relatives.
Editor of this issue: Zhang Xiaoyi, Yu Ning and Chen Jun.
Image source: Yu Ning
This audit: Chen Jun and Yu Ning.