Is there no limit to this doctor's skills?

Chapter 165 Who would dare join such a crazy group?!

Ning Sanlong was in the surgeon's position, his mind and even his heart were filled with the surgery.

Guo Ziyuan was standing in some obscure corner, so Ning Sanlong completely ignored him.

Perhaps Ning Sanlong heard it but ignored it, or perhaps Ning Sanlong didn't hear it at all.

The two people standing next to Guo Ziyuan heard his voice clearly, but they only turned their heads slightly to give him a look before remaining in their original positions.

The surgery requires a surgeon and an assistant.

The assistant is there to help the surgeon, and may have to take over some of the operations at any time, so they cannot be careless.

Guo Ziyuan did not make a fuss, and knew that it was not convenient to disturb Ning Sanlong's train of thought at this moment!

Guo Ziyuan has also been a chief surgeon and participated in the rescue of such extreme patients.

Therefore, Guo Ziyuan knew even better that such extensive bleeding of this magnitude could not be interrupted during your surgery.

What's needed now is not to interrupt the surgical rhythm, but to quickly and appropriately participate in the surgical process.

Given the current situation, patients don't have much time left.

Guo Ziyuan's eyes began to scan—

Qian Shuhang, associate chief physician of the emergency department, and Zhang Yang, associate chief physician of the trauma surgery department, were targeted by Guo Ziyuan.

Guo Ziyuan was very calm at this moment.

If we follow the principle of being more familiar, then in this life, I am more familiar with Qian Shuhang, so it seems more advantageous to call out to Qian Shuhang.

In his previous life, Guo Ziyuan and Zhang Yang were just colleagues, and in this life, they barely even met.

However, Guo Ziyuan knew even more clearly in his heart.

In the case of this patient's massive traumatic bleeding, Associate Chief Physician Zhang Yang from the Department of Trauma Surgery would have a greater technical advantage.

After a moment's thought, Guo Ziyuan made up his mind: "Professor Zhang Yang from the Department of Trauma Surgery, I am Guo Ziyuan."

"This patient's retroperitoneal hematoma has a very extensive bleeding volume. In this case, I would recommend placing a one-way valve on both femoral veins!"

Guo Ziyuan called out names directly, and Zhang Yang, who was looking down, turned around.

Because Guo Ziyuan had identified himself, Zhang Yang did not react: "The intravenous check valve is useless."

"Veins themselves are a natural one-way valve!"

Seeing that Zhang Yang had managed to find the time to respond, Guo Ziyuan calmed down: "No... the one-way valve is useful!"

"The biological one-way valve of veins is only relative, not absolute!"

"We need to install an absolute check valve. When the flow rate at one end of the absolute check valve is very high, the hydraulic pressure will be relatively reduced."

"The vein at the unblocked end will allow for faster blood return!"

Guo Ziyuan spoke very quickly, giving Zhang Yang no time to refute: "What we're doing isn't to stop the bleeding, it's just to increase the amount of blood returning to the heart."

"Under the current circumstances, maintaining circulation is more important than stopping the bleeding."

At this critical moment, Guo Ziyuan could not explain the most basic principles to Zhang Yang.

The objective must be clearly stated!

"Doing this is at least harmless."

Retroperitoneal hematomas can be caused not only by arterial bleeding, but also by venous bleeding.

Although veins are natural biological one-way valves.

However, this one-way valve is unreliable; when a small vein is damaged, blood from the large vein will still flow back through it.

Only when the vein is completely unobstructed will the blood flow velocity cause the venous valves to act as biological one-way valves.

No one spoke again.

Zhang Yang's expression was slightly conflicted for a moment.

Actually, if Guo Ziyuan hadn't revealed his identity, Zhang Yang wouldn't have bothered with him at all. Who the hell are you?

However, recently, because of Chi Huanlin, Guo Ziyuan's name has become quite influential in the field of trauma orthopedics!

Guo Ziyuan's statement, "At least it's harmless," led Zhang Yang to choose to believe it, erring on the side of caution.

Retroperitoneal hematoma and extensive traumatic bleeding in the abdomen.

At this point, no one had a clue.

The surgeon was an associate professor from Peking Union Medical College Hospital, so Zhang Yang was naturally willing to believe that Ning Sanlong had the ability to save the patient!

He's using his brain, but he won't be the mastermind behind the entire surgery.

"Cycle, open two check valves for me," Zhang Yang ordered.

"We have to find this!" Xun Hui, of course, heard Guo Ziyuan's words.

In such a rescue, as a circulating nurse, she must remain vigilant and not overlook any orders from anyone on the operating table!

"Then let's go find him first." Zhang Yang ultimately chose to trust Guo Ziyuan.

After all, Guo Ziyuan cured a patient in the Department of Trauma Orthopedics who even Professor Dai Ruping of Tongji Hospital couldn't cure.

This kind of healing is definitely not a matter of luck or coincidence.

Even if there's an element of luck involved, you still need to have the ability first.

Surgery is similar to mathematics in some ways.

You may not have a high level of education, but you must have a foundation in mathematics; otherwise, you won't even have the ability to falsify.

"Hurry up!" Zhang Yang glanced at Guo Ziyuan again and urged him.

Guo Ziyuan only needed a one-way valve, but there wasn't one in the operating room at the moment.

It's not that I don't want to believe Guo Ziyuan.

……

Without anything, Guo Ziyuan was also at a loss.

He was standing quite far from the actual operating position, and there wasn't much to do. Guo Ziyuan couldn't push the others aside to get closer to the operating position.

Therefore, Guo Ziyuan tried to find another solution.

What should we do about this patient?

Currently, his most critical problem is blood loss!

The "one-way valve" he proposed is actually just an effective measure to indirectly reduce blood pressure and increase the amount of blood returning to the heart.

Guo Ziyuan's current hemostasis skills are at the "national master" level.

True hemostasis cannot be understood simply as a concept of mechanical hemostasis.

The simplest way to stop bleeding is to turn off the tap and let the bleeding stop.

This is the most basic concept.

But in reality, hemostasis is about "saving" the patient's life!

The core of trauma treatment is stopping the bleeding, and the fundamental purpose of stopping the bleeding is to save lives.

Therefore, hemostasis is not just a technical skill, but an art of saving lives.

Therefore, it is the core skill of emergency medicine and trauma surgery.

More broadly, any technique that achieves the life-saving element in trauma can be called hemostasis.

The term "hemostasis" was given to it simply to make it easier for people to understand, as it is contrasted with surgical procedures.

The essence of blood loss is that the outflow exceeds the inflow!

An ordinary person does not have blood injected into them.

Once there is blood loss, it is pure blood loss.

Therefore, the concept of "blood transfusion" came into being in medicine...

Therefore, in clinical medicine, the concept of extending the "rescue window" can be developed if the transfusion rate can be nearly balanced with the amount of blood loss.

At this point, it's crucial to focus on the key points!

Stopping bleeding requires addressing shock; in the simplest terms, that's how it should be understood!

Shock is defined as a pathological process caused by a sharp decrease in effective circulating blood volume and severe inadequate blood perfusion to tissues, leading to functional, metabolic, and structural damage to vital organs.

Shock is a process, not a single moment.

Cardiac arrest is not shock, but sudden cardiac death.

Therefore, according to the definition of shock, to reverse shock—

It is necessary not only to prevent a decrease in effective circulating blood volume, but also to restore blood perfusion to tissues and at least ensure the function of vital organs.

This has already reached the stage of sustaining life!

Guo Ziyuan's mind was racing!

At that moment, many theoretical points flashed through Guo Ziyuan's mind!

The most effective theory comes from the "national-level hemostasis technique" itself.

Secondly, there's the "circular concept" that An Yue shared with Guo Ziyuan!

At the very least, Guo Ziyuan didn't know why, but he suddenly remembered half a person...

A so-called "half-person" is someone who survives after having a limb amputated from the abdomen or even higher!

Abdominal amputation can still result in survival.

The concept of a cycle.

The human body has multiple circulatory systems!

At one point, Guo Ziyuan seemed to feel that his "secret" had been unlocked!

Guo Ziyuan asked again, "Director Qian, does this patient have money?"

Guo Ziyuan's repeated mention of his name brought Qian Shuhang back to his senses, and he said curtly, "This isn't about money!"

Of course, after he saw that it was Guo Ziyuan, his tone softened: "The patient has a third party responsible, and the other party has insurance."

"If you have the money, prepare for ECMO!"

Guo Ziyuan couldn't care less about anything else. After he finished speaking, he looked at Professor Ning Sanlong and said, "Professor Ning, prepare for a high-level abdominal amputation!"

"Temporarily abandon the retroperitoneal hematoma!~"

"What did you say?" Ning Sanlong was struggling with the patient's hematoma when he heard this, and he couldn't help but gasp sharply.

"Abandon hematoma treatment, preserve the function of vital organs first, and prepare for a high-level abdominal amputation!"

"This is extensive retroperitoneal bleeding in the pelvis, with an active hematoma. Simply stopping the bleeding may not be very effective."

"It's definitely too late!"

"But?" Ning Sanlong's scalp tingled.

Damn it, do you know what you're saying?

High-level amputation?

What you're calling high-level body dissection, okay?

Is it really necessary to be so ruthless?

Do these patients still have a quality of life after surgery?

"Save your life first!" Guo Ziyuan insisted on giving his advice.

He's too far from being the surgeon right now, so he can only offer advice for now!

"First, preserve the blood supply to vital organs such as the liver and kidneys."

"First, establish a separate circulation above the patient's renal artery. Ensure the patient doesn't die and that vital organs don't fail."

"Then, we'll figure out how to deal with the next segment of the hematoma."

"Otherwise, this patient will surely die!"

"If we drag this out, it will only lead to shock symptoms!" Guo Ziyuan's voice was concise and to the point.

Ning Sanlong's brain really seemed to be malfunctioning: "You mean, we should directly reconnect the aorta and vena cava to the systemic circulation, and discard all the bleeding below the systemic circulation?"

No, you've lost quite a lot of things, haven't you?

This isn't because Ning Sanlong wasn't calm enough.

Discarding everything below the major circulation level represents the patient's lower limbs, bladder, pelvis, etc.

"Give up first, then take!"

"Professor Ning, only in this way can we save the patient's life to the greatest extent possible."

"If the blood loss area is too large, the circulating blood volume will continue to decrease. We must effectively preserve the existing circulating blood volume."

Shock is a process.

"The patient hasn't reached the point of shock yet, so there's still a chance..."

"Our rescue efforts will take longer!"

"By first cutting off the circulation, we have more time to save the patient."

Even the liver has a certain period of ischemic window.

"We must reduce the circulating blood volume to zero!"

"This requires the oxygenation and blood storage functions of ECMO!" Guo Ziyuan didn't want to waste time, but he had to convince Ning Sanlong first.

Guo Ziyuan's suggestion is too extreme!

Therefore, Ning Sanlong hesitated.

Of course, Guo Ziyuan's suggestion was also "fair"!

If we insist on stopping the bleeding step by step now, the patient is likely to be impatient.

In such a situation, one must make sacrifices in order to survive!

However, there are a few things that need to be given up!

In Guo Ziyuan's theory of hemostasis, this is called abandonment hemostasis!

The theory originates from amputation for life-saving purposes and high-level limb amputation.

"Activate ECMO!" Ning Sanlong had no better option at the moment, so he gave the order decisively.

However, after giving the instructions, Ning Sanlong added, "Qian Shuhang, you must go out and talk to the family!"

Although the methods of emergency surgery are not fixed, doctors have absolute autonomy in saving lives.

But if a patient loses all of their lower body in an effort to save their life, can their family accept it?

"Guo Ziyuan... what's your suggestion?" After Ning Sanlong gave the order and everyone else had already started to tense up, he looked at Guo Ziyuan with a hint of hesitation.

Guo Ziyuan then said, "Professor Ning, you are responsible for preserving the upper circulation and treating any minor bleeding in the vital organs."

"For example, a liver contusion..."

"We can provide emergency treatment for the hematomas in the lower abdomen and pelvis. Once the bleeding is completely controlled, we will restore circulation."

"This can prolong the time it takes to stop the bleeding and also control the amount of blood loss to the greatest extent possible!"

Guo Ziyuan swept his hands down from the patient's navel: "Our decision now is to assume that we don't need any blood circulation from here down!"

"The remaining circulating blood volume is still sufficient to maintain the function of vital organs!"

This is actually similar to the emergency repair of a water pipe in a residential area in the city.

I first stopped the water supply for everyone in this community, but kept the water supply running in other communities.

This idea is easy to understand!

But a person is a person, and a person is a whole.

If you say you don't want it, then you don't want it.

Let alone ordinary people, even ordinary doctors wouldn't dare to think so extremely.

Guo Ziyuan's proposal of "semi-severance of limbs" was an extreme surgical choice made only when there was absolutely no other option.

This patient still has a chance to be saved; it's not entirely hopeless...

However, Guo Ziyuan was able to make such a decisive choice to include "high-level limb amputation" as part of the rescue process.

Is this the idea of ​​a genius?

That's crazy!

That was certainly decisive.

Deep-seated diarrhea must be eliminated, even if it is very painful!

Only by removing the accumulated waste can one regain health.

Surgery is not suitable for being fussy and indecisive; it requires decisiveness and efficiency.

Sometimes, hesitation leads to defeat; only those with great courage can become truly mature surgeons.

Of course, surgeons must also be meticulous.

This idea was proposed by Guo Ziyuan and is quite extreme.

Therefore, on the entire operating table, apart from Ning Sanlong who dared to follow, no one else dared to easily join the group for a while.

This allowed Guo Ziyuan to finally move slowly to Ning Sanlong's second assistant position, diagonally opposite him!

Who would dare to join such a crazy group like yours?

……