Is there no limit to this doctor's skills?

Chapter 179 Simple Lower Limb Circulation Device

There were many people in white coats gathered around the emergency bed.

Director Zhou Yong, Associate Chief Physician Qian Shuhang, Attending Physician Peng Jingye of the Emergency Surgery Department, and Director Lu Guoan of the Trauma Surgery Department, among others, also saw through all of this.

Their expressions were unusually blank.

"What's going on?"

After Guo Ziyuan finished speaking, Peng Jingye instinctively started to push the bed into the operating room.

Push first, then ask.

Guo Ziyuan didn't have time to explain to Peng Jingye: "Let's go into the operating room first."

After Guo Ziyuan finished speaking, he looked up at Zhou Yong and asked, "Director Zhou...has our hospital's burn unit been basically converted into plastic surgery?"

With the development of the times, the burn unit has gradually faded from the historical stage.

While some hospitals still have burn units, the names of these units have changed dramatically.

The Department of Burns and Plastic Surgery is the current name for the Department of Burns.

Currently, their department's main focus is on plastic surgery, not burns.

There are really no patients... There aren't enough doctors and nurses to go around.

Director Zhou Yong nodded quickly: "That's basically it."

"He...didn't suffer from blood-borne shock and coma?"

Guo Ziyuan nodded: "That's most likely the case!"

"In any case, these two lower limbs need to be treated, and it is too early to determine the 'sex change' segment."

Kuo Tzu-yuan did not use colloquial terms like "necrosis" or "cooked," but instead professionally used the medical term "transformation" to express it.

When a comatose patient goes through a series of inexplicable illnesses, one possible cause can be quite encouraging.

Many people, upon seeing the degenerated muscles in the lower limbs, immediately understood: "It might be a sign similar to rhabdomyolysis... Get your liver and kidney functions checked quickly... Don't let it turn into liver failure."

"It is really difficult to directly associate a patient with unexplained shock who comes to the emergency room without any signs of skin burns or trauma with extensive tissue necrosis."

To be fair, while the reasons given by these medical professionals may seem like justifications, they are also understandable.

If a comatose patient is admitted to the hospital, don't you prioritize hemorrhagic shock? Don't you consider stroke, but instead consider soft tissue necrosis?

You might as well say he's asleep, in a "dream within a dream" where no one can be woken up after someone has died!

With plenty of manpower, the transfer speed is fast enough.

There were many people, and most of the staff from various departments were called in for consultations, so the doctor team was fully staffed.

The chief physicians of general surgery and orthopedics are all on the front line.

After making room for a bed, Zhou Yong went to call the burn and plastic surgery department for a consultation...

One group of people rushed to talk to the patient's supervisor and colleagues to get their signatures, while another group took the patient into the operating room and quickly disinfected and draped them.

Outside the emergency room, colleagues and superiors, whose identities were difficult to discern as young or teenager, turned bloodshot upon hearing the 'true' reason.

"Is there any way to save him?" someone asked quickly.

"If the cause is identified, there is still a chance. We must perform the surgery as soon as possible."

"The tissues of both lower limbs have been extensively burned and degenerated. After degeneration, they will die. Once dissolution occurs, a large amount of dissolved material will enter the bloodstream."

"This could lead to liver and kidney failure, so surgery is necessary..."

A young man, his face covered in soot, said, "I saw it. Cao Songou wasn't burned."

"This is not a direct contact burn. If it were a direct contact burn, the diagnosis would be much easier."

"It's a non-contact, persistent burn..."

"Therefore, the skin didn't react in time, and there were no typical burn appearances."

Zhou Yong then looked at the patient's supervisor: "It's possible, amputation is necessary, there's a high probability that amputation will be required..."

The family has been notified, but they haven't arrived yet.

"this?"

Zhou Yong: "This is not the time to hesitate... Besides, in a sense, we may just be informing you..."

"We are calling his family..."

In the operating room, the young man had already undergone endotracheal intubation and anesthesia, and the disinfection and draping process was nearing completion.

At the sink, Qian Shuhang saw Guo Ziyuan scrubbing his hands.

"Dr. Guo, would you like to perform this surgery?"

The diagnosis for this surgery is currently clear, and the treatment is also relatively clear.

The solution is to amputate both lower limbs while ensuring adequate blood volume.

Amputation surgery does not require much technical skill and is considered a resident physician procedure.

In principle, an intern is capable of performing amputation surgery.

"Since we're already here," Guo Ziyuan said with a smile.

"Director Lu, Director Wu, would you mind taking me along?" Guo Ziyuan looked at Lu Guoan and Wu Qiong from the Department of Trauma Surgery.

Lu Guoan is the chief physician, and Wu Qiong is the associate chief physician.

Lu Guoan and the others certainly knew Guo Ziyuan!

Chi Huanlin, a previous inpatient in the trauma orthopedics department, had several surgeries performed by professors from Tongji Hospital, but the results were not good.

Guo Ziyuan reversed the outcome, which made Lu Guoan and others remember Guo Ziyuan.

Previously, Lu Guoan and Wu Qiong had been unable to find a reason to exchange pleasantries with Guo Ziyuan.

"Dr. Guo, you're too kind. You're our trauma specialist, so feel free to come in for surgery if you want." Lu Guoan had a standard square face, was tall, and had thick, piercing eyebrows.

But at this moment, the voice was exceptionally gentle.

Lu Guoan extended the invitation to Guo Ziyuan at just the right time, and it was not limited to the surgery that was currently underway.

After that, Lu Guoan, Wu Qiong, Guo Ziyuan, and Qian Shuhang officially took the stage.

Meanwhile, the on-call doctor in the burn and plastic surgery department also arrived late.

After entering the operating room, he first examined the patient's skin on both lower limbs, and then looked at the muscle tissue that Guo Ziyuan had cut open.

Some were completely baffled: "I've basically never seen this kind of burn before."

Most people would instinctively flee from a scorching heat.

Those who couldn't escape mostly stayed where they were.

He escaped, but it's as if he didn't escape at all, or he escaped but didn't really escape. He's truly ignorant.

The person who came was not old, probably in his thirties.

From the era in which he was born, it was destined that he would not see many typical burn patients...

Many people looked at him, but no one spoke.

The presence of a burn surgeon is not a necessity; it does not mean that the surgeon is obligated to perform the operation.

If it is a typical burn, he can undergo burn management.

But the burns he suffered were completely different from regular burns, so he was unsure how to adapt to the emergency treatment procedures for burns...

Those who needed to undergo gender reassignment surgery have changed.

"They were steamed alive." A director emphasized the word "steamed" very meticulously and in a hoarse voice.

The entire operating room remained silent.

This is not a typical operating room; there is no laughter, no jokes between doctors and nurses.

There wasn't even the bawdy jokes that are popular in the operating room, or the pleasant music that the surgeon was listening to.

There was only the calm, heavy breathing of a group of surgeons, circulating nurses, and scrub nurses in scrubs.

An anesthesiologist is the head of the anesthesiology department.

He sat down in front of the young man without picking up his phone: "Man, you've made it through so much, keep going."

……

After Director Lu Guoan led the team onto the platform, he instructed, "Wu Qiong, first go up along the gradual path to determine the necrotic section."

Amputation cannot be performed haphazardly; it must be done precisely, a little more is acceptable, but absolutely no less.

However, as soon as Lu Guoan spoke, he noticed that Guo Ziyuan had already started to "touch and grope" the patient.

Guo Ziyuan pressed down on the patient's right lower limb and extended the pads of his index and middle fingers, seemingly probing for something.

But it wasn't until Guo Ziyuan checked him for the third time that Lu Guoan understood what Guo Ziyuan meant: "Are you checking his lower limb arterial pulse?"

As the chief physician, Lu Guoan quickly determined that Guo Ziyuan was exploring according to the direction of the arteries in his lower limbs.

Guo Ziyuan did not hide anything: "Yes, Director Lu, I am checking whether the blood in his aorta and venous vessels has also degenerated and become blocked."

"How did it go?"

Kuo Tzu-yuan responded: "The results of the investigation so far... are not good."

"Sigh..." Lu Guoan was actually hoping that someone would descend from heaven and bring about a miracle.

Medicine is one of the disciplines in the scientific field that most eagerly anticipates the existence of metaphysics.

However, after being a doctor for a long time, you'll find that...

Not only does it lack the power of a god descending to earth, but it also lacks the "power of a hero."

They are just ordinary people who, at most, follow the example of their predecessors, fight against unknown diseases, and try their best to help patients. That's all.

"You can take your time to investigate, there's no rush."

"The patient's electrolyte levels are currently acceptable..." Lu Guoan said.

Whether Guo Ziyuan was simply curious or just daydreaming, Lu Guoan wanted to give him a little more time.

Patients can't wait several hours, but waiting an hour or two is fine.

Tissue necrosis and dissolution do not occur very quickly.

It just needs to be stopped as soon as possible.

Guo Ziyuan also gave up on the physical examination at this point, even though Guo Ziyuan's physical examination skills are "national level".

However, the patient's degenerated tissue was hard and rigid, which really prevented Guo Ziyuan from getting any tactile sensation with his fingertips.

Guo Ziyuan possesses such abilities and can be confident in their existence, but he should not be superstitious that these abilities can handle all variables.

"Director Lu, let's try femoral artery exploratory thoracotomy first."

"The subcutaneous tissue degeneration is severe...the physical examination won't reveal anything," Guo Ziyuan suggested.

"Alright," Lu Guoan said.

This patient needed to have the necrotic tissue examined, and the blood vessels also needed to be checked for patency.

Although Guo Ziyuan could not clearly detect the pulsation in the blood vessels of the patient's lower limbs, he could roughly tell from the tactile sensation during the physical examination that the patient's bilateral hip joints and genital area had not undergone any changes!

At this thought, Guo Ziyuan suddenly said, "Director Lu, I have an idea."

"Go ahead," Lu Guoan nodded, giving Guo Ziyuan enough space.

The surgery was not technically difficult, and Lu Guoan was not worried that it would be difficult to perform.

"Director Lu, I think one of the reasons this patient fell into a coma might be because the circulation in both lower limbs was blocked."

"This leads to a certain degree of discontinuity in the arteriovenous circulatory network."

"We can first perform arteriovenous shunts in the patient's lower limbs to increase circulating blood volume."

"Otherwise, the patient's current condition is actually one where both the major artery and the major vein are clamped."

The human body has multiple arterial and venous return systems.

However, if the arterial blood that is pumped out cannot be returned to the heart, the effective circulating blood volume is reduced to some extent.

"You mean, we should first reconnect the arterial veins, and then look for the necrotic segments?"

"But if that's the case, the lower limbs will lose their blood supply. How can we determine the necrotic section?" Lu Guoan understood what Guo Ziyuan meant.

However, this will create challenges for treatment.

Currently, most orthopedic surgeons rely on the most direct evidence to determine whether tissue is ischemia and necrosis.

Localized bleeding!

If there is localized bleeding, then the blood vessels in that area must be healthy.

What if there is no arterial blood supply?

Then the only way to determine that would be through guesswork or a brute-force interpretation of tissue activity.

Guo Ziyuan replied, "Director Lu, this is what I think!"

"Directly introduce blood components that are compatible with the patient's blood type into the ECMO to form a certain pre-circulation."

"Then, the arteries and veins of both lower limbs were reconnected to the ECMO, thus creating an alternative circulation."

"We can still determine the necrotic segments using normal methods..."

Lu Guoan frowned: "But, the cost of starting ECMO is very high!"

"It would be a waste to turn on the device just to determine the level of amputation."

Guo Ziyuan smiled and said, "This brother's medical expenses were fully covered by the government. ECMO saves lives, and saving the length of his lower limbs is also a form of saving lives."

"So what if we waste a little?"

What do you think?

"This way, our surgery time can be extended a bit."

Lu Guoan didn't dare to make a decision easily, so he asked the others in the operating room to make a phone call outside.

The cost of starting ECMO is very high, but that's for the average person.

Firefighters' "work-related injuries" are funded by their employers. Tens of thousands or hundreds of thousands of yuan is just a drop in the ocean for an employer.

Moreover, this was for the purpose of saving lives, so a reply was received very quickly.

Money is not a problem, as long as it's not too outrageous.

With this phone call as the answer, ECMO was then introduced into the operating room!

At the same time, the general surgeons also took over. They began to take charge of the direct connection of arteries and veins in the lower limbs to complete the body's proper "grand circulation"!

The patient's blood pressure was already relatively stable, so there was no immediate risk of hypotensive shock.

However, since the degeneration and necrosis of both lower limbs have been confirmed, the anesthesiologist is now continuously drawing venous blood to determine the patient's electrolyte, lactate, and other conditions.

Especially when paying attention to the patient's urine output...

Once everything was ready, the ECMO specialists brought in from the ICU were also prepared.

Actually, everyone knows what Guo Ziyuan wants to do.

However, everyone tacitly refrained from saying it directly.

This is something that is almost impossible to accomplish. They can't even do it, so they won't put pressure on Guo Ziyuan.

What's the point of gathering a young man in his twenties together under the guise of moral blackmail? What's the significance?

The point is simply to make a young doctor in his twenties back down on the spot, and then make the patient obediently accept the routine "amputation"!

Guo Ziyuan has brought about miracles in the emergency department.

It has also brought miracles to trauma surgery.

Therefore, since we have accepted the miracles that Guo Ziyuan has brought, we must also tolerate his failures, which may prevent him from bringing miracles.

Currently, surgeries are mainly handled by trauma orthopedics and emergency surgery.

Associate Chief Physician Wu Qiong stopped her procedure.

There must be a demon in the abnormal situation.

Guo Ziyuan has always been a very cautious person, and Zhou Yong and the others were really afraid that if they said the wrong thing, they would send Guo Ziyuan home.

because.

Guo Ziyuan will not participate in this surgery; he can go home and sleep. Even if the sky falls, it will not be Guo Ziyuan's business.

……