Tokyo, 1994, starting with medical training

Chapter 32 Why is it still bleeding?

The entire room fell silent for a second.

Minamimura Masaji opened his mouth, wanting to refute, but found that he couldn't find a reason to refute it.

C-clamps are indeed a relatively new technology introduced in recent years, specifically for emergency treatment of pelvic fractures.

But he was just a medical student, and he had only seen the professor use it once or twice before. He had never actually used it himself, and in the panic just now, he had completely forgotten that this thing even existed.

Although Dr. Inoue didn't understand orthopedics, he still grasped the logic behind it.

"Then hurry up!" Dr. Inoue shouted.

"If the orthopedics department can't handle it, I'll just have open surgery. Even if I die on the operating table, I'll have done my best!"

This statement put Minamimura Shoji in a very difficult position.

If we don't do it, and the patient dies, it's the responsibility of the First Surgery Department. But if we do it and fail to do it, it's still the First Surgery Department's responsibility.

Minamimura Shoji glanced at the blood-covered patient, then at Kiryu Kazusuke beside him.

Should we let him do it?

No.

This is a high-risk procedure that must be performed by a senior physician. If the nail is driven off course and punctures the iliac crest or directly enters the abdominal cavity and punctures a major blood vessel, it would be a major medical accident.

When that time comes, his professional career will come to an end once he is approved to undergo medical training.

"I'll do it." Minamimura Shoji gritted his teeth and made his decision. "Go get the C-clamps! Kiryu, you'll be my assistant and be in charge of positioning."

Although he had never done it, he understood the principle.

As long as Kiryu Kazusuke can find the right spot to insert the needle, all he needs to do is forcefully hammer the nail in.

"clear."

Kazusuke Kiryu had no objections.

In his previous life, C-forceps were standard equipment in the emergency center; he could insert them even with his eyes closed.

But now, he's just a medical resident and has to obey his superiors.

As long as it can save lives, it doesn't matter who operates the system.

……

In the operating room, room number three, under the shadowless lamp, two teams quickly assembled.

This was an extremely rare combined surgery.

Standing on the left side of the operating table were the people from the First Surgery Department, with Minamimura Shoji as the chief surgeon and Kiryu Kazuichi as his assistant.

Standing on the right is the Second Surgery team, with Dr. Inoue as the lead surgeon, accompanied by another resident surgeon.

The anesthesiologist stood at the head of the monitor, staring intently at it.

"C-clamps are ready."

The scrub nurse unpacked the sterile pack, revealing the huge metal support.

"Let's begin."

Minamimura Shoji took a deep breath and took the C-clamps.

His gloves were covered in slippery blood, and his palms were sweaty.

This instrument needs to be operated under fluoroscopic guidance, but there is simply no time to bring in a C-arm machine for testing, so we can only perform blind printing using anatomical landmarks on the body surface.

This is what is known as "blind operation".

This requires doctors to have extremely high anatomical skills.

Minamimura Shoji's hands were a little stiff. He groped around for a long time on the patient's bruised hip, but he couldn't pinpoint the exact insertion point.

The patient's pelvis was fractured, and with the addition of subcutaneous emphysema and hematoma, normal bony landmarks became blurred.

"The anterior superior iliac spine is here."

"That's a subcutaneous hematoma, not bone. The anterior superior iliac spine is two centimeters down from there."

Kazusuke Kiryu's fingers were firmly pressed on a point on the patient's left hip.

Minamimura Shoji's face flushed, but he couldn't care less about that now. He followed the finger and sure enough, he felt a hard bone protrusion.

"This is the greater trochanter of the femur. The insertion point is located posteriorly from the midpoint of the line connecting these points."

Kiryu Kazusuke's fingers moved swiftly, pressing two distinct indentations into the skin.

"I know!"

Minamimura Masaji said impatiently, trying to hide his guilty conscience.

He raised the hammer, aimed it at the end of the positioning nail, and with the first blow, the nail tip pierced the skin and pressed against the bone.

Kazusuke Kiryu confirmed from the side: "The position is exactly in the center, and the angle is perpendicular."

Clang clang—

With a dull thud, the steel nail pierced the cortical bone and became firmly embedded in the iliac bone.

The same method was used on the other side.

Kazusuke Kiryu's positioning was very precise, while Shoji Minamimura only needed to be a ruthless hammer-wielding machine, gradually giving up thinking.

"Move the pressure bar!"

A huge C-shaped stent spans the patient's abdomen, connected by steel nails at both ends.

Minamimura Shoji began to rotate the pressure knob.

As mechanical force is transmitted, the originally loose and exaggerated pelvis is forcibly squeezed inward and closed.

The sound of broken bone ends snapping together is enough to make your teeth ache.

The anesthesiologist exclaimed with delight, "The blood pressure has risen! 80/50!"

The pelvic volume decreased, and the packing effect took effect, temporarily suppressing the massive retroperitoneal hemorrhage.

"Our turn! Open the abdomen!"

Dr. Inoue had been waiting impatiently for a long time. As soon as the C-clamps were in place, his scalpel cut open the patient's abdominal wall.

Fresh blood gushed out instantly.

"Suction device! Quick!"

The abdominal cavity was filled with dark red blood, and the spleen was rotten.

Dr. Inoue moved swiftly, lifting the spleen, clamping the splenic pedicle with forceps, ligating it, and removing it.

The whole process was very quick.

Once the active bleeding in the abdominal cavity is resolved, the patient's life is half saved.

however--

Just when everyone thought the situation was under control.

beep beep-

The electrocardiogram monitor suddenly emitted a rapid alarm sound.

"Blood pressure dropped again! 60/40! Heart rate 150!" The anesthesiologist's voice suddenly changed. "The vasopressor has been pushed to the maximum! Plasma is dripping at full speed! But it's not going in!"

Minamimura Shoji frowned: "What's going on?"

Dr. Inoue was rinsing the abdominal cavity: "The spleen has been removed, the liver is fine, the mesentery is fine, and there's no more bleeding in the abdominal cavity!"

All eyes turned to the First Surgery Department.

Since there is no bleeding in the abdominal cavity, it means that there is still bleeding in the retroperitoneum.

"Impossible!" Minamimura Shoji categorically denied. "The pelvis is already fixed, the C-clamps are perfectly positioned, the venous plexus should be compressed!"

Kazusuke Kiryu stared at the retroperitoneal area that was constantly bleeding.

"Is there still arterial bleeding?"

C-clamps can only reduce pelvic volume to compress the venous plexus and cause bleeding.

However, if it is a branch of the internal iliac artery, such as the superior gluteal artery or the internal pudendal artery, the high-pressure arterial spurting bleeding cannot be stopped by external pressure.

Fresh blood was gushing wildly into the retroperitoneal space, stretching that thin membrane like a balloon about to burst.

"We must stop the bleeding!" Dr. Inoue urged urgently. "Your First Surgery Department needs to find a way quickly!"

However, Minamimura Shoji's mind went blank.

Think of a solution?

Interventional arterial embolization?

It was too late; the patient couldn't be moved out of the operating room at all.

Exploratory laparotomy to examine the retroperitoneum?

Once the peritoneum is cut open, the pressure is released, and blood will spray onto the ceiling, making it impossible to find the bleeding point.

Ligation of the internal iliac artery?

Searching for blood vessels in that mass of rotten flesh and blood is no different from suicide.

This is a dead end.

This kind of critical care, which goes beyond the usual procedures, was completely outside his capabilities.

Kiryu Kazusuke said in a deep voice from the side, "Fill it up."

"What?" Minamimura Shoji turned his head sharply.

Kiryu Kazusuke explained very quickly, "Preperitoneal packing."

"Through a midline incision in the lower abdomen, without entering the peritoneal cavity, we directly enter the prevesical space."

"Pack the area in front of the sacroiliac joint and the bladder fossa with large gauze pads, three on each side, to directly apply physical pressure to the pelvic blood vessels."

"This is currently the only damage control technology that can replace interventional embolization."

"Preperitoneal packing?" Minamimura Masajiro had never heard of this term before. "Packing gauze in will stop the bleeding? What if it gets infected? What if it compresses the bladder?"

His first reaction wasn't whether the method would work, but rather that it was against the rules.

It's not written in the book, and the professor never taught it.

(End of this chapter)