"Did you see the preoperative angiography?" Dudley shouted in a low voice.
"Mr. Dudley, I remind you again that this is the operating room. Please keep quiet," said Wu Mian gently. "If you roar in the operating room again, I may drive you out like a stray mad dog without mercy."
Dudley''s eyes were red, his fists were clenched, and a creaking voice came out.
"Don''t think about doing it. Did you forget that I beat you into a dog last time?" Wu Mian said coldly.
"Shameless!" Dr. Dudley squeezed a word out of his teeth, but his voice was much lower.
Wu Mian did not continue to talk to daideli. He stared at the liquid and waited silently.
After 11 ′ 12 ", Wu Mian said," prepare for resuscitation and stop cardiopulmonary bypass. "
"You''re crazy!" said Dudley. "You haven''t found the cause of hemorrhagic shock!"
In Dudley''s imagination, Wu, who made him sick and disgusted, must know where there was bleeding, and the amount of bleeding would not be small, otherwise there would be no decrease in heart rate and blood pressure as soon as he stopped.
But unexpectedly, Wu Mian stood in the position of the operator, and the first doctor''s order after infusion was to stop cardiopulmonary bypass!
It''s crazy!
"Are you a magician?" Wu Mian said slightly. "Now I''m standing here. I''m the only magician!"
Chu Zhixi has opened the ascending aorta blocking forceps. She carefully ensures the smooth drainage of the left heart to prevent left heart expansion.
Under normal circumstances, if the conditions are appropriate, the heart can restart automatically. But principal TOPT''s heart remained silent after the ascending aorta occlusion was lifted, as if he had died.
"Prepare for defibrillation." Wu Mian stretched out his hand, and the instrument nurse then handed him the defibrillator.
Wu Mian debugged the power of defibrillator, 45j. Defibrillation was successful and the heart began to work again. With the help of cardiopulmonary bypass, the load of the heart was not large, and Wu Mian was not in a hurry, but waited quietly for another 5 minutes.
This period of time is particularly necessary. After re beating, the heart should be kept in no-load beating for a period of time, so as to facilitate the recovery of myocardial function.
After resuscitation, the upper and lower lumen blocking bands are opened to change the complete extracorporeal circulation into parallel circulation, so as to assist the heart beat and reduce the heart burden.
After checking another blood gas, Wu Mian and other returns, all conditions were compounded, looked up and said, "offline, don''t neutralize heparin."
Extubation and offline, this is the second time this operation has repeated this process.
The cardiopulmonary bypass division of Dr. Dudley''s medical group habitually injected protamine to neutralize heparin according to the normal process.
Before he injected protamine, a hemostatic forceps flew out and hit the cardiopulmonary bypass division on the head.
The cardiopulmonary bypass technician felt a pain on his head, and then saw the silver hemostatic forceps fall to the ground, making a crisp sound.
He stood up angrily and heard a series of London accent english before he spoke.
"Didn''t you hear what I said?" Wu Mian scolded. "Don''t neutralize heparin. You don''t understand this sentence? Is my English not fluent enough or are you trying to murder?! Mayo''s people are so stupid that they can''t even understand the most basic words!"
"..." the cardiopulmonary bypass division was stunned for a moment, and then said angrily, "don''t you want to go offline? Don''t you need to neutralize heparin?!"
"No neutralization," said Wu Mian. "I reiterate for the last time, no neutralization of heparin."
In the operating room, everyone was silent. Daley looked at Wu Mian like a fool. He was stunned for a few seconds, then looked back at Mrs. TOPT, his eyes full of unspeakable banter and contempt.
Before cardiopulmonary bypass, systemic heparinization is required. The cardiopulmonary bypass machine should also be pre filled with heparin, and the patient can be transferred only after checking the patient''s act for more than 480 seconds, so there will be no blood coagulation during cardiopulmonary bypass.
Heparin should be neutralized when cardiopulmonary bypass is stopped. Even so, there will still be bleeding at the coronary anastomosis.
But Wu Mian said he didn''t need protamine to neutralize heparin, and then?
When blood seeps from the anastomosis, the patient suffers from hypotension shock due to continuous blood loss, and finally dies?
It is not that there is no similar operation, but it is a forced situation, and the probability of successful operation of patients is quite low, which is to a heinous extent.
Dr. dedley doesn''t understand Wu Mian''s operation at all. Is he worried that principal Stephen TOPT is allergic to protamine?
The results of preoperative allergen determination have ruled out this, otherwise Dudley would not choose the operation of coronary artery bypass grafting under cardiopulmonary bypass.
"Wu, are you sure?" Mrs. TOPT asked in a trembling voice. She didn''t expect that Wu Mian would give such an incredible medical order.
"Yes, madam," Wu Mian answered softly.
Mrs. TOPT didn''t ask any more questions. She had completely lost herself in the strange operation. Although she is a world-famous cardiologist, principal TOPT''s situation is so strange that she can''t judge what''s going on anyway.
The drugs used were tested for allergens, and the operation was very successful. At least Mrs. TOPT couldn''t find anything wrong. But in this almost perfect process, principal TOPT had a weak heart.
Under great pressure, Wu Mian refused to neutralize protamine and Heparinize the whole body, and went offline directly!
Not to mention anything else, only postoperative anastomotic bleeding is enough to be fatal!
Mrs. TOPT had countless questions in her heart, but she didn''t ask. She just stood quietly behind Wu Mian and looked at her.
After the shutdown, Wu Mian observed Stephen TOPT. Vital signs were stable, and there was continuous blood exudation at the anastomotic site of bridge vessels.
He removed the upper cannula and retracted the lower cannula into the right atrium. After 3 minutes of observation, the condition continued to be stable, and the inferior cavity intubation was removed. Input the blood in the machine and remove the arterial intubation as early as possible.
The last time was when the heart beat weakly after cardiopulmonary bypass was stopped.
And now, shut down again. The difference is that protamine is not neutralized by systemic heparinization.
Both Mrs. toput and Dr. dedley know this. They have long wondered whether Wu Mian suspected that protamine induced allergy led to Stephen toput''s weak heart beat.
This is the only reasonable explanation.
After cardiopulmonary bypass was shut down, there was silence in the operating room. Everyone''s eyes were on Stephen TOPT''s heart, even if there was bleeding from the coronary artery.
A few minutes, a few milliliters of oozing blood is not fatal enough. The key is whether the act of neutralizing heparinization is effective.
1 minute
Stephen TOPT''s heart beat strongly, and ST segment changes were relieved under ECG monitoring.
2 minutes
3 minutes
5 minutes
Stephen TOPT''s vital signs didn''t have any problems except that the bridge anastomosis was still bleeding!
i see!