325 Knotted
Director Qian nervously pushed open the door to report the situation.
"Director Bai, the patient has problems."
"Say." Director Bai said one word concisely.
"The patient just developed stubborn hypotension, and the phthalmifier was given no effect, and he is rehydrating."
“Where is the drainage?”
"The drainage is fine, I gave norepinephrine."
Director Bai got up and put on a sterile hat and mask, and went to the ichi with Director Qian.
Under the influence of norepinephrine, the patient's blood pressure began to rise. Director Bai did not blame Director Qian, but stood at the head of the bed with his hands behind his back and looked carefully.
The situation is not as stable as before. Under the action of norepinephrine, the patient's blood pressure has indeed returned, but it has not stopped at a normal value or slightly higher normal value.
Blood pressure is like a roller coaster, with high pressure rising from 70 mmHg to 80, then 90,100,130,150, and finally frozen around 183 mmHg.
“There are problems with the waveform of the swan-ganz catheter.”
The directors of circulatory and cardiac surgery both discovered this, and they both reminded each other in unison.
When Director Qian saw that Director Bai didn't say anything, he started to get busy on his own.
I stopped norepinephrine first, Director Qian discussed with Director Zhang of the Department of Cardiac Surgery and Director Zhang of the Department of Circulation for a few minutes, and reported to Director Bai, "Bai Chu, the swan-ganz catheter may have lost its effect, so it is recommended to remove it."
"Take it." Director Bai stepped aside and did not interfere with clinical work.
Director Zhang of the Department of Cardiology Surgery began to insert the right subclavian venous catheter and tried to remove the swan-ganz catheter.
But in the last part, Director Zhang felt a slight resistance. The force was very small, so small that it seemed that the catheter could be removed with a little force.
But he was very careful and did not use brute force to pull out the swan-ganz catheter.
For various surgeries, the most taboo thing patients are to use brute force after surgery, because people's hearts are separated from their belly, and no one knows what is happening inside.
Director Zhang asked someone to push the X-ray machine at the head of the bed to see what happened to the swan-ganz catheter.
Swan-ganz airbag floating catheter is a tool for measuring pulmonary arterial pressure and pulmonary capillary wedge pressure, and is essential for cardiac surgery.
After going down during the operation, the measurement was carried out, but the waveform displayed by the floating catheter was not correct. No matter how you look at it, you feel that there is something wrong with the swan-ganz catheter.
After taking the film, a doctor at the ICU went to the radiology department to wash the film with the film box.
Ten minutes later, Director Bai and others saw the image on the computer.
The moment I saw the image, everyone was stunned and inexplicably.
A joint was tied to the head of the swan-ganz catheter...it was like the first knot of tying the shoelaces.
Really fucking!
Director Bai cursed in his heart.
What's wrong with this? How come such a strange thing happened in a very good heart transplant surgery!
With knotting, the swan-ganz catheter enters from the internal jugular vein and passes through the superior cavity artery to the right atrium, right ventricle, and pulmonary artery.
During the process of taking out the swan-ganz catheter, I didn't know what was going on, so I tied a knot. The floating catheter that could be removed was simply not able to be removed because of a knot.
The knot was not killed, because Director Zhang was very careful and did not use brute force in the end. But what if it was killed? The form has been formed, and no method is useful.
After seeing the film, everyone in the expert group present was speechless.
The incident happened suddenly, and everyone present was a little confused. The operation went smoothly, but the problem actually occurred after the operation and appeared on a dead knot.
The swan-ganz catheter is knotted, what should I do next?
No one expected such a difficult thing to happen if the heart just transplanted was.
The experts in the expert group wanted to scold people, especially Director Zhang of the Department of Cardiology Surgery, and his face turned red.
Swan-ganz catheters are expensive and not many patients can be used, but cardiac surgery is still used frequently. Director Zhang has seen many patients using swan-ganz catheters, but has never seen knots.
Swearing cannot solve the problem, the problem is what to do next.
Outside the heart, circulation, and several experts who were seriously ill were silent, and even Lu Gang, who was above the top, stopped talking.
No one has seen this situation before and does not know what to do with it.
Director Bai started to call and asked relevant directors and experts from the Vascular Department and other departments to consult together.
Also with them was Dean Zhao Jixiang and Dean Zhao.
First understand the condition, and then remove the subclavian venous catheter under the guidance of two-dimensional color ultrasound under the guidance of the B-ultrasound room.
At this point, the patient's vital signs were stable and there were no other complications.
Then how to remove the swan-ganz catheter.
"Can the Vascular Department incision the jugular vein?" asked Director Bai.
"It's very difficult." Director Wang of the Vascular Department said without hesitation. "If you pull it out, the knotted part will be tighter and thicker in diameter. It's hard to ensure that you don't touch anything when you pass through the jugular vein."
He said it was quite general, but those present knew it.
The blood vessels in the neck are dense and a thick knot is walking in the jugular vein. It should not be too easy to encounter any nerve sensors that cause sudden cardiac arrest.
"Director Zhao, what do you think?" Director Bai asked with a frown.
"Listen to the opinions of the experts." Dean Zhao began to practice Tai Chi.
He himself was clinical, but it is not very likely that an orthopedic doctor would ask Zhao Jixiang to make a constructive opinion when it comes to heart transplantation.
Director Bai was just respectful and followed the process to ask President Zhao for his opinions.
"Where is Zhao Xiangming, why haven't you come yet!" Director Bai asked with a frown.
"Director Zhao should go fishing on weekends." Director Qian of icu knew Zhao Xiangming's habits and hobbies and said helplessly, "And Director Bai, I don't say it nicely, it's useless to Zhao Xiangming come."
"We'll always give it a try."
The location of the swan-ganz catheter knot is in the blood vessel, involving this operation, the interventional department has sufficient weight.
After more than half an hour, Zhao Xiangming rushed over panting.
"Director Zhao, Director Bai, I'm sorry, the fishing place is a bit far away today." Zhao Xiangming came and reimbursed first.
"Look at the situation, do you think you can take it out?" Director Bai did not curse, but asked directly.
Zhao Xiangming looked at the video data and shook his head into a rattle.
"Impossible, absolutely impossible." Zhao Xiangming said, "Although the position is relatively shallow, if you want to unbutton it, you need to use a guide wire to push the head of the swan-ganz catheter out."
"There is a blood flow effect, and there is basically no such possibility to solve the problem point-to-point."
Zhao Xiangming said it very straightforwardly and resolutely.
"well."
I don't know who sighed deeply.
Swan-ganz floating catheter tied knots in the body. I have never heard of such a ridiculous thing! But I encountered such a rare situation. It is definitely not possible to use interventional surgery. What should I do next?
"It's really not possible?" Director Bai stared at Zhao Xiangming.
"..." Zhao Xiangming concluded, he hesitated for a moment, "Director Bai, I'll make a call."
Chapter completed!