The injured patient's forklift hits the thigh
Cut the thighs and buttocks almost off
"Doctors save people quickly!" The 120 ambulance rushed into the emergency center of the Second Hospital of Zhejiang University, and the patients on the stretcher were wrapped in thick gauze, and the blood oozing from the gauze dripped on the floor of the emergency room, shocking the eye.
This is a worker who was unfortunately injured by a forklift on the construction site, the forklift touched the thigh, the thigh and buttocks were almost broken, the blood was like a river gushing, could not stop flowing out, the worker's situation was critical, and it was in danger.
"Hello, here is the emergency department, there is a forklift half pelvic away from the broken wound patient just arrived at the emergency department, heavy bleeding, need emergency surgery ..." After receiving the call, the doctor of the anesthesia surgery department immediately realized that the trauma patient was seriously ill and was in danger of life at any time, immediately prepared for emergency combat, organized the team to divide labor and cooperate, and was ready for rescue and treatment at any time.
A few minutes later, the co-worker was sent to the prepared operating room, Rao is accustomed to seeing the scene of injury the doctor's heart is also a shake, the co-worker's right lower abdominal wall soft tissue is mostly torn off with the lower limb, the active bleeding from the section is serious, accompanied by some organ bulging, the bleeding volume is estimated to exceed 6000ml (normal human blood volume 70-80ml/kg), the patient is already on the verge of death.
"Closely monitored! The fastest hemostatic rehydration solution! Do everything in your power to create the conditions for surgery! "The anesthesia surgery department team did the first time to do ECG monitoring, rapid opening of multiple venous access for rapid rehydration transfusion, invasive hemodynamic monitoring and thermal management; and immediately assessed the heart, lungs, abdomen and other conditions;
Hemostasis is the most important link in the current rescue process, through evaluation, the main cause of major bleeding is the rupture of the internal and external arteries of the iliac, which is the main blood vessel in the pelvis, and once the rupture, the amount of bleeding is very large.
The balloon blocking team of the Anesthesia Surgery Department immediately performed abdominal aortic balloon occlusion, which is a technique like building a dam in a wide river to quickly block the "upstream river", reduce bleeding, save patients' lives, and create conditions for surgery.
The multidisciplinary surgical team on the operating table nervously performed vascular exploration and anastomosis, cystous ostomy, intractomy and abdominal tamponade debridement, pelvic ring closure reduction and external fixation. And for anesthesiologists who escort the whole perioperative period, the challenge is not easy.
"The bleeding is too bad, and the hemoglobin can't be detected!"
"The internal environment is very poor, the lactate is very high, the calcium is very low, the potassium is very high..."
"The patient's hair chamber is going up"
The monitor next to the bed is constantly calling the police, and the anesthesiologist, the surgeon, and the operating room nurse work together to solve one sudden situation after another in an orderly manner in the urgency, just like driving a flat boat in a rough river, this emergency operation lasts up to 6 hours. The patient's bleeding stopped, the first operation was successful, and everyone breathed a long sigh. In the next treatment process, the worker underwent more than ten reconstructive surgeries to overcome a series of life difficulties, and after a few months of injury, the worker was able to stand and walk on his own crutches and was finally discharged from the hospital.
Is anesthesia "a shot, a sleep"?
Some people misunderstand that anesthesia is "a shot, sleep", and anesthesia in the modern sense is manifested in three aspects:
The first is to relieve the pain caused by the operation in the state of anesthesia, and to provide the surgeon with the best possible surgical environment to ensure the smooth operation.
Second, anesthesia to ensure the safety of patients' lives, the patient's state during the entire operation is a very fragile state, anesthesiologists will monitor vital signs throughout the process, establish liquid pathways, carry out fine management of circulation, breathing, internal environment, etc., to ensure that the patient's life is in the optimal state.
Third, it provides a better state for patients' postoperative recovery and long-term efficacy. Modern anesthesia is not simply to prolong the patient's life during surgery, anesthesiologists participate in the whole process of preoperative and postoperative management, adjust the patient to the best surgical state before surgery, and provide patients with rapid recovery services after surgery.
Precision anesthesia
In the context of precision medicine, the development of anesthesiology tends to be precision...
Autologous blood transfusion
Neuroelecological monitoring
Transesophageal echocardiography
Under the existing traditional monitoring methods such as heart rate, blood pressure, oxygen saturation, etc., high-end monitoring methods with specialized characteristics are continuously introduced, such as surgical patients with weakened cardiopulmonary function or pathological state, anesthesiologists will carry out intraoperative transesophageal ultrasound, cardiac displacement monitoring and real-time observation of cardiovascular function, use brain oxygen saturation monitoring to dynamically understand the supply and demand of brain oxygen, and deal with it according to the actual situation, and refine to ensure that the patient's organs function well and pass the operation smoothly; when carrying out surgery such as spine and brain surgery that may damage nerves, If the patient's postoperative movement or other dysfunction or absence, the use of intraoperative neuroelecological monitoring can detect nerve damage earlier in the surgical process and provide early warning and intervention.
The development of anesthesia discipline to today, anesthesiologists have gone from intraoperative to the entire perioperative period, preoperative through anesthesia clinic and preoperative assessment and other ways to understand the patient's state as soon as possible to provide personalized advice, so that patients can reach the best preoperative state as soon as possible; intraoperative in the traditional way to introduce personalized monitoring, to provide patients with fine and perfect intraoperative management, to ensure patient safety; postoperative anesthesiologists are more actively involved in the rapid recovery of patients, providing patients with individualized analgesic programs, etc., to provide patients with accurate perioperative management in an all-round way.
Comfort anesthesia
Comfort medicine is through the pursuit of medical comfort, personalization, so that patients throughout the medical process to achieve psychological and physiological pleasure, pain-free and no fear, which requires the need to rely on anesthesia to provide painless services.
Endoscopic center
In the past, people were awake in the gastrointestinal endoscopy, only containing gargling local anesthetic drugs in the oropharynx, and the examination process was often accompanied by continuous and difficult to suppress nausea and vomiting, which not only discouraged many people who should undergo gastrointestinal endoscopy, but also affected the careful observation and operation of endoscopic surgeons. With painless gastrointestinal endoscopy, countless people have gone from fear endoscopy to gastrointestinal endoscopy as part of a routine physical examination.
With the demand for comfortable medical treatment, in addition to the painless gastrointestinal endoscopy that is now very common, many examinations and procedures have also begun to carry out painless projects, such as painless bronchoscopy, painless esophageal echocardiography, painless ultrasound-guided puncture biopsy, painless cystoscopy, painless egg retrieval, etc.
The risk of bronchoscopy is very high, on the one hand, the tracheoscopy occupies the patient's respiratory channel, which will significantly affect the patient's breathing, on the other hand, many patients who need to do tracheoscopy have serious lung diseases, reduced respiratory function, and other diseases such as cardiovascular diseases, which are prone to emergencies under the stimulation of operation. The painless bronchoscope can make the patient fall asleep through anesthetic drugs, reduce or eliminate the patient's pain in the bronchoscopic diagnosis and treatment, create better operating conditions for the tracheoscopic operation doctor, and at the same time, the anesthesiologist monitors the patient's breathing, circulation and other conditions in time to deal with any accidents in the operation process and maintain the safety of the patient's life.
The development of comfort medicine is inseparable from the development of anesthesiology. Painless services and safe monitoring provided by anesthesiologists make more "impossible" become "possible" and benefit more patients.
Anesthesia Surgery Department of the Second Hospital of Zhejiang University
The Anesthesia Surgery Department of the Second Hospital of Zhejiang University is the earliest innovative platform for intensive and refined management in the country and the largest in the province. It is the affiliated unit of Zhejiang Clinical Anesthesia Quality Control Center and Zhejiang Resident Standardized Training Anesthesiology Professional Quality Control Center, the anesthesiology Branch of Zhejiang Medical Association and the Pain Physician Branch of Zhejiang Medical Doctor Association, and the national clinical key specialty. The first overseas training site for anesthesiologists certified by the Post-Graduation Medical Education Accreditation Council (ACGME) and the only national key professional residential training base for anesthesia in Zhejiang Province. For 6 consecutive years, it has been shortlisted in the reputation ranking of anesthesiology specialties of Fudan University, ranking in the forefront of the phalanx.
The Department of Anesthesia Surgery consists of anesthesiology department, central operating room, pain department, painless diagnosis and treatment/endoscopy center, day ward, intervention center, etc., taking the medical quality as the core and scientific management as the link, and establishing a "postoperative acute pain service model system" and "severe trauma comprehensive treatment system" with hospital-wide collaboration; the first in the country to carry out "intraoperative neuroelectrophysiological monitoring technology" led by the department of anesthesiology; the national leading "perioperative ultrasound visualization technology", "perioperative blood protection management system", "perioperative blood protection management system", "perioperative blood protection management system", "perioperative ultrasound monitoring technology", "perioperative blood protection management system", "perioperative blood protection management system", "perioperative ultrasound" and "perioperative blood protection management system" Anesthesiology Quality Control Management System"; normalized "perioperative medical simulation training... Provide patients with safe, comfortable and efficient anesthesia diagnosis and treatment services.
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Figure, text | Contributed by the Department of Anesthesia Surgery
Audit | Chen Guozhong, Yan Min
Editor-in-charge | Zhu Junjun