—— Fell from a height of 8 meters and suffered serious multiple injuries, cardiac arrest, and 3 consecutive major surgeries within 8 days after successful rescue
Brief introduction - The patient with severe multiple injuries caused by a fall from a height was successfully rescued after 3 consecutive surgeries
The 50-year-old uncle fell from a height of 8 meters, with serious multiple injuries all over his body, coma and shock, and the patient was hovering on the edge of the ghost gate. In the rescue treatment for nearly a month, the patient has undergone 3 major surgeries, cardiac arrest on the operating table, cauda equina nerve damage is at risk of paralysis, and the total amount of blood transfusion before and after reaching more than 4,000 ml has almost changed his own blood, and he has brushed shoulders with death many times.
The course of the disease - the patient's life hangs by a thread, and multidisciplinary rescue treatment is carried out
At 16:50 p.m. on March 1, Longhui County People's Hospital received a patient who was urgently transferred from the local hospital in Simenqian Town, the county-50-year-old villager Uncle Long, who lived in Yangguao, fell from a height of 8 meters 3 hours ago and suffered serious multiple injuries and hemorrhagic shock.
The patient suffered cardiac arrest on the operating table, and after the successful cardiopulmonary resuscitation, the gastrointestinal surgery department of the hospital performed an emergency "laparotomy" operation
After the emergency examination, the preliminary diagnosis of "multiple rib fractures on the right side, traumatic hemopneumothorax, pulmonary contusion, multiple thoracic vertebral fractures, lumbar 2 vertebral fractures and spinal stenosis", etc., the cause of hemoperitoneum is considered to be abdominal organ injury and bleeding, which directly leads to the patient's "hemorrhagic shock", and the current blood pressure has dropped to 88/57mmHg! The top priority is to urgently carry out "laparotomy" to find the cause of bleeding and stop the bleeding, and at the same time notify the blood transfusion department to urgently prepare blood, and place indwelling gastric tubes, urinary catheters, and right closed chest drainage tubes.
At 18:05, the patient was rushed to the operating room, and after the anesthesia was successful, a sudden scene occurred at 18:25 - the patient suddenly suffered cardiac arrest, and immediately gave on-site cardiopulmonary resuscitation! At 18:30, the patient's spontaneous heartbeat resumed, cardiopulmonary resuscitation was successful, and the patient's blood pressure, heart rate, and oxygen saturation gradually stabilized, and the surgical team immediately assessed: the patient could continue the operation.
At 19:05, Hu Huancheng, deputy director of the Department of Gastrointestinal and Vascular Surgery of the hospital, led the surgical team to begin the "laparotomy exploration" for the patient, and after taking the median incision next to the abdomen, about 800 ml of bloody fluid gushed out, and the small mesentery rupture and active bleeding were seen after suctioning and exploration, and the stomach, liver, gallbladder, and spleen were continued to explore after the joint stop bleeding, and it was seen that there were lacerations in the gastric serous layer and two contusions and lacerations in the right lobe of the liver. After the adhesions were loosened, the surgical team carefully sutured and repaired the breaches in turn, washed and recovered the blood during the operation and reinfused it, and cooperated with multiple parties to complete the first emergency surgery for the patient.
The MDT of critically ill trauma patients discussed "step by step", and the Department of Thoracic Surgery of the hospital completed the second operation in time
During the hospitalization in the ICU ward, Wang Yonghua, the vice president of the department, led the intensive care medicine department and gastrointestinal surgery team to visit the patient and formulate the next treatment plan according to the patient's situation, after the patient lost a lot of blood, the hemoglobin was once as low as 55 g/L, and red blood cells and plasma were transfused many times to correct the anemia and prepare for the next operation.
In order to ensure the safety of the patient and ensure the surgical effect, on March 4, the hospital organized neurosurgery, hepatobiliary hernia surgery, gastrointestinal vascular surgery, spine and orthopedics, cardiovascular medicine, thoracic breast and nail surgery, anesthesia surgery center, and blood transfusion department to conduct a MDT discussion (multidisciplinary joint consultation) for critically trauma patients.
▲The patient had multiple rib fractures, and some of them were obviously misplaced
On the afternoon of March 6, Su Caijie, deputy director of the trauma center of the hospital, and Fu Libo, director of thoracic surgery, collaborated on the same stage to perform the second operation for Uncle Long under thoracoscopy. Packed red blood cells and plasma were transfused in time to replenish blood volume during the operation, and the patient was returned to the ICU ward after the operation.
▲Chest X-ray was re-examined on the first day after surgery
Cauda equina nerve damage was at risk of aggravating paralysis, and the spine surgery team successfully completed the redemption by "dancing on the tip of the knife".
The patient suffered multiple fractures of the thoracic and lumbar vertebrae and spinal stenosis, both lower limbs were paralyzed at that time, and the cauda equina nerve was damaged and was at risk of aggravating paralysis.
▲CT scan showed vertebral blowout fracture and spinal stenosis
"At that time, the patient not only had multiple fractures of the thoracic and lumbar vertebrae and spinal stenosis, but we also found that the patient's cauda equina nerve was imbedated at the fractured end, knowing that patients with cauda equina nerve damage would face the risk of paralysis and aggravation!" Chen Xiaoping, director of the Department of Spine Surgery, recalls that this operation is still fresh in his memory: "During the operation, we carefully separated the immobilized horsetail and carefully carried out decompression repair, and every step seemed to be 'dancing on the tip of the knife', for fear of accidentally damaging the patient's nerve root and causing irreversible damage......
After two hours of collaboration on the same stage, the spine surgery team successfully completed the operation of "lumbar vertebral fracture reduction + spinal decompression, injured vertebral bone grafting + dural repair, and nerve root release" after two hours of cooperation on the same stage, and the patient was returned to the ICU ward with tracheal intubation, and everyone finally breathed a sigh of relief.
▲Postoperative vertebral body reduction is good
Cauda equina nerve is damaged
▲Left: Dural rupture, cauda equina embedded in the fracture end
Right: The horsetail is in good condition
▲Three-dimensional lumbar spine after surgery
After the successful completion of the third operation, the patient was successfully deprived of the ventilator at 22 o'clock on March 9, and the abdominal and pelvic drainage tubes were removed after the re-examination of CT on March 10, and Uncle Long continued to be hospitalized in the intensive care department of the hospital for 12 days and then transferred out to the general ward of spine surgery, where he was given symptomatic supportive treatment such as anti-infection, stomach protection, liver protection, expectorant and pulmonary function exercise, and the condition gradually improved. After significant improvement in liver and kidney function, he was discharged from the hospital on March 26.
Recovery after surgery
The multidisciplinary cooperation of the whole hospital, timely and divided surgery, and the integration of medical care and careful treatment of the patient, and finally the patient recovered and discharged, the treatment process of this case once again reflects the perfect cooperation and significant improvement of the ability of various disciplines since the establishment of Longhui County People's Hospital as a tertiary hospital.
After the patient recovered from the disease, he presented a pennant to thank him - the gold and silver cups are not as good as the good reputation of the people
In early June, the patient, Uncle Long, had basically recovered to normal in more than two months after being discharged from the hospital, and when he came to the hospital for a follow-up, he went to the intensive care department, spine surgery, thoracic breast nail surgery, gastrointestinal vascular surgery, and anesthesia surgery center of the hospital where he had been carefully treated to sincerely thank the medical staff and presented a bright red pennant.
(Text: Long Tujuan)