Kudos to the benevolent doctors
In the early morning of January 1
The New Year's bell has just rung
An ambulance was accompanied by a rapid call
Drive to the front of the emergency building of Beijing Tongren Hospital Yizhuang Branch
The patient in the car was a young man in his twenties
A sharp knife is inserted from the left eye
The tip of the knife goes deep into the base of the skull
Unconscious, difficulty breathing
The situation is complex
Multi-disciplinary consultation to start the relay of life
Even the emergency medical staff who have experienced hundreds of battles have inhaled a cold breath after seeing it. Without the slightest hesitation, the medical staff acted quickly. Maintain vital signs, multidisciplinary consultation, establish green channels... After consultations with ophthalmology, otolaryngology, head and neck surgery, neurosurgery, thoracic surgery, and orthopedics, other important organ injuries and bleeding are excluded. The main cause of dyspnea is the left chest wall gas, and the thoracic surgery department immediately gives the patient a closed drainage of the left chest cavity. Timely and accurate judgment of the condition, rapid and stable treatment and treatment, has won valuable time for saving patients' lives.
After some rescue, the patient's consciousness gradually recovered, but the structure of the left eye could not be explored, blood scabs could be seen in the left nasal cavity, and the blade had been pierced into the base of the skull, and the specific depth was not yet known...
The hospital immediately launched an in-depth consultation with the participation of the directors of relevant departments to discuss the best surgical plan. Chen Xiaohong, director of the Department of Otolaryngology, Head and Neck Surgery of Yizhuang Hospital, rushed from home and led physicians Dong Yi and Li Jin to carefully examine the patients, at the same time, neurosurgeon Li Yong, ophthalmologist Yang Dia, anesthesiologist Xin Feng, vascular surgeon Miao Peng, thoracic surgeon Gao Xiang and others arrived, and multidisciplinary jointly opened an emergency relay of life.
Multidisciplinary experts discuss the surgical situation
"Four Steps and Ten Seconds"
Make sure to open your airway for about 10 seconds
Reduces the risk of anesthesia
First of all, it is necessary to determine the anesthesia regimen, whether to first tracheostomy or induce general anesthesia?
If the patient is awake, the risk of secondary injury to the blade is increased, but the patient's protective reflex and difficulty opening the mouth will also increase the risk of direct anesthesia. Chen Xiaohong analyzed that from the perspective of reducing secondary injuries in patients, direct induction anesthesia should be taken. If anesthesia intubation is difficult, the airway can be made available in a "four-step ten-second method" to ensure that the airway is open for about 10 seconds to reduce the risk of anesthesia.
Whole cerebral angiography
Make sure the knife is drawn accurately
The next step is how to draw the knife safely. In order to avoid secondary injuries caused by intraoperative knife extraction, the internal cervical arteries and veins must be dissected in the neck first, and many cranial nerves must be grouped in the posterior group. Based on the path of the blade, Chen Xiaohong predicted that the maxillary artery may have been broken, and it is not excluded that the internal carotid artery may have contusion laceration. In order to ensure that there is no mistake during the operation, a complete cerebral angiography examination is required before the operation to clarify the relationship between the blade travel route and the large blood vessels in the neck and the degree of damage to the large blood vessels.
Patients with complete cerebral angiography
When the results of the total cerebral angiography came out, the expert group was worried again. The patient's internal carotid artery is not ruptured, but the tip of the knife has been deeply pierced into the base of the skull, into the parapharyngeal space, just reaching the sheath of the carotid artery, the maxillary artery has been broken, and the tip of the knife is against the internal carotid artery; Merriam-Webster ring dysplasia. This means that if the internal carotid artery is directly ligated during surgery, it may cause hemiplegia in patients, which is undoubtedly another kind of "death" for young people in their twenties.
Debridement and suturing are performed during surgery
Hurry in the second, save on the edge of life and death
The boy has normal eyesight and good vital signs
After careful and careful consideration, the surgery begins. In order to reduce the risk of carotid intussional contusion and hemiplegia caused by thrombosis, the expert team took heparinization during the operation, although this will make the operation more difficult, but the doctors are calm and cautious to avoid possible dangers.
Subsequently, extraneous cervical approach surgery was taken, the cervical sheath was fully exposed, and the internal and maxillary arteries of the left internal jugular vein and the branch of the external carotid artery were found to be ruptured, and the ligation was stopped. After exposing the tip of the knife, give it full protection and slowly pull it out. With the extraction of the sharp blade, the rupture of the internal jugular vein and the bleeding from the broken end of the maxillary artery were very critical, Chen Xiaohong quickly tightened the ligature line reserved in advance, the bleeding stopped in time, and everyone's hanging heart was slightly relaxed.
Finally, the ophthalmologist performed wound debridement and suturing, the surgery was successfully completed, and the patient was smoothly transported to the intensive care unit (ICU) for further life support.
At present, after careful treatment and care by medical care, the patient has safely passed the dangerous period, the posterior cranial nerve function is normal, the vision is normal, the vital signs are good, the physical condition is gradually improving, and it is recovering.
Source: Beijing Traffic Radio, Beijing Daily
Editor-in-charge: Zheng Huaju
Proofreader: Zang Hengjia
Plate making: Xue Jiao