Surgery Godfather

Chapter 97: Chapter 0095: Eight Hundred Milliliters of Blood

“Aortic clamp!”

The surgeon placed the aortic clamp in a handy place in advance.

The chest cavity is opened from the middle!

Blood gushed out, and the aortic clamp got there first, clamped lightly and accurately after the aorta bifurcates into the arm, blocking the heart’s blood supply to the lower half of the body.

Several suction tubes were working at the same time to remove the blood clot in the chest cavity.

As the hematoma receded, the heart and lungs appeared in view, the warm heart beating rhythmically, and the lungs expanding and contracting under the drive of the respirator.

The thick aorta emerges from the heart, turns a corner, and extends downward into the thoracic aorta and abdominal aorta.

The human hood is open, and the engine is displayed in front of your eyes, still working, with life illustrated intuitively in its physical form.

Using the original wooden stake as a dashboard, it is now at the 12 o’clock position. There were no significant vascular injuries found other than a diaphragmatic rupture. The heart and lungs were undamaged, slightly displaced by the pressure of the stake, with some minor bleeding from small vessels quickly tied off and stopped.

However, this amount of bleeding is definitely from a rupture of the aorta, the rupture just isn’t at this location, so the examination continued.

The operator was calm and composed, their hands moving fast, the operation carried out quickly and rhythmically, showing no signs of impatience or urgency.

Director Li, a thoracic surgeon, was standing by, assisting. He had seen prominent surgeons work during his advanced studies. Isn’t this emergency surgery supposed to be carried out in a tense and noisy environment?

How could it be so quiet, so composed? The operating surgeon’s control over the surgery was exceptional, and the team’s cooperation was flawless.

By blocking the heart’s irrigation to the lower body, the pressure of bleeding in the surgical area is relieved; simultaneously, the finite blood is concentratedly directed to supply the brain tissues, which have a far lower tolerance for ischemia than the trunk and limbs.

Under ischemic conditions, brain tissue can only hold out for three minutes safely; the abdominal organs that are currently cut off from the blood supply can tolerate this for twenty minutes.

Blocking the aorta in this area can only be done for twenty minutes, because the patient is already in a state of low perfusion, the time of occlusion has to be even less than twenty minutes.

Is he going to complete the operation and end the battle in twenty minutes?

Tian Yuan looked at the aortic clamp that had already been placed, understanding the operator’s intention. He must speed up, align well with Yang Ping. Although the tasks on the back road are not as dangerous and complex as those on the front, completing an operation in twenty minutes is a tough challenge.

The back road is also a midline incision, the automatic retractor is in place, the spine has been exposed, the spine is transected, the spinal cord is destroyed on the same plane, it needs to be fixed with pedicle screws and steel plates in front and back, otherwise, the whole body will lose its support.

A midline sternum incision was made at the 12 o’clock position. Now, a midline abdominal incision is needed to be made at the 6 o’clock position. The two entry points need to be opened on both sides to fully expose the surgical area.

With the midline abdominal incision, the skin, subcutaneous tissue, deep fascia, and three layers of abdominal muscles were cut, right down to the abdominal cavity, blood clots burst out, and the intestines spilled out, being caught in a sterile single-folded cloth pocket.

The hook was put in, pulled left and right, in cooperation with the chest retractor, the surgical area was well exposed.

Similarly, the abdomen was full of clotted blood, several suction devices worked together, and it took a few minutes to suck it all up.

The aorta and inferior vena cava were pushed to the right at the junction of the thorax and abdomen by the wooden stake, the entry of the stake was a bit oblique, just avoiding the aorta and the vena cava, otherwise, the patient wouldn’t have made it to the ambulance.

The 6 o’clock position was examined, the duodenum was ruptured, the pancreas was ruptured, and the bleeding vessels were ligated.

In fact, because the aorta was blocked, there was not much bleeding. However, due to the surgeon’s proficiency with the anatomy, they could still easily locate the broken vessels and ligate them.

“Blood pressure 54/37mmHg-”

Liang Fatty reported the blood pressure, which was dropping consistently.

The human body’s compensatory ability is steadily decreasing. The moment of collapse will be when the spark of life goes out.

“Blood! How come it’s not here yet?” The chief surgeon’s voice was loud, but he didn’t yell.

“It will take a few more minutes! It’s on the way!” Dr. Tao said.

Even though there were volunteer blood donors, they still had to go through the procedure, test for blood type, test for infectious diseases, and cross-match blood, all this needed time.

The examination turned to the 9 o’clock position, there was a large amount of blood clot around the aorta and inferior vena cava, with fresh blood leaking out, there must have been an opening, the remaining blood in the vessels was coming out.

Fingertips extended to examine, for sure, the aorta had a two-centimetre slit, an aortic tear, this was a fatal injury. Generally, you only have 6 hours for rescue, with the help of excellent and experienced great vessel surgeons, there’s a chance for survival.

This 6 hours is just an average time, many with larger tears, die instantly or within a few minutes.

The patient was able to buy some time to get to the hospital because the wooden stake pressed and slowed down the speed of bleeding from the slit.

Two clamps were placed on the opening of the aorta each from above and below, to prevent the loss of remaining blood, now every milliliter of blood is precious.

The inferior vena cava was unscathed as was the liver, although it too had been crushed.

The wooden stake, at its 9 o’clock position, had a nail exposed about three centimeters out, forming a hook, it was so terrifying that it made one’s scalp numb at the sight of it.

The hook was perfectly hooked onto the aorta, tearing a slit, it was a dangerous move!

The large scissors cut off the nail, and it was carefully removed.

“Blood pressure 50/32mmHg-”

The doors of the operating room opened, finally, two bags of blood were seen, the patrolling nurse quickly hung them up, it seemed that the emergency command had thought of a solution.

“Blood transfusion from the upper limb vein!” Yang Ping reminded the nurse.

Director Tian was also probing and trying to stop the bleeding.

The 9 o’clock position was investigated thoroughly, then the 6 o’clock position was investigated, and another nail was found, similar in shape to the previous one, but with the tip pointing in the opposite direction. Surprisingly, the spleen was fine, and the stomach and duodenum were torn. They cut the nail and removed it.

If the reckless people tried to pull out the stake, the nail would hook on the surrounding tissue, large blood vessels, or organs, no matter from which direction, the consequences would be unthinkable.

Directors Li and Zhang had worked in grassroots hospitals for many years and had been to big hospitals for further study. They had seen a lot, but never had they seen someone so proficient in anatomy. They held immense respect for such a person. This patient was indeed fortunate, regardless of whether they could be saved or not.

A unit of red cells, 400 milliliters of whole blood, was inputted by pressurizing it quickly, The blood pressure showed no signs of rising, but at least it was no longer falling. There had been too much blood loss before.

“How is it?” The Head of Medical Department walked in, Director Miao was already operating on the pelvis fracture.

“Ready the pedicle screws and anterior steel plates, we need to fix the spine. The spine is fractured in half, we need to stabilize it from both front and back!” Director Tian said while operating.

The Head of Medical Department immediately made arrangements over the phone. They had both the pedicle screws and anterior steel plates, which were originally for a surgery scheduled tomorrow, now to be used in this emergency.

“The blood pressure is not rising, we don’t have enough blood, we need to transfuse more.” Liang Fatty said.

The Head of Medical Department said: “We are trying to figure it out, we have already drawn 400ml, currently, there’s only one blood donation volunteer.”

An orthopedic doctor was astonishingly adept at performing abdominal surgery, it was a matter of shame and embarrassment for Director Zhang who specialized in general surgery.

Now, All sides of the stake were completely separated, the anterior and posterior sides had met, making the anatomical structure clearly visible.

“We can remove the stake now.” Yang Ping looked up, his neck was sore, this position was too difficult to operate from, and the field of vision was very bad.

“Sterile tourniquets, four!” Yang Ping said.

Sterile tourniquets are commonly used in orthopedic surgeries, finding a few was not a problem.

Sterile tourniquets were laid on the table.

“Large straight pliers, the largest!”

With the pliers, he took the tourniquet, carefully threaded it through the hole between the stake and the wound, which Director Tian caught.

When all four sterile tourniquets were handed over, they were slowly unfolded and they stretched in the opposite direction, causing tissues near the stake to pull apart as they formed a small space, protecting the surrounding organs and blood vessels.

Yang Ping and Director Tian carefully removed the wooden stake, trading off between pushing and pulling, and eventually, the stake was safely taken out.

Flushed and explored again for injuries, then thoroughly flushed again.

Using tissue scissors, the rupture of the aorta was repaired, four 0 non-damaging vascular sutures were prepared and the rupture was quickly fixed.

Repaired the diaphragm, liver, pancreas, stomach, duodenum, and again thoroughly ligated to stop the bleeding.

This kind of operation doesn’t have a fixed procedure in textbooks, it entirely depends upon the surgeon’s abundant experience and the ability to apply knowledge.

The disassembly during the surgery was like an experienced butcher cutting meat. Every single blood vessel was undamaged, even the minor arteries.

While probing, she tied off the small blood vessels that bled, layer by layer without the slightest pause or repetition.

The whole process was like an intense prison escape, a prison escape from the prison of Death itself.

Directors Li and Zhang thought, if they were to perform this surgery, the patient surely would not be saved.

They simultaneously thought of studying at Sanbo Hospital when they reached the age of forty.

“Four hundred milliliters of whole blood!” It was brought again.

This person has donated eight hundred milliliters.

Equivalent to the blood loss from a serious femoral stem fracture.

Usually, blood donation doesn’t exceed 400 milliliters at a time, going beyond poses risks. This person had donated 800 milliliters.

“There is only one volunteer, the Blood Bank is not daring enough to draw more blood.” Dr. Tao said.

With this added 400ml, at least, they could hang on, afterward, several units of red cells could keep them afloat.

“Blood pressure! 76/42mmHg–”

It is raising! The anesthesiologist is updating the blood pressure dynamically.

The time was nearing the limit, the obstructive clamp was released, directed the blood to circulate in the whole body.

What’s left is to fix the spine now.