mijobooks Chapter 1036: First Battle Outside the Chest (Part 1)
Chapter 1036: First Battle Outside the Chest (Part 1)
"Use interrupted mattress sutures with pledgets and 2-0 Prolene sutures." Chen Yang gave the order.
Chen Yang chose to start suturing from the relatively safe posterior valve ring area with a more stable calcified "foundation".
The needle and thread seemed to come alive in Chen Yang's hands. He moved the needle steadily and precisely, each stitch penetrating the remaining calcified "shell" or relatively solid annular tissue, pressing the gasket firmly against the outside of the tissue. He used moderate force when tying the knot, ensuring the suture was secure without cutting the fragile tissue.
"Be careful to avoid the P2-P3 area (close to the circumflex branch), and the suture in the anterior diplomatic area (close to the conduction bundle) should be shallow. It is better to use a few more stitches for reinforcement than to go deeper!" Chen Yang reminded his assistant while operating.
As the first assistant, Tang Yan was responsible for assisting with exposure and thread cutting, and he was fully focused.
He Yonghua closely monitored the ECG to prevent arrhythmias that might be caused by suturing the stimulation conduction bundle.
The suturing was carried out in a tense and orderly manner. When the suturing was carried out close to the anterior external boundary (i.e. the high-risk area of the conduction bundle), the originally regular waveform on the ECG monitor suddenly became abnormal!
"Ventricular premature beats! Frequent!" the anesthesiologist's voice rang out.
Then, the waveform became wide and deformed!
"Ventricular tachycardia! Heart rate 160!"
Everyone's heart sank! The most worrying situation had finally occurred! The suturing operation might have irritated or damaged the tissue near the atrioventricular node!
"Stop suturing! Prepare lidocaine!" He Yonghua made a prompt decision.
"50mg of lidocaine, intravenous injection!" The anesthesiologist executed it quickly.
"Prepare the defibrillator pads!" He Yonghua growled, while quickly checking whether the ECG lead connections were reliable.
After the drug was injected, the ventricular tachycardia waveform on the monitor struggled for a few times, but instead of stopping, it deteriorated into a more dangerous graph!
"Ventricular fibrillation! Ventricular fibrillation has occurred!" The anesthesiologist's voice was filled with a hint of horror!
On the screen, the QRS complex that originally represented the heartbeat completely disappeared, replaced by chaotic, rapid, and irregular fibrillation waves! The heart had lost its effective pumping function!
"200J, asynchronous, charging!" He Yonghua's voice was firm! Defibrillation was the only way to save his life at this moment!
"Charging complete!"
"Everyone get out of the bed! Clear!"
boom!
A powerful electric current instantly passed through Zhang Tiezhu's chest, and his body bounced violently.
Everyone's eyes were fixed on the monitoring screen!
The tremor wave...is still there!
The first defibrillation failed!
"360J, recharge!" He Yonghua shouted without hesitation, though cold sweat was already beading on his forehead. The longer ventricular fibrillation persists, the lower the chance of resuscitation and the greater the risk of brain damage.
"Charging complete!"
"Clear!"
boom!
The second, stronger electric shock!
The trembling waves on the monitoring screen...finally disappeared!
But what appeared was not the expected sinus rhythm, but an almost flat baseline with occasional extremely slow and tiny fluctuations.
"Ventricular fibrillation has terminated! But... it is ventricular arrest! The escape rhythm is extremely slow! The heart rate is 20 beats per minute!" The anesthesiologist's voice was filled with despair.
My heart almost stopped beating!
The operating room instantly fell into a dead silence! The air seemed to freeze! A huge fear gripped everyone! The extracorporeal circulation machine was still maintaining blood circulation and oxygenation, but if the heart itself could not resume beating effectively, the consequences would be disastrous! Prolonged cardiac arrest could also cause irreversible brain damage or even death!
Domestic and foreign experts who watched the live broadcast also held their breath.
Professor Muller from Berlin, Germany, frowned: "This is trouble! The conduction system may be severely damaged or compressed by edema!"
Experts in Cleveland are also rapidly discussing medication and pacing options.
Ichiro Yamamoto in Tokyo showed a hint of "as expected" sneer on his face.
At this critical moment!
Chen Yang, who had been paying close attention to the monitor and the patient's condition, had a gleam in his eyes!
An idea formed in Chen Yang's mind.
"1mg of epinephrine, intravenous push! Prepare for temporary transvenous endocardial pacing!" He Yonghua gave the order hurriedly. This is the standard rescue procedure in Western medicine.
"Silver needle, alcohol disinfection!" Chen Yang's voice rang out.
The instrument nurse was stunned, but the conditioned reflex formed by long-term training made her act immediately. She quickly opened the silver needles and prepared and disinfected them.
Because Chen Yang was involved in the operation, silver needles were also essential instruments.
While He Yonghua was directing the drug injection and preparing for pacing, Chen Yang moved as fast as lightning. After the nurse prepared the silver needles, Chen Yang took out two silver needles, simply disinfected the inside of Zhang Tiezhu's wrists with an alcohol cotton ball, and inserted the needles through the sterile sheet.
puff!puff!
Two silver needles accurately penetrated Zhang Tiezhu's bilateral Neiguan acupoints, reaching a depth of one and a half inches!
Chen Yang gathered all his strength, twisting the needle handle with his thumb and index finger, performing a powerful stimulating drainage technique! The lifting, thrusting, and twisting movements were extremely rapid! He wanted to use the strongest needle sensation to stimulate the heart qi and unblock the yang meridians!
"Uh ah..." Zhang Tiezhu, who was in a deep state of anesthesia, couldn't help but twitch violently. It was a reaction to the strong needle stimulation to his nerves!
At the same time, the anesthesiologist had completed the epinephrine injection, and the nurse was busy preparing the temporary endocardial pacing electrode catheter.
Everyone's heart was in their throat, and their eyes switched frantically between the monitor and Chen Yang's hand twisting the silver needle!
One second...two seconds...three seconds...
Just when He Yonghua was about to give the order for endocardial pacing!
Beep...beep...beep...
On the monitor, the almost flat baseline suddenly jumped!
A wide but clearly discernible QRS wave jumped out!
Then, the second, the third... the heart rate quickly climbed to 60 beats/minute, 70 beats/minute... the rhythm gradually became regular!
"Sinus rhythm has been restored! Heart rate is 75! Blood pressure has risen!" The anesthesiologist's voice changed with excitement!
"Huh..." A suppressed and huge exhalation sound was heard in the operating room!
He Yonghua's tense body relaxed instantly, his back drenched in sweat. He looked at Chen Yang with eyes filled with disbelief and fear. Qiu Yunshan was so excited that he almost jumped up.
"Chen... Director Chen..." Tang Yan looked at the two silver needles that were still trembling slightly, as if he was looking at a miracle.
Chen Yang slowly stopped twisting the needle, but didn't remove it. He maintained the lifting and inserting technique, but reduced the amplitude and frequency, switching to a balanced tonification and drainage to maintain the effectiveness of the needle. His face turned pale. The last few seconds of all-out rescue had also consumed a great deal of his mind and energy.
"Continue to sew. Be gentle and avoid dangerous areas." Chen Yang's voice was a little tired, but still as calm as before.
After this thrilling lesson, the subsequent sutures were carried out more cautiously.
Chen Yang and Tang Yan worked together perfectly to complete the suturing of the remaining valve ring. When the last knot was tied, the trumpet-shaped biological valve sat firmly on the "reshaped" calcified valve ring.