Zhang Ming (pseudonym), 49 years old, lives around Chengdu.
html On June 27th, after 12 noon, I had just entered the West China Hospital of Sichuan University and sat down in the advanced thyroid cancer joint clinic. My neck suddenly began to spray blood in the shape of a watering can, and there was blood in my mouth and nose. After a while, the clinic The wash basin in the room turned red... This unexpected occurrence also caught experts who had seen various "big scenes" off guard.
Zhang Ming’s wife, Ms. Li (surname changed) was also completely frightened. Although Zhang Ming himself could not speak, he was conscious and stared at the doctor with despair...
At this time, Professor Li Zhihui, director of the Thyroid Surgery Department of West China Hospital of Sichuan University immediately contacted the emergency department of the hospital. Come to transfer the patient for treatment, and immediately notify the hospital chief of the corresponding department and bring the tools for rescue.
What I didn’t expect was that during the 24 hours of treating Zhang Ming, his neck bled for the second, third, and fourth times. The largest bleeding was about 1,200ml, and the total bleeding volume of 4 times was close to 3,000ml ( The blood volume of a normal human body is about 4000~5000ml, and more than half of the blood is lost ) . Blood replenishment cannot keep up with the bleeding speed. Hemoglobin once dropped to 50g/L (under normal circumstances, it is more than 120g/L for men). ) , showing symptoms of hemorrhagic shock.
At this time, the strange bleeding point of has not yet been found.
▫ Where is Zhang Ming’s bleeding point?
▫Can he still be pulled back from the line of death?
In moments of life and death, the West China 7 Departments (thyroid surgery, emergency department, vascular department, anesthesiology , otolaryngology and head and neck surgery, and respiratory and critical care medicine) have always faced difficult challenges and never abandoned or given up on any patient. (Respiratory Endoscopy Center), Interventional Department) doctors, led by Professor Li Zhihui, staged a 24-hour relay race-style rescue, snatching Zhang Ming back alive from the hands of the "god of death" and saving a family. In crisis.
(After the successful treatment of Zhang Ming, some of the doctors who participated in the treatment took a group photo. Picture provided by the doctor)
01
"I have worked in West China for more than 30 years.
This is the first time I have encountered such a dangerous thing."
Two years ago, Zhang Ming had a tumor resection operation in a local hospital due to thyroid thymoid carcinoma .
In mid-May of this year, due to difficulty in breathing, he had another tracheotomy operation at the local hospital, and a endotracheal tube was installed. After being discharged from the hospital, because I wanted to resume spontaneous breathing as soon as possible, I came to West China Advanced Thyroid Cancer Joint Clinic on the recommendation of a friend.
According to Professor Li Zhihui: Because Zhang Ming’s throat was swollen at that time, he was told to go home and rest for a while before coming back.
html On June 27, it was the second time that Zhang Ming came to the West China Advanced Thyroid Cancer Joint Clinic for treatment. Unexpectedly, just as he sat down, the scene at the beginning of the article happened, with about 1000ml of bleeding.Professor Li Zhihui said: "I have been working in West China for more than 30 years and have seen various critical situations, but this is the first time I have encountered such a dangerous situation."
The 10 experts from various disciplines who were present for the consultation at the time Most of them have been practicing medicine for 20 to 30 years and have never encountered such an accident. However, a more dangerous situation is yet to come...
02
What is most worrying about is the occurrence of
Where is the strange "bleeding point"?
In the emergency department, Zhang Ming was given blood and fluid replenishment and other treatments. Slowly, his physical signs stabilized.
The emergency department is a life-saving place, what should we do next? It is necessary to transfer to a specialist department for further resolution of the problem.
But which department should I transfer to?
Because Zhang Ming’s condition met the treatment requirements of multiple departments, Professor Li Zhihui later said: “Take it to us and see what’s going on first.”
At about 3 p.m. that day, Zhang Ming was admitted to the Thyroid Surgery Department . At the same time, Professor Li Zhihui and his team are urgently discussing to formulate a set of treatment plans that are as comprehensive as possible.
At that time, Zhang Ming's various examination results were all negative. It was still unclear what the cause was and where the bleeding was. However, the first suspected bleeding point was - "bronchial artery bleeding."
At 7 o'clock in the evening, what everyone was most worried about happened... Zhang Ming's neck was bleeding again . This time the bleeding was not as large as the first bleeding, about 200ml.
Professor Li Zhihui immediately coordinated doctors from the anesthesiology department, vascular surgery department, respiratory and critical care medicine department (respiratory endoscopy center), and the interventional department to come for consultation.
If bronchial artery bleeding is suspected, then " bronchoscopy examination" (that is, inserting the bronchoscope into the trachea for examination) is needed.
But when the patient is under anesthesia, when the bronchoscope enters the trachea, if there is no bleeding, the bleeding point cannot be found; once there is bleeding, the blood in the trachea cannot be actively coughed out, the patient will drown like drowning .
If the patient is examined while awake, it will stimulate aggravation of bleeding... Both plans have dangers.
Doctors have never seen such a difficult situation before.
Considering that Zhang Ming’s condition was relatively stable after the supportive treatment, Professor Li Zhihui’s team decided to optimize the treatment plan overnight to make it as comprehensive as possible, and then conduct a " bronchoscopy" the next day ", if a bleeding point is detected, seal it immediately.
03
Gathering the strongest medical resources in the hospital to carry out a major rescue operation
More than twenty doctors stood in the operating room
That night, almost all the thyroid surgery and chief residents were busy around Zhang Ming, and Professor Li Zhihui started from 12 noon From the moment he clicked, Zhang Ming never left his sight.
However, after six o'clock in the morning the next day, Zhang Ming who was in stable condition suffered from bleeding for the third time. Although the amount of bleeding this time was smaller, less than the previous two times, the "time bomb" was always there. If it is not dismantled, it will eventually threaten lives.
Fortunately, the leaders of the medical department went to the thyroid surgery department that morning to discuss Zhang Ming's condition. According to Professor Li Zhihui's recollection: The leaders of the medical department of Hospital attach great importance to it. If you have any difficulties with on-site explanations, just ask them and the hospital will organize and coordinate.
Although Professor Li Zhihui had already contacted various departments at that time, with the coordination and support from the hospital, he gained an extra level of confidence and strength in treating Zhang Ming.
After 9 a.m. on June 28, Zhang Ming was transferred to the respiratory interventional hybrid operating room of Respiratory Endoscopy Center. At this time, two doctors, Zhu Hui and Yang Sai from the Respiratory Endoscopy Center, were already on standby and coordinated the interventional hybrid operating room specifically for the treatment of Zhang Ming.
In addition, doctors from thyroid surgery and anesthesiology departments also arrived at the scene. Doctors from otolaryngology and head and neck surgery, vascular surgery, and interventional departments also arrived one after another. Each department sent 2 to 3 of the strongest doctors, including second- and third-line doctors. An operating room of about 50 square meters was full of people, and more than 20 doctors were making preparations in an orderly manner.
But just as the doctors were discussing treatment plans, Zhang Ming suffered from his fourth major hemorrhage..
According to Professor Li Zhihui, the quilt and the yellow medical garbage bag were all filled with blood, about 1,200 ml. The color of the blood had faded, and hemoglobin dropped to 50g/L (normally, male hemoglobin is 120g /L or above) , the blood pressure was 80/40mmHg, Zhang Ming's face turned pale, his skin was cold, and he had symptoms of hemorrhagic shock. The tension in the operating room was stretched to the extreme .
This time the bleeding was more severe than the previous three times. Dr. Yang Sai said: He lifted the bag and felt that the weight of the bag was not light.
At this time, Zhang Ming's wife, Ms. Li, had no idea what to do. She did whatever the doctor told her to do, and left her husband's life and death in the hands of the doctor.
04
Never give up until the last moment
Peel away the cocoon and uncover the "bleeding point"
Although Zhang Ming bled a lot, he was awake throughout the whole process. Seeing his condition, he was desperate and frightened to the extreme...
Imagine that the patient is awake How much suffering must it be to watch oneself bleed to death in such a state?
This also makes Professor Li Zhihui, who has practiced medicine for many years and treated countless patients, unacceptable.
With the development of medicine today, although there are still many problems that have not been overcome, West China has never bowed its head to intractable diseases and impossibility. Professor Li Zhihui said:
"A person's power is limited, but West China The hospital has such powerful specialties. If they are combined to maximize the effect, the patient may be saved. "
At the critical moment, the two teams of doctors worked together to replenish blood volume and fluids while finding out the cause of the bleeding. .
According to Dr. Zhu Hui, based on their past experience and Zhang Ming's bleeding condition at the time, does not look like bronchial artery bleeding. Zhang Ming's bleeding site should be above the endotracheal tube balloon .
Dr. Yang Sai further explained: Because when Zhang Ming was bleeding for the fourth time, his mouth and nose were bleeding out in a linear manner, the nozzle of the endotracheal tube showed mild bleeding, and the amount of bleeding was small. Combined with Zhang Ming's lung CT showed a small shadow, that is, not much blood entered, so it was determined that Zhang Ming's bleeding point was above the endotracheal tube balloon.
At this time, the plan of doing "bronchoscopy" to find the bleeding point was still very dangerous, so decided to make a rescue diagnosis-bronchial arteriography.
During respiratory endoscopy, doctors Jiang Faming and Guo Li of the cardiovascular interventional medical team performed angiography on Zhang Ming and discovered that there might be a pseudoaneurysm at the root of his right common carotid artery. , there is contrast agent flowing in the tumor cavity , , could it be the culprit?
At this time, the doctors in the command module carefully compared Zhang Ming's previous CT scans and found that , a pseudoaneurysm, had grown a lot in 24 hours ... had grown rapidly in a short period of time, and it was very likely to bleed. The point is right here.
Dr. Yang Sai gave an analogy: It is like a plastic bag filled with water with a small hole poked into it. When the pressure increases, water will spray out; when the pressure decreases, it will stop spraying, causing tidal bleeding. .
This is also the reason why Zhang Ming bleeds 4 times, with different amounts each time. The "bomb" of
has been found, but how to dismantle the bomb has become a new problem.
05
Ensuring the patient’s life safety
Two sets of plans for relay treatment, outperforming death!
Because during the "bomb disposal" process, it is very likely to cause ulceration of the right common carotid artery . If so, the consequences will be disastrous...
After full communication with Zhang Ming's wife, the family members expressed their full trust in the doctor. , everything depends on the doctor’s advice.
The trust of family members is the greatest motivation for doctors to treat illnesses and save lives.Under the leadership of Director Li Zhihui: two sets of treatment plans were determined.
Plan 1: Interventional Dr. Ke Jiaohe cooperated with the examination and everyone discussed the plan. Finally, two vascular surgeons inserted the vascular stent to seal the breach;
Plan 2: Once the vascular stent was inserted, When an accident occurs, surgeons who are ready will go into battle at any time to perform surgical operations.
Just like this, doctors entered the operating room in batches in an orderly manner, and were replaced one after another, like a relay race. Director Liu Dan of the Department of Respiratory and Critical Care Medicine was also giving instructions over the phone...
Dr. Yang Sai Said: Fortunately, after the vascular stent was inserted, the injected contrast agent did not leak out, indicating that the bleeding point had been successfully blocked. In order to avoid accidents in the contralateral blood vessels, the left common carotid artery was also treated. examine.
After it was determined that there was no risk, everyone cheered happily, and Zhang Ming's wife, who was highly nervous, finally breathed a sigh of relief.
It was already after two o'clock in the afternoon after rescuing Zhang Ming, but everyone had already forgotten about eating...
That night, Zhang Ming's eyes were filled with life again after he had passed through the gate of hell. During the ward rounds the next day, his wife became even more enthusiastic. She asked Professor Li Zhihui concernedly if he had eaten and asked him not to work too hard.
On June 30, Zhang Ming’s overall condition has stabilized. Professor Li Zhihui said: He still has two hurdles to pass, one is nutrition and the other is infection. Only after passing these two hurdles can it be considered a staged victory. .
As for this narrow escape, because he could not speak yet, Zhang Ming gave a big "like" for half a minute.
(Zhang Ming gave the doctors a "like")
As Zhang Ming's wife, Ms. Li, said: Fortunately, this accident happened in a hospital, fortunately in West China. If it had been in another place, another hospital, Maybe there is another ending... During the 24 hours of treating her husband Zhang Ming, she did not close her eyes. Although she was notified of critical illness 5 times, she always believed that Dr. Huaxi would definitely save her husband. .
Doctors are not gods, but they dare to fight death for people.
Professor Li Zhihui said that although the entire treatment process sounds uneventful, it is the embodiment of the West China spirit, the West China MDT mechanism, and the advantages of interventional hybrid operating rooms .
If there is a way, you must do your best and spare no effort; if there is any hope, don't hesitate or waver. If you give up because of a certain idea, then the patient will also be given up...
Finally, Let us pay tribute to the angels in white who participated in the relay to save lives:
Thyroid Surgery Department, Emergency Department, Anesthesiology Department, Otolaryngology and Head and Neck Surgery, Vascular Surgery, Department of Respiratory and Critical Care Medicine (Respiratory Endoscopy Center), Interventional Department
Written/Editor by Mkiki Video: Bai Yiwen A Fish
Picture source丨123rf Doctor provided picture
Producer丨Huang Liqin
Review丨Lan Lan
