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Chapter 188 I Won't Die! (Please Subscribe)

The number of operating rooms on this side is clearly not as good as the nine operating rooms on the other side.

There is only one circulating nurse and one scrub nurse.

There are only four surgeons at this time: Wu Xuanqi, Hong Du, Huang Kai, and Zhong Xuegao from Zhang Mingcan's team.

Originally, Director Wu Guonan had arranged for Zhong Xuegao to lead Guo Yunlei in this surgery.

Liu Linjie's condition appears to be relatively simple, consisting only of knife wounds to his thigh and arm, without damaging any important blood vessels or nerves, requiring only simple debridement and suturing.

Just find an attending physician to do it, or even have Fang Ziye come over to do the cleaning and suturing, and it can be done.

Unexpectedly, just as Zhong Xuegao entered and was about to begin chest compressions, the patient went into shock.

This made everyone realize that there was likely bleeding in a hidden cavity, and the patient's abdomen became increasingly swollen, which was most likely due to damage in the pelvic cavity.

After investigating, Huang Kai, who had been called in by Fang Ziye, found that the result was indeed the case. Without hesitation, Huang Kai called in the old director of Hongdu.

However, Director Hongdu did not have much experience in this area, so he immediately called Wu Xuanqi. Wu Xuanqi rushed over after stepping down from his post and arrived at the operating room in just over twenty minutes.

Previously, Director Hongdu and Huang Kai had only performed a hemostatic suture procedure in the pelvic cavity to allow for exploration of blood vessels.

Now, the pelvic cavity is still a bloody mess. It was only after Wu Xuanqi arrived that they dared to tentatively open the retroperitoneal hematoma!
Fang Ziye's sudden intrusion caused many people to look up at him.

Nie Mingxian remained calm and composed, and after controlling his blood pressure, he said, "Dr. Wu, this is Dr. Fang. He performed the limb-saving surgery in the next operating room. His technique is quite good."

"If needed, you can ask someone to come up on stage and help."

Before Wu Xuanqi could react after Nie Mingxian finished speaking, Director Hongdu immediately asked, "Do you still have the strength, Xiao Fang?"

Fang Ziye was looking for an opportunity to go on stage. Even as an assistant, he could probably gain a lot of knowledge. Moreover, he had rested for almost an hour. He was not fully recovered, but he was about 70-80% recovered.

"Director Hong, I'll go wash my hands right away." Fang Ziye glanced at Wu Xuanqi, who was skillfully operating the machine, and immediately left the operating room without any politeness.

After washing his hands again and going on stage, Fang Ziye squeezed into the corner.

The surgery is underway. Unless you are a very key person, you cannot get involved in the critical positions. You can only start with the assistants who will not affect the surgical procedure, and work step by step.

Wu Xuanqi had reached a critical moment in the surgery. He took a deep breath and, instead of explaining to Fang Ziye, addressed everyone.

"There is definitely active bleeding in the retroperitoneum, but the exact number of bleeding points and the extent of vascular damage are unknown."

"Moreover, the pressure in the retroperitoneum is high. If we rupture the peritoneum, a large amount of blood may gush out in a short period of time. This gushing process may cause secondary damage to the already damaged blood vessels."

"Therefore, we must find the bleeding point as soon as possible and perform temporary hemostasis."

"At most, I can only catch two bleeding vessels in a short period of time."

"The patient did not have any preoperative examinations, so no one could determine exactly how much bleeding occurred. We could only try our best to temporarily stop the bleeding manually, and then hand it over to our assistants to bandage and stop the bleeding."

"To achieve temporary hemostasis as quickly as possible."

“However, in this process, unless you are absolutely certain, you must not fight or scramble for positions. Rather than having several hands running around in there, you should wait to take over and tie things up at any time,” Wu Xuanqi said.

Upon hearing this, Hongdu nodded: "Xiao Wu, I'll try my best to cooperate with you. The others won't be able to handle it."

Upon hearing this, Wu Xuanqi nodded.

Since Hongdu made these arrangements, at least no one will interrupt.

He looked at Nie Mingxian and said, "Dr. Nie, the patient's blood pressure will fluctuate rapidly for a period of time. The maintenance of vital signs and the control of blood pressure will be left to you."

"During this period, there may be a large amount of fat flowing back into or impacting the blood system, which can also cause hemorrhagic shock."

“Okay, I’m ready at any time.” Nie Mingxian’s expression was serious, and he wasn’t joking at all.

Wu Xuanqi continued, "Two negative pressure suction devices are ready to clear the field of vision and blood accumulation. I'm going to open the peritoneum."

"A large amount of silk thread has been prepared. Each of you will have one. After I stop the bleeding temporarily, you will work together to temporarily tie up the blood vessels."

"It's important to know that a blood vessel may have two bleeding points."

After speaking quickly, Wu Xuanqi immediately took the sharp knife in his hand and cut a small gash in it.

Once the peritoneum ruptures, the accumulated hematoma inside gushes out like a newly formed spring.

Wu Xuanqi turned the dagger away from his assistant with his right hand, while his left hand, without hesitation, quickly reached into the pool of blood through the opening created by Zhong Xuegao and Huang Kai.

With a slight twist of the palm, a blood vessel head, wriggling like that of an eel, was coagulated and removed.

At the same time, Director Hongdu reached in with one hand and grasped an unnamed artery.

The scrub nurse swiftly retrieved the scalpel from the tray. Upon seeing this, Wu Xuanqi tossed the scalpel aside, and it landed on the tray. He then immediately plunged his right hand back into the gap between the pools of blood.

“Silk thread!” Wu Xuanqi whispered.

Huang Kai pressed down on one end of the S-shaped retractor with his stomach, then immediately reached up with both hands to take the blood vessel head that Director Hongdu had grabbed and began to tie it.

Zhong Xuegao, however, lost his position due to Huang Kai's actions. He continued to pull the S-hook open with his left hand, while taking over Huang Kai's original hook position with his other hand: "Brother Kai, let go first."

This leaves Fang Ziye with very little room to maneuver.

Even so, Fang Ziye still held the silk thread in both hands, wrapped it around one of Wu Xuanqi's hands, and quickly tied a knot with both hands, temporarily binding a blood vessel.

After quickly dealing with the knot, Fang Ziye swiftly pulled out a thread and tied it to Wu Xuanqi's other hand, creating a slip knot, which then slid down like a sleeve.

Once he reached the blood vessel, he pulled hard again, and before Wu Xuanqi could react, Fang Ziye had already tied another knot.

This is a flexible application of knot-tying techniques.

Fang Ziye came here to fill in the gaps, so he took on whatever job was missing.

Wu Xuanqi glanced at Fang Ziye, but before he could give any instructions, Fang Ziye had already finished tying the knots in two places. He then decisively withdrew his hand, picked up the suction device that was currently unattended, inserted it directly into the device, and moved aside to make room.

At the same time, he shifted his body to the side, giving more space to Wu Xuanqi.

This is called yielding the throne.

Although Fang Ziye felt that he could also perform manual hemostasis, the division of labor on the operating table was already clear, and he could not take someone else's place!
Let alone pushing aside the surgeon, even if it contaminates oneself, one must give up one's place to the surgeon.

Two tigers cannot share one mountain, and two rulers cannot share one country. On an operating table, there can only be one surgeon; everyone else is an assistant. This is an ironclad rule!
Fang Ziye had already skillfully assumed the slanted horse stance, his buttocks tilted to the side.

He looked at Wu Xuanqi.

Wu Xuanqi only paused for about two seconds before continuing to operate the machine.

When Wu Xuanqi once again grasped a blood vessel remnant through the turbulent flow of blood through his sense of touch, Fang Ziye immediately slipped his suction device into Wu Xuanqi's other hand.

As his eyelids blinked rapidly, he was about to speak to remind him, but Wu Xuanqi seemed to understand what he meant and took the attractor.

Fang Ziye immediately withdrew half a step from his backward horse stance, pulled out a silk thread with his left hand, and sent it to the index finger of Wu Xuanqi's right hand.

With his hands moving quickly in circles, Fang Ziye completed two more knots in just two seconds!

Immediately afterwards, Fang Ziye moved both hands away without any unnecessary words or movements, skillfully moving the knot of the two lines to his left abdomen with his left hand, and then taking the suction device from Wu Xuanqi's hand again with his right hand.

He turned his head and said, "Medical technician, could you use forceps to untie the knot in my sutures?"

The previous knots were too urgent to untangle, but the current knots must be removed because the situation is no longer so urgent.

After the ends of the four blood vessels were tied off one by one, the bleeding rate in the pool of blood was reduced by more than three-quarters, and the bleeding rate could no longer keep up with the suction speed of the negative pressure suction device.

The blood was visibly dripping down.

At this point, Hong Du and Huang Kai had barely finished suturing the head of a blood vessel.

Were they moving slowly? Not at all. Only fifteen seconds had passed since Wu Xuanqi made the cut.

The fact that Director Hongdu was able to find the vein and that Huang Kai cooperated to remove it, all within fifteen seconds, was already quite fast.

After all, in critical situations, it's not about sewing a knot, but about creating an opportunity to tie a knot and then completing the knot; it takes time.

Not everyone can be like Fang Ziye, possessing level 4 knot-tying skills to quickly tie knots and ligate blood vessels.

Seeing this, Hong Du and Huang Kai realized that their cooperation had completely slowed down the operation. Their faces darkened slightly, and they each moved aside.

At the same time, he took the negative pressure suction device from Fang Ziye and the S-hook from Zhong Xuegao.

Wu Xuanqi was not idle at the moment either. He glanced at Fang Ziye and said, "Use hemostatic forceps for subsequent bleeding points."

Wu Xuanqi secretly gave Fang Ziye a hint: if Fang Ziye understood, he could operate it; if he didn't understand, Fang Ziye could hand him a hemostat.

In the blink of an eye, he wouldn't waste a single extra word.

"Okay!" Inside the curved tray, there were a large number of vascular clamps, at least the vascular clamps from three instrument packs, all of which were placed inside.

After Fang Ziye got the hemostat, he took a small step back. Only after Wu Xuanqi inserted both hands into the hemostat simultaneously did Fang Ziye place the hemostat in his left hand into the bleeding point in his best field of vision.

At the same time, the hemostat in his right hand was used to deliver the bleeding point to a location that was within the field of vision of both him and Fang Ziye.

There was no fighting, and the timing was staggered, but both were able to simultaneously stop the bleeding by temporarily ligating the bleeding points with hemostatic forceps.

This is also a common application of hemostasis techniques.

There are many forms of hemostasis. Any operation that can stop bleeding can be classified as hemostasis. Manual hemostasis is just one of the forms of hemostasis.

Among them, the hemostasis technique of temporary clamping with vascular clamps is actually a part of manual hemostasis, and it is one of the simplest and most basic hemostasis surgeries.

Fang Ziye is naturally able to operate freely when the situation is visible to the naked eye.

Each person's position has blind spots and advantageous positions, whether they are the surgeon or the assistant.

"Go to the other side!" Wu Xuanqi's eyes lit up when he saw Fang Ziye's skill level. He could tell that Fang Ziye's skill level was quite high. He was very experienced in the basic skill of hemostasis.

This statement does not mean that Wu Xuanqi drove Fang Ziye away, but rather that he made Fang Ziye his first assistant to perform hemostasis and follow-up procedures on bleeding points within his blind spot.

The surgeon and assistant stand on either side to complement each other.

However, it is clear that Director Hongdu, for various reasons, cannot achieve such a complementary position, so Fang Ziye can only go to the other side.

Fang Ziye nodded without hesitation, took two steps back, turned around and left the operating table with Wu Xuanqi back to back, then turned around again, facing the operating table, and began to walk around it.

On the operating table, when moving between patients, they need to be back to back to ensure aseptic technique.

When walking around the operating table, it is a big no-no to have your back to it, because if you are not looking directly at it, you don't know if you might contaminate the operating table.

Hong Du moved to a different position, while Huang Kai, very considerately, walked from another direction, facing the operating table, to the position where Fang Ziye had previously been.

Although we don't know why Fang Ziye is so skilled, the operating table is never the time to ask questions. Right now, the most important thing is that Fang Ziye and Wu Xuanqi can cooperate more perfectly.

As Fang Ziye simply changed position, Wu Xuanqi clamped down on three bleeding points with a series of sharp, quick movements.

The active bleeding in the retroperitoneum is now visibly under control.

At this point, Nie Mingxian, standing in front of the anesthesia table, said, "The blood pressure is temporarily stable. Circulation, call over four more plasma transfusions and 400 mg of suspended red blood cells."

"The blood bank is running low," the circulating nurse said.

"If the blood bank is running low, tell them the operating room is also running low, and find a way to divert some blood!" Nie Mingxian ordered, leaving no room for argument.

"Okay, I'll call right away." She didn't dare to argue.

On the operating table, Fang Ziye, Wu Xuanqi, and the others were completely unaffected by the conversation. Only after Fang Ziye stood to the opposite side of Wu Xuanqi did he have time to use hemostatic forceps to close several bleeding points that Wu Xuanqi could not see.

After this, upon examining the interior of the retroperitoneal hematoma, a peaceful atmosphere returned, and no more active bleeding occurred.

Even if there is only slight bleeding, this is not bleeding that can be handled by hemostats. It is necessary to use hemostatic materials such as gel sponges to stop the bleeding.

Everyone breathed a sigh of relief.

Wu Xuanqi breathed a sigh of relief: "To clean and stop the bleeding of a hematoma in just over forty seconds, that's considered timely."

"Director Nie, how's the situation on your end?"

"Director, you son of a bitch." Nie Mingxian had already stood up and started drawing blood to check electrolytes, cursing under his breath.

He clearly couldn't stand Wu Xuanqi calling him Director Nie.

The old director of Hongdu narrowed his eyes and asked, "Dr. Wu, would you feel more comfortable working with Dr. Fang?"

Wu Xuanqi's statement that this was timely speed was an implication that his teamwork with Huang Kai was somewhat lacking, and that he was being led astray.

Only Fang Ziye's skills can complement his. Although he might be working with Fang Ziye, the difference in skill level wouldn't be too great.

The more skilled the assistant, the more comfortable the surgeon will be.

This is also the main reason why, in many surgical training sessions, highly skilled personnel serve as assistants, making it much easier for less skilled personnel to perform the surgery.

"Director Hong, I didn't mean that, but Xiao Fang's skills are really quite good." After saying that, Wu Xuanqi bowed again and began to clean up the mess.

At this point in the surgery, the vital signs have been temporarily stabilized, but the subsequent hemostasis procedures must not be taken lightly.

If the bleeding is not stopped properly, and a hematoma develops again, or the blood vessel stump ruptures again, the risks are much higher than the initial hematoma and blood loss.

After all, humans are made of flesh and blood and cannot withstand many injuries.

Fang Ziye actively helped, cleaning up the blood clumps, blood masses, and black blood clots without saying a word.

He was neither arrogant nor pretended to be dead, waiting for Wu Xuanqi's orders.

Wu Xuanqi is the main surgeon, so this person doesn't take up Wu Xuanqi's position or steal his actions. However, he can freely make other minor moves.

Wu Xuanqi was also silently cleaning up the debris after the hematoma, saying, "Ziye, when we're suturing the blood vessels later, you and I will sew them together."

"Sew up what needs to be sewn up, and if it can't be sewn up, just slit it off. Don't force it to be sewn up."

“Okay, Senior Brother Wu.” Fang Ziye nodded, not daring to make any further suggestions without authorization.

Wu Xuanqi's skill level is higher than mine, so what he said is better advice. I shouldn't try to guide Wu Xuanqi with my own limited skill level.

Moreover, Fang Ziye also realized that if he were to experience such hematoma rescue in the future, his skills in hematoma incision and hemostasis must be high enough to ensure the successful incision, cleaning, and hemostasis of such active hematomas.

The two worked together methodically and gradually advanced the surgery to the final stage of vascular suturing.

Huang Kai and Hong Du became assistants, helping Fang Ziye and Wu Xuanqi cut the wires.

Then, occasionally, he'd joke, "Huang Kai, look at them, they're rubbing so fast!"

Huang Kai, however, maintained that he was older and said, "After all, it's a skill that's been practiced, but it might be a bit harmful to your health."

While Huang Kai and Hong were joking around, Fang Ziye noticed that his senior brother Wu Xuanqi was also silently immersed in his work, not daring to refute him, as if he knew that young people like him had an inherent disadvantage when it came to driving compared to these 'directors'.

"Damn, thank goodness they found hypokalemia."

"Don't worry about them, they shouldn't die." Nie Mingxian approached again, speaking in a cursing tone, saying the most outrageous things.

Everyone smiled knowingly and felt relieved.

Anesthesiologists are the guardians of patients' lives in the operating room. Since Nie Mingxian said the patient wouldn't die, they could operate more freely.

(End of this chapter)