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Chapter 375 The Culprit! (Please Subscribe)
Like the orthopedics department, the anesthesiology department at Zhongnan Hospital also has a clear hierarchical structure. From top to bottom, there are chief physicians and professors; associate chief physicians and associate professors...

In the emergency operating room, the anesthesiologists are not usually professors or associate professors, but senior attending physicians who are very aware of the risks of post-peritoneal hematoma.

During the surgery, most of the responsibility for vital sign monitoring falls on the anesthesiologist. Seeing that it is beyond their capabilities, even junior doctors have superiors they can call upon.

There was nothing to be embarrassed about. Fang Ziye was able to call in a big shot like Deng Yong, so the anesthesiologist quickly brought in an even more senior associate chief physician.

He glanced at the scene as soon as he entered and immediately understood the situation. He asked, "When do you plan to open your surgery department? If it's not too urgent, I'd like to call Director Zeng from our anesthesiology department and see if he can come over in person."

Even within a hospital, the skills are tiered.

"We'll wait for the vascular surgeon. You make the call first. As soon as they arrive, we'll be ready to start..."

“Otherwise, this can’t just drag on like this. This active retroperitoneal hematoma is a ticking time bomb right now. I won’t feel at ease until it’s resolved.” Deng Yong gave Han Yuanxiao face by not speaking, allowing Han Yuanxiao all the opportunities to speak.

Fang Ziye remained silent, observing the anatomical structures of the intestinal tract in the general surgery department, his mind racing.

To open a retroperitoneal hematoma, a meticulous plan is essential, but following conventional surgical approaches might not be enough.

Once a retroperitoneal hematoma opens, a large amount of blood will gush out.

The reason there is no significant blood loss is that the pressure within the localized retroperitoneal hematoma is high enough to balance blood pressure and relatively block active arterial bleeding.

The patient's hemorrhagic shock is currently just a symptom, and arterial vascular injury is also a clinical manifestation. The most fundamental cause is actually the active hematoma resulting from the pelvic fracture.

The bones of the pelvis are mainly cancellous bone, the pelvic wall has many muscles, and there are many arterial and venous plexuses nearby, resulting in a rich blood supply. The space between the pelvic cavity and the posterior skin membrane is composed of loose connective tissue, which has a large gap that can accommodate bleeding. Therefore, fractures can cause extensive bleeding.

A large retroperitoneal hematoma can extend to the renal area, subdiaphragmatic region, or mesentery...

The mortality rate of severe pelvic fractures is 25% to 39%, all of which are caused by bleeding from direct or indirect pelvic fractures.

Therefore, the early treatment of pelvic fractures must follow the basic principles of advanced trauma life support. First, life must be saved and vital signs stabilized before the pelvic fracture is examined and treated accordingly.

Once it is determined that the shock is caused by bleeding from a pelvic fracture, treatment should be initiated according to the emergency procedures for pelvic fractures.

But no matter what, saving lives comes first, then treating the illness, and dealing with shock first.

The extraperitoneal pelvic hematoma has been temporarily cleared away. They still need to wait for someone. Fang Ziye's mind was racing. He didn't know how much time had passed before his eyes finally lit up.

This retroperitoneal hematoma is not an 'extended' hematoma caused by damage to large blood vessels such as the aorta or inferior vena cava. Therefore, opening it is not as dangerous as this super-large hematoma.

The patient did not undergo any preoperative examinations. Based on the current exploration results, the hematoma is likely caused by vascular damage in the retroperitoneal pelvic region.

The blood vessels in this area have a more complex origin and are more difficult to clean, such as the presacral venous network, which is a sign of large bleeding from small blood vessels.

Caused by external trauma.

The patient's obvious trauma from the violent external injury did not reach the presacral venous plexus. However, she likely suffered a coccyx fall injury, which resulted in a coccyx fracture and subsequent damage to the sacral venous plexus.

The structure of the veins in the presacral region is extremely complex, and can be described as chaotic, with two sets of venous systems.

The presacral veins are venous branches located in a narrow region between the sacrum and the posterior wall of the rectum, on the inner side of the bilateral presacral foramina. They include the presacral venous plexus and the vertebral veins of the sacrum. These are two systems of origin.

The presacral venous plexus is a network of veins consisting of the lateral sacral veins, the middle sacral veins, and the communicating veins between them. It is located deep to the presacral fascia and attaches to the pelvic surface of the sacrum. This is the location of the venous plexus.

The vertebral veins of the sacrum often exist as venous sinuses in the distal sacral vertebral body, with a diameter typically between 2 and 5 mm. After emerging from the bony foramen anteriorly, they join tributaries of the anterior sacral venous plexus. Numerous branches originating from the posterior venous sinus extend into the 0.1 cm thick layer of cancellous bone, connecting with the sacral veins that make up the sacral canal venous plexus…

After processing a large number of complex and detailed knowledge points in his mind, Fang Ziye finally figured out a rather special path.

Since neither the spinal venous system nor the inferior vena cava system has venous valves, their blood can flow into each other. Therefore, blood from the inferior vena cava system can also participate in the massive hemorrhage process after injury to the presacral veins.

The amount of blood stored in the inferior vena cava is no joke; it can bring a patient down to the shock line in no time.

However, it was precisely because of this that Fang Ziye came up with a better method. "Master, Professor Han, I have an idea that might be useful." Fang Ziye asked for instructions first, but before waiting for a reply, he spoke directly: "There are many sources of bleeding from retroperitoneal hematomas in the pelvic region. Once opened, a large amount of blood will be released from the presacral venous plexus, making hemostasis very difficult."

"Perhaps even if we solve the bleeding point, the patient's blood has already been replaced with a whole set, so opening it directly might not be the optimal solution."

"My idea is this: since the spinal venous system and the inferior vena cava system are two independent systems, we can first create a venous channel, which is equivalent to creating a short circuit to directly connect the two venous systems."

"At the same time, because the inferior vena cava has no venous valves, we will directly clamp the distal end of the femoral vein. The blood in the femoral vein will still return to the heart through blood circulation. In this way, we have created a temporary short circuit to temporarily introduce blood from the spinal venous system into the inferior vena cava."

"Due to the siphon effect of blood flow, a large portion of the blood in the spinal venous system will inevitably flow into the inferior vena cava, further reducing the blood supply to the presacral venous plexus."

"A temporary vascular bridging can be a one-way valve, so we don't need to worry about the blood in the inferior vena cava..."

To be honest, what Fang Ziye said was a bit too much about vascular surgery and strayed from the vague outline of trauma surgery.

No one has ever thought of using bridging to stop bleeding; the purpose of vascular bridging is to improve blood flow.

"You should talk to the vascular surgeon about this later. We can't really comment on it."

"Most of the pelvic fractures we encounter involve bleeding that isn't as severe as this one. If the bleeding were this severe, and we had waited until now, we might not have even been admitted to the hospital or started surgery before we even had a chance to have surgery."

"Therefore, for professional matters, you should consult with professionals." Professor Han Yuanxiao glanced at Professor Deng Yong with a slightly embarrassed look, his eyes filled with pity.

Teacher Deng, is this how you teach your students nowadays?
Upon hearing this, Deng Yong raised an eyebrow: "Yes, Ziye's rebellious nature is particularly prominent now. If one day he follows others and dives into hand surgery or vascular surgery, I wouldn't be surprised at all."

As they were talking, Liu Faming and Associate Professor Chen Minghao from the Department of Vascular Surgery entered.

When Fang Ziye mentioned his point, Chen Minghao's eyes turned strange: "It's possible? But no one has ever done it before. Vascular bridging is used to improve blood flow, not to stop bleeding."

Fang Ziye said, "Professor Chen, regardless of whether the main purpose of vascular bridging is to improve blood flow or stop bleeding, as long as it can be effective in stopping bleeding, I think we can give it a try."

"Perhaps because the fluid flow in the inferior vena cava is so large, the bridging created a short circuit, which actually made the hematoma a little smaller?"

Fang Ziye still maintains that the current method is better than a non-existent one. Furthermore, if this can be achieved, the unique structure of the vertebral veins and inferior vena cava will actually make treating simple retroperitoneal hematomas in the pelvis much simpler!
"Then let's give it a try. Now that you mention it, it actually makes some sense."

Chen Minghao asked, "No, bro, which professor are you a student of? You're not Professor Deng's, are you?"

"What the hell do you mean? Who the hell are you?" Deng Yong was furious!

Chen Minghao was working under Professor Deng Haibo in the Department of Vascular Surgery, but Chen Minghao didn't give his full name. Deng Yong had no idea who Associate Professor Chen Minghao was working under, or whether he was even a staff member of the hospital. Deng Yong couldn't even remember.

Deng Yong just said that Fang Ziye might be rebellious by nature, but that was a joke.

Chen Minghao said to Fang Ziye's face that he was not Professor Deng's student. Wasn't that just picking a fight?
Upon hearing this, Liu Faming quickly whispered an explanation in Chen Minghao's ear.

Chen Minghao's expression immediately tightened. He knew that Professor Deng Yong, who shared the same name as Professor Wu Yong of the Vascular Surgery Department but had a different surname, had a notorious reputation in the hospital. He was known for his shamelessness and was often seen slamming his fist on the table and cursing people.

He apologized first: "I'm sorry, Professor Deng, I mistook you for someone else. I thought Xiao Fang was a student in our vascular surgery department, a doctor brought by Liu Faming."

"Find out beforehand what you mean by not being Professor Deng's student? Did my student offend you or did I offend you?" Deng Yong naturally knew this was a misunderstanding, but he still earnestly explained that this needed to be clarified.

Fang Ziye is Deng Yong's student, and also Professor Deng Yong's student; this cannot be a rumor.

Han Yuanxiao quickly said, "Professor Deng, now that the vascular surgery team has arrived, let's begin..."

Chen Minghao quickly nodded: "Yes, yes, Professor Deng, let's have the surgery first, let's have the surgery first..."

As he spoke, he glanced at Fang Ziye, the culprit. If Fang Ziye hadn't been a little too professional, he wouldn't have made such a basic mistake.

(End of this chapter)