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Chapter 682 Atrial Fibrillation and Thrombosis! ~ (First Update, Please Subscribe)
The night sky is dotted with stars, and the moon hangs like a shadow.

At 9 pm in October, the humidity on the mountain in Enshi was quite high. Under the lights, the fog was like a veil, forming bright beams of light.

After Chen Song's condition stabilized, Fang Ziye and Nie Mingxian, unable to help much inside, went out of the consultation room for some fresh air.

Nie Mingxian took a sip of cold tea, gulped it down several times, his brows furrowing deeply. He turned to look at Fang Ziye, his voice low and menacing: "Ziye, tell me, was today's incident a spontaneous symptom of Dean Chen's instincts, or did he inflict it himself with needles?"

Fang Ziye shook his head. He also took a sip of tea, and after tasting that it was cold tea, he put down the teacup and opened a new bottle of mineral water: "From our perspective, it seems nothing but mysterious."

Do you understand Traditional Chinese Medicine?

"Anyway, I don't understand it."

In recent years, some scholars have advocated for the integration of traditional Chinese medicine and Western medicine in the treatment of diseases. However, the reason why this integration has not developed on a large scale is that doctors of both modern and traditional medicine find each other's theories to be "mysterious and esoteric"!
"Modern medicine emphasizes a detailed understanding of all disease mechanisms, examining local lesions and blood markers."

"Traditional Chinese medicine emphasizes a holistic approach to disease diagnosis, combining the four diagnostic methods (inspection, auscultation and olfaction, inquiry, and palpation) with the concepts of Yin and Yang, the Five Elements, the Five Organs, and the meridian system..."

Nie Mingxian shook his head and sighed, "If you say it's fake, then if Dean Chen really caused all this by stimulating himself with acupuncture, then the theories we've learned can't explain it."

"You're saying it's completely true, right?"

"Based on his condition just now, without ECMO and angiography, I think Dean Chen would have definitely died."

"Shh..." Fang Ziye quickly took off his water bottle and gestured for Nie Mingxian to be quiet.

This is the Enshi Sanatorium, and most of the people inside and outside are Chen Song and Chen Guangbai's 'direct followers'. If you say such things, Chen Song should have died long ago. If idle people hear this, it won't be a good thing.

Nie Mingxian continued, "Let's make an assumption: if the corresponding theories of traditional Chinese medicine are true, then Dean Chen Song's situation will not be so easy to reverse, and he will probably be busy for a long time."

Fang Ziye nodded: "The result can be measured, but the process cannot; this is also a form of ignorance."

"Death pulse?"

"Even if today's acupuncture points used by Dr. Chen Guangbai, Dr. Wang Qishan, and others have confirmed that local stimulation of acupoints can change the body's microenvironment, we still cannot find a better explanation or a solution to Dr. Chen's current situation."

"Because I've heard that the effects of stimulating acupoints in Traditional Chinese Medicine vary depending on the force and depth applied. Therefore, to truly delve into this area, it would take at least a hundred years to even begin to understand it..."

"Not to mention the chain reactions between acupoints." Fang Ziye's scientific thinking was very sharp, so he knew what Chen Guangbai and the others wanted to do.

However, at most, Chen Guangbai and others have only proven the phenomenon of effectiveness; they cannot answer the questions of how effective it is or how it is linked to other effective mechanisms.

"Personally, I still think that interpreting traditional Chinese medicine using modern medical thinking is, given the current level of technology, a brute-force approach is unacceptable." Fang Ziye is not optimistic about the 'scientific research' done by Chen Guangbai and others!
Nie Mingxian said, "Even if it's not feasible, someone still has to do it. Without trial and error, we can never get started."

"Let's take a break first. I think there might be more than one tough battle ahead."

"In fact, the collapse of one's Dao heart is not a bad thing; at least it will make us always maintain a sense of awe."

"It's a pity that neither you nor I work in the ICU, so we can't truly feel the helplessness of each life slipping away."

The intensive care unit is different from the emergency department, where deaths are often violent and swift.

If you die, you die; if you live, you live temporarily.

As for the 'routine monitoring' after the rescue was completed, it had nothing to do with Fang Ziye and Nie Mingxian.

Perhaps some people are rescued in the operating room and their vital signs are stable, but then they die due to other special circumstances. In that case, Fang Ziye and his team cannot be blamed!
Unless the death is due to hemorrhagic shock on the operating table, the cause of death is usually unrelated to the surgeon.

After eating something simple, Fang Ziye and Nie Mingxian found two beds in the medical staff rest area in the courtyard, wrapped themselves in blankets, and fell asleep.

Surgery is not just a physical task, but also a mental drain that requires intense mental activity in a short period of time.

……

23:08 Intensive Care Unit.

The green waveform on the electrocardiogram monitor twisted into jagged edges in the darkness, and a buzzing sound exploded in the silence.

Luo Tingzhu suddenly looked up from in front of the anesthesia recorder. The cold light from the six monitoring screens intertwined in her pupils, and her pupils contracted to the size of pinpoints in the reflection of the screens.

The moment she pressed the pause button on the sedation pump, Chen Song's emaciated chest suddenly heaved violently, and the blue and white stripes on his hospital gown transformed into the rotating overhead light of an ambulance under the red light of the monitor.

"Teacher Tan. Polymorphic ventricular tachycardia! R-on-T!!" Luo Tingzhu's warning rang out simultaneously with the monitor's alarm. Her voice was like a scalpel cutting through the air; the moment her left hand stopped the sedation pump, her right hand was already gripping the defibrillator handle.

Fang Ziye burst open the ward door, and Chen Song's withered wrist trembled in his palm: "The pulse rate is slowing down, and the peripheral circulation is failing!"

"200J synchronous preparation!" Tan Mengbai's action of tearing open the patient's hospital gown caused static sparks.

The defibrillator electrodes were precisely positioned against the right sternal border and the apex of the heart. His curly sideburns flashed blue as Luo Tingzhu held the defibrillator and discharged the signal: "Clear!"

Chen Song's body bounced up and down on the hospital bed, his electrocardiogram briefly returned to sinus rhythm, and then twisted into a sawtooth shape again.

“Ventricular tachycardia! Continue defibrillation,” Tan Mengbai said.

"Norepinephrine combined with dopamine infusion pump!" Tan Mengbai quickly instructed the nurse. Dosage of commonly used emergency drugs does not need to be specified.

"Breathing and heartbeat stopped!"

Fang Ziye took out an ultrasound probe and scanned the carotid artery. The elastography showed that the vessel wall was as hard as rock: "Engine ECMO now!"

The sound of Nie Mingxian tearing open the metal buckle of his lead apron pierced the silence, and the ECMO tubing gleamed coldly under the emergency light.

As he twisted the 14Fr cannula into the femoral artery, dark red blood suddenly gushed out in a foamy vortex: "Distal perfusion cannula!"

Fang Ziye's suturing of the silicone tube was as precise as a joint replacement surgery, and the 3mm balloon catheter looked like a transparent centipede under the microscope.

"Esmolol 0.5 μg/kg/min, QT interval 520 ms!" Luo Tingzhu's voice was as flat as an electrocardiogram sheet...

Under the operating light, Li Yongjun's No. 11 blade sliced ​​open the femoral artery at a 45-degree angle, and blood splattered onto the lead glass in a fan shape.

“15Fr cannulation.” Li Yongjun used mosquito forceps in his left hand to open the blood vessel incision, and with his right hand, he rotated and inserted the heparin-coated cannula, his movements as precise as assembling a spacecraft component.

Fang Ziye adjusted the interpupillary distance in front of the microscope, and 8-0 polypropylene sutures wove a spider web on the wall of the perforating blood vessel.

"Flow rate 50ml/kg/min, rotation speed 3000." Nie Mingxian tapped the ECMO control screen, then suddenly frowned: "Intravenous drainage turbulence, HCT 28%, immediately infuse 2 units of type O red blood cells!"

"Perform DSA thrombectomy under ECMO monitoring!" Fang Ziye shouted.

Li Yongjun continued to look at Fang Ziye, now more confident in Fang Ziye's precise execution.

Upon hearing the order, Luo Tingzhu, who was assisting Chen Song, immediately injected the contrast agent into Chen Song's body again, and Chen Song's heart and major blood vessels were once again visualized.

"Distal occlusion of the right coronary artery and distal occlusion of the left anterior descending artery!"

"Interventional thrombectomy!~"

"Under ECMO, blood oxygen level is 96%, blood pressure is 112/85 mmHg." Professor Tan Mengbai gave everyone the greatest reassurance at the right time!
Chen Song's rescue process was very fast. ECMO was administered immediately, so his blood oxygen and blood pressure levels did not fluctuate arbitrarily, and there was no need to consider the golden five-minute rescue time limit.

Fang Ziye was sweating profusely inside his lead apron. DSA 3D imaging showed a blood clot in his left atrial appendage floating like a ghostly jellyfish.

"Watchman occluder in place!" Fang Ziye replied.

Fang Ziye was the operator at this moment. He trusted the advice of Professor Tan Mengbai and Professor Yang Fenggen from the Department of Cardiology, and he simply followed it.

"put!"

The DSA 3D image cast a ghostly blue shadow on the lead glass. Fang Ziye manipulated the guidewire through the trabeculae of the atrium, feeling as if an intramedullary nail was passing through the bone cavity.

The moment the Watchman occluder deployed, the 4mm thrombus suddenly contracted into a spherical shape.

"Switch to catheter-based thrombolysis!" Yang Fenggen's voice was calm but urgent.

As Fang Ziye pushed the microcatheter closer, the pulse jet of rt-PA burst into silver fireworks under X-ray.

Luo Tingzhu said, "The D-dimer concentration has exceeded 10000 μg/L!"

"There's also a blood clot in the vein of the right lower limb!" "Place the filter first!" Fang Ziye reacted quickly again.

After atrial fibrillation, blood clots can travel erratically and may accumulate in any location.

After a venous thrombus breaks off, it can either cause a pulmonary embolism or potentially travel back to the heart and cause another embolism.

Intravascular ultrasound revealed needle-like hyperechoic foci at the core of a deep vein thrombosis in the lower extremities—precisely the Han-style stimulation needle that Chen Guangbai implanted at Zusanli yesterday…

Fang Ziye: "..."

Nie Mingxian and Li Yongjun, who also understood what was inside, looked at each other in bewilderment, but none of them said anything.

Now is not the time to complain and hold people accountable; solving the problem is the only thing to do.

It doesn't matter why it's here; what matters is solving the problem of its existence.

"Pause!" Nie Mingxian chewed the third mint and fused the CT images for projection: "The tip of the stainless steel acupuncture needle is 1.2mm away from the thrombus."

“Switching to contact thrombolysis.” Fang Ziye brought the microcatheter close to the thrombus and injected rt-PA with a hand as steady as a robotic arm.

"ACT 280 seconds! Thrombolytic dose halved!"

The monitor showed the APTT value dropping from 280 seconds to 210 seconds. The HPLC real-time monitoring curve and coagulation elastography intertwined on the screen to form a DNA double helix.

Fang Ziye and Nie Mingxian finally breathed a sigh of relief after the last blood clot was removed.

Luo Tingzhu adjusted the brain oxygen monitoring probe and suddenly turned the propofol target control knob: "BIS value 45, EEG burst suppression."

She increased the norepinephrine pump rate by 0.02 μg/kg/min and used a warming blanket to maintain her core body temperature at 36.5°C.

When Fang Ziye examined the femoral artery incision, he found that the effusion had the bitter taste of angelica. However, Fang Ziye did not say much. A person's faith is a person's life, and may be even more important than life itself.

"Urine output 30ml/h." Tan Mengbai stared at the catheter.

"Transmembrane pressure gradient in the membrane lung is 120 mmHg!"

"The patient's vital signs have now returned to normal!" Tan Mengbai said.

"Thank you for your hard work, Professor Tan, Professor Li, Professor Fang." Chen Guangbai bowed slightly.

He remained silent throughout the rescue, fearing that he might disturb Fang Ziye and the others and cause unforeseen accidents.

Neither Tan Mengbai nor Li Yongjun replied; they remained intently focused on their respective screens, not daring to be careless in the slightest.

If it were just an ordinary patient, they would have let their guard down long ago, but clearly, Chen Song's current situation cannot be explained by common sense.

"Professor Fang, the test results are in..." a nurse whispered in Fang Ziye's ear.

Intravascular OCT showed that the treated blood vessel wall was covered with nanoscale lattice, which was completely consistent with the coating of Chen Guangbai's acupuncture needles.

In the electron microscopy laboratory, the energy spectrum of ECMO bearing debris overlapped with that of thrombus crystals, and the metallic composition included rare lanthanide elements.

"Oh, I see."

"It should be alright." Fang Ziye didn't actually know if anything was wrong, so he could only try his best to reassure everyone.

Whether Chen and Song are dead or not, no one will be held accountable!
After the sounds inside gradually subsided, Chen Xiqian, carrying the "Pulse Classic," slowly squeezed into the consultation room. Fang Ziye noticed the "Shrimp Swimming Pulse" illustration in the ancient book in her hand.

Perhaps due to nervousness, Fang Ziye's perspective even began to hallucinate, as if the pattern of the 'shrimp swimming veins' overlapped with the vascular image of Chen Song on the holographic screen.

But upon closer inspection, Fang Ziye realized it was indeed just a hallucination.

"Reset the flow rate to 55 ml/kg/min!" Li Yongjun's voice sounded slightly muffled under his lead apron, and the hum of the ECMO centrifugal pump suddenly became soft.

Fang Ziye felt the tremors of the 'shrimp swimming vein' begin to weaken. Ginkgo leaves through the layers of buildings floated down, and the light shone on one side, making it golden, while the other side could not be seen.

Chen Guangbai removed the stimulation needle from Zusanli (ST36), and the nano-coating shimmered with iridescence in the sunlight.

Chen Guangbai glanced at Fang Ziye, his expression and eyes showing a slightly complicated look.

Even if he was unwilling to admit that the stimulation needle had broken off and entered the blood vessel, the broken end that Fang Ziye took out from the blood vessel matched the broken end of the stimulation needle.

"Perhaps my technique wasn't good enough," Chen Guangbai murmured.

"The patient's electrolyte levels are normal, there is no electrolyte imbalance, and the heart rate has returned to sinus rhythm."

"If the vital signs remain stable, the machine can be removed as appropriate." Luo Tingzhu carefully carried out her work as a junior anesthesiologist assistant, no longer coveting other tasks.

Being able to be in charge of anesthesia monitoring for Chen Song was an extremely helpful experience for her growth.

Suddenly, at that moment, Fang Ziye, who had been staring at the screen, gripped the ultrasonic probe control handle tightly!

Immediately afterwards, Fang Ziye rotated his hand to the right, while his left hand pointed to a certain spot!
On the screen, a 4.1mm blood clot is seen passing through the patent foramen ovale with the precision of a bullet through a keyhole.

"Right-to-left shunt!" He pressed the freeze button, and the ultrasound image showed that the head of the thrombus had entered the left atrium!
"Prepare for cerebral artery thrombectomy, anesthesiology department prepare for deep sedation!"

The moment Fang Ziye spoke, his scalp began to tingle, because he had no idea where the blood clot had come from!
But this isn't the time to dig deeper; the first thing to do when faced with a problem is to solve it!
If the problem of Chen and Song were so easily solved, then Chen Guangbai and others would never have dared to use Chen and Song as test subjects.

Upon hearing this, Li Yongjun, Nie Mingxian, and the others also began to tightly bind their scalps.

It's not surprising that Fang Ziye was able to detect the blood clot under the imaging monitoring, but his ability to capture its trajectory so quickly is simply unbelievable.

However, Fang Ziye always manages to make people question the meaning of life without them even realizing it.

"Nie Mingxian!" Li Yongjun shouted at Nie Mingxian, urging him to get into the zone quickly.

Upon hearing this, Luo Tingzhu immediately adjusted the target concentration of dexmedetomidine to 0.7 μg/kg/h, and the BIS value stabilized at 60.

She glanced at the brain oxygen saturation monitor: "Left side rSO2 42%, right side 58%, prepare for hypothermia."

When the ice blanket is started, the sound of refrigerant flowing resonates strangely with the hum of the ECMO centrifugal pump.

Nie Mingxian pointed to the DSA real-time image: "The thrombus turns at the bifurcation of the brachiocephalic trunk!"

Enhanced angiography showed that the thrombus, which should have entered the common carotid artery, was flowing backward toward the opening of the vertebral artery.

As a precaution, Fang Ziye had previously placed stents in his carotid artery and superior and inferior vena cava to prevent blood clots in his limbs from returning to his heart, or arterial blood clots from entering his brain or heart.

As long as we hold these key positions, even if other areas are blocked, there's no need to panic!
In such a situation, even if a thrombosis occurs suddenly, it can be dealt with again.

This is the benefit of being prepared in advance.

However, the medical and human resource costs are quite high, and it is simply impossible to achieve such comprehensive prevention unless there are special circumstances.

Moreover, most people cannot afford such medical expenses.

Fang Ziye immediately inserted the 6F Navien catheter (Medtronic) into the radial artery. The hydrophilic coating at the tip of the microguidewire (Traxcess 14) glowed blue under X-ray.

When the microcatheter passed the thrombus by 0.5mm, he pressed the release button on the Solitaire FR 4×20mm stent: "Deployment time limit".

“Negative pressure suction pressure -28kPa.” Nie Mingxian was monitoring the Penumbra suction system when he suddenly noticed that the blood clot fragments in the collection tank had a layered structure—the core was a dark red blood clot, and the outer layer was wrapped with a fibrin network with a pearly luster.

"Retrieve the stent!" Fang Ziye withdrew the catheter at a steady pace. Intravascular ultrasound showed that the thrombus captured within the stent had a volume of 82 mm. Luo Tingzhu's voice came through the walkie-talkie: "rSO2 on the left side has risen to 51%, but TCD shows a sudden increase in flow velocity in the middle cerebral artery to 210 cm/s."

"Capture successful!" Nie Mingxian's voice rang with joy as he watched Fang Ziye retrieve the blood clot.

Having made the necessary preparations, they are no longer waiting passively to resolve thrombi, but can now capture moving thrombi at any time.

This is equivalent to the roles of attacker and defender being reversed in a life-or-death duel!

If Chen and Song still lost their lives despite such thorough preparations, then it can only prove one thing.

A fatal pulse means certain death, it's irreversible!
Even if they wanted to verify this, Nie Mingxian and Fang Ziye needed to figure out exactly how the "death pulse" detected by traditional Chinese medicine would kill Chen Song in a way that modern medicine could understand!
(End of this chapter)