top student at medical school

Chapter 684 Forcefully Pushing Through the Gates of Hell!
Fang Ziye and Li Yongjun rubbed their hands together under the disinfectant, the water carrying light blue foam sliding down their wrists.

The two men turned and quickly flung open the airtight door, their scrubs fluttering in the airflow. Li Yongjun's long neck tilted slightly forward, his gaze behind his gold-rimmed glasses as sharp as a scalpel:
"Professors Lin, what exactly is going on here?"

At this moment, the surgeons in charge of the operation in the operating room are Professor Lin Qiaoshan from the Department of Hepatobiliary Surgery and Professor Lin Guoqiang from Fuwai Hospital!

Under the operating lights, Lin Qiaoshan, a hepatobiliary surgeon, trembled slightly as he performed the DSA: "Three minutes ago, the patient experienced another sudden onset of ventricular fibrillation!"

"Rapid electrical cardioversion was performed, but multiple vascular fibrillation occurred throughout the body. A large number of thrombi entered solid organs from the arteries. According to DSA imaging, multiple embolisms were found in the kidneys, liver, intestines, and other areas."

"Splenic artery embolism!"

"Bilateral lower extremity arterial embolism, bilateral upper extremity arterial embolism!"

"Blood return is obstructed!"

Professor Lin Guoqiang of Fuwai Hospital rapidly zoomed in and out on the DSA screen, where the three-dimensional vascular images resembled a dried-up river network: "The intracranial barrier is intact, and the ECMO flow rate has fallen below the critical value."

As he turned to look at Fang Ziye and the other man, the lead apron clinked against his waist with a dull metallic sound. "Professor Fang, this is very troublesome!"

Fang Ziye immediately turned to the DSA display screen halfway through the conversation, observing the blood flow signals inside, and his brows furrowed instantly.

"What is the status of blood flow in the intracranial vessels and heart?"

"The filter was put on in advance, no obvious abnormalities were found in the intracranial blood vessels, and the blood flow to the heart was smooth, but the ECMO blood flow dropped sharply!" Lin Guoqiang replied very professionally.

Fang Ziye thought of a saying at that moment: "You can dodge the first day of the month, but you can't dodge the fifteenth."

It protects the heart and brain in advance, but it cannot block all blood vessels, nor can it design a protective plug by putting a filter on all blood vessels in advance.

Fang Ziye's gaze rapidly switched between the DSA images, with the shadow of the interrupted blood flow remaining on his retina.

Three seconds after the screen went dark, Fang Ziye decisively said, "Nie Mingxian, Professor Li, you two will immediately take charge of the arteriovenous blood flow transection of both upper limbs, rebuild blood supply using a miniature circulatory device for the limbs, and treat the blood locally with heparinization."

"Wu Xuanqi, immediately work with Professor Du Donglin to cut off blood flow to both lower limbs!"

"Heparin concentration increased to 200 IU/kg!"

"Rebuild ECMO arterial and venous circulation to ensure blood supply to the heart and intracranial blood vessels."

"Professor Lin, let's work together to remove the thrombus from the organ."

"Chen Guangbai!" Fang Ziye spoke too fast and couldn't control how he addressed Chen Guangbai at that moment. He paused slightly after calling him that.

Although he realized that calling Dr. Chen would be better, Fang Ziye didn't have time to hesitate: "Dr. Chen's condition is very critical right now. If it is not handled properly, it is very easy for him to develop multiple organ failure."

"We may have to use a micro-circulation device for organs that has not been validated in animal trials."

"But this is risky, and very risky!"

Chen Guangbai and Lin Qiaoshan were conducting a traditional Chinese medicine examination on Chen Song, and Chen Guangbai, in particular, was slightly excited at the moment.

According to the principles of modern medicine, the arteries in both upper limbs are currently blocked. Logically, there should be no arterial pulsation in both upper limbs, but he was able to feel a faint "pulse".

This proves that the meridian theory in Traditional Chinese Medicine may be partly derived from the pulsation of arteries, while another part of the pulsation may not be related to the pulsation of arteries.

This could be a major discovery in the theory of meridians in Traditional Chinese Medicine.

Of course, Chen Guangbai's pulse was also bad at this moment. Even if acupuncture was used to protect Chen Song's vital energy, it would not be able to reverse the final result.

A fatal stroke is inevitable; one can only leave it to fate!
"Go!!"

"Professor Fang, you can handle this as you see fit! Everything for the rescue will be done according to your plan."

"Professor Wang Qishan, Professor Deng Huai, suspend all pulse recording, acupuncture, nasal feeding of Chinese medicine, and the derivation and use of prescriptions!" Chen Guangbai hesitated for only about three seconds before making the decision decisively.

"Lan Tianluo, call Jie Han and Director Song Libo, and tell them to quickly transfer the miniature circulatory system (numbers 3-6) from the spare room to the operating room."

"ECMO blood supply channels have differentiated, begin surgery immediately..." Fang Ziye did not make any further detailed arrangements.

Nie Mingxian was one of the founders of the theory of microcirculation instrument. He and Li Yongjun had a profound understanding of the circulatory cutoff technique of microcirculation instrument, but Li Yongjun's operation may not have been as smooth as Nie Mingxian's.

Similarly, Wu Xuanqi and Professor Du Donglin of the Department of Hand Surgery are also extremely skilled in performing circulatory transection using the miniature circulatory device for the limbs.

After Fang Ziye gave his instructions, the four of them began to operate on the femoral artery sheath and brachial plexus sites suitable for limb transection using the miniature circulatory instruments, and began limb transection and limb preservation procedures.

Meanwhile, Fang Ziye, Lin Qiaoshan, Lin Guoqiang, and the others gathered together after Fang Ziye put on his sterile surgical suit.

Lin Guoqiang asked, "Ectopic embolisms in the liver and kidneys are the most serious and extremely difficult to treat! Should they be treated as a priority?"

"I think the spleen can be sacrificed."

"But the patient's condition is very bad at the moment, and it is estimated that electrolyte imbalance will occur soon. If thrombectomy and organ preservation surgery are performed on the liver and kidney at the same time, the patient probably will not survive to that point."

"What I mean is that even with ECMO intervention, patients can still die from ventricular tachycardia due to electrolyte imbalance."

Chen Song is no longer in a normal state.

If it is simply a liver or kidney embolism, then with ECMO monitoring and assistance, there is still plenty of time.

The human body needs to metabolize, and the liver and kidneys are the largest metabolic factories in the body. Almost all metabolic waste needs to be metabolized and removed through these two organs.

Fang Ziye quickly replied, "Professor Lin, the ECMO and dialysis machine in this operating room are connected. The dialysis parameters can be adjusted at any time, and it can temporarily replace the metabolic functions of the liver and kidneys!"

"We will ignore the embolism in the spleen for now, and we can also postpone the treatment of embolism in the limbs, but we will prioritize the treatment of embolism in the liver and kidneys."

"You and Professor Lin Qiaoshan will jointly administer local thrombolytic therapy to the liver! I will perform local reconstruction of the liver's blood supply in advance!"

“I will handle the blood clots in both kidneys on my own.”

"Multiple embolisms in the mesenteric artery and splenic artery will be dealt with later!" Fang Ziye responded quickly.

"But?" Lin Guoqiang wanted to express his concerns.

Fang Ziye's casual remark, however, revealed a multitude of complex issues to this professional vascular surgeon.

"No need for 'buts,' Professor Lin!"

"I believe you are a professional!" Fang Ziye still flattered Professor Lin Guoqiang at this moment.

In urgent situations, expediency is necessary; the current circumstances do not allow for a detailed explanation of the underlying principles.

Time is not on our side!
Chen Guangbai immediately understood, his voice resolute: "Professor Lin, thank you for cooperating with Professor Fang's operation. I will bear all the consequences!"

Don't use the suspect, but don't use it.

Fang Ziye had long since won over Chen Guangbai and Chen Song with his personal skills and expertise. In the field of surgical emergency care, Fang Ziye was one of the three people they trusted most.

Of the other two, one has already passed away, and the other has long since retired and is unlikely to be in the operating room.

Professor Lin Qiaoshan also chimed in at the opportune moment, "Professor Lin, the rescue process should not be altered!"

Lin Guoqiang took a deep breath and quickly suppressed all his emotions: "Prepare for local contact thrombolysis of the liver! ~ Hypersensitive anticoagulation therapy."

With Chen Song's son bearing all the blame and Fang Ziye as the primary commander of the surgical rescue, the situation was urgent; further words were futile!
Moreover, Lin Guoqiang already knew about the twists and turns that had happened to Chen Song, and he found Fang Ziye's actions to be extremely impressive!

"Open the abdomen!~"

Because there are many things to be done at once, it is difficult for a simple intervention operation to satisfy multiple operation fields at the same time.

We need to act quickly now, so we can't continue using a small surgical field just to minimize local damage!
Song Libo and Jie Han were already on standby, and in just a minute and a half, they delivered the micro-circulation device that had not undergone clinical trials.

During this brief interval, Fang Ziye and Professor Lin Guoqiang boldly opened the abdominal cavity directly.

The moment the scalpel sliced ​​through the peritoneum, Fang Ziye and Lin Guoqiang's wrists crossed in mid-air. The coordination between these two top surgeons was like precise gears—the acrid smell of the electrocautery burning fat hadn't even dissipated when the hemostatic forceps had already precisely clamped the portal vein…

The two worked together seamlessly without uttering a word. In a glance, they both saw the words "mutual appreciation" in each other's eyes.

When two surgeons who are intimately familiar with anatomical structures and whose incision techniques have reached a level of perfection (Level 5) work together, it is as if one person has four unobstructed hands.

"Strain the abdomen to open it up!" Lin Guoqiang instructed Lin Qiaoshan without any hesitation.

He has performed numerous surgeries and instructed at least three or four hundred professors like Lin Qiaoshan. As one of the most outstanding vascular surgeons in the country, his status in the field is even higher than that of Li Yongjun.

Even when Li Yongjun saw Lin Guoqiang, he would respectfully call him Teacher Lin.

That's what a national champion is like; they can completely overwhelm someone in terms of strength, temperament, and many other aspects, leaving the opponent convinced of their superiority.

Lin Qiaoshan could only follow Lin Guoqiang's instructions and behave as obediently as he had when he was assisting the old director during his tenure.

Jiehan was very sensible; after entering the operating room, he stood close to the wall.

Firstly, to continue observing this extremely difficult rescue, and secondly, to avoid their presence obstructing the movement of positions and locations within the operating room.

Standing against the wall, even though you can't see the details, at least you can see the venue manager, which helps you avoid being cleared out—a rare opportunity…

At this moment, Lan Tianluo very sensibly said, "My senior brother is here, and I need him to help me process the data."

Lan Tianluo, this data processing master, was an absolute powerhouse in the operating room, occupying a corner of the space where no one dared to challenge him. Even the anesthesiologist couldn't arbitrarily alter his area's structure. Chen Guangbai and Wang Qishan, understanding each other's intentions, immediately beckoned to Jie Han.

The person I'd been eagerly anticipating was finally within two meters of the operating table...

"The sterile catheter is ready." Circulating nurse number four and scrub nurse number five worked seamlessly to install the catheter for the organ microcirculation device on the table.

This organ microcirculation device has a similar structure and operating principle to the limb microcirculation device.

Everyone was talking to themselves, just to show what they were doing and avoid being seen as disruptive, without waiting for a reply.

Fang Ziye rapidly separated the arteries and veins in the liver at an astonishing speed.

After completing the temporary arterial and venous blood flow occlusion procedure, he turned and picked up two pairs of catheters, saying, "Not enough catheters, keep going!"

"At least ten pairs!"

Circulating nurse number four repeated: "Ten pairs of catheters! Get them on the table immediately."

Lin Guoqiang watched very closely as Fang Ziye connected the catheter to the arterial and venous inlets and outlets of the liver, and his brows furrowed instantly.

"What happens to blood oxygen levels after a partial cutoff of blood supply?" Lin Guoqiang still found it somewhat unbelievable.

In fact, my doubts were even greater. Could this be the liver microcirculation device that the world is currently racing to develop?
It has no officially launched products internationally, yet in this small sanatorium in Enshi, a model that can be applied clinically already exists?

Lin Guoqiang's questions remained unanswered, and Fang Ziye only instructed him: "Liver blood flow has been blocked; suture the arteriovenous connection!"

"Can it be done?"

Lin Guoqiang nodded stiffly.

Fang Ziye continued, "After the single-organ microcirculation treatment is completed, local contact thrombolysis will be performed immediately. The safe thrombolytic dosage is unknown!"

Fang Ziye said this last sentence to Lin Guoqiang, and also to Chen Guangbai.

It's not that Fang Ziye is unreliable; he didn't conduct animal testing. This is the 'background' he made clear long ago!
Without experiments, where do we get objective data?
Pure theoretical speculation? Pure conjecture?
No, it's better not to say anything at all, and just refer to the clinically specific thrombolytic dosage standards for adjustment.

Data that hasn't been tested is just data; it's not theory at all.

……

Fang Ziye dismissed the liver area and then quickly called Professor Tang Meng from the vascular surgery department, who was standing opposite him, to help him treat the bilateral renal arteries.

Fang Ziye said, "Professor Tang, you will be responsible for the left renal artery and vein blood flow obstruction. Later, I will connect both renal arteries and veins to the micro-circulation device to form a dual-renal linkage system."

"Anesthesiologist, please monitor the urine volume in the urine bag. Increased fluid flow to the kidneys locally will not increase the burden on the kidneys!"

“Received!” one of the anesthesiologists replied quickly.

The current team is neither Tan Mengbai nor Luo Tingzhu, but Fang Ziye knows that these people can be absolutely trusted.

……

Dark red blood flowed into the miniature circulator through the silicone tube, and a glaring red warning suddenly popped up on the LCD screen.

"The oxygenation index has dropped below 300!" The anesthesiologist's voice trembled with a metallic quality.

Fang Ziye's voice immediately came through: "Activate the bionic pulsation mode, and match the pulsation frequency to the patient's baseline heart rate."

"Jie Han, Lan Tianluo!" Fang Ziye's voice was almost a shout, and he didn't turn around!

Lan Tianluo was busy recording data and couldn't leave, but Jie Han arrived at the miniature circulatory system immediately. Parameters poured down like a waterfall, and as the mechanical pump emitted a deep-sea whale-like hum, the dark red blood suddenly glowed with the bright light characteristic of oxygenation.

Lin Guoqiang's pupils contracted slightly. He saw that Fang Ziye's movements in suturing the blood vessels possessed a certain rhythmic beauty; the stitches of the Level 5 suture technique were as precise as a Swiss movement…

Five minutes later, Fang Ziye actually completed the microcirculation severance linkage microcirculation device for both kidneys before Lin Guoqiang.

Simply put, although Fang Ziye's suturing technique is not as good as his incision technique, only at level 5, not every national-level athlete's suturing technique is at level 5!
The speed and effectiveness of a Level 5 suturing technique far surpasses that of a Level 4 skill!
After connecting the micro-circulation device, Fang Ziye did not explain to anyone. Suddenly, the catheter gun in his hand beeped, and sixteen micro-filters bloomed simultaneously at the bifurcation of the renal artery.

"RT-PA pulse preparation, dosage calculated based on body surface area." His fingers, as steady as a rock, pushed the medication.

"Between the kidneys, contact thrombolysis." The words fell.

The image of the dark red blood clot disintegrating under X-ray resembled ice crystals melting in slow motion. As the first drop of urine fell into the collection bag, the creatinine level on the monitor began to plummet.

"ACT 140 seconds! Thrombolytic dose reduced to one-fifth, microcirculatory system activated with preset parameters, follow my command for fine-tuning..."

“Received!~” Circulating Nurse No. 6 kept a close watch on the 'Kidney Miniature Circulation Device' that Fang Ziye was connected to!
Once the thrombolytic agent enters the dual-kidney linkage system, the blood in both kidneys begins to flow normally with the microcirculation device.

After about ninety seconds, the miniature circulator lit up with a green light, accompanied by a soft beeping sound and continuous flashing!
At the 110th second, Fang Ziye said, "The renal blood vessels have resumed their rhythm. Adjust the heart rate index of the microcirculation device to 90 bpm! ~ Blood oxygenation 95%!"

"Adjust the filter parameter to 3!"

Five seconds later, the quick-thinking circulating nurse reported: "Adjustment complete! Flow parameters are all normal."

"Adjust filter parameter 2 in ten minutes, adjust filter parameter 1 in half an hour, switch back to parameter 2 in three hours, and switch back to filter parameter 1 in three and a half hours. I will remind you regularly!"

"ECMO parameters report!" After asking the circulating nurse, Fang Ziye immediately asked the anesthesiologist for the data.

"Oxygenation level is normal, blood pressure is 98/66!" The anesthesiologist didn't waste a single word, and didn't even refer to Luo Tingzhu's more accurate report before.

But the meaning is precise.

Fang Ziye didn't hesitate!
“Professor Tang Meng, continue separating the splenic artery and vein. I’ll come to help you in five minutes!” Fang Ziye said, and then saw that Professor Lin Guoqiang had just finished connecting the hepatic artery and vein to the microcirculation device.

He hesitated, as if he wanted to say something but then stopped.
Lin Guoqiang felt incredibly frustrated, but he could only respect the facts and back down slightly: "Surgical handover, Professor Fang, you take over!"

"Microcatheter!"

"Prepare the thrombolytic dosage." Fang Ziye didn't mince words.

He is now the core of the entire rescue effort, and he has already defined his role. Therefore, at this moment, it doesn't matter who it is, whether it's Lin Guoqiang or anyone else.

Even if academicians from the fields of hepatobiliary surgery and orthopedics came, Fang Ziye could only make them his assistants!
Fang Ziye knew he was worthwhile, he was confident, and he had completed the necessary preparations and accumulation. If an explanation was needed, it could be given after the operation was completed.

Even if accountability is pursued, please postpone it.

"Set capacity parameter 2, change to capacity parameter 3 after half an hour, change to capacity parameter 4 after one hour, and change to capacity parameter 1 after two hours. Liver capacity parameter is set separately. Please record the details."

"If you have any questions, ask them on the spot!" Fang Ziye interrogated the circulating nurse after completing the thrombolysis procedure.

"Recording complete. 3 in half an hour, 4 in one hour, 1 in two hours, 2 currently." The circulating nurse answered more concisely, confirming that she had finished recording.

"ECMO data report." Fang Ziye continued to ask the anesthesiologist for parameters.

"Everything is normal, the blood potassium level has reversed." The anesthesiologist once again explained what he was doing in the simplest terms.

They weren't playing games; they just didn't tell everyone what happened like Fang Ziye did.

But Fang Ziye had to say it.

"Sampling and sending for testing the blood flow in the microcirculation of both kidneys and liver, paying attention to necrosis and metabolites! Report back immediately." After giving this instruction, Fang Ziye began to take over the microcirculation severance procedure of the spleen's arteries and veins, which was being overseen by Professor Tang Meng.

Having witnessed Fang Ziye's two miraculous surgical procedures, and knowing that Fang Ziye wanted to save all the embolized organs, Lin Guoqiang proactively suggested, "Professor Fang, is it necessary to reconstruct the blood flow in the mesenteric artery and vein?"

Fang Ziye lowered his head but shook his head: "The blood flow in and out of the mesenteric arteries and veins is different. If the thrombus is not large, it will circulate naturally in the panheparinized blood flow."

"If the human intestinal tract has a capacity excess of over 200%, even with segmental necrosis, it can simply be removed without adding further complications!"

"Pay attention to the severance of blood vessels in the heart and brain. Monitor the status of the filter and occluder at all times!" Fang Ziye's voice was not loud, but it was the only one in the operating room, and it was firm and resounding.

If we are determined to push through the gates of hell, we must not have any second thoughts, and no one can question us!

"Professor Fang, you've achieved the first-ever successful resuscitation of a systemic embolism in medical history." Lin Guoqiang's voice was weak yet desperate, like a heart tremor: "These devices..."

Fang Ziye lowered his eyelids slightly, instantly suppressing all his excitement, and said in a meditative voice, "Professor Lin, you've misjudged."

"The operating room only contains common equipment and instruments; these are merely tools to assist in surgery, not the actual equipment!"

Surgical instruments are auxiliary surgical tools that the surgeon may bring onto the operating table to assist in the operation and do not need to be included in the surgical record.

However, the equipment is different. In principle, all equipment used during surgery should be shown in the surgical record.

Even desperate attempts to revive a lost cause require caution.

Even though Fang Ziye knew that Chen Guangbai wouldn't report him.

Lin Guoqiang's mouth opened and closed a few times under his mask, then he paused, and didn't say anything more.

As a mature surgeon, or as a mature adult, learning appropriate hypocrisy is an essential skill for everyone.

Fang Ziye has previously emphasized that these things have not undergone clinical trials, so they are medical devices.

Asking further questions would be nitpicking.

Fang Ziye's caution in order to protect himself is not wrong!
(End of this chapter)