Chapter 1788 Dilemma

"What if I don't have the signature of the patient's family?" Su Yun asked.

"Look for Director Lin." Zheng Ren said.

"Well, the work of the medical department is to escort the clinic." Su Yun said contemptuously: "But it doesn't include you!"

"Emergency first aid, is there any other way?" Zheng Ren said, "Ask Zhao Yunlong if the signing is done. After a long time of work, I guess I should be able to sign this time."

"how do you know?"

"It takes a day to do a head MRI, not to mention IABP." Zheng Ren said: "The state is not very good, let me know that the patient is critically ill, and the patient will come back when he can."

"..." Su Yun frowned, "Are you sure?"

Zheng Ren sighed and looked at the patient's red system panel that was dripping blood, feeling a little helpless.

"May also need extracorporeal membrane lung support, will you get off?"

"No problem." Su Yun said with certainty.

ECMO is an extracorporeal circulation technique that goes out of the cardiac operating room.

The principle is to draw the venous blood from the body out of the body, and then inject it into the patient's arterial or venous system after being oxygenated by a special material artificial cardiopulmonary bypass, which plays a role in partial cardiopulmonary replacement and maintains the oxygenation and blood supply of human organs and tissues.

There is no ECMO in Haicheng First Hospital. The first time Zheng Ren saw this thing after graduation was on Dr. Mehar.

Zheng Ren smiled wryly and shook his head, "Have you seen the NMR?"

"The diagnosis of moyamoya disease is very clear." Su Yun said: "If the upper outer membrane lung is used, a large amount of heparin will enter the circulatory system. Do you think it will lead to aggravation of moyamoya disease and lead to cerebral hemorrhage?"

"Well, it's very likely." Zheng Ren said relatively politely. He had just entered the operating room of the system and tried to perform extracorporeal membrane lung operations.

But less than two hours after the procedure, the patient died of a brain hemorrhage.

This is a dilemma.

Contradictions between heparin anticoagulation and bleeding, hemolysis, and poor histocompatibility of biomaterials. The road of exploration is long. On this road, there are countless dead people, but also countless living people.

Technically speaking, there is no problem with Su Yun's extracorporeal membrane lung.

But Zheng Ren judged that a large amount of heparin would cause cerebral hemorrhage, and Su Yun hesitated. Using extracorporeal membrane lung, not to mention the cost, it is a very difficult thing in terms of technology.

"Looking for neurosurgery?" Su Yun asked.

"Look for Ringo first, right now!" Zheng Ren said, "The operation was performed after the heart stopped beating, and the blood is heparinized. It's probably already... Why hasn't Zhao Yunlong been back yet?"

"I'll make a call to urge you." Su Yun said.

"Look, I'll take a look." Zheng Ren packed up the IABP's things, glanced at the patient's vital signs, opened the door, and strode into the EICU corridor.

Facing Zhao Yunlong, he took a piece of A4 paper and walked back quickly.

"Old Zhao, I'm looking for you for something." Zheng Ren beckoned.

"When I go back to finish IABP, I'm worried that I will have cardiac arrest." Zhao Yunlong said hurriedly.

"It's done." Zheng Ren said.

"It's done... finished?" Zhao Yunlong said in surprise, then lowered his voice and hurried to Zheng Ren's side, "Boss Zheng, did you just do it?"

"Well, if there is a heart attack, it won't work if you don't do it. The state is a little relieved now, but not much." Zheng Ren said, "I'm considering using an extracorporeal membrane lung to support it for a while, but there is a contraindication."

"Moyamoya disease? Can you diagnose it?" Zhao Yunlong was in trouble.

"Yes." Zheng Ren said, "How did you explain to the patient's family before you opened your chest?"

"In the beginning, I didn't have time to explain, the patient was sent to the operating room for surgery under the state of external chest compression." Zhao Yunlong said: "I later explained it to the patient's family before opening cardiopulmonary bypass. I suspected Moyamoya disease, blood Heparinization is likely to cause cerebral hemorrhage."

"What did the family say?" Zheng Ren was most concerned about this question.

If the family members cooperate, there is at least a 30% to 50% chance that the patient can be saved.

But if the patient's family doesn't cooperate...

It is better to give up the rescue directly and be more happy. In that case, medical disputes and conflicts will be much less.

With extracorporeal membrane lung, it is hard to say whether the patient will die or live. But for undecided patients' families, the cost of hospitalization has skyrocketed.

However, if the extracorporeal membrane lung is not used, the patient will surely die, the difference is only a few hours longer.

The heart is so tired, and Zheng Ren is not willing to face this situation.

But life is like this, it is impossible to let yourself do whatever you want like in a system operating room.

"The patient is married for the second time, and her current husband said that she would give up the treatment." Zhao Yunlong said, "but her daughter just came over and insisted on treatment, and she happily signed it."

Just as Zheng Ren's heart sank, it rose again.

In such a complicated family environment, it is no wonder that even the MRI had to wait a day before doing it.

Being able to undergo surgery and survive, Zhao Yunlong has already taken a huge risk.

"I'll take a look." Zheng Ren said.

"Boss Zheng, Professor Zhang is communicating with the patient's family outside." Zhao Yunlong said: "Wait a while and then go."

"What's the communication?" Zheng Ren heard a trace of embarrassment in Zhao Yunlong's tone.

"To be honest, it is unlikely that the patient will survive again." Zhao Yunlong said in frustration.

No one can expect the patient to be alive more than the chief surgeon and the doctor in charge of the bed. Such expectations are complex and difficult to articulate.

Zheng Ren also knew that after Professor Zhang's explanation, the family members would most likely give up the treatment, and the patient was doomed.

As long as the patient's family gives up the rescue, withdraws the IABP, and waits for the next rapid ventricular beat and heart failure, the patient will die.

He sighed deeply.

"Is it an economic problem?" Zheng Ren asked.

"Well, the family is not very well-off." Zhao Yunlong said: "I am a migrant worker, and I have never paid social security in my hometown."

"If I..." Zheng Ren stopped halfway through his words.

Zhao Yunlong patted Zheng Ren's shoulder helplessly, and walked back to the ward silently without saying anything.

Live emergency rescue, upper extracorporeal membrane lung?

The success rate of Xinglinyuan's live broadcast is a very critical factor.

And the patients themselves have various problems, what about extracorporeal membrane lungs? Moyamoya disease, because the blood in the body is heparinized, a tiny aneurysm ruptures and bleeds, and the patient has to die.

For mature business operations, this is completely untenable.

The reputation that Zheng Ren has worked so hard to accumulate will also be fatally damaged by the death of the patient.

But... what Zheng Ren is thinking about is not the matter of the upper extracorporeal membrane lung, but the surgical treatment of moyamoya disease.

Block the bleeding spots first, and other things will be easier to solve.

Zheng Ren judged that with the support of the extracorporeal membrane lung, the bypass surgery would be fine, and the patient would still have a chance of surviving.