Great Doctor Ling Ran Chapter 601
603 High Risk
As he looked at the blood in the abdominal cavity, Fang Pingzhu asked Ling Ran, "How are you going to suture this?"
"I will use the B-Lynch suture," said Ling Ran. It was a special suturing skill for wombs. It was easy to handle and able to stop hemorrhages as well as safeguard the fertility function of the womb.
Ling Ran had only taught himself about the skill and had not practiced it or obtained related experiences and skills from the system.
However, Ling Ran's skills in suturing were enough to cover his unfamiliarity with the procedure.
It was not a complicated suture method, but the idea was quite clever. With Ling Ran's Master Level Simple Interrupted Suture Technique, it was very simple to perform the related processes.
Fang Pingzhu did not doubt Ling Ran's ability to perform the B-Lynch suture. As long as a doctor could name the suture and was not a newbie, he or she could carry out the suture properly.
The difference between high-class doctors and low-class junior doctors was that junior doctors knew nothing, so when they encountered unfamiliar surgical methods, they did not just need to learn the surgical method in theory but also every step within it. High-class doctors were only unfamiliar with surgical methods. Once they learned the method, it would not be too difficult to carry out the surgery. Many scholars who participated in international conferences would go home and look up recommended surgeries to try testing out the results.
Of course, certain complicated methods could be tested out on a dog first. As for those that were simpler or variants of another surgical method, doctors could just go ahead and operate on a patient. There would be no need for them to sacrifice a dog.
In fact, the B-Lynch suture was a suture that applied pressure to the anterior and posterior wall of the uterus. It could stop the bleeding and preserve fertility. There was nothing special about it.
However, Fang Pingzhu did not believe that suturing the uterus was appropriate right then.
Fang Pingzhu calmed down and tried to sound as cordial as possible. "Doctor Ling, if you suspect uterine bleeding, the safest measure would be to perform a hysterectomy. The patient already gave birth to a child."
"The effect of using the B-Lynch suture and a hysterectomy is the same. Moreover, the prognosis of suturing is better." Ling Ran insisted.
The effect of the B-Lynch suture was of course better. Although the most important role of the uterus was fertility, it also affected the female endocrine system. In simple terms, after hysterectomies, women would enter menopause in an instant, and the resulting consequences were often unpredictable.
In terms of prognosis, that was certainly not a good thing.
Since this was her specialty, Fang Pingzhu still shook her head and said in a proper tone, "Shouldn't we protect the patient's life first? Saving lives comes first, treatment comes later."
"The effect of the B-Lynch suture isn't bad. It can also save lives."
"But you're not sure about the extent of internal bleeding. What if it's outside the sutured area?"
"The odds are low." Ling Ran pondered for a few seconds before he said, "Her blood loss is great. If the B-Lynch suture can't stop the bleeding, I don't think it'll make much of a difference even if she loses three to six ounces of blood. It won't be too late to perform a hysterectomy at that time."
Fang Pingzhu had to admit that Ling Ran was right. If the patient were asked that question, forget three to six ounces of blood, the patient would probably be willing to try keeping her uterus even if she had to lose another thirty-three ounces.
However, that was not in line with the doctors' habits.
In places like the Gynaecology Department, if there was a problem with the uterus, the doctors would just go straight for a hysterectomy. No one would turn one surgery into two just to let patients try keeping their uterus.
In better terms, doctors had the ability to make judgments, and they were also confident that they could make good judgments. In worse terms, hospitals, like other industries, had a dark side to it. When these dark sides involved people, they often made people feel as if hospitals were like black holes.
Fang Pingzhu was not part of the dark side. However, after thirty years of working as a doctor, she had long since become familiar with how things went and what to do.
Fang Pingzhu did not bother to suture or perform a hysterectomy. She then slowly said, "You still can't be sure that there is bleeding in the womb."
Hence, they returned to the problem of making judgments and diagnoses.
Why did she always give pregnant women who experienced blood loss blood tests at first? It was all so to confirm that the patient was suffering from amniotic fluid embolism.
Making judgments was just like guessing while diagnosing involved medical knowledge.
However, not being able to be certain of the bleeding point was just Fang Pingzhu's concept alone.
Ling Ran decisively said, "There is no bleeding in the abdominal cavity, it must be intrauterine hemorrhage."
Fang Pingzhu looked at the accumulated blood in the abdominal cavity and sighed. "You just touched it once. How are you sure that there's no bleeding in the abdominal cavity? There are many hidden bleeding points."
It was only natural that she would think this way. Most doctors could barely find all exposed bleeding areas, let alone the unexposed.
Ling Ran did not argue with her about her judgment either. Instead, he said, "The patient's uterine contraction is very weak, which should be an indicator."
When different organs bled, they would have indicators. Fang Pingzhu may not have been able to identify the indicators for other organs, but she was incredibly familiar with the uterus.
After Ling Ran's reminder, Fang Pingzhu immediately started to put pressure on the fundus.
"The contraction is relatively weak, but" Fang Pingzhu still hesitated.
To be honest, if she were asked to carry out a hysterectomy, she would have probably done it. She was not willing to carry out the B-Lynch suture because the only explanation for its use was intrauterine hemorrhage, and right then, they could not diagnose with 100% certainty that there was functional bleeding. Plus, there was even a possibility that there was amniotic fluid embolism, so there was a risk of misdiagnosis if they used the B-Lynch suture.
On the contrary, if a hysterectomy was done and the patient's bleeding stopped, she could explain that the hysterectomy was carried out to stop intrauterine bleeding. If the bleeding did not stop, she could explain to the patient that there were other complications, and no matter what, the evidence would have been cut off, so she was safe.
Ling Ran did not know about such tips for self-protection, and he did not intend to seek a mutual agreement through verbal communication.
Based on Ling Ran's experience, there was a huge gap between people's understanding. When people who were unfamiliar with each other talked, the efficiency of verbal communication was so poor that it could kill three hundred people suffering from hemorrhages.
"Increase the speed of fluid aspiration and expose the surgical field," Ling Ran just went on ahead and gave a command.
Fang Pingzhu retreated to one side silently. In other words, she pretty much completely gave up her right and responsibility as a chief surgeon.
Ling Ran did not wait for the blood in the abdominal cavity to be entirely emptied. He straight away took a needle holder, made an incision from the front wall of the uterus to the bottom of the uterus, then circled around the inner wall
Although he was unfamiliar with the surgery and organ, Ling Ran was so familiar with the anatomy of the abdomen that when he mentioned the word "uterus", he sounded like he was mentioning the gallbladder, which was something he was very familiar with. He could not compare the uterus to the liver because he had operated on more than hundreds of livers and was more familiar with it.
"Sixty ounces of intraperitoneal hemorrhage." The female doctor who was the second assistant had now been automatically upgraded to the first assistant, and she finally sucked out the blood in the abdominal cavity.
The big container next to the operation table was filled halfway with thick blood like the secret treasure of an old wizard.
Ling Ran hummed and sutured the front wall of the uterus into an eight-figure as he said, "Pay attention to fluid and potassium chloride replacement."
"Yes. Thirty-three ounces of colloidal fluid, sixty-five ounces of potassium chloride solution, and thirteen ounces of blood plasma have been infused" the female doctor reported. Some chief surgeons liked to be in control of such details themselves, while some would give the task to junior doctors.
At that moment, Fang Pingzhu said, "You can inject carboprost tromethamine into the uterus. It's good for postpartum hemorrhage"
"Okay," Ling Ran agreed when he was given the little reminder. He then began to tie the knot.
The B-Lynch suture was completed.
Everyone in the operating theater focused their gazes on the wizard's big container.
"It seems that there's still bleeding," the female doctor whispered.
"Let's take a look again." Ling Ran's expression was relaxed. At that time, the amount of bleeding was very small. Even if there was still bleeding, they could just remove the uterus. It was nothing but a waste of several sutures.
Several people on the scene were stunned and soon realized that it was a good thing that the bleeding was under control.
The phone inside the operating theater rang.
The circulating nurse picked it up, turned around, and said, "Department Director Fang, there is no evidence of amniotic fluid embolism."
If there was amniotic fluid embolism, there would have been signs of fetal hair in the venous blood, which had been taken many times. This was the most direct pathological evidence. Find authorized novels in Webnovelfaster updates, better experiencePlease click www.webnovel.com for visiting.
Fang Pingzhu let out a hum, but there were no changes in her expression.
Amniotic fluid embolism had always been something that rarely occurred, mainly because the mortality rate for it was too high. It was also due to how much attention they paid to amniotic fluid embolism that it had been reduced from its initial ninety percent mortality rate to its current sixty percent. The previous mortality rate of amniotic fluid embolism in Yun Hua Hospital's Gynaecology Department was thirty percent, which was a lot better than the average standard, and they had only managed to lower it by screening through their patients one by one
"The bleeding has stopped," an anesthetist reported again.
Fang Pingzhu was stunned. She could not help but sigh, and the first thing that came to the front of her mind was, 'If my family has an accident in the future, I should look for Ling Ran first.'