Surgery Godfather
Chapter 814 - 729: Hanging by a Thread

Chapter 814: Chapter 729: Hanging by a Thread

Comprehensive Surgery Department office.

On the professional imaging electronic screen, the head and neck CT scan images of the injured child appeared on the display, with the cross-sectional pictures switching one by one, followed by the three-dimensional reconstructed images rotating 360 degrees, making the entire skull and cervical spine distinctly clear.

Traumatic atlanto-occipital dislocation! It was confirmed.

The atlas had a bone cyst, which due to trauma caused a comminuted fracture. Luckily, the fracture spread outward instead of encroaching into the vertebral canal. This was the reason the boy did not die on the spot from spinal cord injury. However, since his successful rescue from the scene, his limb muscle strength had remained at level one.

This indicated that spinal cord damage was present, but if the injury did not worsen, there might be a possibility of recovery after the surgery.

With limb muscle strength at level one, the muscles in the thoracic and abdominal area would be nearly the same, and many muscles in the thorax are respiratory muscles. Without the function of these respiratory muscles, breathing would be impossible.

Following the rescue from the trapped vehicle, Dr. Lv immediately performed a tracheostomy on the injured child, connecting him to a manual respirator to sustain breathing.

In addition to the traumatic atlanto-occipital dislocation, the injured child also had multiple fractures throughout his body, including a comminuted pelvic fracture, resulting in a significant amount of blood loss.

Looking at the images on the screen, Yang Ping took a sharp breath—the survival rate for traumatic atlanto-occipital dislocation combined with atlas fracture at the scene was slim to none, and even if he was lucky to survive, any minor error during the rescue operation, transfer to the hospital, or at any link in between, could have led to the injured child’s breathing and heartbeat stopping.

"Atlanto-occipital fixation is no longer very possible, we can only bypass the atlas and perform occipito-C2 fixation," August suggested.

There are not many precedents to refer to for such surgery, which are already extremely rare, and with the atlas also having a comminuted fracture, there are even fewer references available. The doctors would have to rely on their subjective initiative.

Yang Ping didn’t speak, just silently observed the image pictures, thinking about the methods and details of the surgery.

As a doctor, one must be more diligent than in any other profession—life is singular and fleeting.

"The patient is already on the emergency operating table, undergoing fixation with an external pelvic fixator, and internal pelvic vascular interventional embolization to stop the bleeding," Song Zimo kept abreast of the rescue efforts and briefed Yang Ping.

The principle of trauma emergency care is to put life first, with everything else taking a back seat.

For such patients, the first step is to control bleeding to stabilize the volume of blood circulation, which is a standard procedure.

And for comminuted pelvic fractures with a high volume of blood loss, using an external fixation frame to stabilize the pelvis in an emergency; if blood pressure remains unstable after stabilizing the pelvic volume, emergency interventional embolization is needed to arrest the bleeding.

If even interventional embolization cannot control the hemorrhage, then the last resort—packing hemostasis—comes into play, using a large amount of gauze to pack the retroperitoneal space, relying on the pressure from the gauze packing to compress the bleeding vessels and stop the hemorrhage.

"Let’s go have a look in the Emergency Department!"

Yang Ping’s surgical plan was clear in his mind as he and the others hurried to the Emergency Department.

The conditions of the surgery rooms in the Emergency Department were good, and this particular room was a hybrid operating room, capable of both interventional surgeries and open surgeries.

Hybrid operating room, although this term isn’t exactly accurate—a ’composite operating room’ would be more fitting.

Essentially, it combines 3D imaging technologies of DSA, CT, MRI, and other equipment with the surgical cleanroom technology of a surgical suite, allowing for both minimally invasive interventional surgeries and traditional open surgeries, thus addressing a variety of complex surgeries, reducing surgical risk, and saving surgery time.

It’s simply the integration of imaging monitoring and surgical operation functionalities into one unit.

In the emergency operating room, Dr. Zhong from the Trauma Orthopedics had already fitted the patient with an external pelvic fixator, while Director Ji from the Intervention Department was performing an emergency interventional vascular embolization on the patient.

The Intervention Department’s top experts, Director Guan specialized in cardiovascular interventional surgeries, while Director Ji was an all-rounder, capable of handling trauma hemostasis, tumor embolization, and more. This combination of specialization and versatility, paired with seamless cooperation, led to the rapid development of Sanbo’s Intervention Department.

The two experts also had a good private relationship, which contributed to the tradition at Sanbo Hospital—since its establishment, the hospital had fostered a spirit of unity. Rather than engaging in internal conflict, any problems were laid out on the table for discussion and collaborative solutions.

Yang Ping, donning a lead apron, entered the operating room, where Director Ji was engaged in battle, with Director Guan observing by the side.

Director Guan knew that this kind of trauma hemostasis was Director Ji’s forte, and as someone from outside this specialty, he should not casually speak out of turn, let alone intervene—so he merely stood by quietly, observing the proceedings.

Yang Ping tiptoed into the operating room; he walked around the operating table to the head side of the patient, carefully lifted the cloth covering the head, and saw the support device in front of him, as pristine as a piece of art.

Director Wei indeed did not disappoint—his skills honed over thirty years proved vital. The support device he fashioned by hand at the emergency scene had functioned excellently, safeguarding the patient’s safe return to Sanbo Hospital.

"Limb muscle strength is at level one," Dr. Lv came up and reported.

Yang Ping nodded; the fact that there was still level one muscle strength in the limbs meant there was hope for recovery.

"This support device is alright, isn’t it?"

Director Wei was also wandering around the operating room; he rarely had the chance to be there and seemed a little uncomfortable, his sterile cap not quite properly in place.

Yang Ping said with a smile, "Without your support structure, we wouldn’t have much left to do. Your device is truly a lifesaver."

Like a child, Director Wei touched his sterile cap, "The thing might be a bit rough around the edges, but as long as it doesn’t hinder your real work, that’s what counts."

"Blood pressure stabilized, it’s stable!"

The anesthesiologist, staring at the monitor screen, exclaimed excitedly.

Director Ji’s forehead was covered in sweat; he turned his head and moved out of the surgical area. The patrolling nurse hadn’t yet had the chance to help him wipe it away when Director Guan took out a stack of tissues and had already wiped the sweat from Director Ji’s forehead.

Succeeding in arterial embolization not only requires high technical skill but also carries risks, possibly leading to ischemic necrosis of the embolized limb. Of course, limb necrosis is better than dying on the spot, so some methods are only used after weighing the risks and benefits.

Since the blood pressure was stabilized, it indicated that the interventional embolization was successful.

"Old Ji, your embolization technique is impressive," Director Guan admired sincerely.

Director Ji shook his head, "Without Professor Yang’s progress in anatomical research in this area, I wouldn’t have been able to reach this level. I’m just borrowing the concept, applying what Professor Yang has achieved."

Successful embolization is predicated on a thorough familiarity with the systemic vascular anatomy and a strong ability to interpret angiographic images; all of these rely on basic research and clinical experience.

"Professor Yang, when did you get here?" It was only then that Director Ji noticed Yang Ping standing behind him.

"Just arrived." Yang Ping was focused on the blood pressure reading on the screen.

"Should we perform the cervical spine fixation now or as a second-stage surgery?" Director Ji was preparing to finish up.

Yang Ping shifted his gaze from the screen, "After you finish here, transfer the injured to the trauma ICU. We’ll proceed with the second-stage surgery once hemodynamics are stable. Director Wei, is that okay?"

Because the second-stage operation would require waiting many days, stabilizing the injured person’s cervical spine during this short period presented a big challenge. If the stabilization wasn’t reliable, a single oversight could be fatal.

For instance, during nursing care shifts, not only does the cervical spine fixation need to be extremely reliable, but also the group of nurses responsible for shifting must coordinate flawlessly. Otherwise, the slightest twist of the cervical spine could have unimaginable consequences.

Director Ji and Director Guan had never dealt with Director Wei from the support structure department, so they were not familiar with him, but as colleagues of twenty years, they recognized each other.

To operate now or postpone the surgery—that was the dilemma.

Immediate surgery could ensure reliable stabilization of the head and neck, but the injured, having just been snatched from the clutches of death, could not withstand another surgical strike. Moreover, to fix the head and neck, it would be necessary to customize special fixation devices, which obviously couldn’t be delivered to the operating table right away.

Postponing the surgery, which meant a second-stage operation, would allow the injured person’s body to recover to some extent. Particularly after stabilization of hemodynamic parameters, surgery would be much safer, but during the waiting period, cervical spine protection requirements would be extremely strict, with no room for error.

So, Director Wei was key to the treatment plan—did he have the confidence to ensure that the injured person’s cervical spine wouldn’t have any issues over those days?

"Of course!"

Director Wei said decisively. He decided to personally oversee the trauma ICU, taking charge of the injured person’s head and neck fixation and assisting with nursing and transfers.

With Director Wei’s firm answer, Yang Ping was reassured. He had great confidence in Director Wei’s skills.

"Then we’ll schedule a second-stage surgery. We’ll transfer to the trauma ICU after emergency surgery is over," Yang Ping decided on the spot.

Director Wei had never felt such immense pressure before. During the wait before the second-stage surgery, the boy’s life would hang on his support structure.

"Old Wei, you have a heavy responsibility. This child’s life is literally hanging by a thread, and that thread is in your hands," Robert joked, having appeared at some point.

"Relax, take a deep breath—the people will support you!" August encouraged Director Wei.

"My palms are sweating right now."

Director Wei was slightly nervous, but he quickly regained his composure, reminding himself: No need to fear; when it comes to casting plaster and making support structures, if Old Wei can’t handle it, who can?

"Don’t worry. I’ll pick a few experienced nurses to care for this patient. I will be at the bedside 24 hours a day. I refuse to believe we can’t get through this," Director Wei said confidently.

He had never been so prominently in the spotlight in his life. At this moment, he could not afford any mistakes.