Chapter 624 - 312: Snatch Them Back! (Part 2)

Generally speaking, VA mode requires choosing paired vein-artery connections like femoral vein-femoral artery or jugular vein-jugular artery.

However, the patient's current condition is special. As long as we can connect the vein and artery first to push extracorporeal circulation to increase blood oxygen, it is considered good progress!

Finally, Lu Cheng felt the strongest pulse on the left radial artery!

"Disinfect!" Lu Cheng instructed the circulating nurse.

"And my gloves too!~"

For catheter sheath insertion, strict sterile procedure isn't necessary. If the patient's condition is relatively stable, it can even be done in the ward without entering the operating room.

But this patient obviously requires surgical intervention after ECMO monitoring.

And Lu Cheng suspected it was likely a heart attack...

The circulating nurse had previously worked with Director Xu, so she quickly arrived at the operating table to start disinfection.

After three rounds of disinfection, she used povidone-iodine to disinfect Lu Cheng's glove fingers several times.

After Lu Cheng wiped off the povidone-iodine residue with sterile gauze, Director Xu expertly positioned the patient's left hand, personally assisting Lu Cheng!

Lu Cheng searched again for the previously strongest pulse of the radial artery.

After precise location, Lu Cheng continued to gently press with his fingertips, feeling the subtle aspects of the patient's vascular width and fullness.

These are needed later when he finishes the puncture to find the direction of catheterization and insertion depth.

There are specific standards, but textbook and guideline standards don't apply to this patient.

This patient requires personal assessment and "mental calculation" to derive precise data based on basic principles.

Without such ability, Lu Cheng would be just another Director Xu.

It's not that Director Xu is incapable, but that the depth of his knowledge is insufficient.

Any skill, once honed to a certain level, inevitably transcends established data, emphasizing fundamental principles varying from person to person!

Just like in surgery, you transcend specific surgical procedures.

Once Lu Cheng mentally grasped the task, he began the puncture at a thirty-degree angle without hesitation.

The needle pierced the skin, subcutaneous tissue, fat, and vessel efficiently without pause!

When the needle perforated through the vessel, Lu Cheng proceeded about 0.3cm further before adjusting the direction to be parallel and maintained the angle at about 15°, not a bit more, not a bit less.

Vascular puncture allows no hesitation; it requires seamless execution. These data reserves need thorough mental preparation beforehand.

The worst mistake is trying to maintain an angle once inside.

Therefore, basic skills need to be refined beforehand, so you have absolute control over your hands!

All medical operations involve hand control over instruments!

"Sheath!~" Lu Cheng shouted to Director Xu.

While needle puncture might not be difficult, inserting the sheath without damaging the vessel wall is.

This requires Lu Cheng to puncture precisely without deviating from the midline and clearly operate within the vessel using the guide needle.

Additionally, the sheath insertion must not cause the dragging effect typical of ordinary sheath insertions!

Ordinary vessels are resilient, a little drag doesn't matter, still within the vessel.

That's not the case for her.

This elderly patient's vessel, if dragged, could rupture and cause a vascular leak, failing to naturally close.

"Director Xu, don't move my hand yet; I'll continue with the insertion." Lu Cheng's voice was precise and rigorous!~

No pleasantries, no formalities, just strict instructions.

This is a conversation between doctors, not between Lu Cheng as the attending and Director Xu!

Even though Director Xu hesitated for a moment at those words, he nodded: "Okay!~"

"Sheath!~ Here!" The instrument nurse handed over the instrument.

Lu Cheng took it, fitted it onto the catheter, and said, "Director Xu, once I insert the sheath, you start withdrawing the needle, just focus on extracting it."

"The speed can't be too fast; control the entire procedure within five seconds, no less than three, no more than eight seconds!"

Director Xu frowned slightly at Lu Cheng's precision.

Primarily, Lu Cheng's tone was so deliberate in directing him, which naturally induced a psychological resistance.

But, Lu Cheng was not the newcomer in his mind, marked in his mind via Huang Haibo.

He knew Lu Cheng's capability was good, so he nodded: "Alright!~"

"I'll strive for precision." Director Xu also got professional, setting aside his internal distractions!

"Start!~" Lu Cheng's operation was still swift and practiced.

Director Xu, now focused, began slowly withdrawing the guide needle at the first opportunity!

The entire five-second process was uneventful.

There wasn't an opportunity for adjustment; it was a one-time deal!

Either it's successful or it's utterly disappointed!

This was the deal with this patient's operation; there was no room for correction.

Once Director Xu and Lu Cheng completed their tasks, their eyes were fixated on the sheath insertion point to check for arterial leaks!

If a perforation occurred, the arterial insertion would be considered unsuccessful too.

Withdrawal, compression, hemostasis!

A few dozen seconds later, the patient's skin still didn't change color, nor was any swelling visible locally.

Lu Cheng then said: "Start the machine!~"

The machine slowly started, and the blood within the artery was drawn out of the patient's body, the oxygenator (artificial lung) and pump (artificial heart) began to drive the blood forward.

The physiological saline within the cavity was replaced by dark red blood.

Heat exchanger, anticoagulation system, monitoring system gradually started working.

Of course, the vital signs data wouldn't display immediately; it would take at least half a minute to circulate!

The pump speed was fast, viewed by ordinary people as almost maxed out, with 3000 RPM corresponding to a 3L/min flow rate!

As the machine operated, the patient's vital signs began to display.

MAP 80!

Mixed venous oxygen saturation SvO2 65

Hematocrit Hct26

Arterial oxygen saturation SaO2 87%

The machine had just started, so all the basic vital signs data weren't very good yet.

But everyone knew the machine was running correctly, these numbers could be gradually improved.

Director Xu finished reviewing and promptly said: "Monitor the machine closely, call the blood bank to continue sending blood, the blood pressure is very low!"

"Notify the Cardiology Department and Interventional Department to prepare to receive the patient."

"Coordinate with Cardiac Surgery..."

"Dr. Lu, are you available to join?" Director Xu asked hesitantly after giving instructions.

Lu Cheng stood on tiptoes, observing the machine operation of the patient: "Director Xu, I haven't eaten."

"If everything is okay here, I'd rather go eat first, it should be fine now."

"Regarding maintaining order, Director Xu, you are certainly more skilled than I am. I don't know about the other specialized surgeries either."

Lu Cheng spoke the truth.

Currently, with his limited Skill Points, even if the Interventional Department and Cardiology Department can't extract the thrombus or solve the present cardiac infarction, the patient would only face death.

He doesn't have the time to invest in interventional techniques to save people!

Skill Points are limited and can only be slowly earned!

"Hmm, alright, go ahead and eat first."

"Much appreciated!~"

"Director Huang," Director Xu called Huang Haibo.

Huang Haibo said: "We must quickly address the electrolyte imbalance and continuously infuse Noradrenaline; I recommend reducing the dosage a bit because..."

A group from the Internal Medicine and Anesthesia departments went to discuss further, but Lu Cheng didn't bother listening in detail.

As they say in Xiangxi, when it comes to food, it comes first.

Even if immortals came, one must first eat to satisfaction.

Not to mention, that boxed meal looked sumptuous...

Lu Cheng immediately ran out of the operating room!

Outside, the sun was bright, dazzling Lu Cheng's eyes slightly.

However, Lu Cheng didn't have time to appreciate any scenery.

The hunger in his belly made his thoughts spiral; for instance, Lu Cheng began to have mixed thoughts.

Rich people are truly wealthy, and those without money are genuinely in need.

Just the cost of starting the machine moments ago equaled his monthly salary.

How many boxed meals would that be?

A month, with an eighty-dollar gourmet boxed meal every day, three meals a day, Lu Cheng could eat for three months.

Secondly, this wealthy person also used up sixty of his Skill Points.

If those Skill Points were used in other areas, how many lives could that save?

Of course, putting aside all distractions!

Saving a life feels truly rewarding.

I am also a doctor who can save lives, not just someone waiting for handouts...

Skill Points are not enough...

There are so many diseases draining my strength.

Many techniques I haven't learned.

Hmm, so hungry, need food...