Chapter 1921: 1853 The Doctor's Responsibility

"The patient's preoperative diagnosis was pulmonary torsion, and because the disease course was relatively long, when they came to our hospital for consultation, the condition suddenly worsened." Su Yun began to introduce, "Lao He, turn down the volume of the song!"

Lao He pretended not to hear and went to adjust the ventilator.

"Boss, you talk about Lao He." Su Yun was dissatisfied.

"Thoracic retractor." Zheng Renze also didn't hear, reached out and took the thoracic retractor, inserted it into the chest cavity, and began turning the screws.

With a creaking sound, the chest cavity was opened. The size was just right, the rib elasticity was extended to the maximum, yet no fracture occurred.

"During the operation, we found that the right middle lobe had shifted upward and rotated counterclockwise by about 170 degrees. This is a fairly standard value, as various textbooks state it as 180 degrees." Su Yun connected the microphone and began to chatter, "The lung congestion is visibly severe, and ischemic foci have already appeared at the edges."

He knew why Zheng Ren was in such a hurry, because if they followed the procedure, in as little as five minutes the marginal necrotic area would become permanently dead and could not be reperfused.

Moreover, if the tissue were completely necrotic, restoring blood flow after correcting the torsion would bring the necrotic tissue into the body's blood circulation.

Things like bacteremia arise in this way.

If time has run out and similar problems are discovered, directly removing the lung lobe is the best option.

What will the boss choose?

Su Yun chatted on one side while assisting Zheng Ren on the other.

His actions needed to be slightly delayed, because during the linked microphone live broadcast, he could not ask questions or communicate, and the requirements for the linked microphone participants were extremely high.

Zheng Ren did not hesitate; he directly began to dissect the right lung.

"Generally, for pulmonary torsion, the surgical choice is resection. But our 912 emergency and rescue capabilities are high, so we don't waste time; the patient's lung is not yet necrotic, so we can choose to preserve it." Su Yun said.

Lin Ge walked in and happened to hear this sentence.

This sentence was like heavenly music, making him feel delighted. Zheng Lao Ban, even while performing a live broadcast surgery, didn't forget to give 912 a plug in the rhythm—truly righteous!

"Lao He, get ready!" Zheng Ren said.

"Ready."

Zheng Ren, with Su Yun's assistance, twisted the right middle lobe back, restoring its original anatomical structure.

Lao He's fiber bronchoscope, equipped with a suction tube, had already been inserted.

"The strength of anesthesia is very important; the anesthesiologist uses the fiber bronchoscope under direct vision to suction secretions. Boss, give Lao He a close-up." Su Yun said.

Zheng Ren raised his head and glanced at Lao He.

Lao He felt happy inside, but his face showed no expression; he seriously and attentively used the fiber bronchoscope to suction secretions, trying to display the demeanor of a senior anesthesiologist as he imagined it, striving for perfection.

"A large amount of blood-tinged sputum was suctioned out; I won't explain in detail why this secretion occurs." Su Yun said while beginning to treat the bleeding point left from when Zheng Ren Gang just opened the chest.

Crackling sounds, electric sparks flew; upon touching the bleeding point, it stopped immediately.

There's nothing much to explain here; Su Yun also didn't bother to say. Fang Lin used hemostatic forceps together with Su Yun to achieve hemostasis.

Zheng Ren remained motionless, gazing at the patient's right middle lobe.

"The surgeon is observing the blood flow condition of the patient's right middle lobe; now it looks like the right middle lobe can be preserved." Su Yun said while doing the hemostasis with cracking sounds, describing what Zheng Ren was doing.

"Now I leave a question for those watching the live broadcast: over the next 20 to 60 minutes, we need to continuously draw blood for tests. What items should the surgeon check?" Su Yun said.

Fang Lin was also a bit startled; after thinking hard, he whispered, "Yun Ge'er, are we supposed to check serum potassium and lactate dehydrogenase?"

"Alas, after so many years, we still have no tacit understanding." Su Yun sighed and said, "When you speak, anyone with good ears can hear it."

"……" Fang Lin lowered his head and used the hemostatic forceps to expose the blood vessel for Su Yun.

Small ones are directly cauterized; larger ones need ligation.

Soon this side was finished; the three people stood on the operating table, with nothing else to do.

Before opening the table, they were busy as hell; after opening the chest cavity and repositioning the right middle lobe, they shifted from extreme dynamism to static.

Such surgeries are not common; usually one waits for intraoperative frozen section. In a well-trained hospital, the pathology side can produce results within 20 to 30 minutes.

But for a live broadcast surgery, just waiting like this is rather odd.

Su Yun took advantage of the waiting time, with the song "Good Luck Come" playing, and began to recount the patient's previous medical history.

His memory is excellent; having only glanced at the lab report once in thoracic surgery before the operation, he took it out and began to analyze it thoroughly.

Time flew by; after three consecutive blood draws, the values of serum potassium and lactate dehydrogenase also showed no significant increase.

Zheng Ren let out a sigh of relief.

The patient's lung should have been preserved.

"Serum potassium and lactate dehydrogenase are fine; now the surgeon begins to explore." Su Yun started speaking into the microphone: "One hour has passed, and the surgeon finally moved! Friends watching the live broadcast, do you feel a little excitement?"

Zheng Ren, while checking the pulsations of V4 and V5, asked, "When you did the live broadcast for Liu Xu zhi, were you also this unfocused?"

"Boss, do you really have to be so solemn in performing surgery? Friends, did you hear the background music? What taste! It's hard to believe that a top-tier surgeon in the world of surgery actually likes this song."

Zheng Ren didn't bother with that person; being in a live broadcast, he certainly couldn't have a hemostatic forceps thrown at his face.

He reached out, slapped the needle holder into his palm.

Zheng Ren began suturing the right middle lobe to the right lower lobe.

This is to prevent postoperative torsion of the right middle lobe, in case the ligaments are lacking or insufficient, so we fix it to the other lobes.

"After restoring the normal physiological structure for one hour, the bloody sputum disappears." Su Yun looked at the suction tube in Lao He's hand, which had drawn out only a small amount of white foamy sputum, then began to withdraw the fiber bronchoscope and explain.

"Why wait an hour? First, naturally, to observe whether the patient's right middle lobe can be preserved. I… the surgeon will not lightly perform a highly damaging but simple and crude operation."

"Removing a lung lobe would cause about a 20% loss in the patient's respiratory function. Although it wouldn't affect life, it would somewhat affect quality of life."

"And the one-hour wait during the operation means an improvement in the patient's quality of life for decades afterward."

"This is a doctor's duty, right, boss?"

"As for the surgery, you should speak less." Zheng Ren felt that opening the microphone was truly unreliable; usually Su Yun's chatter and jokes were fine, but today, once the microphone was opened, nobody else spoke—only Su Yun did.

Originally, I had no feeling for the song "Good Luck Come," but today I felt that Su Yun's voice mixed with the song was quite grating.

"To control airway secretions, the patient will receive mechanical ventilation for about 12 hours post-operation, after which we will observe the condition before extubation."

"Because the residual pulmonary vein stump may retain a thrombus, postoperative warfarin anticoagulation therapy is given."