Surgery Godfather

Chapter 299 -0283: Acid Poisoning

Huang Jiacai and his sister were reliable in a crucial moment. This set of equipment was truly one-of-a-kind in the city, as it was custom made by Huang Jiacai. He had extended the connecting rod between the guidewire and the steel plate to accommodate particularly obese patients. He had also customized some unusual equipment, such as elongated steel plate screws, to be prepared for unexpected circumstances.

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Once the fracture was repositioned, the steel plate was successfully inserted. Led by the guidewire, the locking screw was put into place. The long steel plate with a high span dispersed the stress, bridging the fracture.

“Why do others have equipment while your company doesn’t? Are you trying to sabotage us?”

Director Ouyang, disgruntled and humiliated on stage, vented his spleen to the surgical equipment representative.

They had tried every avenue to get the equipment, but to no avail. A couple of the bigger companies were inquired, but who would customize a set of equipment for a four hundred pound patient? Even frustrating them to the point of cursing was of no use. Yet, Yang Ping’s supplier unexpectedly had it and even brought it. Director Ouyang had reason to suspect that the supplier was not giving his best effort.

If it were not for Yang Ping saving the day, or for the exceptional performance of Yang Ping’s supplier, this operation wouldn’t have been able to proceed.

...

“Sorry, sorry, sorry, our work was subpar. Our manager will arrive shortly, he will come to apologize personally,” the representative of the surgical equipment company didn’t dare to retaliate.

Director Ouyang was still considered easy-going, if this had happened with Director Bai, the equipment would be thrown in your face and all you could do was nod, bow and smile in apology.

Regardless of whether they were at fault or not, the only thing to do was endure till Director Ouyang let out his frustrations. The surgical equipment representative was currently the punching bag, the necessary party to receive the anger. In this industry, without the ability to swallow one’s pride, one would not be able to make money. Especially when the Chief Surgeon runs into difficulties and no equipment seems to handle well, avoiding reprimand was impossible.

Once all the screws were set, the C-arm X-ray machine was used for fluoroscopy. There were no issues. Dr. Jin measured the leg force line with an electric knife, targeting the front upper spine, the centre of the patella and between the first and second toe. Like aiming for a shot, the three points were aligned – normal.

This type of surgery was an innovative result of bone fracture treatment technology, called biological fixation, applicable to long bone fractures of limbs. Of course, it was not applicable for ulna and radius fractures because their delicate rotation function required them to be treated as an intra-articular fracture, needing anatomical repositioning and strong fixation.

For this type of femoral shaft fracture, anatomical reduction wasn’t necessary, and there was no need to restore it to its original condition. As long as its length and force line were restored to normal, the aim of the surgery would be achieved. Those meddled fragments of bone could be ignored. Even though these bone debris may appear sloppy and ignored, their blood circulation was protected. Eventually they would mend and the body would reshape them. After a while, the femur would not differ from its normal shape and it wouldn’t affect its function at all.

This was the advancement of medicine, the innovation of theory which brought about changes in surgical methods and equipment, ultimately improving treatment outcomes.

“What a damn thing, don’t bring this here again,” Director Ouyang fiddled with the original guidewire for a while before throwing it directly into the trash can, easing some of his frustrations.

The manager of the surgical equipment company did, indeed, come rushing into the operating room, his back continuously bent, “Director Ouyang, our service didn’t keep up with your needs, causing you troubles. How about we dine together after work as an opportunity for me to sincerely apologize to you and your team?”

Like a grandchild enduring scolding, allowing the Director to vent his anger then treating him to dinner and drinks was inevitable. The quality of the dinner should not be below par.

After catering to everyone and everything, they still had to carry on business as usual. After all, it was not a negligent error, but a lack of necessary equipment. They had also tried to source the equipment from their brother company but they didn’t have it either.

Only after the manager had quietly conferred with the representative about the situation was he informed that a small company had provided the equipment. Seeing it fulfilled Director Ouyang’s urgent need, the manager glanced at Huang Jiahui, an inexperienced young woman.

After glancing a few times at the special guidewire on the surgical equipment table, he couldn’t figure out why such an eccentric guidewire existed. After his many years of experience in the industry, he considered himself a surgical equipment expert.

Director Ouyang took off his surgical gown, and the manager quickly went up to him with a smile, helping to untie the straps. His assistant brought a chair and adjusted the height. Director Ouyang didn’t sit but walked up to the film viewer to look at the X-rays, with Yang Ping standing beside him.

“Old Jin, explain clearly to the family members. There is no need to reposition these bone pieces. It won’t affect the function,” Director Ouyang instructed Dr. Jin.

The hardest part of such a surgery was dealing with the relatives. The family members didn’t understand. When they saw the post-operative X-rays, they thought that the doctor was incompetent, and the surgery wasn’t successful because the bone pieces were still jumbled.

Regardless of the doctor’s explanation of medical principles, the family members didn’t understand. In the end, just one sentence remained: the X-rays post-operation look almost the same as before the surgery.

In fact, utilising this method, rather than cutting up to piece the bone pieces together, would result in faster and better fracture healing.

Joint fractures couldn’t be operated on like this. Joint fractures must be pieced together piece by piece, ensuring complete repair.

Director Ouyang approached, intending to ask Yang Ping how he achieved repositioning at once successfully. However, because the equipment manager was there, he restrained himself due to face-saving issues.

Yang Ping did not have an impulse to lecture and naturally, he didn’t take the initiative to explain. Some people were keen to learn, others were not. It was everyone’s call. For those who wanted to understand further, they could directly ask him and he would gladly explain. If no one asked, he wouldn’t take the initiative to explain- except for Song Zimo.

The operation ended, but moving the patient onto a gurney was still a challenging task.

Upon entering the operating room, the stretcher was not wide enough, so they had to push the patient in on a bed directly. Now for the bed transfer, the width of the bedsheet wasn’t sufficient. The nurses took a innovative approach, spreading several bedsheets horizontally, which worked fine.

Six people, three on each side, pulled strenuously while another group pushed. It felt as if their intervertebral discs were almost protruding, and it was only then the patient moved a sliver.

They had no choice but to call in two more young men. With five people pulling together, they finally managed to move the patient onto the bed.

The equipment manager and the assistants participated heavily in this process, putting a lot of effort to prove their worth to Director Ouyang.

The patient was under general anesthesia with an endotracheal tube. The common type of anesthesia used in these surgeries is sciatic and femoral nerve block, or combined spinal and epidural anesthesia. However, due to the thick fat layer, it was extremely difficult to locate the injection point.

Combined spinal and epidural anesthesia requires the anesthetist to inject an anesthetic into the epidural space. The regular needles for doing lumbar punctures used by anesthesiologists wouldn’t be able to reach the epidural space as the puncture path was too thick, the regular puncture needle comparatively too short.

“Wei Danian, wake up!” The anesthesiologist tapped the patient’s face, hoping to awaken him by stimulating his senses to be ready for extubating.

Dr. Jin reminded the anesthesiologist, “Try a different method. Not long ago, in the Emergency Department of a hospital, an old lady’s heart stopped beating and her breathing ceased. A doctor used a fist-pounding method to resuscitate her. After a punch, the lady’s son retaliated instantly with a slap saying, ‘You bastard, she’s already in this condition and you’re beating her, right in front of me, it’s outrageous, you think I’m a fool.'”

The frightened anesthesiologist halted. This habit was not good, it is better to use voice rather than force. He strained his voice and shouted at the patient, “Wei Danian, wake up! The surgery is over.”

The patient was groggy, he opened his eyes, seemingly following the voice, and then closed them again. Once he opened his eyes, indicating spontaneous breathing, the anesthesiologist could remove the tube. The anesthesiologist used a suction device to clear the respiratory tract of secretions and successfully extubated.

“Blood pressure is dropping!”

Dr. Jin, who had been staring at the monitor, reported that the blood pressure had surprisingly dropped to 76/35mmHg, and the patient’s breathing had become deep and labored.

“Ketoacidosis?”

The patient had diabetes. The sudden change to deep breathing combined with a drop in blood pressure led the anesthesiologist to suspect ketoacidosis first. He sniffed near the patient’s nose, slightly pulling down the mask to reveal a gap, but didn’t detect the smell of rotten apples from the breath.

“Reintubating!” The anesthesiologist swiftly reintubated.

“Test the capillary blood sugar with the glucometer. Collect blood samples for complete blood count, biochemistry, liver and kidney function tests, arterial blood gas analysis…” the anesthesiologist gave out a series of orders.

Being an experienced anesthesiologist, he knew the deep breathing signified acidosis. The patient had diabetes and his blood sugar level was 38mmol/l upon admission. It was only after careful adjustment with insulin that they dared to proceed with surgery. But perhaps the surgery had somehow raised his blood sugar level again.

In the operating room, the anesthesiologist is responsible for the patient’s life. Naturally, the anesthesiologist was on edge.

“Blood glucose is 6.2mmol/l.” The nurse looked at the data on the glucometer.

“It’s not high? What’s the matter?” The anesthesiologist was perplexed.

Director Ouyang and Dr. Jin also became anxious, suspecting that a fat embolism might have caused a pulmonary embolism, but the blood oxygen level wasn’t low.

“Test the blood lactic acid!” Yang Ping suggested.

“Yes, test the blood lactic acid.” The anesthesiologist instructed the nurse.

The hospital has a specialized automatic logistics system for the transportation of emergency specimens, so there is no need for manual transportation. The nurse only needs to apply a label to the sample, scan it into the computer and put it into a logistics tube. It will then be automatically transported through the pipeline to the laboratory.

The results came out quickly. Bicarbonate ions 8mmol/l, PH value 7.21, blood lactic acid concentration 2.8mmol/l.

“Certainly it’s acidosis – lactic acidosis, not ketoacidosis!”

Lactic acidosis has a higher mortality rate and is often fatal.