Check-in at the Hospital: The First Surgery Shocked the Nation!-Chapter 42 - 38: Four Surgeries Together, First Craniotomy
"Great! Qin Feng, you’re here!"
Director Zhang Fan from cardiac surgery saw him walk in, his eyes lit up immediately, and he exclaimed with surprise and delight.
"Director Zhang."
Qin Feng nodded and stepped forward,
"What’s the problem?"
"Here’s the situation..."
Zhang Fan quickly explained the condition of the injured person to him in detail, fearing he’d miss something.
The two directors from the Second City Hospital exchanged looks, surprised.
This is Qin Feng?
The first doctor in Jiangcheng City to complete a liver tumor resection with the organ detached?
Although they had read reports about Qin Feng, it was their first time meeting him in person.
So young!
Even Zhang Fan, a top cardiac surgeon in Jiangcheng, is so enthusiastic about him.
Truly astonishing!
At this moment, Qin Feng couldn’t care less about their surprise and became focused.
The injuries of the person in front of him were really severe!
Compound fractures, shock, ventricular fibrillation, splenic rupture, cardiac vein rupture and bleeding, intracranial hemorrhage...
Several cardiac arrests, vital signs disappearing—if it weren’t for Zhang Fan, a cardiac surgery expert, and the two directors from the Second City Hospital with their rich experience, the patient’s life wouldn’t have been saved.
Still alive now, it’s truly a miracle!
Of course, given the strict orders from superiors, as long as there’s a shred of hope, no patient can be abandoned. Otherwise, they might have died several times over.
"We can handle the heart, compound fractures, and splenic rupture,"
Director Shen Yan of the orthopedics department at the Second City Hospital frowned,
"But the patient’s intracranial pressure and massive hemorrhage require brain surgeons, and all of them are currently operating. We’re short-staffed.
If we operate recklessly, the patient might not survive the procedure!"
"Indeed, it’s too risky to move. Once the heart is compromised, combined with a brain hemorrhage, survival is impossible."
Zhang Fan nodded in agreement, helplessly.
"Yes, there are over twenty critical cases undergoing surgery right now. Twelve patients have brain hemorrhages; the neurosurgeons from three hospitals are all occupied, literally stretched too thin!"
Deputy Director Qian Cheng of the internal medicine department at the Second City Hospital shook his head, inwardly having almost given up hope.
"Did you get a CT scan?"
Qin Feng nodded slightly, understanding the gravity of the situation, and asked the three of them.
"Yes, it’s here."
Director Zhang Fan promptly handed him the examination report,
"The patient is beginning to experience respiratory failure, likely due to brain edema causing a brain hernia and pressing on the respiratory center, according to the CT scan."
He stared intently at Qin Feng, knowing that Qin Feng had completed many major surgeries in cardiology, obstetrics, and internal medicine.
And each surgery was textbook perfect!
To date, his surgical videos have become teaching materials across departments, available for learning by all doctors.
But who knows if he can perform brain surgery?!
"Director Zhang, isn’t Qin Feng still an intern right now?"
Just as Qi Fang was examining the report, Deputy Director Qian Cheng frowned at Zhang Fan and asked,
"Can he really perform surgery?"
"Hehe~
Qin Feng is already a full doctor at our First City Hospital and has been given special surgical signing privileges by the director, what do you think?"
Zhang Fan smiled slightly, his tone calm yet filled with pride.
Crack!
Upon hearing this, the two were shocked!
They looked at Qin Feng with eyes that suddenly became serious and incredulous!
Surgical signing privilege granted by the director?
You should know, only deputy chief physician level and above usually have such authority!
This is also to manage the surgical processes within the department properly, with strict oversight on each operation.
And Qin Feng already got the authority that every regular doctor dreams of!
Is this guy really an intern?
"Of course, I don’t know if he can perform brain surgery, let’s wait and see."
Zhang Fan added another sentence seeing the two of them dazed.
Poof~!
Deputy Director Qian Cheng and Director Shen Yan almost spat out their old tea.
Isn’t this just messing around?
What’s the point of coming if he can’t perform brain surgery?
"Old Zhang, are you joking with us?"
Deputy Director Qian Cheng couldn’t help but speak solemnly,
"This is brain surgery, any mistake can be fatal!"
About two or three minutes later,
Qin Feng put down the examination report and fell into deep thought.
"How is it, Qin Feng, can you handle it?"
Zhang Fan asked nervously.
"The intracranial hemorrhage seems to exceed 30ml, accompanied by increased intracranial pressure, and the situation is not good. It requires a craniotomy."
Qin Feng glanced at the patient’s monitoring data, then looked at the three of them and said,
"Give me a neurosurgical instrument nurse, I need assistance."
"Okay!"
Zhang Fan was uncontrollably overjoyed to hear his answer and immediately pointed to a nurse,
"Quick! Go find an experienced instrument nurse in neurosurgery!"
The nurse nodded and quickly ran out of the operating room.
Based on the examination report, Qin Feng already understood the specific condition of the injured and had multiple surgical plans forming in his mind.
The patient’s blood pressure is currently 134/72 mmHg, already somewhat unstable.
GCS score (Glasgow Coma Scale assessment, including eye response, verbal response, and motor response; mild coma is 13-14 points, moderate coma is 9-12 points, severe coma is 3-8 points, and below 3 points is brain death, while above 14 points is normal):
points (severe coma)!
And there’s an 8cm crack on the top of the skull, deep into the cranium, with active bleeding.
Brain contusion appears in the cranial examination, and the subarachnoid meningeal has varying degrees of damage.
The most suitable surgical method is being selected in his mind.
Currently, the most effective surgical methods for addressing intracranial hemorrhage are roughly three types.
The first, minimally invasive!
The advantage is local anesthesia, minimal trauma, simple operation, and quick recovery.
But the downside is significant, with incomplete hematoma clearance, insufficient intracranial decompression, and a high risk once a thrombus forms due to the limited surgical field.
The second, small bone window!
This involves chiseling a small window in the hematoma area for craniotomy hematoma evacuation surgery, commonly used for basal ganglia hemorrhage, with less trauma than bone flap craniotomy.
The surgical field is large, allowing hematoma clearance, decompression, and hemostasis under direct vision.
However, it’s not suitable for patients with a tendency for brain herniation (displacement and compression of other tissues).
The last type: bone flap craniotomy hematoma evacuation surgery (opening the skull): the most perfect surgical plan for doctors, with complete visual fields, thorough hematoma clearance, complete hemostasis, and decompression.
But the downside is that the trauma is too severe!
Of course, there is also a fourth option, the stereotactic aspiration surgery.
This surgery is more advanced, developed only in recent years. Qin Feng can do it too, but it’s similarly not suitable for patients with brain herniation.
Moreover, the most important thing is that all hospitals in Jiangcheng don’t yet have this equipment.
It’s too expensive!
The current patient shows obvious signs of brain herniation, making them unsuitable for the first, second, or fourth surgical options.
Now only craniotomy is left.
And according to the GCS score of 8, it fits within the scope of [Craniectomy Hematoma Evacuation Surgery].
It’s decided, let’s do it this way!
Qin Feng had already determined the surgical plan in his mind.
About ten minutes later,
the nurse who left didn’t come back, and another nurse arrived, the head nurse of neurosurgery!
"Dr. Qin, I’m here."
She walked to Qin Feng at first sight and said in a deep voice.
"Okay."
Qin Feng nodded, scanned the three in front of him, his tone serious,
"Everyone, let’s begin."
"Okay!"
Zhang Fan responded without hesitation and immediately walked to the operating table.
Meanwhile, the two directors from the Second City Hospital looked at each other, both seeing the helpless worry in the other’s eyes.
But they couldn’t say anything.
Because the dean had already ordered that regardless of what happened, they must follow the arrangements and instructions of the First City Hospital unswervingly.
The two could only silently walk onto the platform, looking at Qin Feng with doubt in their eyes.
Can this really work?
In 5 minutes, all preparations were complete.
Zhang Fan also held the occlusion clamp and looked at him, seemingly waiting for an order.
"I’ll start the craniotomy first, and after decompression is completed, you can proceed with the surgery."
Qin Feng said, reaching out to the head neurosurgery nurse.
The head nurse handed him a 3% iodine solution-soaked disinfectant cotton.
Disinfecting~
"Drape the sheets, lift the patient and stabilize them."
Qin Feng spoke while simultaneously operating with the head nurse,
"Bring over the cranial dynamics system. (Craniotomy instruments)"
The head nurse immediately assembled the cranial dynamics system, selected the appropriate drill bit, connected it to the handle, and handed it to him.
Qin Feng took it and placed it beside him, nodding.
The head nurse connected the other end to the main unit and assembled the milling cutter head and placed it on the standby table.
Fix the suction device, secure the suction device head, electrosurgery, and bipolar electrocautery.
Turn on the bipolar electrocautery, adjust its intensity.....
Everything is ready!
Second step:
Craniotomy!
Qin Feng picked up the round knife and using an arched incision, cut the skin and subcutaneous aponeurosis.
He used scalp clips to lift the skin, clamping the scalp to stop bleeding.
Then, he cut and stripped the periosteum.
Bzz bzz bzz~
Qin Feng put down the knife, held the cranial power drill, and pressed the switch.
Whirr whirr whirr whirr~~~
The blade slowly sank into the skull along the edge, performing the craniotomy while injecting saline into the bone hole with a syringe and synchronously applying bone wax to stop bleeding...
At this moment, the entire operating room was unusually quiet.
Everyone held their breath, fearing that any noise might disturb Qin Feng.
This is a craniotomy; even a slight slip could end the surgery.
Directly suture, cover with a white sheet, and push to the morgue.
Zhang Fan and the other two equally tensely watched his every move, especially Qian Cheng and Shen Yan, their hearts in their throats.
Really unsure what extent Qin Feng could accomplish!
Terrifying!
Approximately ten minutes later, the bone flap was mostly detached. Qin Feng used a periosteal elevator to gently pry open the bone flap.
Wrapped wet gauze, performed hemostasis on the wound, rinsed the incision, opened the surgical field.
Finally, gently placed wet brain cotton into the cranial cavity to protect brain tissue.
"Phew~"
Seeing this, everyone breathed a sigh of relief.
Qin Feng also stopped, removed his gloves, washed his hands again, and put on new gloves to eliminate infection risk.
And both Director Qian and Director Shen couldn’t help but be increasingly amazed; the technique was so proficient.
Hadn’t he done neurosurgery before?
People wouldn’t believe it if spoken!
...
"Alright, I’m going to clear the accumulated blood and relieve the patient’s pressure."
Qin Feng looked up at the three of them and said in a low voice,
"Director Qian, Director Shen, you can start the surgery, Director Zhang, wait a moment."
"Okay."
Zhang Fan nodded; Qian Cheng and Shen Yan heard this and walked up to the surgical position, each beginning the surgery within their respective domains.
Because once the heart is occluded, the brain enters a state of hypoxia and ischemia, so heart surgery cannot be done now.
"Line 1."
Qin Feng reached out, and the head nurse immediately handed over a small round needle, threading through the dura mater, suspending the dura mater.
The first one...
The second one...
The third one...
By the tenth one, his speed gradually increased, catching everyone’s eyes and was pleasing to watch.
Next, Qin Feng cut the dura mater, used a dural hook to lift the dura, then a blade to cut a small opening, using dural scissors to enlarge it.
Throughout, he repeatedly used bipolar electrocautery for hemostasis, using dural forceps to wipe residual blood with wipes.
At this point, the craniotomy was completely finished!
Many at the surgical site had never personally witnessed a craniotomy, including the three directors.
Watching this process, they couldn’t help but get goosebumps!
When Qin Feng opened the dura, the deep-colored brain hematoma appeared in front of them.
A lot!
Estimated to be about 50mL, it began to slowly flow outwards.
Qin Feng took a deep breath, his gaze turning solemn.
Need to hurry!
