愛善醫院對開斜坡 車禍現場 專線小巴內63Please respect copyright.PENANACPE1KKiBPE
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"哎...." 漸漸恢復知覺的輝SIR,微微睜開眼,驚見其他座位上盡是重傷昏迷的乘客,回過神來,記得從小巴滾下斜坡時令自己失去知覺,心想若沒扣上安全帶,早已被拋出車外,神志稍定後立即想以左手解開安全帶扣,才驚覺左臂因撞擊導致脫骹,只好轉以右手解開帶扣後,雖發覺雙腿移動時出現劇痛,仍忍痛緩緩地爬出車廂,好讓自己呼吸新鮮空氣之餘,亦靜待救援,深懂拯救之道的輝SIR,評估自己現時情況後,已自知並不符合拯救他人條件,因此縱使面對遍地盡是被小巴拋出傷者,心中感覺如何不忍仍愛莫能助,況且輝SIR漸漸感覺到,意識開始再度陷入模糊,可能全因腦部受劇震所致,正當眼見救援隊伍向自己步近時,身後突然發出隆然巨響,人隨即被氣流震飛,將要著地時剛好被數個救援隊員接著,但已因衝力再度失去知覺...63Please respect copyright.PENANAaHge9XXtHG
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15分鐘後 急症室內63Please respect copyright.PENANARZ8Mcua4u3
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"DR.張,呢度有個傷者雙耳出血,呼吸脈搏微弱,仲有INTERNAL BLEEDING...."急症室護士正高聲作出呼喚63Please respect copyright.PENANARxAMofjbDM
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"係佢!? 瞳孔開始放大,係顱內出血,人來同我搓住上CT,要快!!" DR.張驚覺重傷者竟是輝SIR,即時進行施救,並邊推病床邊下指令" 唔該CALL埋心胸肺DR.楊,骨科DR.劉同神經外科DR.洪去CT室.."63Please respect copyright.PENANAQss7Q8tgK0
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30分鐘後 電腦素描室63Please respect copyright.PENANAQpnFCa2Y9e
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"診斷結果係SDH,二尖瓣撕裂,肝臟出血,雙腿骨折同左臂脫骹,小巴爆炸後剩低佢仲有得救,而且係我地同事,點都唔可以俾佢死,SDH就由我同DR.洪負責!!" DR.張正與幾位醫生研討如何拯救輝SIR63Please respect copyright.PENANAdGaDWoCuQp
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"我都要救番佢,repair of mitral valve就交俾我!!" DR.楊自信地拍了拍胸口63Please respect copyright.PENANAyCtklP8bJ9
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"肝臟止血就由我負責,仲會睇埋有冇其他部位出血..." DR.羅看了看CT之後說63Please respect copyright.PENANAelqmN5V3lp
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"同一時間要開刀,麻醉科醫生仲處理緊手術,咁搵邊個去負責....."DR.洪正在質疑63Please respect copyright.PENANAD9a9j86cW8
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"仲有我可以處理.." 自動門打開,一名醫生徐徐步進63Please respect copyright.PENANAGJs0nV4a8s
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"DR.洛,你返左來?" 眾醫生訝異地望向DR.洛63Please respect copyright.PENANAefepkPi7cB
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"我啱啱由英國到香港,一落機DR.林就通知我醫院有災難警報,要我即刻返來.."63Please respect copyright.PENANAQqwB5BONoZ
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"咁駁骨就由我去做啦,之不過打石膏就....."DR.劉欲言又止63Please respect copyright.PENANAhjinLt2qnw
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"救左人先,唔好諗咁多!! CALL OT STAND BY!!" DR.洛以代CEO身份下令63Please respect copyright.PENANABOlDuWgDjT
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"咁我地去準備,5分鐘後OT見!!"一眾醫生隨即離開,同一時間,床邊盡是維生儀器,奄奄一息的輝SIR被推進手術室準備接受手術63Please respect copyright.PENANAVDCOBmGB3z
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硬腦膜下血腫(Subdural hematoma, SDH)發生於20%~40%的嚴重頭部外傷患者,是最常見的頭部創傷性腫塊。Subdural hemtoma位在硬腦膜和蜘蛛網膜之間,形狀通常呈新月型,挫裂傷是出血的主要來源。又依時程分為acute subdural hematoma(3天內,發生率占70%)、subacute subdural hematoma、chronic subdural hematoma。通常是由於靜脈血管破裂而引起,主要是由於腦組織與顱骨相對磨擦的結果,造成穿越硬腦膜下腔注入硬腦膜竇的大靜脈因牽扯而破裂。根據臨床症狀之出現,可分為急性,次急性及慢性三類,其中急性硬腦膜下腔出血因其表示有嚴重腦損傷,故死亡率高。63Please respect copyright.PENANAPIISj8EGQP
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一般Subdural hematoma的治療取決於大小與發展速度,一些小型的subdural hematoma可以在監控下由身體自行吸收,或是用暫時性導管穿過顱骨將血腫吸出。較大型或有症狀的subdural hematoma則多以手術打開硬腦膜將血腫取出並止血,然而手術後有併發症如顱內壓上升、腦水腫、出血、感染及癲癇等可能性。63Please respect copyright.PENANA35YHpms9pd
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repair of mitral valve二尖瓣修補手術,在過去30年已有重大的改良;雖然過去其治療角色一度受到懷疑,然而因為它比二尖瓣置換術更符合生理,並且較能降低人工瓣膜相關的併發症,令其今日成為二尖瓣逆流的主要治療方式之一。長期累積的實證亦使心臟外科醫生採取更積極的態度進行修補手術,藉此改善病人的生活品質。在現今主要的醫學中心裏,二尖瓣修補術已是司空見慣的常規手術。63Please respect copyright.PENANAXbrX190U5u
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5分鐘後 手術室外63Please respect copyright.PENANAcWOvM7q4Uo
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"ANNIE,係妳? 師傅強呢?" DR.劉望著身穿綠色手術服的ANNIE迎面而來63Please respect copyright.PENANAcHwyMQTJWq
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"強哥有第二個手術要跟,叫我幫你手,不過今次係我第一次單獨做..."63Please respect copyright.PENANASyItzx34Dx
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"師傅強都覺得妳得,就應該俾D信心,一陣我地係最後先開始,所以唔使緊張...之不過..."63Please respect copyright.PENANAMYC2oJcBo1
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"不過咩呀DR.劉?" ANNIE見DR.劉欲言又止,配上口罩的她不禁展現疑惑眼神63Please respect copyright.PENANAsiSIoPlOhA
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"冇咩....我地入去啦....."DR.劉無奈引領她進內....63Please respect copyright.PENANAkHkbMkFa6I
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當第一重門打開,兩人進入內門前,按下腳踏開門63Please respect copyright.PENANAv40LfWvXkD
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當左右門向兩邊徐徐展開,首先映入ANNIE眼簾的,乃一眾準備就緒的醫生及手術室護士,然後再望向躺於手術床上全身插滿喉管的,竟是...63Please respect copyright.PENANAqij6mOAKDe
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"輝!!"ANNIE呆立了一秒,對眼前的景象顯得難以接受,眾醫生同時以無奈目光望向她63Please respect copyright.PENANA4Rlko9w3fq
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"妳如果要出去,呢度冇一個人會怪妳..."DR.劉實在不願ANNIE接受如此殘酷時刻63Please respect copyright.PENANAIG3wZqooRU
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"DR.劉,各位醫生,我OK!!" ANNIE眼神顯露前所未有的堅定63Please respect copyright.PENANAE1Ucy0rRUY
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"ANNIE,我係代CEO DR.洛,妳唔需要勉強自己,如果妳要離開我唔會話妳擅離職守..."DR.洛之前有替至愛開刀相同經歷,從DR.張口中得知情況後實在不願ANNIE步自己後塵63Please respect copyright.PENANAZ7an6XXVw6
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"多謝你DR.洛,我要陪住佢,用精神支持佢!!我控制到自己情緒!!"ANNIE仍舊以堅定目光示人63Please respect copyright.PENANAoVThryfXS3
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"OK,咁我地開始..." 眾醫生點頭示意下,護士按動跳字鐘開始計時....63Please respect copyright.PENANA0R3qrHD6y4
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"首先做Craniotomy同佢減腦壓,再放EVD,DR.洪,妳幫我HOLD 住..."DR.張邊在輝SIR頭蓋開孔邊吩咐DR.洪在旁準備63Please respect copyright.PENANAi3GqzZttyv
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"DR.洛,出血量.."DR.楊已作好準備63Please respect copyright.PENANAuhBiuEJ5ch
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"UNDER CONTROL,DR.楊你可以開始.."DR.洛望了望身旁血量計後示意DR.楊可以準備開胸63Please respect copyright.PENANAgxeh4DfF30
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"OK...手術刀.....RETRACTOR...Mitral Valve exposure..."DR.楊以最少出血量熟練地完成開胸63Please respect copyright.PENANAKz0rhO2xsO
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"人工心肺機已經STAND BY..."DR.洛作出指示63Please respect copyright.PENANAAL2SutbXZr
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"OK,喉管接駁好,可以START.." DR.楊同樣以最快速度完成接駁63Please respect copyright.PENANAbB9kdwa4J5
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"人工心肺機START!!倒數計時30分鐘!!"DR.洛示意操作員開動按鈕63Please respect copyright.PENANA4BKrXZWzzx
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"而家開始REPAIR OF MITRAL VALUE....Malleable spatula.....你同我撐開同HOLD住...Cardiac stabilizer.."DR.楊示意助手協助擴闊空間以進行二尖瓣修補...63Please respect copyright.PENANANdxXtWnutL
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"唔該CROSS MATCH 4包血...DR.羅可以開始..." DR.洛檢視出血量後作出準備輸血指示,以防DR.羅閞始剖腹時因出血量大增導至輝SIR出現失血過多風險...63Please respect copyright.PENANApNEOFthN4C
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"OK...手術刀.....Self-Retaining RETRACTOR,紗布止血,太多血睇唔清楚出血位, Suction,見到出血位....Hemostatic Forceps.....已經夾住血管止血,Vein Retractor,幫我拉開....暫時未有其他出血位...Needle Holder 4號線.....開始縫合肝臟....."DR.羅同時以快速手法進行止血並縫合以盡快減低出血量63Please respect copyright.PENANAAp09JwnPKL
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"頭蓋骨開左...走燈,MIRCOSCROPE....DR.洪準備EVD....POINT MATCH....HOLD....."63Please respect copyright.PENANAr7RyLplM2D
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"DR.張,腦壓比之前回落10% BP110/80 SPO2 90....DR.楊,仲有15分鐘..." DR.洛不時發布儀器顥示維生指數及剩餘時間63Please respect copyright.PENANAUrH499AWdJ
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"OK....仲差少少....輝SIR,撐住呀...."DR.楊正埋首與時間競賽,務求盡快完成...63Please respect copyright.PENANAtnbWIjQBaH
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同樣地,表面強作鎮定的ANNIE此刻只好默默在精神上作出支持...63Please respect copyright.PENANAAElcyjl3Pp
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"已經搵到血塊,左手SUCTION....右手BIPOLAR........開始止血....止血完成,麻煩DR.洪同PATIENT做瞳孔檢定..."63Please respect copyright.PENANA6yacH8oIfi
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"PATIENT左右瞳孔已收細..."DR.洪作出回報63Please respect copyright.PENANAxi5rDgEYNs
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"GOOD,暫時放置引流管,腦腫脹開始消退,可放回頭蓋骨縫合,兼且沖洗積血..."DR.張在DR.洪協助下開始進行最後步驟並縫合63Please respect copyright.PENANA25xPefmrtc
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"我呢便都完成...可以準備DISCONNECT人工心肺..."一番努力,DR.楊亦完成二尖瓣修補..63Please respect copyright.PENANAhigPmc7uZ8
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"OK...人工心肺STOP..."再次確認後,DR.洛指示操作員關閉人工心肺運作..63Please respect copyright.PENANAgsy4Dw6qbD
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眾人屏息以待,手術床上的輝SIR心臟再次跳動....63Please respect copyright.PENANATNffITGORn
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然而經過1秒.........63Please respect copyright.PENANAr2cq918zdr
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2秒.............63Please respect copyright.PENANAZLMqbbz9iF
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3秒...............63Please respect copyright.PENANAxUzn3dzNDo
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4秒................63Please respect copyright.PENANA78kUhR6JPa
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5秒.....................63Please respect copyright.PENANA8QYXzIw73M
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輝SIR心臟仍舊處於靜止狀態.................63Please respect copyright.PENANAr88YJw6rI0
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朦朧中,輝SIR感覺自己置身一片草原上,望到遠處一個熟悉身影,意念一動,已站於身影之前63Please respect copyright.PENANAXd182JabeG
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"CONNIE,原來真係妳..." 輝SIR頓時喜出望外63Please respect copyright.PENANAJFggYuuYbc
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"輝,點解你咁快會黎到呢度㗎?" CONNIE訝異地望向輝SIR "你唔應該黎,快D返去....."63Please respect copyright.PENANAflTSOxCOc4
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"妳要趕我走?而家可以同妳一齊唔係好好咩?點解要咁對我?"63Please respect copyright.PENANAX5Bx6JamxA
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"輝....."CONNIE顯得無奈 "總之呢度唔係你應該黎,快D返去,返去佢身邊..."63Please respect copyright.PENANAbgNZfjVzZX
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"我冇面目再見佢,我想一直陪住妳,唔想返去喇....."輝SIR苦苦哀求CONNIE讓他留下63Please respect copyright.PENANAevIX1sDFGn
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"輝,唔好再逃避,返去啦,呢度唔屬於你...."63Please respect copyright.PENANA7TYegIFBBQ
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"我唔返,點都唔返....." 輝SIR將CONNIE擁入懷內.."我唔會再離開妳㗎喇...."63Please respect copyright.PENANANaxREK5LjY
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"輝....." CONNIE無言以對,雙手緩緩環抱輝SIR.....63Please respect copyright.PENANAzOIVCYMM7G
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手術室內 63Please respect copyright.PENANA3dFXDcYjCK
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輝SIR心臟靜止後10秒.......63Please respect copyright.PENANAnzA1EqIaCP
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"唔可以再等....心臟按摩!!" DR.楊邊以右手握著輝SIR心臟邊向助手下指示 "ADRENALINE0.5mg,用10ml生理鹽水稀釋之後直接注入左心尖.."63Please respect copyright.PENANA6QPNrkhnG7
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ANNIE此時緩媛步向手術床,望著正被搶救,臉孔蒼白的輝SIR,不發一言63Please respect copyright.PENANAehwmoCBr1O
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"輝SIR,快D返來啦..."DR.楊正以一分鐘80次向輝SIR心臟施以擠壓,弄得滿頭大汗63Please respect copyright.PENANAYTUXqrwpip
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DR.洛面對儀器顯示因心臟擠壓而構成的數據變化正在沉思63Please respect copyright.PENANAayduNg3aG4
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其他醫生亦唯有站於原位上等待奇蹟出現63Please respect copyright.PENANAXAddXKyuHz
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可惜,過了30分鐘,輝SIR心臟仍只是由DR.楊右手去"構成"跳動....63Please respect copyright.PENANAqkqb81yIco
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"輝SIR,我就來支持唔住喇,唔好玩啦..." DR.楊已漸感不支63Please respect copyright.PENANAfCJ1FxEPDU
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"輝...."一直沉默的ANNIE終於開口 "你係咪唔想再返來?如果係,我唔會勉強你,但我會覺得你係一個....懦夫!!"63Please respect copyright.PENANA7lzGEGVa3Y
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草原上63Please respect copyright.PENANAAi4jlPVnnS
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"噢!!.."正擁抱著CONNIE的輝SIR,忽然自內心產生一下刺痛63Please respect copyright.PENANAuobCoZcA8c
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"輝,佢等緊你,你走啦!!"CONNIE即時推開輝SIR63Please respect copyright.PENANACXAxHdK5Tb
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"CONNIE..."63Please respect copyright.PENANApWgNzkH1Gp
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"唔好再掛住我,你仲有好長嘅路要行...."CONNIE伸手指向輝SIR63Please respect copyright.PENANA8KEjF8x59n
63Please respect copyright.PENANAgGrRTkY2Lu
"噗通" 輝SIR再次感覺自己心跳時,忽然被強大引力扯上了半空63Please respect copyright.PENANApTfu2q7qwe
63Please respect copyright.PENANAmWgK6tYtQu
"哇~~" 隨即再度失去意識63Please respect copyright.PENANAgKfl0hl3ni
63Please respect copyright.PENANAcrnH8efbZX
63Please respect copyright.PENANAnr87TUFwTt
63Please respect copyright.PENANABsvkg1Z6ku
同一時間 手術室內63Please respect copyright.PENANAVzilu15Dpw
63Please respect copyright.PENANAcBLYPGHjnb
"DR.楊,唔好再勉強自己同輝SIR,好多謝咁多位醫生,你地已經盡哂力..."ANNIE低頭示意DR.楊停止63Please respect copyright.PENANAcooYdaIYKY
63Please respect copyright.PENANADHzb8IhjKY
DR.楊望向DR.洛與DR.張,只見他們同時點頭,於是緩緩鬆開已極度痠痛右手,脈搏儀隨即顯示一條直線63Please respect copyright.PENANAfnf1BfflQM
63Please respect copyright.PENANA2qRmuhnIFp
面對數天前還生龍活虎,一起奮戰的同事,此刻變成一具屍體,靜靜的躺在手術床上,雖說在醫院已是司空見慣,然而對在場的眾位醫生來說,仍是一個殘酷的事實,只有ANNIE,此刻拿起輝SIR的左臂,熟練的轉動,再施力一推 "卡嘞"一聲,將左臂托回原位63Please respect copyright.PENANAcAVX1gFkKM
63Please respect copyright.PENANATDY2L3Foox
"DR.劉,可唔可以幫我,輝SIR生前咁落力救人,唔好要佢殘廢咁走..."63Please respect copyright.PENANAMi2stWSohG
63Please respect copyright.PENANAUj3EPAySgd
"好..."63Please respect copyright.PENANAt1K293Gu1D
63Please respect copyright.PENANAwqiA0vD2Hg
DR.劉與ANNIE正步向手術床下方時63Please respect copyright.PENANA7yTALGuvCI
63Please respect copyright.PENANAsheP72vStm
63Please respect copyright.PENANAR17ENwCeWf
"噗通"....輝SIR的心臟微弱的跳了一下,脈搏儀顯示波紋,亦同時重燃了各人希望63Please respect copyright.PENANAXNOorYDTYR
63Please respect copyright.PENANAOeOSUA5taR
" IV DOPAMINE 3ug,繼續心臟按摩..輝SIR,你唔放棄自己,我地都唔會放棄你!!" DR楊忘了痠痛,再次以右手擠壓輝SIR心臟,務求將輝SIR由鬼門關拉回來63Please respect copyright.PENANAdE0GMajBKG
63Please respect copyright.PENANAlxRbN1BUOz
"通知NeuroICU準備好CRITICOOL,然後送入來.." DR.洛評估情況後作出以上指示63Please respect copyright.PENANACSe6I4rjOk
63Please respect copyright.PENANAnBeqmJstsk
腎上腺素(ADRENALINE)舊稱「副腎上腺素」,一般作用是使心臟收縮力上升;心臟、肝、和筋骨的血管擴張和皮膚、粘膜的血管縮小。在藥物上,腎上腺素在心臟停止時用來刺激心臟,或是哮喘時擴張氣管。63Please respect copyright.PENANA4NufZmjER6
63Please respect copyright.PENANAi3whcsbgdV
腎上腺素能使心肌收縮力加強、興奮性增高,傳導加速,心輸出量增多。對全身各部分血管的作用,不僅有作為強弱的不同,而且還有收縮或舒張的不同。對皮膚、粘膜和內臟(如腎臟)的血管呈現收縮作用;對冠狀動脈和骨骼肌血管呈現擴張作用等。由於它能直接運用於冠狀血管引起血管擴張,改善心臟供血,因此是一種效用快而強的強心藥。腎上腺素還可鬆弛支氣管平滑肌及解除支氣管平滑肌痙攣。利用其興奮心臟收縮血管及鬆弛支氣管平滑肌等作用,可以緩解心跳微弱、血壓下降、呼吸困難等症状。63Please respect copyright.PENANAfehDajs8JU
63Please respect copyright.PENANAOLrms8BCrK
多巴胺(Dopamine)為體內合成去甲腎上腺素的前體,具有β受體激動作用,也有一定的受體激動作用。能增強心肌收縮力,增加排血量,加快心率作用較輕微(不如異丙腎上腺素明顯);對周圍血管有輕度收縮作用,升高動脈壓,對內臟血管(腎、腸系膜、冠狀動脈)則使之擴張,增加血流量;使腎血流量及腎小球濾過率均增加,從而促使尿量及鈉排泄量增多。用於各種類型休克,包括中毒性休克1JLl源性休克、出血性休克、中樞性休克、特別對伴有腎功能不全、心排出量降低、周圍血管阻力增高而已補足血容量的病人更有意義。DARPP-32基因有三種變體:TT TC CC ,這些變體決定大腦中多巴胺的水平。 63Please respect copyright.PENANAG621sVzC2W
63Please respect copyright.PENANAlHmPT5fFrU
自1960年Kouwenhoven等報告胸外心臟擠壓有效以來,已很少再用開胸擠壓心臟,開胸擠壓心臟需經訓練和有開胸經驗者行之。目前主張僅由外科醫生在手術室內應用。胸腔打開后呼吸支持是很重要的。63Please respect copyright.PENANAl1EsUiZ9j5
一經發現心音、脈搏、血壓消失或呼吸停止后,應立即進行心臟按摩,不應反復尋找原因或注射藥物以免延誤時間。在消毒操作及胸部切口的同時,應準備好氣管內插管以進行控制呼吸。開胸心臟按壓術(open cardiac massage),可更直接有效地按壓心臟,同時在直視下行心腔內注射藥物,其療效確切可靠,尤其在外傷等情況下。63Please respect copyright.PENANAgyXfKswsGA
63Please respect copyright.PENANATSUQEN6kE8
注意事項63Please respect copyright.PENANALmnoZh3sdJ
63Please respect copyright.PENANABx98RTODcI
1.心臟按摩的成敗關鍵在于按摩是否及時、有效,心搏驟停的原因能否及時消除,故決定手術及剖胸要快,按摩方法要正確。63Please respect copyright.PENANAEHvbOaR9o7
63Please respect copyright.PENANA7yuOpsNSZ6
2.有病變的心臟按摩更要小心,不要用手指尖與手掌相擠壓,以免擠破心臟。63Please respect copyright.PENANAW9K2NoP3Np
63Please respect copyright.PENANAsNmyvb7YLz
3.按摩時,應力求不過分牽動心臟,以免心臟移位過大,影響腔靜脈回流。63Please respect copyright.PENANAs6qWC33dTp
63Please respect copyright.PENANAd95bkBFUpl
4.開胸心臟擠壓需要特殊器械,併發症包括:感染、心肺外傷。由受過訓練的人員可立即進行有效的胸外擠壓,故開胸心臟擠壓的實用價值有限。63Please respect copyright.PENANAhbUGZS2fpZ
63Please respect copyright.PENANAyc2B62KyMS
5.多數情況下,如在適當藥物治療和人工呼吸的輔助下,有效地施行胸外心臟擠壓仍無效,再開胸心臟擠壓亦不會成功。因此胸外心臟擠壓失敗不應認為是開胸擠壓的適應證。在任何情況下胸外心臟擠壓總是首選并應立即施行。63Please respect copyright.PENANAtHaxjX3Nyw
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拯救生命時,可否同時拯救愛情?
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拯救生命時,可否同時拯救愛情?
作者:
Haro葉郎
篇 #14
CASE 14
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