274 Facial gunshot wounds

The subway station suddenly became busy.

Several policemen and several armed policemen immediately flew towards the criminals and hostages, and soon someone shouted: "Hostage is safe, the criminals were shot dead!"

The hostages were only able to come back to their senses and understand what was going on. Of course, she noticed the criminal who had been beaten with a hole beside her and screamed in fear. The police hurriedly pulled her away while evacuating and comforting her.

But all the chaotic and noisy in Su Yang's world were automatically filtered. At this moment, there was only the wounded person in his eyes.

He took two steps at once and soon ran to the injured.

The injured person's condition was very dangerous, so Su Yang had no time to conduct a careful examination and manual diagnosis, so he directly started the system diagnosis.

bite--

The injured person, female, 38     year-old, had a gunshot wound to the right jaw.

Ten minutes ago, he was hit in the jaw with a standard pistol with a close distance.

The patient was in a coma, had difficulty breathing, and had a lot of bleeding in the mouth.

Examination: acute illness, trance, irritability, pale face, p    120                                                                                                                                                                         

2    cm    ×     2                                                                                                                                                                                                                                                

Laboratory examination: hb    58    g   /l,hct    20%. Diagnosis: puncture injury of right mandibular, left upper maxilla, facial gun; medicated fracture of maxillary bone and mandibular bone with bone defect; partial tongue defect, hemorrhagic shock; obstructive asphyxiation.

Seeing the systematic diagnosis, Su Yang immediately formulated a first aid plan:

Emergency intubation of the tracheal catheter with airbag, filling the oral cavity with hemostasis, and quickly input balance fluid!

He had just finished the examination and two doctors rushed over, and the two doctors were carrying stretchers.

Both doctors are doctors in the emergency department of the military district hospital, one is the hospitalization officer, and the other is the resident doctor. They are colleagues with Su Yang, and the relationship between the three of them is pretty good.

"Su Yang, what's the situation?" the two of them asked while squatting down and opening the stretcher.

Su Yang hurriedly told the situation. Of course, he only mentioned the gunshot injury and first aid plan. He did not disclose a single word about the laboratory examination data that the system diagnosis notified him, and he did not say a single word.

When both doctors heard this, they were shocked.

The first reason why I was scared was that Su Yang's diagnosis was too detailed and too fast. If they came to check, they could at most see where the patient was injured by a bullet. However, Su Yang had already diagnosed so many things, which was too powerful and terrible!

The other one, the two were shocked by the patient's injuries.

There are very few gunshot wound patients, which are very rare, but most gunshot wound patients are shot in the chest or abdomen. Like this patient at this moment, there are very few, and they have never seen it. In fact, let alone see it, I have never even heard of it.

The mouth, nose, throat, head, neck, and maxillofacial parts are located at the upper end of the respiratory tract, which is the exposed part of the human body. They are prone to gunshot wounds during wartime and are rare in clinical practice during peacetime. Once encountered, the injury is often very serious, disability and a high mortality rate.

How to treat it in time is particularly important!

So, after hearing about the injured, the two of them were stunned and didn't know what to do!

But in sharp contrast to them, Su Yang was very calm.

After he and the two doctors lifted the injured person onto a stretcher, they grabbed the second when the two doctors were adjusting their posture and quickly entered the system space.

"Open the training room!" He ordered the system.

The patient's condition is quite complicated. To be honest, he can't guarantee that he will definitely be able to save the patient, so he must first have some experiments.

The training room will open soon.

Su Yang first formulated a treatment plan for the patients.

The first step for this kind of patient is to relieve respiratory obstruction. The mouth, throat, head, neck, and maxillofacial are the upper end of the respiratory tract, causing bleeding and tissue displacement after gunshot injury. High-energy bullets can produce instantaneous cavity effect, causing shock injuries to the tissue in the injured area to varying degrees. After injury, tissue swelling will cause tissue swelling, and a large amount of bleeding can also be stored in the cavity, causing tissue displacement to compress the respiratory tract and causing respiratory obstruction.

The main symptoms of patients are dyspnea, cyanosis, and decreased blood oxygen saturation.

First, a respiratory channel should be established immediately, and tracheal intubation or emergency tracheotomy can be used.

A catheter with an airbag should be used in the established passage to prevent blood and secretions from flowing into the airway, causing inhalation asphyxiation.

The second step is to stop hemostatic and actively anti-shock treatment.

Gunshots of the mouth, throat, head, neck, and maxillofacial areas can easily lead to acute blood loss. Timely hemostasis and replenishing blood volume are the primary tasks in treating hemorrhagic shock. For active major bleeding, surgery should be performed as soon as possible to stop bleeding. The source of the bleeding should be found. If necessary, ligate the external carotid artery and internal jugular vein. However, if there is any damage to the common carotid artery and internal carotid artery, it should be anastomotic and repaired; in the case of diffuse and large bleeding and difficulty in stopping bleeding, tamponade can be used to stop bleeding.

Then there is the third step: early debridement and foreign matter removal.

Because the throat, mouth, head, neck, and maxillofacial blood supply is abundant, and the tissue has strong anti-infection and healing ability, it is not advisable to easily remove tissue that may survive.

Close the oral and pharyngeal mucosa layer tightly, and those who have broken nerves and gland ducts found during debridement should be as close as possible; the free small bone fragments, broken teeth, and metal foreign bodies in the ballistic and tissue should be removed, and the larger bone blocks above 1                                                                                                                                                                                                                         

The last step is to fight infection.

Based on the above treatment principles, Su Yang immediately formulated an emergency rescue plan: emergency intubation of the tracheal catheter with a balloon, filling the oral cavity with hemostasis, and rapid input of balance fluid 2500 ml, red blood cell suspension 600 ml. After the condition is stable, the upper and lower mandible bones were tested and then debridement and suture were performed. The left mandible fracture was strongly fixed with small titanium plate titanium nails to restore the occlusal relationship; the left maxillary sinus open fracture was accompanied by bone defects, and the palate flap was repaired.

Preventive tracheostomy.

After some hard rescue, the experimental subject recovered well.

The rescue effect is perfect.

The patient's wound healed after surgery, and denture repaired tooth defects after 3 months.

Satisfied appearance.

At this point, the injured were treated successfully.

If the full score is 100, Su Yang's treatment can score more than 95 points.
Chapter completed!