Doctor's Life Simulator

Chapter 174 The first appendectomy!

After being diagnosed with gonococcal peritonitis, although he had been mentally prepared for it, Dr. Liu still had some mood swings when the cause was really clarified.

"However, although I am not as talented as Dr. Qin, I still have at least several years of clinical experience. I have seen it, I know it, and I am still far superior to Qin Lang."

Doctor Liu comforted himself with a few words, and went to treat the patient.Now that it is clear that it is gonococcal peritonitis, the most important thing is anti-infection treatment.

Therefore, Dr. Liu sucked out the pus, fully flushed the abdominal and pelvic cavity, placed a drainage tube, and performed anti-infection treatment after the operation.

The whole process was very fast. After the completion, I went to the duty room for a rest, and Dr. Liu returned to the consultation room again.

24 hours on duty, the time is short and short, and the time is long is also very long.

When it was almost four o'clock in the morning, another patient was sent to the emergency department.

It was a patient transferred from a community hospital, so Dr. Liu naturally stepped forward to check on the situation.

The patient was a 30-year-old woman who complained of right lower quadrant pain for 2 days.

It was a woman again, and it was pain in the lower right abdomen. This time, Dr. Liu raised his spirits, asked more detailed questions, did a physical examination, percussion, and finally gave his diagnosis:
"T38℃, P83 times/min, R20 times/min, BP101/63mmHg.

Obvious abdominal muscle tension, obvious tenderness and rebound tenderness in the right lower quadrant, no liver and spleen under the ribs, no mass in the abdomen, no percussion pain in the liver and kidney area, hydropneumoperitoneum sign (-), Rovesin's sign (+), Psoas test (+), obturator test (-).

WBC13.7×109/L, N85.6%.

Diagnosis: appendicitis.

Treatment: Appendectomy! "

After deciding to perform appendectomy, Dr. Liu remembered Director Zhuang's instructions before he left. After all, appendectomy is the most common and relatively simple minor operation in the emergency department, and it is only a first-level operation in classification.

So, Dr. Liu thought for a while and asked, "Qin Lang, can you perform appendectomy?"

[Ding, new task, complete the first appendectomy in life, task rewards: 1. Diagnostic paracentesis: master level. (According to the nature, color, clarity, smell, etc. of the peritoneal fluid, the etiology can be clearly diagnosed and the treatment plan can be determined.)]

Qin Lang rewarded appendectomy when he published the paper for the first time before. Now that he has started, he naturally clicked:

"Yes, Doctor Liu."

"Okay, then come with me to operate on the patient. This time, you will be the chief surgeon. I will check it out for you."

Dr. Liu is also planning to take this opportunity to get a comprehensive understanding of Qin Lang's level and basic surgical skills.

After all, the biggest difficulty in appendicectomy is to find the appendix, which is not a problem with him.For the rest, incision, dissociation, and suture, the test is the basic surgical skills.

In Director Zhuang's words, it seems that Qin Lang's basic surgical skills are highly praised, but after all, he is so young, so Dr. Liu also wants to take a good look at the amazing basic surgical skills that Director Zhuang said.

Is it, exaggerating?
Since the patient had been in pain for 2 days and her condition was relatively severe, she was given fluids before the operation to correct the disturbance of water and electrolyte balance.

Before Qin Lang and Dr. Liu entered the operating room, the instrument nurse, itinerant nurse and anesthetist had already arrived in the operating room.

Chu Fei, the anesthetist for this operation, felt a little drowsy when he cooperated with the anesthesia during this period of time.

With great effort, after giving the patient anesthesia meticulously and conscientiously, he retreated to a corner and sat on a small bench to wait.

It is said that the chief surgeon of this operation is a new rookie in the emergency department, so Chu Fei is going to take a good look at it for a while. It has been a long time since I have seen a newcomer remove his appendix. I don’t know what he will be scolded for. The embarrassment of being on duty can be regarded as a little adjustment during the shift.

"I hope he will be more resistant to pressure and have a stronger psychological quality, so that he can at least persevere."

After all, Chu Fei has seen too many little doctors. It was the first time that the appendix was operated on. During the operation, either the appendix could not be found, or the dissociation was not complete, and even more outrageous, it was not completely removed, and the mesangial blood vessels were damaged. There are also crooked stitches at the end, and the hips are stretched endlessly.

Generally speaking, appendectomy is the first severe beating that rookies must experience on their growth path.

Soon, Dr. Liu led Qin Lang into the operating room.

For the two of them, Qin Lang stood at the chief surgeon's position, while Dr. Liu watched from the side.

For the incision of the operation, the most classic Maxwellian incision was chosen.

Although Qin Lang performed appendectomy for the first time, he was not considered a newcomer in the operating room. A person who was able to create the Qin method, free flap transplantation, and proficient in various incisions and sutures was naturally not at all afraid.

".Scalpel"

Qin Lang gave the order, and after getting the scalpel, he began the first step of incision of the skin, subcutaneous tissue, and external oblique aponeurosis.

The silver light flashed, flowing like clouds and flowing water!
"This"

In the corner of the operating room, Chu Fei, who was eating melons on the bench, almost stared out:
"Is this really the first appendectomy? The level of the incision is amazing."

Liu Peichun was also a little surprised, and then realized that what Director Zhuang said was true, and Qin Lang's basic surgical skills were indeed unique.

In the next step, Qin Lang has begun blunt separation, and with the assistance of Dr. Liu, stretched the internal oblique and transverse abdominis muscles.

Qin Lang carefully lifted and cut the peritoneum.

Liu Peichun was just about to remind him to avoid contaminating the incision with intraperitoneal exudate, but Qin Lang quickly lifted the peritoneum and fixed it on the skin, completing the protection of the incision.

"This kid, consciousness is fine."

Dr. Liu applauded slightly, it seems that he didn't watch the surgery video less before, otherwise he wouldn't be so proficient.

After completing this step, Qin Lang also carefully collected the peritoneal exudate for subsequent bacterial culture and drug susceptibility testing.

Next, it is the most critical time to find the appendix, and it is also a novice, flustered and embarrassed moment.

Chu Fei sat on the small bench and began to observe with a full face.

Dr. Liu was also watching all the time, and was going to leave Qin Lang alone to try it out first, and if he couldn't find it, he would remind him.

Qin Lang also began to search. According to the conventional method, first search for the ascending colon and follow the colon to the ileocecal area. The root of the appendix is ​​where the three colon bands converge.

However, Qin Lang found nothing after searching like this.

"what's the situation?"

Qin Lang was shocked.

Physician Liu on the side also frowned. Sure enough, novices will always have a lot of problems when they are looking for the appendix. Physician Liu raised his spirits and calmly guided:

"Qin Lang, if you have difficulty finding the appendix, you should distinguish it from the transverse colon connected with the greater omentum and the sigmoid colon with a longer mesentery and a narrower base of fat pendulum, and then look for it along the colonic band at the end of the cecum to its confluence. , you can find the appendix."

Qin Lang nodded, and followed Dr. Liu's method, but after a search, he still found nothing.

"No? Not yet?"

All of a sudden, Dr. Liu, who was still calm at first, also changed his complexion, and a bad thought came to his mind. Could it be that he encountered a rare ectopic appendix?

There was a little sweat on his forehead, this can't be such bad luck, he wanted to take Qin Lang to fly, but he broke his wings before it even started.

"calm down."

Dr. Liu muttered silently in his heart for a few times, and then it emerged that Director Zhuang's experience and skills when he was checking him out.

Dr. Liu imitated Director Zhuang's calm posture and kept his tone steady:

"Qin Lang, clinically, ectopic appendix is ​​not uncommon. It is generally high (under the liver), low (in the pelvis), left, extraperitoneal, and subserosal."

Dr. Liu directed Qin Lang to search everywhere according to the formula, but he still found nothing, and his tone became anxious: "Qin Lang, how is it? Did you find it?"

Qin Lang followed Dr. Liu's instructions and went around, but found nothing.

"still none."

The anesthesiologist Chu Fei also stood up from the stool nervously, this, no way, generally speaking, the ectopic appendix can be found no matter what.

"Are you going to ask the second-line deputy director Pang to come to the rescue?"

Dr. Liu was a little dazed when an appendix operation was done like this, how unlucky and embarrassing it was?
Qin Lang on the side is also a little depressed. This is the first appendix operation in his life, but he must complete it by himself:

[Consume 1 life simulation point to start the simulation! 】

(End of this chapter)