Doctor's Life Simulator

Chapter 183 Level [-] Surgery, Partial Pancreatectomy (Subscribe)

Director Pang asked: "However, this 120 ambulance has just been delivered to the first hospital of the city. Where did you get the time to complete the paracentesis?"

Director Zhuang also couldn't understand Director Pang's incomprehension.

The person involved, Dr. Liu is still in a daze until now, so he reported to the two directors in detail:
"The situation is like this. Dr. Qin and I followed the car to the scene. Before landing on the island, Dr. Qin temporarily assembled a set of simple abdominal puncture kits from the first aid supplies. After we landed on the island, the patient The situation is very critical, so Dr. Qin suggested performing a paracentesis to identify the specific type of acute abdomen."

While Dr. Liu was explaining, Director Lin of the General Surgery also hurried over. Seeing Director Zhuang and the others, he asked directly:
"Director Zhuang, what's the situation now? Didn't you say that we will go together to identify the ascites and do color Doppler ultrasound for the patient?"

Director Zhuang explained again, and Director Lin couldn't believe it:
"You mean, you only completed the preliminary identification with a set of temporary paracentesis equipment?"

Doctor Liu made a point, then summed up Qin Lang's previous judgment:
"Based on the patient's dark red turbid peritoneal fluid, as well as the lack of stench and feces, Dr. Qin has locked on hemorrhagic necrotizing pancreatitis in every possible way. That is, let me contact Director Pang as soon as possible, and inform me To Director Zhuang. As soon as he entered the hospital, he sent the peritoneal effusion for examination, and I arranged for the patient to undergo CT examination."

"According to the nature, color, clarity, and smell of the ascites, combined with the patient's signs, this possibility is really very high."

After a little analysis, Director Lin came to the same conclusion as Qin Lang, but if he followed the car at the scene at that time, he might not have been as decisive as Qin Lang.

"This kid is really courageous. In such a temporary situation, he can still think of passing the items on the ambulance in advance to complete a paracentesis. This greatly reduces the time for us to diagnose the disease and provides early treatment for patients. , bought a lot of precious time..."

Director Zhuang also admired him in his heart, this Qin Lang is really a good material to be an emergency doctor.

At such a critical juncture, it takes a lot of talent to be alert and have such solid basic skills, and to be able to distinguish the appearance and smell of peritoneal fluid so carefully.

At the same time, we can arrange the gold standard CT diagnosis in the first time, which is really amazing!

Dr. Liu also added: "Actually, when Dr. Qin was on duty last time, he hadn't mastered abdominal cavity puncture. It was the first lesson I taught him. After returning, he mastered abdominal cavity through self-study and watching videos. The essence of piercing."

"No way?"

Hearing what Dr. Liu said, several directors were stunned. If so, Qin Lang's learning ability is too terrifying.

However, this can also explain why in this case, he can remember the appearance, smell and corresponding symptoms of so many peritoneal effusions.

Obviously, after observing Dr. Liu's operation, I went back to supplement the knowledge systematically. These contents are still fresh, so I was able to blossom and bear fruit when I happened to meet this patient.

"I can only say that Dr. Qin is very courageous, daring to take responsibility, and able to flexibly use the knowledge he has learned. He is a good seed."

Director Lin praised, and said to Director Zhuang and others:

"Then let's go see the patient now and analyze the results of the CT test."

Director Zhuang nodded, feeling much more at ease in his heart. After all, Qin Lang's operation had given them enough time to deal with it calmly.

Soon, Director Zhuang and others joined the doctors of the imaging department.

CT examination is a relatively advanced medical imaging examination technology. It scans a certain part of the human body at a certain thickness through X-ray beams, and then processes and analyzes the scanned information, converts it into an image, and can observe the scan more intuitively. Part information.

After Dr. Lu from the Radiology Department finished the film, he gave the film to the experienced Director Lin.

Director Lin took it over and looked at it, and his face became serious:

"Director Zhuang, Director Pang, look, there are patchy shadows and low-density spots in this area of ​​the patient, and it can be seen from this that the pancreatic bleeding can basically confirm that the patient is acute hemorrhagic necrotizing pancreatitis."

At this time, Qin Lang also rushed from the laboratory department to the imaging department. When he saw Director Zhuang, Director Pang and the others had already checked the CT results again, so they felt relieved.

"Director Zhuang, Director Pang, Director Lin, the patient's ascites has been detected."

After Qin Lang submitted the test results to Director Lin, Director Lin confirmed the patient's illness after comprehensively analyzing the various signs and the most critical CT test results: "Now that the illness has been confirmed, the next step is to carry out the treatment plan." design."

[Congratulations to the host for completing the task. Through the ability to identify the paracentesis fluid, he can diagnose the patient's illness so that he can perform surgical treatment as soon as possible after being admitted to the hospital.Rewards obtained: 1.1 life simulation points, 2. sense of smell +1]

"Qin Lang, Dr. Liu, thank you for your hard work. Thank you for allowing enough treatment time for us, and we will leave it to us. After a while, you two will learn together with us. For the treatment of acute hemorrhagic pancreatitis Surgical treatment."

Director Zhuang thanked Qin Lang and Dr. Liu very solemnly, and immediately went to arrange surgery with Director Lin.

Acute hemorrhagic necrotizing pancreatitis is not uncommon in clinical surgery, accounting for about 20% of pancreatitis. Generally speaking, the cause of death is due to missed diagnosis, misdiagnosis, and delay in the early stage.As long as the cause is determined as soon as possible and the right medicine is prescribed, there is still a very high hope of saving the patient's life.

Director Zhuang and Director Lin, while preparing for the operation, discussed:
"Pancreatic necrosis is an irreversible pathological change. The necrotic tissue is difficult to absorb. Toxic substances and vasoactive kinins, elastase and phospholipase A2, etc., form a toxic culture base in and around the pancreas. Therefore, its removal is the treatment. The theoretical basis of surgical treatment and lavage treatment of this disease"

"The purpose of the operation is to remove completely necrotic tissue, fully and effectively drain the pancreatic enzyme-rich exudate through early and thorough incision and decompression of the pancreatic capsule, so as to improve the blood supply of the pancreas and prevent the spread of pancreatic necrosis and inflammation. .”

The two quickly reached a consensus and formulated a surgical plan:

The omental sac is fully opened, the pancreatic capsule is fully incised, the pancreas is dissociated, necrotic tissue is removed, the pancreatic bed is drained by 3-4 tubes, and the postoperative pancreatic bed is lavaged.

Because of Qin Lang's decisive response, Director Lin, Director Zhuang and others started the operation very calmly. As for Qin Lang and Dr. Liu, of course they could only watch from the sidelines.

After all, incision and drainage of the pancreas is already a third-level operation. If the situation is found to be serious during the intraoperative observation, partial pancreatectomy is a fourth-level operation.

It is far from comparable to a first-level operation like appendectomy!
Although Qin Lang is now showing super talent in basic surgical skills, after all, he is only the chief surgeon performing first- and second-level minor surgeries in the presence of superior doctors.It's still early for this kind of third- and fourth-level surgery!

This is also the charm of medicine. There are too many departments and too many diseases. In modern medicine, basically one field is enough for a top doctor. If you want to make achievements in several fields, That's basically impossible.

Therefore, there are specializations in surgery, and Qin Lang has made some achievements in the field of burns, but in the field of general surgery, there is still much to learn.

Qin Lang's mentality was also very good, so he and Dr. Liu watched it with relish.

Director Lin is the head of the general surgery department of the city's No. [-] hospital, and his strength is beyond doubt. He and Director Zhuang started the operation.

First of all, they chose the surgical route, and soon, Director Lin determined the transabdominal route.

The incision was made in the middle of the upper abdomen, and I chose to incision. The one-handed incision technique already has Qin Lang's [-]-[-] success.

"Amazing."

Qin Lang also observed carefully, and soon Director Lin opened the lesser omentum cyst and retroperitoneum, and entered all areas of pancreatic necrosis and fluid accumulation.

As expected of Director Lin, since the pancreatic necrosis and exudate accumulated in the lesser omentum capsule, in order to reach all areas of pancreatic necrosis and fluid accumulation, he used a combination of several approaches, first freeing the hepatic flexure of the colon and the splenic flexure to enter the peritoneum , and the Kocher incision was used when freeing the rear of the pancreatic head.

Both Qin Lang and Dr. Liu appreciated it seriously.

"Doctor Qin, how long do you think it will take us to learn these techniques? I really want to be the chief surgeon."

Qin Lang said casually: "If you study for a lifetime, you should be fine."

Dr. Liu was taken aback. Is this Dr. Qin in such a good mood?
Then, feeling ashamed, Dr. Qin's talent can be used well to learn a technique for a lifetime, and he dared to hope that he could master it in a few years.

It seems that I also want to learn from Dr. Qin, not to be impatient.

PS: Thank you Scarlet Hummer for the reward of 500 coins, thank you big brother~
(End of this chapter)