Doctor's Life Simulator

Chapter 333 Shocking Professor Yang and New Reward: Electrocardiogram Diagnosis (addition for the random dangerous boss)

Qin Lang began to make a careful diagnosis. Under the series of master-level ventricular corrective surgery, ideas appeared in his mind, and soon a preliminary plan appeared:

Patient: Xia Dongpeng, male, 53 years old

Symptoms: Double outlet right ventricle (DORV) with complete atrioventricular septal defect (AVSD)
Treatment plan: use the optimized and improved national first double ventricle correction surgery for patients in the simulated world.

It's just that some details still need to be adapted during the operation.

[Ding, new task: Create a new surgical procedure in front of the senior expert Professor Yang, and successfully operate on the patient.Task reward: 1.1 life simulation points. 2. Electrocardiogram diagnostic technology: entry level]

Seeing this award, Qin Lang was also quite happy. Electrocardiogram diagnosis is a very useful diagnostic tool, especially for cardiovascular diseases. With this, he will become more and more versatile.

While Qin Lang was constructing a brand-new biventricular corrective surgery in his mind, Professor Yang's cell phone rang suddenly.

Professor Yang took out his mobile phone and saw that it was his attending physician. Generally speaking, the attending physician would not call him unless there were some special circumstances.

Professor Yang greeted Director Huang, and then walked to the corridor outside the ward with his mobile phone.

As soon as the phone was connected, I heard the attending physician anxiously asking for advice in the microphone:

"Professor Yang, just now the department sent a somewhat complicated patient with a very rare corrected transposition of the great arteries. I just had a preliminary consultation with Director Ling. After we discussed this disease, we couldn't come up with a solution. The perfect solution is to preliminarily decide on single ventricle correction surgery, but single ventricle correction surgery is difficult to operate, and the other is that even after the operation is completed, because the patient has lost the right ventricle that supports the pulmonary circulation, the pattern of the circulatory system is similar to low The circulation characteristics of the crawling arteries, etc., the short-term and long-term complications after surgery are unpredictable, and the heart function and quality of life are not satisfactory. Therefore, we would like to ask for your opinion whether it is surgery or simply insist on Conservative treatment."

After listening to Professor Yang, he took a deep breath. He is quite experienced in this kind of cases. After thinking about it, Professor Yang replied:

"Although single ventricle correction is difficult and the later complications are unpredictable, relatively speaking, the average life expectancy and quality of life of patients after surgery are still higher than those of conservative treatment."

"So, I suggest single ventricle correction. Director Ling will be the chief surgeon, and he can handle it with his level. Where is Director Ling?"

"Oh, Director Ling told me to contact you first. He is going to post a post on the medical forum to ask for advice. At the same time, he will also search to see if there are similar cases and see how his peers handle it."

The attending physician honestly reported that there are still a lot of dry goods under the Internet, medical forums, especially among the younger generation of doctors, especially rare cases like this one, it is very common to share them.

Of course, an old expert like Professor Yang is relatively more traditional. In addition, he is already a master in the field. If less than 1% of the forums are better than him and have more experience, they will not be wasted. Time to watch the little dolls mess around.

"Okay, then you can pass on my opinion and perform surgery as soon as possible. Don't look at those messy things on the forum."

After listening to Professor Yang's words, the attending physician on the opposite side agreed: "Okay, Professor Yang, then I will go and pass your opinion to Director Ling now."

After Professor Yang hung up the phone, he walked into the ward and continued to wait for Qin Lang's diagnosis.

"How about it, Doctor Qin, can you complete the operation?"

Director Huang asked expectantly. The patient's daughter and son also stretched their necks and looked at Qin Lang nervously.

"no problem."

Qin Lang directly gave an affirmative reply, but was about to say that he had a better plan when Director Huang interrupted him.

"Professor Yang, since Qin Lang can perform the operation, let's go to the consultation room, and you will explain the details and attention points of the operation to Dr. Qin, and we will start the operation as soon as possible."

Director Huang led the way directly, Professor Yang thought about it, and then followed.

As he walked, he asked, "Doctor Qin, how many cases of body-to-pulmonary shunt have you performed before?"

Wang Xiaoying was also very curious to see that a young doctor who is not much older than her can have such a profound accumulation, and the body-to-lung shunt is not an ordinary operation.

"No."

Qin Lang was thinking about how to put forward his biventricular correction surgery plan concisely and concisely, so he answered casually and fell into his own thinking.

Seeing Qin Lang's perfunctory attitude and lack of answer, Professor Yang was shocked.

He even felt a little incomprehensible, it's okay for young people to be ignorant, but why Director Huang and Deputy Director Qian are also messing around with him.

Moreover, Qin Lang's attitude made him even more annoyed, even if the young man had something special, he shouldn't be so arrogant and rude.

However, after all, it was in someone else's hospital, Professor Yang controlled his dissatisfaction, but his tone was a bit cold:
"Director Huang, are you kidding me? How dare you let him go to the operating table without a body-pulmonary bypass operation?"

Director Huang and Deputy Director Qian took it for granted when Qin Lang said that he had never done it before. Director Huang explained directly:
"Professor Yang, maybe you don't know that Dr. Qin's surgical talent is amazing. He only needs to read the general surgery once. Moreover, Dr. Qin's only a few surgeries in our department are unique. Many formulas have been completed. Therefore, we cannot treat it with common sense."

Professor Yang looked at Director Huang again, and the latter gave him a positive nod. Professor Yang almost shut himself up.

When will surgery not require repeated practice and accumulation, and it will be enough to read it once?

Wang Xiaoying also looked at Qin Lang suspiciously, but the latter still seemed immersed in his own world.

Could this be a genius way of doing things that is different from ordinary people?

At such a time, shouldn't one concentrate on listening to Professor Yang's question, and then deal with it as if walking on thin ice.

In Wang Xiaoying's opinion, it is a once-in-a-lifetime opportunity to get the guidance of Professor Yang, a senior expert in the 301 PLA Hospital. I don't know how many young doctors can't ask for this opportunity.

Do you think you are an old expert with decades of skill?
After all, Professor Yang is a guest, so he endured his anger and entered the consultation room, and then began to explain his operation design carefully:
"The whole operation adopts tracheal intubation and intravenous anesthesia, and the operation is performed through a median sternotomy at room temperature. Due to the development of the pulmonary arteries on both sides of the patient, I recommend the modified Waterson operation, that is, artificial blood vessels are inserted between the subclavian artery and the pulmonary artery. An end-to-side anastomosis between the aorta and the pulmonary artery was performed."

Although Professor Yang has some doubts about Qin Lang's attitude and level, it does not hinder his professional analysis. After all, he is very rigorous and responsible for surgery.

"Because of the patient's age, body weight, and pulmonary vascular development, I suggest choosing an artificial shunt tube with a diameter of less than 4 mm. When intraoperative oxygenation is poor, cardiopulmonary bypass should be established in time, and at the same time, it should be done well, and the pulmonary artery and its branches should be observed during the operation. Development."

While Professor Yang was seriously analyzing, Qin Lang also picked up a piece of paper beside him, and began to deduce and structure his diagram of the procedure of biventricular correction.

With all his attention, it wasn't that Qin Lang deliberately didn't give Professor Yang face, but was completely immersed in the design of the technique, drawing diagrams stroke by stroke, and smiling with satisfaction from time to time.

Because Professor Yang was separated by the long conference table, he didn't see the content of Qin Gallery's painting, and thought he was taking notes seriously, so he was finally comforted a little, but it was not hopeless.

However, I am still not very confident about the results of the surgery.

Professor Yang explained carefully, especially the details that he thought young doctors might overlook.

Director Huang and Deputy Director Qian also listened carefully, confirming their experience with each other, and kept nodding. I have to say that Professor Yang is indeed an authoritative expert in this field, and he has put a lot of effort into it.

Wang Xiaoying listened with admiration, holding a notebook to record, looked at the other side, also fell into hard thinking, kept taking notes, occasionally Qin Lang, who was in a state of enlightenment, was very proud, and now knew what Professor Yang said. Great!

Professor Yang is also very satisfied with the serious listening attitude of several people:

"Because the patient's shunt tube diameter is < 4mm, high hematocrit, extracorporeal circulation surgery, and postoperative platelet application, it is very easy to cause tube embolism after surgery, which is especially important"

"In addition, based on my personal clinical experience, special attention should be paid to changes in blood oxygen saturation after surgery. Once blood oxygen saturation is found to drop significantly and the continuous murmur disappears in the right or left second intercostal space on auscultation, first consider artificial vascular occlusion. Or distorted, the artificial blood vessel needs to be replaced immediately. For anticoagulation after shunt, my experience is to give low molecular weight heparin or aspirin early, which can not only reduce the complications of postoperative bleeding, but also effectively prevent early thrombosis.”

"Yes, what Professor Yang said is very good."

Director Huang couldn't help but admired it, and then looked at Qin Lang: "Qin Lang, do you remember?"

And Qin Lang just finished the last stroke, satisfied with his art diagram, raised his head, and answered casually in a trance: "Yes."

Professor Yang also finished his sharing, then looked at Qin Lang, and ordered again solemnly:

"My personal experience has basically been shared. As long as the difficulties I just mentioned are solved during the operation, the operation will be [-]% successful. If it cannot be done, I suggest giving up the operation. It is still too late. Dr. Qin, Do you have anything else to ask?"

Qin Lang is in the excitement of research and development of new surgical methods, and now wants to go to the operating room to practice, can't wait to get up, and directly replied:
"Okay, I'm ready, Director Huang, we'll start preoperative preparations right away."

Seeing that Qin Lang got up impatiently and was about to prepare for the operation, Director Huang also smiled at Professor Yang in embarrassment: "Young people are like this, full of drive."

Director Huang stopped Qin Lang seriously: "Qin Lang, please deduce it in detail again. If there is anything you don't understand about the whole operation, please bring it up now."

"No, I've already thought it through."

Qin Lang walked out of the consultation room directly, with a very confident tone, even a little bit sharp.

Looking at Qin Lang's back, Professor Yang opened his mouth slightly and shook his head. Young people nowadays really don't understand the rules.

"Then let's get ready, let's go to the operating room?"

Professor Yang would also like to see what such a proud young man can do with this operation.

Wang Xiaoying also looked at Qin Lang's back, her face was a little angry, when did Professor Yang belittled by such a young doctor.

"Let's see, why can't we treat it with common sense!"

Under the special instructions of Qin Lang, the cooperating personnel of all parties began to make preoperative preparations in an orderly manner.

Ten minutes later, Qin Lang, Director Huang, Professor Yang, and Deputy Director Qian also entered the operating room simultaneously.

Director Huang was very used to being Qin Lang's help.

"General anesthesia. Hypothermia to establish extracorporeal circulation-assisted ascending aorta, superior and inferior vena cava intubation to establish extracorporeal circulation."

After hearing Qin Lang's instructions, not only Director Huang, but also Professor Yang at the side was also stunned, and quickly reacted, Professor Yang directly reprimanded:

"Doctor Qin, what are you doing? Who asked you to perform extracorporeal circulation at low temperature? Did you listen to my previous operation plan?"

Regarding Professor Yang's doubts, under the aura of talent as the chief surgeon, Qin Lang was confident that everything in the operating room was under his leadership at the moment, and he said calmly:

"I don't want to follow your operation plan. Pulmonary artery bypass surgery is not the best solution, and there are many defects. What I am going to perform is my own modified double ventricle surgery."

"What did you say, biventricular surgery?"

Professor Yang was immediately fascinated. This young doctor was really not joking. He co-authored the explanation for a long time, but he didn't listen to anything, and now he changed the operation plan without authorization?

Qin Lang didn't pay any attention to Professor Yang. After all, he has experienced decades of experience in the simulated world. He is the only authority on this operation!
The patient's condition waits for no one!

Qin Lang directly started the next step.

"Medical Polyester Sheet Scissors"

Under Qin Lang's instruction, the equipment nurse followed up obediently, and after Qin Lang took over, he began to trim and patch.

Director Huang, Professor Yang, and other doctors trimmed the patch into a "comma shape" while they were puzzled.

While operating, Qin Lang revealed the principle of his operation and explained to everyone:

"I am now using the "two-piece method" to repair AVSD. The repair of ventricular septal defect (VSD) uses a medical polyester piece, cut it into a "comma shape" of the corresponding size, and repair it through the incision of the right atrium and right ventricle; part of the VSD is separated from the pulmonary valve. Closer, the entire infundibulum interval needs to be resected backwards and upwards.”

Qin Lang said while performing the operation quickly. Under the perfect level of incision and suture, the operation is extremely smooth.

Even though Professor Yang is still in a state of anger, he has to accept Qin Lang's operation.

This... is really amazing!

"Yizhu helped me repair atrial septal defect (ASD) with an autologous pericardial slice"

Qin Lang's instructions were very clear. Seeing Qin Lang's calmness, director Huang directly chose to trust 100% and cooperated very quickly.

"Suture Needle Holder. Microscope"

Qin Lang continued to start the next step, directly suturing the upper edge of the VSD patch, the common atrioventricular valve and the lower edge of the atrial septal defect patch together intermittently, and separated the coronary sinus in the right atrium when repairing ASD.

Seeing Qin Lang's textbook-level suturing skills and neat and clean suturing speed, Professor Yang has forgotten Qin Lang's rudeness and nonsense before, and stared at his operation steps with eyes closed.

After all, Professor Yang is a senior expert at the 301 People's Liberation Army Hospital. Seeing that the entire operation of Qin Lang has been deduced rapidly here, he soon understood Qin Lang's intentions, and unconsciously said:
"So it's so... What a clever idea, what a bold attempt!"

"Director Huang, always pay attention to the water injection of the left atrioventricular valve."

"okay!"

Director Huang immediately began to monitor the patient's vital signs and water injection.

Under Director Huang's precise report, Qin Lang quickly confirmed the formation of the left atrioventricular valve, and gave the next order:
"Routine suturing of the mitral valve cleft, and corresponding shaping of the right atrioventricular valve."

"understand!"

After all, Director Huang is an old Jianghu who has been working in the Department of Cardiovascular Medicine for decades. He understands Qin Lang's orders and cooperates very tacitly.

In the process of advancing the operation, Qin Lang's train of thought gradually became clearer, and several big bosses also saw the mystery, and the operation became more and more smooth.

"Scalpel"

With Director Huang's perfect cooperation, the operation process was faster than Qin Lang expected. He deserves to be the Chief Physician of the First Affiliated Hospital of Zijingang University!
Such a help is really comfortable!

Qin Lang began to deal with the patient's right ventricular outflow tract due to pulmonary stenosis.

Professor Yang on the side has also figured out the principle of Qin Lang's operation at this moment, and he is also very nervous and excited talking to himself:

"The next step is to remove the abnormally hypertrophic muscle bundles of the right ventricle, and then use an autologous pericardial slice to widen the right ventricular outflow tract."

Sure enough, in the next step, Qin Lang's operation is exactly the same as what Professor Yang said. Of course, Qin Lang's completion and speed are more perfect and faster than Professor Yang imagined.

"Genius, genius!"

Professor Yang has completely forgotten the previous doubts and dissatisfaction with Qin Lang.Now I just want to applaud Qin Lang's operation!
Such a genius, young and frivolous, proud of his talent, what's wrong?
Seeing Professor Yang's reaction, Deputy Director Qian also smiled slightly, looking at Qin Lang on the operating table, his eyes were full of surprise.

At this moment, he also understood that during the previous consultation, Qin Lang was absent-minded and had been thinking about his own operation plan.

It's just that this brat, who read the patient's information back and forth, designed such a complicated improved surgery while taking advantage of Professor Yang's consultation?
Deputy Director Qian suddenly felt that most of his life was really wasted.

At this moment, Professor Yang, watching the operation of Qin Lang on the operating table, is more nervous than his own operation. While watching, he mutters in his mouth:

"By expanding the ventricular communication, using a "comma-shaped" patch to construct a smooth left ventricular outflow tract, and accurately reconstructing the left and right atrioventricular valves, it ensures the smooth flow of the right ventricular outflow tract while avoiding damage to the conduction bundle. It is really a genius idea!"

Professor Yang has not seen such an exciting new technique for a long time.

"This is an excellent improvement! A huge leap in the treatment of double outlet right ventricle (DORV) combined with complete atrioventricular septal defect (AVSD), Director Huang, Dr. Qin in your department is amazing, amazing."

Professor Yang saw that the operation was coming to an end under Qin Lang's frenzied operation, so he took the time to talk to Director Huang.

"Professor Yang, thank you. I wanted to temporarily change the operation method for Qin Lang. I didn't communicate with you. I apologized to you, but I didn't expect it. Fortunately, the operation went well. Qin Lang has this problem. Once he thinks of a new operation method , I will be immersed in it, and I will often make my own opinions, even I can do nothing about it. I didn’t mean to ignore your explanation just now, if I offend you, please forgive the young man for being ignorant.”

Director Huang saw that Professor Yang was in a good mood at the moment, so he apologized for Qin Lang's reckless operation before. After all, the college will have in-depth cooperation with Professor Yang in the future, so there should be no future troubles.

"Where to say, what to say. Dr. Qin's professionalism is worth learning. At his age, how could I dare to calm down and propose my own improvement plan when my predecessors proposed the operation plan."

Professor Yang looked at the talented Qin Lang again.

"Director Huang, to be honest, I'm a little envious of having such a talented doctor in your department."

Professor Yang looked at Qin Lang who was finishing the operation, and praised.

Wang Xiaoying on the side suddenly felt sour for some reason, looking at Qin Lang, her whole face collapsed.

She has been with Professor Yang for so many years, and the praise she has heard is not as much as Qin Lang's operation.

Another 10 minutes later, the operation was perfectly completed.

"I really can't get enough of it! Director Huang, can I take this video of Dr. Qin's surgery back later so that my colleagues in Hospital 301 can learn from it?"

Professor Yang naturally knew that the significance of this operation, whether it was the pioneering double ventricle correction or Qin Lang's own operating technique, was superior.

"of course."

Soon the operation was successfully completed.

...

...

When Professor Yang and Director Huang had just walked out of the operating room, Professor Yang's cell phone rang, and when he took it out, it turned out to be his attending physician again.

Professor Yang's expression changed, did something happen to the surgery?

Immediately connected to the phone, he asked, "The operation didn't go well?"

"Oh, no, Professor Yang, I called because Director Ling decided not to use single ventricle surgery, but to use the latest domestic "one and a half" ventricle surgery."

"A hemiventricular correction?"

Professor Yang was obviously taken aback, what kind of new technique is this:

"Director Ling learned from which expert, why haven't I heard of it?"

PS: [-]-in-[-], oops, what a surprise.Add updates for random dangerous bosses, the boss has a good waist and a good kidney!

(End of this chapter)