Doctor's Life Simulator

Chapter 344 Going to the Changhai Hospital of Shanghai to teach
While listening to Dr. Tian's words, Qin Lang began to make a diagnosis based on the experience accumulated over several lifetimes.

With countless experiences, Qin Lang quickly thought of many similar cases, and compared them, he came up with a complete plan.

Qin Lang is also more and more aware of the advantages accumulated over a large amount of time. He has experienced many patient symptoms, and of course he can safely formulate the best plan.

No wonder it is said that sharpshooters are fed by bullets one by one, and great doctors are also made by patients!
Qin Lang looked at Dr. Tian and nodded slightly:
"Dr. Tian is right. The patient does need another valve replacement operation within one day, but the most important thing at present is to intubate the patient's organs to assist breathing, then choose the thoracic approach, simultaneously separate the mediastinal pericardial adhesions, and establish an extracorporeal valve. Circulation, to complete the protection of the myocardium."

Hearing Qin Lang finish the pre-operation in a clear manner, Dr. Tian kept nodding: "Yes, Director Qin, what you said is not bad at all. Then we will start the preoperative preparation according to Director Qin's idea."

The patient's family members were also watching from the sidelines. Dr. Tian's timidity once made them very scared. After all, the director of the city's No. [-] hospital also talked like this before. It's difficult and complicated, but when it comes to the specific treatment plan, I can't hold my fart for a long time. The final solution is to transfer them to another hospital.

Now that they saw Qin Lang coming over, they made up the operation plan in a few moments, and their hearts were relieved a lot.

It's just that Dr. Tian, ​​who looks like an older doctor, obeys this young doctor so much, he is a little puzzled.

Soon, after communicating with the family members and signing the contract, the patient was sent to the operating room for the first stage of surgery.

For endotracheal intubation to assist breathing, Dr. Tian is still very skilled in doing it.

"Intravenous infusion of positive systolic drugs, combined application of dopamine and dobutamine."

"Increase cardiac output, maintain blood perfusion of major organs, and intravenously inject cedilan and furosemide, rapid diuresis and dehydration"

The first step was completed quickly, and then the second step was started, separating the mediastinal pericardial adhesions.

Qin Lang watched from the sidelines, while Dr. Tian and Dr. Wang were operating, and as they were doing, Dr. Tian stopped.

"Why not?"

Qin Lang watched with relish, and blurted out when seeing Dr. Tian's actions stopped abruptly.

"That... I'm not very proficient in the next operation, Director Qin, why don't you guide me."

Doctor Tian looked at Qin Lang as a matter of course, and asked for advice seriously.

Qin Lang was immediately stunned: "You don't know that you dare to do this first stage of surgery?"

Dr. Tian looked at Qin Lang blankly, a little aggrieved: "Director Qin, isn't this your plan?"

[Ding, new mission: Temporary rescue, and at the same time teach the corresponding surgical skills to cooperate with doctors.Mission reward: 1 life simulation point]

Qin Lang looked at the naive Dr. Tian, ​​a little dumbfounded: "Okay, okay, I'll be the surgeon."

Qin Lang took over the position of chief surgeon and began to control the whole operation: "Nurse with equipment, scalpel and scissors"

"The extent of separation of pericardial adhesions in re-valve replacement surgery should vary according to the number of reoperations, the severity of pericardial adhesions, and the type of surgery."

Qin Lang began to operate while explaining.

"Okay." Dr. Tian nodded, and wrote it down carefully. After all, Director Qin, who made the whole Zijingang No. [-] Hospital proud, personally directed the operation.

"Remember that when performing pericardial separation in the future, it must not be completely separated. Although extensive separation can overcome surgical difficulties, it increases the chance of damage to the myocardium. Moreover, it often leads to extensive bleeding that is difficult to control after the operation. The increase in operation time also increases the risk of operation."

After going through so many operations, Qin Lang's words are really good words, and they are the experience summed up from countless cases.

Before hearing this, Dr. Tian, ​​who was on the side, seemed to have returned to yesterday's demonstration operation, chewing and savoring Qin Lang's explanation carefully, and then, it was like a treasure!
"Then Director Qin, how should we separate better?"

Doctor Tian asked for advice seriously.

"The so-called limited separation is to separate the operation area and meet the operation requirements of the main surgeon. Of course, my current separation degree cannot be imitated by you. After all, the operation area I need is relatively limited. .”

Qin Lang is naturally afraid that these two melon skins will be like cats and tigers. After all, not everyone has his solid basic skills and super wild talent.

"Understand."

Dr. Tian and Dr. Wang nodded. They still have some self-knowledge, but they are a little angry.

"Electric knife"

Qin Lang issued an order, and the equipment nurse immediately cooperated.

With the electric knife in hand, Qin Lang quickly operated and taught:
"The principle of separating adhesions is to use electric knife or scissors to do sharp separation as far as possible without damaging the epicardium. Generally, the pericardium is cut longitudinally at the interventricular groove, and gradually expands to the right atrium and both sides of the right ventricle to expose the right atrium. and part of the right ventricle.”

Qin Lang explained the tricks while quickly completing the operation.

"In addition, in the separation of pericardial adhesions, it can be cut with electric knife or sharply with scissors, so as to be close to the parietal pericardium, so as not to damage the myocardium and coronary vessels. The operation should be gentle to prevent the heart from being compressed and causing arrhythmia or cardiac arrest. For patients with poor myocardial function, the vena cava and aorta must be intubated first, connected to an extracorporeal circulation machine, and separated after preparation for diversion. If the separation of the ventricle and diaphragm is difficult, it can be performed after diversion to avoid separation during pulsation Causes a heart muscle to tear."

"Director Qin, that's amazing!"

After Dr. Tian listened to Qin Lang's explanation, he seemed to understand half of it at first, but suddenly became enlightened.

Dr. Wang listened with a sense of urgency, and looked at Qin Lang with eyes full of admiration. Speaking of which, he was a few years older than Qin Lang.

"Oh, this is talent."

After separating the mediastinal pericardial adhesions, it is time to establish extracorporeal circulation.

"Because the patient has heart failure and pulmonary edema, an ultrafiltration device should be used to expose and separate the common femoral artery and femoral vein, and intubation should be done if necessary to prepare for femoral-femoral bypass to prevent bleeding when separating pericardial adhesions; Prepare enough blood and prepare 3 aspirators connected to the extracorporeal circulation. Once bleeding occurs, ensure that it is returned to the circulation blood circuit device in time.”

Qin Lang continued to operate, and at the same time introduced the solutions for various situations in detail.

"Director Qin, your knowledge is too extensive. If you didn't know that you can learn the operation with just a glance, I really thought you had performed hundreds of valve replacement operations."

Doctor Tian looked at Qin Lang with deep emotion.

Under Qin Lang's stable operation, the establishment of extracorporeal circulation was quickly completed.

"The next step is to protect the myocardium. Because the patient's preoperative heart function was poor, and it was an emergency operation, there was insufficient blood supply to the myocardium. Moreover, the entire operation was complicated, and the aorta was blocked for too long. Moreover, the patient's left ventricle was adhered. There are ice chips on the surface of the heart to cool down, so before another valve replacement, we must pay attention to the strict protection of the myocardium. This is also an important part of the success of the operation."

Qin Lang's very serious education, Dr. Tian and Dr. Wang naturally nodded obediently. They didn't feel disgusted because of Qin Lang's age. Instead, they were full of gratitude in their hearts. After following Qin Lang's operation, they really learned a lot. a lot of things.

Especially for Dr. Tian, ​​who is half-understood, he is only short of this finishing touch. With Qin Lang's strategic plan, next time, he is confident that he can independently perform the surgery.

"Whole body cooling to 26°C. Cold-blooded cardioplegia."

Qin Lang continued to give instructions. Since the next operation was more complicated, Qin Lang reduced the explanation and focused more on the operation.

Dr. Tian watched Qin Lang's operation with full attention: "Mitral valve and tricuspid valve surgery use antegrade perfusion; aortic valve and double valve surgery, first use antegrade perfusion, and then use retrograde coronary sinus perfusion Very precise operation, amazing!"

"Ice chips are used to cool the surface of the heart, and 4°C ice saline is perfused into the heart cavity to cool down."

Dr. Wang also memorized seriously. After 10 minutes, the first stage was completed.

The next step is the extremely difficult valve replacement operation!

At this point, the two doctors were completely relieved.

In order to prevent the previous embarrassment from repeating itself, Dr. Tian behaved this time: "Dr. Wang, the first stage is over, and the patient is out of danger for the time being. Go and invite Director Huang over for another valve replacement."

Dr. Wang nodded, "Okay."

Just as Dr. Tian was about to start the repair, he heard a suspicious voice from Qin Lang's side: "Dr. Tian, ​​what are you asking Director Huang for? Could it be that you still don't know how to perform valve replacement again?"

Looking at Qin Lang who asked such an obvious question in a serious manner, Dr. Tian was stunned, and the old man blushed and suppressed:

"No. Of course I won't do such a difficult operation. Why, you will?"

Doctor Tian looked at Qin Lang, who nodded slightly: "Yes!"

Doctor Tian: "."

After much difficulty, Dr. Wang, who was about to walk out of the operating room, also stopped. This second stage is several levels higher in terms of operation and difficulty. Generally, only senior directors dare to operate.

Director Qin actually knew it again, damn it, he pretended to!

"Director Qin, this is not a joke. Are you sure you can operate? The patient is out of danger now. We have enough time to wait for Director Huang to come back."

Doctor Tian confirmed it again, a bit reluctant to admit that Qin Lang crushed him again!
Qin Lang waved his hand and shouted directly at the equipment nurse: "Scalpel"

After receiving the scalpel, he said to Dr. Tian: "Next, cooperate with me to perform mitral valve replacement again. I will use the right atrium-atrial septal incision. You are all optimistic. If you don't know anything about this, just dare to do it." Into the operating room, the heart is really big."

Listening to Qin Lang's complaints, Dr. Tian and Dr. Wang were also suffocated and wanted to hit someone.

Dr. Tian glanced helplessly at Dr. Wang, shrugged: "Since Director Qin has spoken, we will cooperate."

"Oh."

Dr. Wang is like a duckweed in water, drifting with the current, wherever the wind blows from the superior doctor, he can only float there.

At this time, Qin Lang's scalpel had already made a longitudinal incision on the lateral wall of the right atrium, about 2cm away from the interventricular groove.

"This patient has a small right atrium. If you encounter this situation in the future, the incision will be extended to the position of the inferior vena cava cannula to expand the surgical field. However, remember not to injure the crista ligamentum, because it contains the internode The conduction bundle and the atrioventricular sulcus are unlikely to be injured, which contains the right coronary artery."

Hearing Qin Lang's instructions, Dr. Tian and Dr. Wang wanted to refute, but after thinking about it carefully, they really didn't dare to learn Qin Lang's such a small surgical field and dare to operate.

"What kind of eyes are these, and they are too powerful."

Doctor Tian sighed in his heart, and his confidence was hit again.

"seams"

Qin Lang went on to the next step. Seeing Qin Lang using sutures, Dr. Tian didn't quite understand.

"Director Qin, what is this?"

"The cutting edge of the atria can be drawn with sutures to expose the atrial septum. After that, the incision is made at the center of the fossa ovalis, and then extends upward and downward. The upward incision can reach part of the upper border muscle bundle, and the downward incision must stop at the 1.5cm above the medial coronary sinus."

After Qin Lang's voice fell, it means that this step has been completed.

"So that's it, Director Qin, your excision is too powerful."

Qin Lang continued to operate, and fixed the right atrial septal margin to the parietal pericardium with sutures, and sutured the left margin together with the right atrial wall with two traction sutures.

Dr. Wang, after Qin Lang's operation, suddenly found that his hook became very easy.

"Social experience has improved again!"

Dr. Wang's eyes lit up, watching Qin Lang's operation, it turned out to be okay, the hook, which was a bit laborious to control, was gently pulled, and the mitral valve was exposed.

Oh Huo!

The mitral valve and the artificial valve appeared very clearly in the field of vision.

"The next step is to first remove any blood clots that may be present, and at the same time check for valve failure."

While operating, Qin Lang passed on his experience to Dr. Tian and Dr. Wang.

"Okay, Director Qin."

Dr. Tian began to carry out examinations according to Qin Lang's instructions, and after a while, he became ill.

"Director Qin, this situation is a bit dangerous. The suture ring has been covered by new endocardial growth. How to do it?"

If it weren't for Qin Lang's presence, Dr. Tian would have panicked in the face of this extreme situation.

"Round blade."

Qin Lang glanced at it, then directly took a scalpel from the equipment nurse, and began to cut open with a round-headed blade at the part of the sewing ring close to the host's sewing ring.

"So direct?"

Doctor Tian's heart jumped when he saw it: "Director Qin, slow down, slow down."

Qin Lang ignored it, and extended directly to the sides, and cut a full 3cm in the seam ring after a while.

"Director Qin, just dig like this! How do you determine the depth and length of the incision?"

Qin Lang's mind was full of various cases. After accumulating for several generations, he said casually: "There is no one else, but you are familiar with it."

Doctor Tian slandered inwardly: "I believe in you!"

Then, watching Qin Lang very easily peel off the tissue embedded in the sewing ring to the ventricle wall, is it so barbaric?

"pliers."

After a while, the whole seam ring was caught by Qin Lang and thrown on the iron plate. It was very clean and there was no trace of adhesion.

Looking at the seam loops that Qin Lang processed, Dr. Tian was envious and puzzled. How did this technique come about?

"Scalpel"

Qin Lang didn't give Dr. Tian any time to recuperate, and went directly to the next step, which was the most critical removal of the artificial valve.

"You two, remember, next time you remove the artificial valve, you must find the suture ring from the annulus and remove it at this part, otherwise it may damage the mitral valve annulus and important tissues around it, and even cause atrioventricular annulus. ventricular perforation."

"That's good, but, Director Qin, can you slow down the operation a little bit, I can't keep up."

Doctor Tian's old face turned red.

"Oh."

Qin Lang responded casually, and then the operation remained unchanged: "I'll wash the ventricle cavity with a large amount of saline."

Doctor Tian: "."

Dr. Wang grinned from the side, as if seeing himself when he was helping Dr. Tian again.

It turned out that in front of Qin Lang, Dr. Tian looked like an unintelligent sub.

The next step is to replace the artificial valve. Since the previous steps are very clean and perfect, Qin Lang's subsequent valve sewing method is exactly the same as the first operation.

The only difference is that the needle is inserted on the atrial surface and the needle is exited from the endocardium on the atrial and ventricular surface, so as to avoid leaving a rough surface and affecting the activity of the disc.

Ten minutes later, Qin Lang completed the entire operation.

"The treatment after valve replacement surgery is basically the same as the first surgery, but you need to pay attention to the following points:
The first point is hemodynamic monitoring. The Swan-Ganz catheter can be used to measure the pulmonary intrusion pressure and cardiac output, and monitor the central venous pressure and arterial pressure at the same time, so as to accurately judge the important functions of the heart, blood volume, vascular resistance, etc. The abnormal situation of the indicator can be dealt with in a timely manner. "

After listening to the speech, Dr. Tian's brain processor was not enough, so he looked at Dr. Wang opposite.

Dr. Wang said softly: "Don't worry, Dr. Tian, ​​we still have video, isn't he good at [-]x speed?"

Doctor Tian, ​​now I feel relieved.

Qin Lang continued: "The second point is cardiac function support, the third is respiratory support, and the last is close observation and treatment of bleeding. If a blood clot in the mediastinum blocks the drainage tube and causes cardiac tamponade, trypsin can reduce the non-surgical Sexual bleeding."

After Qin Lang finished giving his orders, he walked out of the operating room.

The two doctors were left in shock.

The ultra-difficult secondary valve replacement surgery was a complete success!

[Congratulations to the host for completing the task: temporary rescue, and at the same time teach the corresponding surgical skills to cooperate with the doctor.Obtain task reward: 1 life simulation point]

A few days later, Qin Lang was resting in the dormitory, and was awakened by a phone call while half asleep.

Qin Lang squinted his eyes halfway, looking at the phone screen, it was a landline number of a magic city, and hung up without thinking about it.

After all, nowadays such unfamiliar landline numbers are either advertisements or various certificates.

Press it, and not long after, it rang again, and it was still the same number.

Qin Lang is annoying, but generally speaking, if the number for advertising sales is pressed, it is rare to call a second time. After the call is connected, a middle-aged man's voice is heard on the opposite side, which is not standard. Mandarin: "Hello, Director Qin, I'm Zhao Ran"

"No need to install ETC, no mobile phone, no certificate, no loan, nothing. Thank you."

Qin Lang was sleeping soundly. When he heard an unfamiliar name, he immediately assumed it was an advertisement and ruthlessly pressed it down.

On the other end of the phone, Zhao Ran, the Chief Physician of Changhai Hospital in Shanghai, was immediately fascinated: "Are young people nowadays so angry? Besides, as a department director, why is it like a sales pitch?"

Zhao Ran called again without being discouraged, and Qin Lang, who was not surprised, was directly blocked, and he was not given a chance to connect.

"These bloody sales pitches!"

Zhao Ran looked at the landline in his hand, put it down depressedly, then took out his mobile phone, and sent a text message to Qin Lang directly:
"Director Qin, I'm Zhao Ran, I'm not a liar. I'm the Chief Physician of the Department of Cardiology at Shanghai Changhai Hospital. You forgot that I was invited to attend the Asia-Pacific Conference on Ventricular Correction that day. It's the one with the hair that looks like it. Not many, the stocky men sitting in the row behind you Director Huang."

After a while, Qin Lang's text message came back: "Oh, I don't remember."

After Zhao Ran finished reading it, his whole body was in a bad mood. Are young people so crazy now? After all, he is also the director of cardiovascular medicine at Shanghai Changhai Hospital.

Zhao Ran took a deep breath, and edited another text message in a grievance:
"Director Qin, it's normal if you don't remember. After all, those directors are either bald or have a big belly. However, I really insisted on watching your operation that day, and I didn't even chew a bite of beef jerky. I personally admire you very much. Why? So, are you interested in coming to our hospital and giving a lecture? Our hospital is also in the top ten in the field of cardiovascular disease in China. Come to our hospital to give lectures, but many doctors can’t wait for it.”

After a while, Qin Lang's text message came back faintly: "Busy."

"???"

Zhao Ran almost smashed his mobile phone, but when he thought that his wife would give him 100 yuan a month as pocket money, if he smashed it, he would really have to use the elderly phone, so he held back.

"Director Qin, I have already explained to Director Wen and Director Huang that they will arrange for you to spare a day. Moreover, we will pay you 5 yuan after you come to our hospital for this lecture exchange. Yuan."

Zhao Ran decided to be more humble. After all, he had already blown his mind, and he said in the department that he would invite a mysterious big guy to give them a lecture.

This time, Qin Lang's message came very quickly: "It doesn't matter whether it's money or not. The important thing is that I think of Director Zhao's temperament, and I appreciate it very much. When? Where?"

After all, who would have trouble with money!
Then, the second text message came one after another: "User name: Qin Lang, account number: xxxxxxxxxxxx, send money!"

Seeing Qin Lang's direct reply, Zhao Ran couldn't laugh or cry.

Three days later, Qin Lang arrived at the Shanghai Changhai Hospital at the time and address set by Director Zhao.

(End of this chapter)