My medical skills add experience

Chapter 174 Real family members, excessive electrocoagulation
Of the five patients under his care, three are waiting for surgery, and two are in the recovery period after surgery. Generally speaking, it is relatively easy.

It was rare to be so relaxed. With a learning and responsible attitude, he began to check the patient's examination report bed by bed to understand the patient's current symptoms and so on.Now how to communicate with family members or patients, he already has rich experience.

After all, it has been trained for so long.

When chatting, start from the concerns of patients or family members, and you can easily open the topic and gain their favor and trust.

The 16-bed patient underwent thoracic duct ligation two days ago. Currently, his physical signs are stable and he is recovering well.No postoperative complications occurred.

The patient in bed 17 was a cardiac aneurysm.

Judging from the inspection report, the diameter of the aneurysm is quite large.There are many surgical options for the treatment of aneurysms, such as aneurysm embolization, stenting, vascular replacement, and clipping.

If it is an ascending aneurysm, a stent cannot be placed.

Director Xue's treatment plan for this patient is surgical clipping of the aneurysm, which should be because the lesion site is not suitable for interventional surgery.

"I'm afraid the clipping of the aortic aneurysm is not so easy to operate!"

After Zhou Can read the inspection report, he thought the operation was quite difficult.

He has not had a clipping operation for a cardiac aneurysm, but has done a clipping operation for an intracranial aneurysm.

And did too many sets.

For the technical difficulties of clipping hemangioma, he has rich surgical experience.

Director Xue is the chief physician, who dared to finalize the operation, and must have made a comprehensive assessment of the risks and difficulty of the operation.It shows that she is sure.

Zhou Can didn't need to worry about this matter.

The most powerful surgeon in cardiothoracic surgery should be the 'most stable scalpel' - Director Hu Kan.

Zhou Can is particularly looking forward to seeing Director Hu Kan's surgical demeanor sometime.

"Xiao Zhou, the department has urgently arranged an operation for bed 19, and sent the patient to the operating room at [-]:[-]! Follow up!"

This related household had surgery just after moving in?
Although it's just a simple chest muscle suture, it doesn't work that way, does it?

Even in the emergency department, it is very cautious to perform general anesthesia on patients.

"Didn't he just move in? How about fasting for 12 hours before the operation?"

Zhou Can asked.

General anesthesia surgery for adults often requires fasting for 12 hours before surgery and drinking for 4 hours before surgery.Otherwise, after general anesthesia is implemented, in case the patient's stomach contents are refluxed and inhaled into the respiratory tract, it is no joke.

"The receiving doctor has already asked, and the patient has not eaten since 5 o'clock last night."

Doctor Zhao explained a little impatiently.

"That!"

Zhou Can began to follow up the operation of the 19-bed patient.

It is very necessary to do preoperative understanding and necessary inspections.Help patients prepare for the operation and face the operation in the best condition.

I will be sent to the operating room at 9.50, and the time is very tight.

Zhou Can can only do this first.

Walking directly to bed 19, three family members gathered around the bed, waiting for the man on the bed saddle-backed.

It can be seen that this man must have been spoiled by his parents since he was a child.

An ordinary adult man, even if he is injured and in severe pain, can't scream like a woman.

At this moment, the man received a painkiller injection and lay on the bed with his eyes closed.

His beautiful wife took a small plastic stool and sat in front of the bed.Constantly playing with the phone.

Zhou Can took a glance and fainted.

She was actually on Baidu, asking what should I do if my chest muscle is injured?
What I am most afraid of is this kind of patients who popularize science on the Internet by themselves.They like to use popular science knowledge on the Internet to identify whether the doctor's operation is correct and whether there is anything tricky.

"Hello, please show me the patient's examination report!"

The inspection report was in her hand, so Zhou Can could only ask her for it.

The woman looked up at him, and asked reluctantly.

"Is it necessary?"

Zhou Can has been rounding the ward in front of the hospital bed, and they must have noticed him a long time ago.

The family members of ordinary patients will respect doctors very much.

But this family of four is not ordinary people.

They felt that they knew the chief physician of the cardiothoracic surgery department, and they had some power, so they didn't take "hands-on" doctors like Zhou Can seriously.

"The patient will undergo surgery at 9.50, and must prepare for the operation immediately! You need to actively cooperate."

Zhou Can said to her seriously.

"How to do the surgery for my husband? Who is the chief surgeon? Even if it is a pre-operative talk, shouldn't the chief surgeon come to talk to us in person? We are very familiar with Director Xue!"

After she asked a series of questions, she even brought up her relationship with Director Xue.

Doctors and nurses are very troubled when they encounter such patients.

Because it's not easy to deal with.

He thinks he is familiar with the procedures and routines of the hospital, and shows off his IQ and sense of superiority everywhere.

Of course, their original intention is to obtain better medical resources.

"The surgeon will talk to you about the operation plan when the time comes. I'm the bed doctor, and I'm in charge of following up the operation and helping patients make the necessary preparations before the operation." Zhou Can felt a bit of a headache when asked by this woman.

The patient's parents stood by without saying a word, allowing their daughter-in-law to show off.

It is estimated that this woman also wants to show her knowledge and ability in front of her parents-in-law.

That's why it's so difficult.

"Okay, okay, I know that you, a bed doctor, don't know anything! When your chief surgeon arrives, I'll ask him to find out about the situation." The woman reluctantly reported the examination to Zhou Can.

In the eyes and tone, the contempt for Zhou Can is really not concealed at all.

Zhou Can made a conclusion for this woman that being beautiful does not necessarily mean having quality.

Might be a nice skin.

Check the inspection report carefully.At least before the operation, it is necessary to see whether the patient has done necessary examinations such as blood routine.

There is whether the patient has infectious diseases, inflammation and so on.

Gui Peisheng follows up a surgery, which seems simple, but there are actually many things to do.

If there are major omissions, you will be scolded by the superior doctor and scolded by the chief surgeon.

When he first started his internship, he was scolded many times.

Almost every doctor has grown up like this.

The patient's condition was fine, and there were no contraindications to surgery.

"You don't have symptoms like a cold or fever right now?" Zhou Can began to ask the patient some basic information.

Some patients may find it annoying, but these must be asked clearly.

Before surgery, patients should avoid respiratory diseases, such as colds and inflammations.

"No no!"

She answered very simply.

"Do you have a cough?"

"There must be a normal cough, but the cold cough you mentioned is definitely not there."

"Do you have underlying diseases such as high blood pressure and diabetes?"

"My husband is so young, do you think there may be diseases that these old people get? Or you'd better wait for the surgeon to come here before coming here! My husband needs a good rest now."

She was annoyed by Zhou Can's question.

"Don't eat or drink before the operation! If you need to go to the toilet, you can go to the toilet in advance!"

Zhou Can was too lazy to ask any more questions.

If the family members do not cooperate, there is a high probability that they will be scolded if they continue to ask.

If something really happened, the sufferer must be the patient himself.

Doctors don't really care that much sometimes.

"I know all this common sense."

The woman is obviously impatient.

"Can you stop making noise here? Let me sleep for a while." The patient's mood is not very good.

The patient's parents obviously affected their son's rest, and their faces became ugly.

Zhou Can didn't say anything, and went directly to other beds to do his own business.

Not long after, the chief surgeon came over.

He is a short, 35-year-old man, about the same age as Jin Mingxi.

Suturing the pectoral muscles is a first- and second-level operation. It is hard to say whether this male doctor is a resident doctor or an attending doctor.

"I'm Duan Shangqing, the attending physician of the Cardiothoracic Surgery Department, and also his chief surgeon. How's it going, isn't it so painful after the painkiller injection?" Dr. Duan went straight to the 19th bed and gently asked about the patient's condition.

The tone is full of concern.

When the patient's beautiful wife heard that the surgeon was coming, she immediately stood up and greeted with a smile on her face, "Thank you for the painkiller prescribed by Dr. Duan. My husband is much better now. Is it necessary to have an operation?"

The patient's parents were also full of smiles and were very polite to Dr. Duan.

"Looking at his film, there is obviously a laceration here. Theoretically, there is a possibility of self-healing without surgery, but it may cause his left arm to move inconveniently, chest tightness and chest pain and other symptoms. If you don't pay attention, it will expand again. The tear may even affect the functions of the esophagus, heart and lungs, etc. In addition, internal bleeding is invisible to us, and it is in the best interest of the patient to repair the wound, stop the bleeding, and suture in time."

"This is just a simple suturing operation between the first and second grades, and the risk is very low. Unlike open chest surgery, the risk is high."

Dr. Duan tried his best to reassure the family members and let them relax.

"Then after the operation, my husband's hands and esophagus won't be affected anymore, right?"

She was still somewhat worried.

"As long as the operation is successful and the recovery is ideal, he can completely return to his pre-operative state."

After listening to Dr. Duan's reply, the woman exchanged glances with her in-laws.

"Okay, then we will perform the operation, and please take care of me."

The patient's father took out a red envelope from his pocket and slipped it to Dr. Duan.

"Doctor Duan, I'm just such a son, so I must ask you to pay more attention to it. If you are a little careful, I will treat you to a cup of tea."

His stuffing of red envelopes scared Dr. Duan into a fright.

The hospital gave repeated orders and repeated orders, and no kickbacks were allowed, and no gifts or red envelopes were allowed.

In front of so many people, if he accepted the red envelope, he might not have to wait until tomorrow before the medical department would invite him to talk.

"Don't do this, don't do this, I will definitely do a good job on him with my heart. If you put red envelopes again, it will hurt me."

Doctor Duan is so small that he really can't stop him.

After hearing this, the patient's father took back the red envelope embarrassingly.

"You are really a good doctor with integrity. I will treat my son to a meal some other day when he recovers and is discharged from the hospital, and please honor him!"

"Let's talk about it when the time comes! If you have no other questions, please sign the surgery notice and prepay the treatment fee."

After the family member finished signing, Dr. Duan looked at the patient.

"Didn't you inform the doctor in charge of the bed to follow up the operation? Why haven't you prepared anything yet?"

Doctor Duan was obviously displeased.

"I just followed up with the operation to help the patient prepare for the operation. The family members said that they will wait until the chief surgeon arrives."

Zhou Can won't suffer from being dumb.

Doctors and nurses help patients to prepare for the operation. If the patients do not cooperate, there is really nothing they can do.

Healing a disease is the patient's own business.

The emperor is not in a hurry, and it is useless for the eunuch to be in a hurry.

"Well... I asked this young doctor just now, but I didn't know anything about it. I definitely asked to wait until you arrive!" After the woman finished speaking, she raised her beautiful melon-seeded face and looked arrogantly at Zhou Can. "You see, after Dr. Duan came, the chat was over very quickly. It's not like you. Asking things are all useless questions. I think you need to study harder. You are not professional at all."

Instead, she taught Zhou Can a lesson.

Zhou Can's face was blackened by her.

Arguing with family members is stupid behavior, Zhou Can did not argue with her.

Instead, do what needs to be done.

It is really tiring to prepare such patients before surgery.

The nurse came over with a plate to disinfect and clean the patient's skin before surgery.The knife position is drawn by the master knife.

After stumbling, the patient was finally sent to the operating room.

The chief surgeon, Dr. Duan, the resident doctor, Dr. Zhao, a surgical nurse, and an anesthesiologist are all ready to be in place.

Considering the cost, the medical equipment for primary and secondary surgery is often not too much.

"Xiao Zhou, my family members told me that you are very unprofessional. In the future, you should pay attention and learn more." Dr. Zhao reprimanded him.

"Ok!"

Zhou Can is so depressed, don't mention it.

This kind of grievance can only be regarded as unlucky, and you can't care too much about it with your family members.

Surgery began shortly after, and the patient was placed under general anesthesia and his vital signs were stable.

I saw Dr. Duan holding a scalpel, carefully making a longitudinal incision from the center of the sternum.The skin, subcutaneous tissue, and muscle are then incised.

Regarding the choice of incision, in addition to the longitudinal incision from the center of the sternum, a transverse incision can also be made from the level of the fourth rib between the two breasts and within the inframammary fold.It mainly depends on the part that needs to be sutured, as well as gender and so on.

If it is a female patient, you need to pay attention to the perfection of the incision and try not to damage their body shape.

When doctors operate on female patients, they take into account their postoperative lives.

For example, after giving birth to a child, if the lower part is torn, the doctor will deliberately sew a little more when suturing.In order to ensure the harmonious life of husband and wife in the future.

Pay attention to the protection of women's body, the same reason.

"Stop the bleeding!"

What Dr. Duan said was to remind Dr. Zhao.

I saw Dr. Zhao electrocoagulate the patient to stop the bleeding, and the operation was okay.The level of hemostasis should reach the excellent level of residents.

Whether it is Dr. Duan, the attending physician, or Dr. Zhao, the resident physician, both of them have surgical abilities consistent with their professional titles.

It seems that although the cardiothoracic surgery doctors are arrogant, their overall strength is quite strong.

It does have a proud capital.

After Dr. Zhao finished hemostasis, Dr. Duan continued the operation.

Start free skin flap and pectoral muscle flap.

Zhou Can looked at it very seriously, this is a good learning opportunity.

He saw Dr. Duan's scalpel, freeing the pectoral muscle flap a little bit from the side of the sternum to the outside.

Whether it's his scalpel wandering, or Dr. Zhao's hemostasis, they are all very steady.

The incision technique shown by Dr. Duan is not bad, but the level of attending is inferior.But his dissociation level is much worse, because it requires a powerful separation technique to support it.

Optimistically, Dr. Duan's separation surgery could barely reach the level of excellent residents.

Separation is very difficult to practice.

Even Zhou Can has only reached the lower level of an attending doctor.

When they separated, Dr. Duan might have struck a little harder, and tiny blood arrows spurted out.

Zhou Can took a closer look, and it turned out that a thicker artery was broken during the separation process.

Dr. Zhao immediately cooperated with tacit electrocoagulation to stop the bleeding.

Zizizi!
The electric coagulation knife burns blood vessels and surrounding tissues.

The level of hemostasis has not reached the level of indications, which is basically the case.The hemostasis operation is as fierce as a tiger, which seems rough.

Only when the level of indications is reached, can both precision and dexterity be achieved.

Dr. Zhao's hemostasis at the moment is more like a drastic move.If Zhou Can is allowed to stop the bleeding, it will be superficial, with butterflies piercing flowers, with both dexterity and precision.

Any medical skill that has reached the level of attending and above, already has a very high level.

Further up, if you want to reach the director level, it will be a qualitative leap.

For example, Zhou Can's current sutures and ligation are all at the deputy director's level. Compared with the attending level, there is really a world of difference.

Zhou Can watched Dr. Zhao's ferocious hemostasis operation, hesitant to speak.

If the time of electrocoagulation to stop bleeding is too long and too fast, the surrounding tissues will be seriously damaged.

Doctor Duan didn't say a word, he really didn't want to talk too much.

His status is low, and he is new to this department. As a subordinate doctor, it is wrong to accuse the superior doctor. It is almost crazy.

Electrocoagulation continued, and finally, the bleeding finally stopped.

Zhou Can subconsciously looked carefully at the bleeding point.I saw that the tissue in that part had changed color slightly.

Perhaps it was because Zhou Can's hemostasis had reached the middle level of indications, and he had a very bad feeling in his heart.

Dr. Duan continued the operation.

"Here, here! Finally found the tearing part! The tear is quite large."

Dr. Duan was very happy to find the torn muscle layer successfully.

Don't look at Zhou Can who is always helping Director Wen with third- and fourth-level major operations.In fact, for many attending doctors, it is quite proud to preside over a secondary operation alone.

"The absorbable thread should be thicker, and the tension here is relatively large."

The invention of absorbable thread is a good news for surgical patients.

Today, the technology is very mature.

And the cost is not high.

Before the invention of the internal suction thread, it was necessary to suture the subcutaneous tissue, and only ordinary sutures could be used.

When the wound inside is almost grown, cut the outer skin again and remove the inner thread.Then sew the skin.

It is conceivable how much the patient suffers.

This procedure is also particularly prone to scarring.

After the torn pectoral muscle was stitched up, Dr. Duan handed over the rest of the stitching and finishing work to Dr. Zhao.

Zhou Can stared at the slightly discolored electrocoagulation site again.

In order to see more clearly, he moved closer.

"Yes, it is indeed a severe injury. If it is not repaired, it will definitely be necrotic."

After he reconfirmed, he already had a judgment in his heart.

Doctor Duan failed to discover this problem, indicating that he was either not good enough or he was careless.

It is likely that the level is not enough.

Otherwise, Dr. Zhao should have stopped the electrocoagulation with a voice.

(End of this chapter)