My medical skills add experience

Chapter 179 successfully helped the patient out of danger.sorry i'm unprofessional

This kind of extracorporeal circulation is not artificial membrane lung, that is called ECMO, and the establishment is much more complicated.

It is only considered to be used when the heartbeat and breathing have all stopped.

The extracorporeal circulation established by Zhou Can for patients is a kind of life support, which can maintain blood supply to tissues and organs throughout the body during open-heart surgery.

Its principle is to use a series of special artificial devices to draw venous blood out of the body, manually exchange gases, regulate temperature and filter, and then return it to the arterial system in the body.

This extracorporeal circulation machine is mainly used for the pause of the heartbeat in the operation, or the pause of the heartbeat and breathing.

It is also Director Xue who considers the operation cost too much for the patient, otherwise this extracorporeal circulation system should be established from the beginning to ensure the safety of the patient's life.

If Zhou Can's operation speed was not much faster than others this time, the consequences would be hard to predict.

Zhou Can connected the instrument, and when the temperature of the patient's nasopharynx dropped to around 28°C, he blocked the ascending aorta below the innominate artery with clamps, and injected cold cardioplegia into the root of the ascending aorta to arrest the heart.

Doctor Guan could finally stop the pericardial compression at this time.

Next, if the operation time is too long, the cardioplegia will be perfused retrogradely through the coronary sinus every 20 minutes or so to maintain the heart in a state of deep hypothermia.

Just clipping an aneurysm should not take that long.

After Zhou Can successfully established extracorporeal circulation, he breathed a sigh of relief.

The patient's life is temporarily guaranteed.

"Director Xue, you can hurry up and get rid of that varicose vein now."

Zhou Can kindly reminded.

"okay!"

She began to rush to clip the aneurysm.

The extracorporeal circulation machine only simulates part of the functions of the heart. It is no problem to supply oxygen and blood to tissues and organs in a short period of time, but it will definitely not work for a long time.May cause damage to organs.

After the establishment of the artificial membrane lung, theoretically speaking, it can replace the human heart and lung function for a long time.

Therefore, ECMO is more advanced than extracorporeal circulation machines, and the start-up fee is also more expensive.

Its circulatory system is more complicated to establish and requires multiple doctors and nurses to operate at the same time.It must also be technically proficient.

If a novice does this, the probability of accidents is extremely high.

After the patient's life is guaranteed, Director Xue is no longer so nervous when operating.The state of mind became stable, and the progress of the clipping operation was obviously much smoother.

It didn't take long for her to successfully clip this relatively complicated heart aneurysm.

It is equivalent to cutting off its blood supply, and it will naturally no longer cause harm to blood vessels.

Some people think that after clipping an aneurysm, it will cause blood vessel narrowing, which is purely nonsense.As long as the operation is done well, it will not affect the patency of the blood vessels at all.

After clipping the hemangioma, it is generally necessary to repeat the blood test to confirm that the aneurysm is completely clipped and the arteries are unobstructed before the chest can be closed.

She checked it carefully several times to make sure there was nothing wrong, and then she looked at Dr. Guan.

"Doctor Guan, the operation has been completed, but the blood test is needed to check the effect of the operation. Do you think the heart can resume beating now?"

"Okay! I'll try!"

Doctor Guan began to warm up the heart.

Gradually, the heart throbbed, and the blood circulation in the body slowly recovered.

Fortunately, the patient's ventricular fibrillation has long since disappeared, and the heart beats normally.The clipping of that aneurysm was also very successful.

After bleeding, it can be confirmed that it will be completely clamped.

And it can be confirmed that the blood of this arterial vessel is unobstructed and has not been significantly affected.

Everyone breathed a sigh of relief, their hearts were hanging, and they fell to the ground.

Deputy Director Lu seemed to be reborn after a catastrophe, his back was already drenched.

After all, the patient's heart problem was caused by blocking the blood flow of the head and arm trunk twice in a short period of time.

"It's finally all right, close the chest cavity!"

Director Xue was also quite frightened.

It is estimated that she will not take such a big risk for surgery in the future.

All doctors are similar. Before the accident, they always feel that they can do it and there will be no problems.

Then after one or two incidents, the courage became smaller.

Acting is also becoming more and more cautious.

Deputy Director Lu and the second assistant worked together to close the patient's chest.

The sawn sternum needs to be re-fixed with steel nails.

Zhou Can watched them operate, very envious.

It's just that something happened just now, and now I'm asking Director Xue for the opportunity to exercise to close the chest, I'm afraid it will be difficult to get it.

He was in no hurry.

This time, he left a good impression on Director Xue, Deputy Director Lu and others, and showed some of his abilities.Are you afraid that you will not get the opportunity to exercise in the future?
After the closure of the patient's cavity was completed and the examination was correct, the patient was given anesthesia.

I won't be able to wake up for a while.

Can only be pushed to the anesthesia recovery room, waiting for the patient to wake up on his own.

Director Xue turned to look at Zhou Can before leaving.

"Doctor Zhou, thank you for today! If you want, I will transfer you to my team tomorrow, and I will take you with the doctors of the team."

Director Xue does things with the empathy of a woman.

She didn't take Zhou Can away directly, which was a kind of respect for Dr. Zhao.

Although she is the chief physician, Dr. Zhao is just a resident doctor at the bottom, but she still saves enough face for Dr. Zhao.

Leaders maintain the majesty of other leaders, not necessarily the protection of officials and officials, but a kind of self-cultivation.

Dr. Zhao is now equivalent to Zhou Can's leader.

He punished Zhou Can. Director Xue wanted to intervene, but with just one word, Dr. Zhao would obediently do so.

But what would Dr. Zhao think?
Uncomfortable for sure.

Maybe because of this incident, I will hate Director Xue and Zhou Can at the same time.

Therefore, her way of handling things is very clever.

Zhou Can is naturally willing to work with a chief physician.

No matter which department he enters, he can learn much more than other doctors if he can be led by a director-level doctor himself.

This is also an important reason why he left other Gui Peisheng far behind in a year.

"I am willing!"

Zhou Can decisively agreed.

"Okay, you report to my doctor's office tomorrow."

Seeing that Zhou Can agreed, she was quite happy.

Because Zhou Can's strength lies there, taking him to do surgery together in the future is equivalent to adding a senior anesthesiologist who can provide life support for patients in the group.

Dr. Zhao's order to punish Zhou Can was irreversible. He looked at Zhou Can with very complicated eyes, but finally did not withdraw the order of punishment.

……

The next day, Zhou Can went to report to Director Xueyan without mentioning it.

In the big office, Director Xue has already helped Zhou Can make arrangements for group adjustment.

"The patient who underwent the cardiac aneurysm clipping operation yesterday has come to life. His vital signs are stable, and the operation was successful." Director Xue must have deliberately told Zhou Can about the patient's postoperative situation.

The patient turned the corner, and when she mentioned this, a happy smile appeared on her face naturally.

"I need to go to the outpatient clinic for a specialist consultation this morning, and I'm going to attend a study in the afternoon. I'm afraid I can't take you with me. I've told Deputy Director Lu to take you with me."

Director Xue has already arranged everything for Zhou Can.

It took a lot of thought.

"Thank you!"

Zhou Can is sincerely grateful to her.

Generally speaking, it is good enough for the chief physician to agree to take him.How can such careful and considerate arrangements be in place?
Zhou Can was really moved by her being so sincere to Zhou Can.

"When you first come to this group, you can take a look at all the cases in this group. If you don't understand anything, you can ask me or Deputy Director Lu in time. If neither of us is here, you can also ask Dr. Long and others."

Not far away, Dr. Long quickly said, "It's almost the same for me to ask Dr. Zhou for advice. He is much better than me."

"Just be skinny!"

Director Xue smiled and gave him a blank look.

Dr. Long really wanted to tell Director Xue that Zhou Can's abilities in all aspects are really strong.

Even surpassed him as the attending physician.

His lips moved, but in the end he didn't say anything.

Because Director Xue wouldn't believe it.

"The time is coming, I have to check the doctor's orders of several important patients, and then rush to the consultation. Dr. Long, come and teach him the daily work of the department!"

After finishing speaking, Director Xue hurriedly turned on the computer to check the important patient's doctor's order.

The doctor's orders of ordinary patients are generally in the charge of bed doctors and attending doctors.

In the actual operation, basically the supervisor of the bed or the resident doctor will issue a doctor's order, and then the attending doctor will take time to check it at two o'clock when commuting to and from get off work.

Amend the unreasonable and problematic medical orders.

The only medical orders that can be handled by the chief physician himself are those priority patients.For example, the patient is critically ill, or has just undergone major surgery, or has many underlying diseases, etc.

Only such important patients need to be checked by the chief physician.

It is much less difficult for other patients to prescribe medical orders. When prescribing medical orders for these key patients, all aspects must be considered, and there are very few opportunities for trial and error.

So we must be cautious.

"Doctor Long, I have caused you trouble!"

Zhou Can walked to Doctor Long and asked for advice humbly.

The daily work and focus of each department are different, so it is always right to know more about it.

"Don't be so polite! As a team, we should help each other. Let me give you a brief introduction to the daily life of our cardiothoracic surgeons!"

Dr. Long was very polite to Zhou Can.

"In the morning, it is generally required to arrive at the hospital department around 7.30, and check the medical records, examination reports, treatment methods, medications, etc. of the patients in this group through the HIS system. The review that should be reviewed and the preparation that should be prepared. You do not have separate surgical tasks now, such as For me, I need to be responsible for some patients’ operations. If the condition is not complicated, I will make a surgical plan and show it directly to Director Xue or Deputy Director Lu for review. If the condition is complicated or difficult, I will take the initiative to ask them for advice and formulate the surgical plan together. "

Basically, every department has almost such a workflow.

This is true of all the gods and bones that Zhou Can has practiced.

"The anesthesia for the first operation will probably be completed before [-]:[-], so there are surgical patients you follow up, and the scheduled operation starts around [-]:[-], and you have to send the patient into the operating room around [-]:[-]."

It was sent late, and the anesthetist seldom swears, so it was difficult to say who was the surgeon.

If you are in a bad mood, you can scold you and bury your head in your pants.

"A ward round at around [-]:[-]. Director Xue will lead the ward rounds once a week, and they will check the cases in this group. Sometimes the department has a large ward round, and it may be led by Director Hu Kan himself. Follow along to learn. During the ward rounds, the attending physicians and directors will listen carefully to the patient’s situation reported by the doctor in charge of the bed, so you must be well aware of the beds you manage. get ready."

One of the most important tasks for bed doctors every day is to introduce the patient's situation in a timely and accurate manner when the superior doctor makes ward rounds.

"The ward rounds are over, around [-]:[-], and the doctor turns over. After the shift is over, you must hurry up to issue a doctor's order and a discharge certificate to the patient in charge. Then if you stay in the ward with the resident doctor, you will be responsible for carrying out the surgery, Changing dressings and other work. If you follow into the operating room, then needless to say, cooperate with the chief surgeon to complete the operation."

Zhou Can basically understands these daily tasks.

"It is worth mentioning that the operation time of our cardiothoracic surgery is usually relatively long. It is common for the operation to be performed around 9 am and end at [-] pm. After the first operation, there will be a short meal break There is also the handover of ICU patients, or sometimes there is an emergency patient in a certain department who needs to be equipped with ECMO, or a CCU patient abandons treatment and asks for ECMO to be withdrawn, so we have to rush over to help. "

The installation of ECMO is generally completed by the cooperation of surgeons and anesthesiologists.

Zhou Can has mastered the skills of installing ECMO thanks to three months of working in the intensive care medicine department.Fully capable of cooperating with the anesthesiologist to complete.

"In your case, you have excellent abilities in all aspects. If the doctors in the group are too busy, they may send you to the internal medicine department or the emergency department for consultation."

This is an advance greeting.

Cardiothoracic surgery requires a lot of consultations, and the manpower here is often tight.

Consultation needs to send excellent doctors to participate.

For consultations that are not too difficult, an excellent resident doctor is often sent there.

Although Zhou Can is only Gui Peisheng, his strength lies there. Sending him there for consultation is no worse than an excellent resident doctor.

Of course, he has just entered the cardiothoracic surgery department and has not studied for two days, so he will definitely not be sent for consultation now.

If he made a joke and made a fool of himself, he would lose face in cardiothoracic surgery.

After introducing the daily tasks of the day, Dr. Long helped Zhou Can log into the HIS system and taught him to check the cases in this group.

……

Zhou Can was thirsty for knowledge, and carefully checked the medical records of this group of patients.

This is the fastest way to learn.

Because each patient has the most authentic records of symptoms, etiological diagnosis, examinations done, treatment methods used, and treatment effects.

Every time he reads a case, his pathological diagnosis experience value can increase by 1.

Deputy Director Lu also had the task of attending clinics in the morning, and Zhou Can stayed in the inpatient department to manage the patients in his group.The morning passed quickly.

After eating Chinese food, when he went to the ward to check the situation of the patients in the group, he heard the family members of the 19th bed patient shouting there.

"Nurse, nurse, my son still feels pain in his chest after the operation, please help me to prescribe some painkillers!"

"Didn't you just take painkillers in the morning? You can't use them all the time! Your son is a man. He woke up from the anesthetic after the operation. It's normal to have some pain. Let him bear it!"

Nurses do not have the right to prescribe, and a doctor with a medical license is required to prescribe medicine.

And, as she said, painkillers can't be used all the time.

This is in a safe dose.

If you really want to use it, you have to wait for the body to pass a metabolic period before asking the doctor to prescribe painkillers.

She just didn't tell the family members clearly to tell your son not to be so squeamish.

After hearing this, Zhou Can glanced at the family members and patients with some sympathy.

After waking up from the anesthesia, it is indeed normal to experience pain.But the pain in this patient may not necessarily be normal.It may be the abnormal pain caused by tissue ischemic necrosis.

This kind of pain is like a slow knife cutting flesh, very tormenting.

The patient's beautiful wife kept operating with her mobile phone, checking the medical records from time to time.

Zhou Can almost fainted.

She is on Baidu again, popularizing science to solve problems by herself.

Are women with big breasts really brainless?
What she did was really ridiculous.

But it would be nice to let her learn a lesson.In case you would rather trust Baidu than the doctor's words next time.

When Zhou Can finished checking the patients in this group, when he came out, the patient in bed 19 was in so much pain that he lost his temper.

He is the only child in his family, and his family conditions are also very good.

She has been spoiled and spoiled since she was a child.

Now that he has suffered so much, it is inevitable that he will become a little manic.

"Doctor, doctor, my son is in unbearable pain, please help me!"

The patient's mother saw Zhou Can passing by, as if grabbing a life-saving straw.

The patient's beautiful wife also seemed to realize at this time that Baidu on the Internet is unreliable and cannot solve the problem at all.

She also stood up and was willing to cooperate with the doctor for the first time.

Unfortunately, Zhou Can is no longer in charge of this patient.

Moreover, this woman complained and sued at every turn, and Zhou Can was even more unwilling to provoke her.

"I'm sorry, I'm just a training doctor, very unprofessional. I can't handle it, and I'm not responsible for the patients in this bed. It's okay for me to inform the nurse for you."

Zhou Can directly refused.

Are you kidding me, last time you told me to get out, I got out.Now you ask me to come back, sorry, I'm going away.

If you have any problems, you can go to the bed doctor and nurse to deal with it yourself!
"What kind of attitude do you have! My husband is in such pain, but you are prevaricating like this. Believe it or not, I will complain to you now?"

Patient's beautiful wife blew up.

The word 'very unprofessional' is what she said to Zhou Can when she complained to Dr. Zhao.

Now Zhou Can is using this as a shield, and she is not stupid, so she naturally understands that Zhou Can is deliberately saying something back to her.

So she was very angry.

Maybe this woman usually relies on her husband's family's power and good financial conditions, so she acts a little arrogantly.

Almost the vast majority of powerful people have this problem.

When encountering things they think are 'unreasonable', they always like to blow their hair.

Zhou Can stared at her pretty face with a straight face, and then his eyes collided with her bright eyes.

"Complaints are your right. I have other patients to deal with, bye!"

This moment, that moment.

Zhou Can is now appreciated by Director Xue and others, and it is true that he is not in charge of this patient. He really did it according to the procedure, and no one can fault it.

(End of this chapter)