My medical skills add experience

Chapter 185 Anesthesiologist, another adventure of the most stable scalpel

Give the patient an anesthetic injection and implement local anesthesia.Or to anesthetize the patient into a coma, which is commonly known as general anesthesia. This is just the most basic and simple job of an anesthesiologist.

The technical content is not high.

Anesthesiologists are truly respected as guardians of life because they can give patients various life supports.

Various crises can be predicted in advance, so that the safety of the entire perioperative period is under their control.

Accidents occur during the operation, the patient is allergic, cardiac arrest, respiratory failure, blood pressure plummets, blood oxygen drop... Any problems related to vital signs that the patient encounters during the operation, they need to Give the solution in the first time.

If the patient is in cardiac arrest, CPR must be performed immediately.

Ventricular fibrillation must be defibrillated.

It can be seen from this that in addition to anesthesia, the work of an anesthesiologist is also responsible for whether the operation can be performed and the safety of the patient during the operation.They need to control the patient's vital signs during the operation to ensure that the patient can successfully complete the operation under painless and safe conditions.

If you just anesthetize the patient, you are not called an anesthesiologist, but an anesthetist in a medical aesthetic institution.

Why do medical and aesthetic institutions often have accidents?Every now and then someone dies.

Because they only have anesthesiologists, not anesthesiologists.

Many people foolishly can't tell the difference between an anesthesiologist and an anesthesiologist. After such a comparison, they should be able to clearly distinguish the difference between the two.

In the future, if you go for plastic surgery or something, you will not easily hand over your life to a fake doctor who only knows how to use anesthetics.

Those anesthesiologists, no matter how tall they are, how much they boast.

They belong to technicians, not doctors.

Anesthesiologists in regular hospitals all have medical practice certificates and physician qualification certificates, have the right to prescribe, and can participate in operations.

Anesthesiologists are much more advanced than anesthesiologists.

Dr. Feng seemed to be in his fifties, and he was only seen every time it was a super-difficult level four major operation.Zhou Can guessed secretly that Dr. Feng was probably the chief physician in nine out of ten cases.

He helped Dr. Feng with his work and never thought of asking for anything in return.

Unexpectedly, Dr. Feng suddenly taught him some profound anesthesia knowledge.

It was also a surprise.

Zhou Can humbly listened to the anesthesia experience he taught, and even wrote down some knowledge points in his notebook.

A good memory is not as good as a bad writing.

Sometimes a surgery needs to memorize a lot of things, even the sutures needed to suture the viscera and peritoneum, Zhou Can writes them down in his notebook.Surgery is related to the life and safety of the patient, and a small suture can sometimes lead to the failure of the operation.

It is by no means alarmist.

There is no exaggeration.

For example, when suturing some organs or tissues with high tension, thinner sutures are used.

The patient just sneezed after the operation, not too much, right?
Then the seamed part burst.

If the body surface is fine and can be found in time, just sew it up again.

If the surgical wound ruptures in the abdominal cavity and thoracic cavity, isn't that the end?
"Do you know what the patient's disease is?"

Doctor Feng asked.

"Thymoma!"

Zhou Can was ashamed, knowing very little about the patient's condition.Because he belongs to Director Xueyan's group, he is only familiar with the patients in this group.

For patients in other groups, there is little opportunity to learn.

"Before performing anesthesia, it is necessary to connect with the patient's disease and physical condition, and comprehensively consider the patient's position and anesthesia plan. For example, this patient, accompanied by myasthenia gravis, needs to be placed in a supine position before the operation, and a pad is placed on the shoulder and back. Thin pillow. For patients with myasthenia gravis, an effective therapeutic dose of anticholinesterase drugs should be formulated..."

Although Dr. Feng has a weird personality, the valuable experience he taught Zhou Can is all dry stuff.

Zhou Can studied with an open mind, picking key points and recording them in his notebook.

Not long after the patient was given general anesthesia with tracheal intubation, Director Le and Director Hu Kan all came.

Zhou Can did his part to insert a urinary catheter for a patient.

It was done easily.

Earned another 1 point of experience value.

"Doctor Feng, is the patient okay?"

Director Hu asked about the patient's condition, and at the same time asked the nurse to help him put on sterile gloves.

"Operation possible."

Dr. Feng really cherishes words like gold.

Even when dealing with the most powerful chief physician in cardiothoracic surgery, his tone was cold and indifferent, and there was no smile on his face.

I heard that the longer anesthesiologists work, the more silent they become.

Because their nerves are always in a state of high tension, the nature of their work does not allow them to chat with others.

From this point of view, the importance of anesthesiologists is as important as that of surgeons.

The annual income of anesthesiologists in the United States is the same as that of surgeons.

But in Huaxia, anesthesiologists are facing various difficulties.The income is not low. The basic salary of an anesthesiologist at the attending level plus various performance and overtime pay is about [-].Coupled with the year-end bonus, it can reach more than [-].

But this is what they sacrificed their lives for.

According to statistics, among the 29 doctors who died suddenly, 14 were anesthesiologists.

The anesthesiologists who died suddenly were all strong young men, the oldest not exceeding 40 years old.

From this death data, it can be seen that the workload of anesthesiologists is seriously overloaded.

It is common to receive a call in the middle of the night and rush to the hospital to administer anesthesia to patients undergoing emergency surgery.

In addition to the tiring work, it is also very difficult for anesthesiologists to be promoted.It is frighteningly difficult to rate high.

What's more, they basically work behind the scenes. No matter how successful a surgery is, their reputation will hardly change.

I worked silently behind the scenes, and the pressure I undertook even exceeded that of the chief surgeon. The workload was extremely heavy, and the importance of the work was no less than that of the chief surgeon.But the treatment received is very different.

Anyone would feel psychologically unbalanced.

It is also all kinds of unfair treatment that lead to the perennial shortage of anesthesiologists.

Even many medical schools do not offer anesthesiology as a major at all.

This is a question worth pondering in the domestic medical community.

Only by changing the status and treatment of anesthesiologists can more medical students be willing to apply for anesthesiology.

Otherwise, the shortage of personnel in the anesthesiology department will only become more serious.

Relying on the leaders to fool Xiaobai in the workplace into the anesthesiology department is not the solution after all.

Director Hu Kan checked the drawn knife positions and marked tumor sites on the patient's body, verified them one by one, and started the operation.

The thoracotomy is completed through a midline incision of the sternum.

Compared with the thoracotomy presided over by Xueyan, Director Hu Kan's operation is as stable as Mount Tai, advancing step by step, giving people a particularly safe feeling.

For so many years, Director Hu Kan has never had a safety accident, which is enough to explain everything.

After thoracotomy, the pleural folds are pushed aside.

At this time, the thymic tissue located in the anterior mediastinum can finally be seen.

Zhou Can had a bad feeling just by looking at it.

In this patient, the thymoma was ill-defined, incorrectly colored, and infiltrated by adhesions.

It can be seen that the adjacent tissues and organs are obviously pushed by the tumor.

"This is undoubtedly a malignant tumor!"

Zhou Can's heart sank slightly, the difficulty of today's operation will increase several times.

Malignancy often results in altered anatomical relationships.

In the resection process, there are many uncontrollable risks.

After director Hu Kan saw the situation of the thymus tumor clearly, he had seen countless big scenes and experienced countless difficult surgeries.At this moment, he couldn't help feeling terrified.

The disease is too powerful.

The patient's body has been destroyed beyond recognition.

To completely remove the tumor, it is a test of the doctor's experience and skills.

"It's fine if the fibrous connective tissue sticks like this, and it's obviously thickened a lot. The risk of surgery is too high."

Director Le shook his head after watching it.

If you ask him to cut it, he will never dare to cut it.

"No matter how high the risk is, you have to do it! We have evaluated and discussed it before the operation. You can't see that the situation is not good, so you can sew up the chest cavity for the patient?"

Director Hu Kan's tone was full of helplessness.

In his decades of surgical career, he has encountered countless difficult operations.

Which time is there no risk?
In the end, he managed to break through.

This time, he believed that he would be able to successfully complete the operation.This confidence comes from his decades of successful experience and decades of hard practice.

He trains his 'steady' skills every day, rain or shine, including the stability and coordination of his arms, as well as his concentration.

Long-term meditation also brought him another unexpected benefit, that is concentration and peace of mind.

Many people think that Buddhist meditation and Taoist meditation are superstitious activities, but this is really not the case.Their respect for Buddha or Taoist ancestors is not superstition, but a kind of belief.

Superstition and belief are actually two completely different concepts.

If the faith of a person, a nation, or even a country collapses, it is a very terrible thing.

There have been a hundred schools of thought contending in the history of China, but after thousands of years of verification, it has finally been proved that only Taoism can rejuvenate the country.Confucianism and Legalism can only govern the country, but cannot make a country prosperous and strong.

In the course of history, even today, Taoism still has a profound influence on China.

Why can't Confucianism and Legalism work?Because legalism is a cruel law, not humane.Confucianism can only reason. In the end, Emperor Shihuang was the first to teach Confucianism to be a man. Burning books and deceiving Confucianism is not just a joke, it is real killing.

Just talking about the truth, if the fist is not hard, can it prosper the country?
There is a classic saying in Taoism that is still regarded as the principle of hospitality by the Chinese people.When a friend comes, there is good wine, when the jackal comes, there is a sword.

Huaxia still adheres to the Taoist way of treating people with courtesy first and soldiers later.

Director Hu Kan insists on sitting quietly every day, which can be regarded as both Buddhist meditation and Taoist meditation.As time went on, his heart became more and more peaceful, and his concentration became stronger and stronger.

This is an important support for stabilizing the knife.

It can make him as stable as an old dog, and not panic when things happen.

As long as you keep calm and concentrate at all times, even if you encounter danger during the operation, you can calmly resolve it.

"The thymoma has come out, let's deal with it with all our strength. Director Le, it's up to you to lift the lower pole of the thymoma."

This work is entrusted to the first assistant, so that he can concentrate on separating the thymoma from the surrounding tissue.

Zhou Can stood under the operating table, watching Director Hu Kan control the high-frequency electric knife, separating the thymoma from the surrounding fat tissue one by one.I saw him carefully separate from bottom to top.

"Such a powerful separation method, such a stable knife."

Zhou Can was secretly envious, if at some point he could practice separation and incision to this level, it would be great.

In addition to his skillful technique and steady knife, Director Hu Kan's concentration is also terrifying.

If the knife is performed with spirit, the amount of separation, depth, width, and even speed of each knife, as well as the avoidance of surrounding blood vessels and nerves, are all amazing.

Even the da Vinci robot may not have such a high accuracy.

Although many doctors are in awe of robotic surgery, and manufacturers are desperately advocating it, the actual effect of the surgery remains to be discussed.

Manufacturers tout robotic surgery as three-dimensional imaging, which can magnify the field of view by 6 to 10 times. The degree of freedom in the operation of the robotic arm is very high. It can rotate 540 degrees, drill into the abdominal cavity and chest cavity like a Monkey King, and cut off everything that needs to be cut.

But in fact, in addition to its high cost, there is also a lack of tactile feedback and the risk of various accidents.

Compared with an excellent surgeon, the gap is actually very large.

Robotic surgery may never replace surgeons.

On the one hand, the development of artificial intelligence is far from being perfect. On the other hand, the combination of human thinking and emotion makes surgery full of warmth, and can quickly and flexibly adjust to various rapidly changing surgical scenes.

There is also tactile feedback.

The human skin and nervous system constitute an extremely complex and sensitive tactile system.

Skilled surgeons cut different tissues and get different hand feedback.When abnormalities are found, they can be noticed immediately.

A robot is a cold machine and programmed. Although there is also a manual remote control, it cuts what should not be cut, and the remote controller has no way to perceive it immediately.

Robotic surgery, which seems to be highly accurate, flexible, and has relatively few complications, has not been accepted by patients, not just because of the high cost.

Director Hu Kan's movements were steady and slow, he was very attentive in performing the operation, and Zhou Can was also very attentive in watching.

Learn from his steady knife style and take advantage of it.

Then merge into your own sharp knife.

Zhou Can is a person who likes to think, and likes to keep pondering.Some advantages will be opposed to his quick knife style. How to integrate it requires hard thinking, and it needs to be integrated little by little through repeated practice.

"laugh!"

A very slight abnormal sound came from the patient's chest cavity.

This is by no means the sound of a high-frequency electric knife, nor is it the sound it should have when cutting body tissue.

Zhou Can's heart tightened, and then he saw blood spurting out.

The closer to the heart, the higher the pressure in the blood vessels.

Once an artery ruptures, the effect of a water gun will appear.

Others also became serious, staring at the patient's chest.

The god in their minds must have accidentally injured an artery.

This is not a failure of the operation, it is just an accident.

"The thickening of the fibrous connective tissue makes it extremely difficult to distinguish it from the blood vessel, and it was accidentally injured. It's all right, stop the bleeding quickly." Director Hu Kan spoke out to stabilize the morale of the army.

His surgical team is also excellent.

Second Assistant immediately clamped the broken blood vessel to stop the bleeding.

The blood spurting that can produce the effect of a water gun, the broken blood vessel is definitely not a small blood vessel.This is already a massive hemorrhage.

Although director Hu Kan is very calm, if the bleeding cannot be stopped in time, it will pose a serious threat to the patient's life.

"Do you think we should ligate this blood vessel first, wait until the separation is complete, and then repair it, or what?"

The strength of the second assistant is also not weak.

From his precise forceps to stop the bleeding just now, and his unhurried, fast and accurate movements, it can be seen that his level of hemostasis is extremely high.

Even if Zhou Can's hemostasis has reached the middle level of attending, he is still ashamed.

"Let's ligate first!"

Director Hu Kan hesitated for a moment before replying.

Accidentally cutting such a large artery will definitely cause some psychological disturbance to Director Hu Kan.

He didn't say anything and didn't show it on his face, but there were already waves in his heart.

Strong concentration and deep stillness do not mean that you can be as calm as a mirror in everything you encounter.

At most, just keep calm like he is now.

Zhou Can looked at the artery, his lips moved, but he didn't speak in the end.

The second assistant gestured to the third assistant, and saw that the third assistant stepped forward and used skillful techniques to quickly ligate the proximal end of the artery, and the bleeding was temporarily stopped.

As for repairing the artery, the only way to do it is to wait until the separation is over and cut off the thymoma in its entirety.

Surgery continues.

Less than 10 minutes later, Dr. Feng said in a very puzzled tone, "The blood oxygen saturation has dropped!"

Take a look, isn't it!

Normal blood oxygen saturation is between 95% and 100%.

Usually more than 99%.

At this moment, the patient's blood oxygen saturation has dropped to 91%, which is approaching the warning threshold.

Zhou Can worked in the ICU for three months, dealing with critically ill patients in the ICU every day.So it is very sensitive to blood oxygen saturation.

In the intensive care unit, if a patient has not urinated for two days, that patient will probably leave.

If the patient's blood oxygen saturation is unstable and keeps dropping, as long as the patient is not paying attention, he may leave.

Therefore, the blood oxygen saturation of this surgical patient has dropped to 91%, and he is very aware of the danger.

Dr. Feng's experience in anesthesia is extremely rich, and he must have sensed the danger, so he reminded Director Hu Kan in such a solemn tone.

"Can adding oxygen increase the blood oxygen saturation by one liter? The separation operation is only halfway through, and it will probably take a while."

Director Hu Kan's tiger eyebrows have been slightly frowned, his energy is limited.

What I want now is to cut off the thymoma as soon as possible, and then come to the arterial vessel.

(End of this chapter)