My medical skills add experience

Chapter 224 Rewarded with 200 experience points for the first time, is this passing on the mantle?

After the patient was successfully anesthetized, Zhou Can stood at the chief surgeon's position to prepare for the operation.

"Xiao Zhou, this is the first time you have performed this kind of operation. There are a few points that you must pay attention to." Mr. Liu said the precautions before Zhou Can performed the operation, explaining that the operation is extremely risky.

"It is necessary to avoid damage to important anatomical structures such as the carotid artery, internal jugular vein, vagus nerve, hypoglossal nerve and accessory nerve during the operation."

This is a normal reminder.

Even if Liu Lao didn't say it, Zhou Can would handle it carefully.

"This disease will cause repeated attacks of inflammation, so it should be surgically removed as soon as the acute inflammation is controlled. If the fistula is small, with no or little secretion, or if the patient is a child under 2 years old, the operation should be postponed."

If the surgical indicators are not met, then the surgery will not be performed.

Otherwise, it is easy to over-medicine, and the harm outweighs the benefit.

Zhou Can listened carefully, keeping these valuable diagnosis and treatment experiences in his heart.

"It goes without saying that a fistula tract will be performed before the operation. This operation is likely to cause massive bleeding, so blood transfusions must be prepared."

Mr. Liu continued to instruct Zhou Can and the subordinate doctors on some key points of the operation.

For this kind of fistula tractography, lipiodol is often used.

The purpose is to find out the direction, depth and course of the fistula.

Some fistulas may have more than one direction, and this kind of path needs to be more careful.

If you don't do angiography before the operation, and you have to operate rashly, even if you have rich surgical experience, you may stumble.

"This patient should have two horizontal incisions, all fistulas in the lower third of the neck. Two horizontal incisions should be made. A lateral fusiform incision is made along the skin around the fistula in the lower Another larger transverse incision is made at the bifurcation of the artery."

Mr. Liu had already drawn the position of the knife edge in advance.

But still explained it to Zhou Can and others.

"If the fistula is located at a high position, a horizontal incision can be made. The position of the incision is determined according to the examination results, and arteries, large blood vessels and important nerves should be avoided."

Neck surgery has always been considered a high-risk area by physicians.

Zhou Can practiced for nearly a year, and he wanted to get a chance to get a neck suture, but Mr. Liu agreed very reluctantly.

If Zhou Can hadn't made great achievements in that thyroid surgery, he wouldn't have agreed at all.

From this little incident, we can see how high the risk assessment of the neck by the superior doctors is.

This moment, that moment.

Now, not to mention the skin stitching on the neck, Zhou Can even dares to operate the knife.

In the past year and a half, Zhou Can has made great progress.

Under normal circumstances, it takes at least six years for a general surgery doctor to be able to operate a knife on a patient's neck by himself, even if it is just the simplest incision of the epidermis and opening a wound.

After three years of regular training and three years of resident surgery training, the superior doctor will consider giving a neck incision epidermis an exercise opportunity.

It must also be the kind of senior resident who performed well.

Don't even think about those who are idle and rash.

In fact, operations on the neck are basically major operations above the third level.

Risk is extremely high.

The attending physician is only worthy of being an assistant in this kind of operation.

Zhou Can carefully followed the position of the knife and made a flat incision.When cutting, Liu Lao's nerves must have been tense, and his hands were instinctively clenched into fists.He was worried that Zhou Can's knife was too fast and cut the patient's neck artery.

Plasma has long been prepared.

In case of an accident, blood transfusions can be rescued immediately.

From this point, it can also be seen how much Liu Lao cultivated Zhou Can.Basically, you are risking your future and your job.

[Cutting experience value +1.]

[The first time you successfully cut the patient's neck, you will be rewarded with an experience value of incision +100.]

Zhou Can didn't expect that he could earn 100 cutting experience points in this way.

I am really happy.

Cutting the neck was not really a big challenge for him.

It feels no different from cutting the epidermis during abdominal or chest opening.

After the incision was promoted to the middle level of attending, his tactile feedback on the scalpel seemed to be a little clearer.When cutting, you can know more clearly and accurately whether the cut is the epidermis, subcutaneous tissue, blood vessels, muscles, etc.

Their tactile feedback to Zhou Can is different.

It is also this sense of touch that allows surgeons to dissociate important tissues such as nerves and blood vessels on the sharp tip of the knife.

After incision, it is actually difficult to clearly distinguish the fistula with the naked eye.

This does not bother the doctors.

They figured out a way to inject methylene blue through the fistula after cutting the neck, so that the fistula can be easily identified during the separation process.

Immediately afterwards, Zhou Can cut the skin, subcutaneous tissue and platysma muscle along the incision design, then clamped the fusiform skin containing the fistula with hemostats, and then made a sharp separation along the fistula.

This separation process is simple to say, but extremely difficult to operate.

It needs to be separated gradually from bottom to top to the bifurcation of the common carotid artery.

"Xiao Zhou, when separating along the fistula to the carotid bifurcation, the carotid sinus should be closed with 1% procaine to prevent carotid sinus syndrome."

Liu Lao reminded Zhou Can in time during the operation.

"understand!"

Zhou Can quickly completed the corresponding operations, and then made a second transverse incision on this plane, and pulled the separated fistula cord tissue out of the skin through the transverse incision.

Even though Zhou Can's first incision on the neck proved his strength, when he made the second incision, Mr. Liu was still worried, for fear that something might happen to Zhou Can.

After all, the risk is too great.

Fortunately, Zhou Can was always as fast as the wind and as steady as an old dog, and he didn't make any trouble for him.

In the next operation, Zhou Can gave full play to that super separation technique.

Because this fistula passes between the internal and external carotid arteries, it turns to the lateral wall of the pharynx.Undoubtedly increased the difficulty of surgery.

Not to mention Zhou Can's operation, even if Liu Lao came to operate it, he would not dare to be careless in the slightest.

After Zhou Can carefully separated the fistula from the internal and external carotid arteries, he pulled the external carotid arteries forward.

When doing the above steps, it is also necessary to pull the posterior abdomen of the digastric muscle and the hypoglossal nerve upward.

Then continue to separate inward along the fistula, reaching the side wall of the pharynx.

Every step of separation is extremely difficult.

It is of great benefit to his improvement of separation medical skills.

At this stage of separation, Mr. Liu personally helped him, pushing the side wall of the pharynx outward with his fingers to make the fistula shallow, so that Zhou Can could separate the remaining part of the fistula.

Finally, the fistula was successfully separated by Zhou Can.

[Separation experience +1.]

【For the first time, you successfully separated the ultra-difficult fistula, and you will be rewarded with +200 experience points for separation.】

This is the first time in Zhou Can's history that he has earned 200 experience points.

Only he himself knows how difficult the whole separation process is.

It can be described as difficult and dangerous.

Therefore, he can take this 200 point reward with peace of mind.

Much harder than earning two rewards of 100 experience points.

"Pretty well done! Clean the cavity and suture it!"

Elder Liu actually broke into a few cold sweats.

Seeing that Zhou Can successfully separated the entire fistula, he breathed a sigh of relief, with a happy smile on his face.

Zhou Can also won the deep trust of Liu Lao by virtue of his operation time and time again without accidents.

So much so that such an extremely high-risk operation dared to be entrusted to him.

After the wound cavity was flushed, the bleeding was completely stopped.

To Zhou Can, these operations were simply pediatrics.

Level [-] hemostasis and level [-] debridement are not free.

Over the past month or so, he has performed more than 700 surgeries in general surgery, and his debridement experience has also earned a lot of money.But if you want to be promoted to level five, there is still a big gap.

The main reason is that it is rare to encounter that kind of difficult debridement, so that there are very few opportunities to earn 100 experience point rewards.

It is too difficult to advance to level five just by earning 1 point of debridement experience each time.

A full [-] debridement operations need to be performed.

Many surgeons may not be able to perform so many operations in their lifetime.

After debridement and hemostasis, Wu Ziyu stared at it with greedy eyes.

"Director Liu, Doctor Zhou, can I suture it?"

She watched Zhou Can challenge more and more advanced surgical tasks, but she couldn't even get a more difficult suture task, and she was very anxious.

Associating with the strong will naturally force you to make progress.

She wants to narrow the gap with Zhou Can.

"The suturing requirements of this operation are very high, and you are not yet capable of it! Next time, I have a simpler suturing task, and I will leave it to you to practice!"

Elder Liu couldn't bear to dampen her enthusiasm.

However, no superior doctor would casually delegate authority over operations.

Don't look at Mr. Liu, who even dared to delegate power to Zhou Can for difficult surgical tasks such as separation and incision of the neck fistula.That's because Zhou Can made Liu Lao believe that he has the strength and can do well through continuous accumulation.

Wu Ziyu had only undergone surgery for less than two days in total, and in Liu Lao's mind, the trust level was still very low.

Moreover, her surgical ability is far from being comparable to that of Zhou Can.

So it's no surprise it was rejected.

"Doctor Wu don't need to worry too much. When the time is right, it will happen naturally." Zhou Can comforted her.

I can understand her eagerness to improve her strength.

Zhou Can once had it too.

Especially at the beginning, I can't do this, and I can't do that. Watching other doctors operate, I feel like a cat scratching my heart.

He was ruthlessly rejected by Dr. Xu many times.

Now that his strength has improved, he doesn't even need to take the initiative to speak, and the superior doctor directly delegates power to him.

Next, he sutures the wound in layers and places rubber tube drains.

Sandbag pressure treatment on the neck.

At this point, the operation is considered complete.

The postoperative care of patients is handed over to the bed doctors and nurses in the inpatient department.

"Okay, push the patient to the recovery room! Postoperative care requires antibiotics to prevent infection. If necessary, dexamethasone can be used to reduce local edema, and nebulized inhalation is given. Depending on the situation, take it out within 24 to 48 hours Drainage strips, stitches removed 7 days after surgery."

These are all doctor's orders issued by Liu Lao.

Doctors and nurses in the inpatient department are required to perform in place.

Zhou Can checked the remaining dozen or so surgeries, feeling a lot of pressure.

I'm afraid I have to work overtime until late today!

He worked so hard, he was doing his best for the newly built nail and breast surgery.

In the future, nail and breast surgery developed, and these initial members of the department would be more or less affectionate.For Zhou Can, there must be a lot of benefits.

……

Four days later, Zhou Can was exhausted and thin, and he solved all the operations accumulated by the doctors in the Nail and Breast Surgery Department.

His surgical experience has been improved by a leap.

I used to do surgery with Liu Lao, and the categories I came into contact with were mainly thyroid diseases.

Although there were less than one hundred surgeries performed in these four days, they were varied and involved various medical fields.It has greatly helped Zhou Can expand his surgical knowledge.

It is difficult for a surgeon to preside over so many fields of operations in a short period of time.

Especially with small and large hands plus minor surgery, Zhou Can almost re-understands the structure and pathological mechanism of the human body.The benefits of learning, cognition, and surgical anatomy of all kinds of diseases in such a short period of time are incalculable.

Much better than a hammer in the east and a stick in the west.

The biggest benefit of coherent learning is that it facilitates more comprehensive cognition and comprehension.

After so many surgeries, the prognosis is pretty good.

The only thing that made Zhou Can feel a little regretful was that the patient who had undergone surgery to remove a huge lipoma on the head and face, because of unavoidable postoperative syndrome, after the initial wound healed, he was transferred to the Department of Internal Medicine for further treatment.

No one can guarantee what will happen to that patient in the future.

Obviously the operation was very successful, but the result was not satisfactory.

This matter made Zhou Can brood.

It was also this case that made him realize that the ability of doctors is more limited than imagined, and they will appear helpless when encountering many situations that cannot be handled.

In the office, Elder Liu looked relaxed with a faint smile on his face.

Zhou Can helped to deal with all the backlog of surgical patients, and the nail and breast surgery department had no worries.

In the past four days, Mr. Liu led Zhou Can to work in the operating room, and the other chief physicians were not idle, and they all devoted themselves to their new work.

Nail and breast surgery has initially started on the right track. For patients with nail and breast disease who come to Tuya Hospital for treatment, as long as the surgery can solve it, the nail and breast surgery has realized all the receivables and cured them.

To ensure that no one is missed, and patients are not allowed to wait in line for several days to see a doctor.

The medical work of the nail and breast surgery is in order.

The experience for patients is believed to be very good.

Doctors and nurses also quickly adapted to their new jobs from the initial discomfort.All of them worked very well, and they all worked very hard.

The whole nail and breast surgery room showed a gratifying situation of prosperity.

"Xiao Zhou, you have worked hard these few days! If possible, I really want to keep you in Nail and Breast Surgery to continue to help this department develop and grow."

Old Liu knew that Zhou Can was determined to go, and he couldn't keep it.

One day the young eagles will grow up, and they will go outside to wander and practice constantly, and finally the eagles will hit the sky, soaring upwards, roaring proudly in the sky.

Zhou Can still has a lot to learn.

Just knowing how to perform surgery is not enough.

Internal medicine is difficult, but it is a compulsory course for every famous doctor.

"Thank you for your great love for me. After I finish my studies, I will definitely have the opportunity to help in the Department of General Surgery. The definition of disease, etiology, pathogenic mechanism, epidemiology, natural history, symptoms, signs, and experimental diagnosis of internal medicine , Imaging examination, differential diagnosis, diagnosis, treatment, and prognosis. These are all things I need to learn in depth. Taking advantage of my current status as a regular trainee, I want to seize the opportunity to study hard in internal medicine, paving the way for my future practice the way."

During the three months of regular training in the Department of Critical Care Medicine, Zhou Can has already deeply realized the importance of internal medicine.

Real medicine originated from internal medicine, not surgery.

Internal medicine studies pathology and pharmacology, while surgery focuses on technology rather than science.

Chinese medicine in China was first developed on the basis of medical classics such as the Yellow Emperor's Canon of Internal Medicine and Su Wen.

Which of the two is more important, Zhou Can's heart is as bright as a mirror.

If you ignore the study of internal medicine because you have shown extraordinary talent in the field of surgery and have made some initial achievements, it is a waste of money.Now it's just a small fight and I don't think there is any big problem.

In the future, if he is really allowed to stand alone, the disadvantages will be seriously revealed.

There will be constraints everywhere.

"Your idea is very good, and you didn't lose yourself because of temporary achievements. It is extremely rare to have such a clear understanding at your age. Don't worry, I am not selfish to that extent. This general surgery The records are some of my experience in practicing medicine for decades, as well as my surgical ideas, including some mistakes and omissions, all of which are written down in detail. You can take it back and look it up when you have time, and you may gain something from it.”

Mr. Liu has practiced medicine for more than 30 years. Although he is only the deputy chief physician in the general surgery department, he has strong surgical skills.

The surgical experience accumulated over the years is like a treasure to a newcomer like Zhou Can.

There are twenty or thirty bound books in a thick pile.

It's hard to imagine, all of this was recorded by Mr. Liu stroke by stroke.

Zhou Can stood up, took it respectfully with both hands, picked up the top bound book and flipped through it.

The admiration for Liu Lao came naturally.

Every recorded operation, or omissions in diagnosis and treatment, as well as some pre-operative and post-operative changes, are clearly recorded.The handwriting is neat, and some are accompanied by pictures.

Properly is a set of medical works.

The painstaking efforts recorded for decades were given to Zhou Can so selflessly for Zhou Can's study and reference.Liu always regarded him as his closest successor.

"This gift of yours is too expensive. I will take it back, make a copy of all of them, and then return the original to you."

Zhou Can felt that the materials in front of him were more precious than a mountain of gold and silver.

"I'm old, and I'm going to retire in a few years. These notes are useless to me. After you read it, if you think it's valuable, you can keep it for other young doctors with potential and high medical ethics. Remember, in the future No matter how high your medical achievements are, when you pass on some core medical skills, you must not pass them on to those with bad morals."

Elder Liu only made one unique request to him.

(End of this chapter)