My medical skills add experience

Chapter 247 The finishing work is also very important, the first time to give the doctor's order for rescue
"thanks, thanks!"

Zhou Can had a flattered expression on his face, but he didn't really feel much in his heart.

Because it was not the first time that the Chief Physician served as his assistant.

He's already used to it.

I saw that he first sterilized the patient's abdomen, and then drew the knife position for the window.

Endoscopic surgery only requires two small incisions.

The entire abdominal window opening process was completed by him alone.

Internal medicine doctors, especially chief physicians, actually have certain surgical capabilities.But it certainly can't be compared with the chief physician of surgery.

Opening a small window in the abdominal cavity is already a high-risk and difficult operation in their view.

Zhou Can finished it with ease.

The surgical prowess revealed was enough to amaze Director Shang and Director Shi.Facing Zhou Can's operation in their hearts, the two felt much relieved.

At least you don't have to worry about it like before.

After the window was opened, an endoscope was inserted to operate the arm. With the help of the endoscope's visual function, Zhou Can carefully began to perform the operation.

Firstly, debridement of the fistula, and a certain degree of incision.

Because after the fistula is formed, it has already formed a healing layer, and it is useless to suture it directly.

This is one of the reasons why fistulas are difficult to repair.

For example, ductal fistula of the breast, many surgeons are not good at this operation.Always lead to patient relapse.

Zhou Can's debridement technique is currently level four, and there is still a certain distance from level five.

The main reason is that the debridement in most cases is normal debridement, and you can only earn 1 experience point at a time.

The speed of upgrading will naturally become slow.

This is the first time such an operation has been done with the help of endoscopic surgery to debride the fistula.

According to his experience, there should be a certain amount of experience points rewarded to him.

As for whether to give 10 points or 100 points, it is hard to say for the time being, and you will only know when you get it.

Under Zhou Can's careful operation, the fistula was finally successfully debrided.

[Debridement experience +1.]

[For the first time you complete the more difficult endoscopic surgery fistula debridement, you will be rewarded with +100 experience points.]

Zhou Can was overjoyed to have successfully received 100 debridement experience points.

The pay is directly proportional to the gain, and this is the best return he expects.

After the debridement was completed and the fluid and tissue residues in the wound were sucked up, he checked the fistula carefully again to confirm that there was no problem before he began to suture.

"Wow, what a strong suture level."

Director Shang's eyes widened in an instant. This was the first time he had seen Zhou Can's suturing ability.

To be honest, with Zhou Can's suturing skills as the deputy director, any department of internal medicine is extremely amazing.

In less than 10 minutes, Zhou Can has successfully sutured the fistula.

"Director Shang, do you think it's okay?"

"It's perfect! Boy, it turns out that your surgical ability is so strong that I was always on tenterhooks when I first started. I was wondering if I should let you complete the fistula repair operation!"

Director Shang smiled openly as if he had picked up a super baby.

Internal medicine needs to do a lot of interventional surgery.

Especially in the Department of Gastroenterology, interventional surgery is required for the resection of various intestinal polyps and tumors.

However, internal medicine is very short of powerful surgical personnel.

Including chief physicians like them, the level of surgery is just that, far from being very good.

Dealing with some routine surgical problems is also competent.

However, in case of some emergencies, or the operation is extremely difficult, internal medicine often requires the help of a surgeon.

Director Shang now finds out that Zhou Can's surgical skills are so strong, and he thinks in his heart that if he encounters some difficult surgical problems in the future, he may be able to solve them without hiring someone.

Asking for help is like swallowing a three-foot sword. Asking doctors from other departments to perform joint operations often takes some leisure.

Gui Peisheng from his own department, of course, can do whatever he wants.

The more he looked at Zhou Can, the more pleasing he was to his eyes, and he was extremely happy in his heart.

Zhou Can lived up to his high expectations, cleaned up the fistula by the way, and then adjusted the drainage tube to a certain extent, then removed the endoscope and closed the two small wounds on the patient's abdomen.

As for the drainage tube, it can only be removed after the patient recovers after the operation and there is no more ascites or pleural effusion.

"Doctor Zhou, just now you adjusted the drainage tube that was originally inserted, is there any deep meaning?"

Luo Jingyi saw Zhou Can's operation and was astonished.

She didn't know until now that this Doctor Zhou, who has stronger diagnostic ability, actually has extremely monstrous surgical ability.

Such a genius, it's amazing.

When she looked at Zhou Can, countless little stars were shining in her eyes.

The other two graduate students, Xie Lin and Qiu Chengyu, also admired Zhou Can's ability.

They haven't even learned the four major punctures yet. Looking at Zhou Can, he can already open his laparotomy alone and complete difficult endoscopic surgery tasks independently. It's really maddening to compare people to people.
How come the gap is so big?
"There should be a problem with the position of the drainage tube. I even suspect that the formation of an esophageal anastomotic leak after the first surgical resection of the patient's entire stomach has something to do with the failure of this drainage tube."

Zhou Can has rich experience in surgery and is familiar with thoracic, abdominal and cranial drainage.

During the operation, he found that the drainage tube was not done properly.

"When I was doing endoscopic surgery just now, I specifically checked the preset position of the drainage tube. When the previous doctor set it, the drainage point was set too high. If the patient can stand for a long time, it may not have much effect. But the patient has been Bed rest resulted in part of the pleural effusion being unable to be discharged. The effusion was soaked in the anastomotic end of the esophagus and jejunum, which eventually caused the wound to become infected and purulent, and could not heal well. Eventually, an esophageal anastomotic leak was formed."

Zhou Can stated his point of view again.

When dealing with the drainage tube, Director Shang didn't say anything, but showed approval instead.

It shows that his operation is completely fine.

"So that's how it is, I understand!"

Luo Jingyi nodded receptively.

"Zhou Can explained this problem very well just now, and it is also a mistake that many newbies make. I guess this drainage tube is not made by the chief surgeon. It is likely that the chief surgeon left the rest of the work to his subordinates after the operation. It happened to be a novice with no actual combat experience who buried this drainage tube. It ended up being a tragedy.”

Director Shang seized the opportunity to educate the three graduate students under him.

The three of them nodded repeatedly, expressing that they would definitely remember it.

The surgical part of the chief surgeon is done very well, and there are not a few medical cases where there are problems in the finishing work.

Some surgeons are very busy. After finishing the key part of the operation, they leave it to the doctors under them.He himself left the operating room directly, or went to the next operation, or did other things.

When the finishing touches are completed, there is a lack of supervision and some problems are prone to occur.

"Okay, this operation has achieved a real success. If the patient's anastomotic leak no longer occurs, the patient will become a normal person again. The problem that has plagued me for more than half a year will be gone forever. Send it to the recovery If there is no problem, they can be sent directly back to the ward for care. But the family members must follow the doctor's instructions. There must be no more cases of Salmonella infection in patients in bed 73."

Director Shang exhorted.

The patient in the 73rd bed was considered lucky, otherwise he had just undergone a major operation, his vitality would be seriously injured, and his body would have wounds, so he would be very easy to die.

"I'll be extra careful."

Zhou Can made a statement on the spot.

He is in charge of this patient, and he will definitely do a good job in postoperative management.

"Director Shang, the wife of the patient whose brain was infected with sparganosis asked me when I could have the operation. How do you answer them?"

"I'll go back to the office and then call the doctor in Shenwai to discuss it. For the family members, you just say that you will arrange it as soon as possible."

Director Shang was going to ask for something from someone else, but he didn't dare to say the exact time.

"There are still 77 bed patients with gastric cancer, and their family members have already rushed to the hospital. In the morning, I talked to the family members and the patient, and they agreed to the operation. The patient's mother said that she would save her daughter even if she was trying to save her daughter."

The patients under his care must be reported to Director Shang in time.

Treatment of patients should not be delayed.

"That stomach cancer patient is a miserable woman! All right, I'll arrange for her later. If it can be scheduled, she will have surgery tomorrow morning at the earliest. Her disease will be dangerous if it drags on for a day. It's better to treat her as soon as possible."

Director Shang has a lot of patients.

Just the few Zhou Can took care of were enough to make him a little bit burnt out.

Coupled with the tasks of sitting in clinics, teaching, and scientific research, one can imagine how busy he is.

In addition, he also serves as the director of the department, and he also takes care of the affairs of the department.

Fortunately, there are two deputy directors of the department to help share the worries, otherwise he must be too busy.

……

Zhou Can went back to the office, wrote the medical records, and then studied the postoperative doctor's order given by Director Shang to the 71-bed patient.

He found that the medicines prescribed by internal medicine were obviously more accurate than those prescribed by surgery.

I also learned a lot about medicine from it.

When he finished studying the postoperative doctor's instructions.

【Pharmacological syndrome differentiation experience value +1.】

This is not the first time learning doctor's orders to increase experience in pharmacological syndrome differentiation.

His pharmacological syndrome differentiation is currently at the third level, that is, the resident physician level.Ordinary small doctor's orders can already be issued by himself, but he can't prescribe postoperative doctor's orders for such complicated operations.

Such an important medical skill must find a way to improve it.

Zhou Can set a small goal for himself, and will spend the rest of the year in internal medicine anyway.I hope that the pharmacological syndrome differentiation can be successfully promoted to the fifth level.

At that time, with the pharmacological syndrome differentiation at the deputy director level, it will be no problem for him to go back to the emergency department and set up his own team.

Although this ideal is a bit lofty, he has confidence in himself.

"Doctor Zhou, Doctor Zhou, the vomit patient under your care passed out just now. Go over and have a look!"

The nurse girl ran into the doctor's office with a panicked expression, and waved at Zhou Can.

"Didn't you be fine in the morning? Why did you faint suddenly?"

Zhou Can hurriedly saved the unfinished medical records, got up and walked out.

"How would I know! Just as he was assigned to bed 11 and was about to take his blood pressure, he suddenly rolled his eyes up and fell unconscious."

The working hours of the nurse girl should be very short.

When she told the story of the incident, her hands were still shaking, and she probably was quite frightened.

"Has the patient's temporary bed been withdrawn?" Zhou Can thought to himself, it's a good thing to switch from a temporary bed to a formal inpatient bed!

Could it be that the patient fainted because he was too excited?
"Didn't Director Shang say hello on purpose? Today, after the patient in bed 11 was discharged from the hospital, the head nurse personally arranged bed 11 for that patient first."

Director Shang's personal greeting was quite effective.

Even the head nurse has to sell this face.

It's just that the patients have no luck!

"Where did the patient's head hit during the bed change?"

When Zhou Cansi thought about it, he could only think of this reason.

"No, absolutely not. It was his wife who carried it all the time. Sister Wang and I supported the patient to bed 11. It is certain that the patient did not hit anything during this period."

The nurse's little sister was just not sure about her immature body.

Since the head was not hit, the possibility of disturbing the sparganosis is very small.

As long as the parasite doesn't penetrate deep into the patient's brain cavity and frantically destroy the patient's brainstem, it will be fine.

But this accident also sounded the alarm for Zhou Can.

The patient's condition is very dangerous and cannot be delayed any longer.

We must find a way to perform surgery on the patient as soon as possible to remove the parasite.

If the patient's illness is cured, it will be a great achievement for Zhou Can.

When I came to the ward, I immediately saw the thin male patient lying motionless on the bed with his eyes rolled up.The patient's wife cried very sadly as if the sky had fallen.

"Sister, don't cry, don't cry! His physical condition was stable in the morning, even if he is unconscious now, it will not be a serious problem."

Zhou Can quickly examined the patient while comforting the patient's wife.

At this moment, the elderly nurse named Sister Wang is measuring the data of key signs such as heart rate and respiration for the patient.

"How's the patient's blood pressure?"

Zhou Can felt the patient's pulse, and felt that the pulse was weak and extremely weak.

As if the lamp is about to run out of oil.

It can be predicted that the patient's blood pressure at this moment must be very low.

"Systolic blood pressure 95mmHg, diastolic blood pressure 65mmHg. Low blood pressure."

The blood pressure value reported by the nurse is really not generally low.

According to international standards, a systolic blood pressure lower than 100 is considered a serious problem.

"Why did the blood pressure drop so badly? Did he eat anything in the morning?"

"I drank a little water and threw up all of it. I haven't eaten anything until now."

The patient's wife replied with tears in her eyes.

Zhou Can checked the patient's symptoms again, and saw that the patient's forehead was sweating, and his body was shaking slightly.Seeing this, he had a bottom in his heart.

"It doesn't seem to be a serious problem. It should be just hypoglycemia caused by hunger. Immediately give him 50ml of 50% glucose solution intravenously."

Zhou Can issued an oral doctor's order.

Having a medical license is different.

In the past, if you encountered such a situation, you had to find a superior doctor to deal with it.

【Pharmacological syndrome differentiation experience value +1.】

[For the first time you use a doctor's order to save someone, you will be rewarded with +100 experience points in pharmacology syndrome differentiation.]

Zhou Can only felt as if he had been hit by a huge happiness shell.

Happiness came so unexpectedly.

That's not all, he received so many pharmacological syndrome differentiation experience rewards at once, and he noticed that his ability to differentiate and understand pharmacology seemed to have improved significantly.

Looking at the attributes, it turns out that the pharmacological syndrome differentiation medical skill has been upgraded from the low level of resident medicine to the middle level of resident medicine.

Although only a small realm has been raised, the benefits gained are real.

The use and understanding of drugs seems to have reached a new level.

"Great, a few more rewards like this will directly raise the pharmacological syndrome to the fourth level."

He is too eager to advance to the fourth level of pharmacological syndrome differentiation.

As long as you are upgraded to the attending level, you can prescribe a doctor's order of general difficulty alone, no problem at all.

The nurse took the glucose solution and injected 50ml into the patient.
Everyone looked nervously at the unconscious patient.

Whether it is a nurse or a doctor who administers medicine to such a patient who is already extremely weak, they are all worried and nervous.

The family members also watched nervously.

The hands unconsciously clasped together tightly.

"Well……"

The patient let out a low hum, which was tantamount to great news in the ears of the doctors and nurses.

It shows that after using the glucose solution, the patient has improved.

People also woke up.

"Give him another 50ML glucose solution."

Zhou Can calmly pointed to the nurse to save her.

【Pharmacological syndrome differentiation experience value +1.】

This time, he was not rewarded with 100 experience points.

But Zhou Can is very contented, taking it once is already very good.

His eyes were fixed on the patient's every move.

Hope the patient can fully recover.

(End of this chapter)