My medical skills add experience

Chapter 267 Fighting for Life with the God of Death, Extraordinary Courage and Courage

After arriving at the cardiothoracic surgery department, I wanted to ask the doctors and nurses which operating room it was in.

He found it all superfluous.

No need to ask at all.

Because there were medical staff jogging in and out of operating room No. 3 all the time, all of them looked dignified.

Outsiders may not be able to see anything, but insiders know that something must have happened at a glance.

Only when the patient's life is in danger, the medical staff will be so nervous.

All kinds of rescue materials were transported in to save people.

Doctors and nurses in multiple departments of the hospital will rush over to participate in the rescue work as soon as they receive the call for help.

Zhou Can followed two nurses into the operating room.

There were not enough clothes in the operating room, and the nurse temporarily placed a large pile of disposable protective clothing.

It can also be used in an emergency.

Uneasy, this kind of protective clothing is not breathable, and it will be very stuffy when worn on the body.If you wear it for surgery, the doctor must be very uncomfortable.

Saving people is the most important thing now, after Zhou Can changed, he walked quickly into the operating room in the inner room.

"Director Xue! Director Le!"

Zhou Can found that many of them were familiar faces. He had been in the Department of Cardiothoracic Surgery for three months, and he basically knew all the formal doctors and nurses in this department.

He couldn't greet ordinary medical staff one by one.I just greeted Director Xueyan and Director Le.

"You're finally here, hurry up and see if you can save the patient!"

When Director Xueyan saw him arriving, she became hopeful again.

"Okay! Let me understand the basic situation of the patient first."

While agreeing, Zhou Can learned about the patient's accident through Director Xueyan's introduction.

The patient, a 41-year-old man, accidentally fell when going down the stairs at home, and his left limb hit the ground first.After falling down, I got up on my own and didn't feel much discomfort in my body.

Before dinner, the patient felt tightness in the chest, palpitations, and labored breathing, as if an invisible big hand was covering his mouth and nose.

Later, the patient began to cough and coughed up blood.

At this time, the family members realized that the situation was not good and took him to the local hospital for treatment.

Because it was night when I went, the doctor on duty sent the patient to the hospital after a simple diagnosis, and prepared to check the patient's chest X-ray after work tomorrow.

The patient was worried about spending money, and felt that there was nothing serious about it. He refused to be hospitalized, so he insisted on going home.

After returning home, apart from coughing and chest tightness, there were no other symptoms.

In the end, I just endured like this, and I hope my body will get better soon.

This delay lasted for 27 days, and the patient's condition did not improve, but the chest tightness became worse.In severe cases, it is accompanied by shortness of breath and chest pain.

Yesterday, the patient passed out suddenly at home, and the family members were worried about the accident and sent to the hospital.

The local health center did not dare to accept him for treatment, and suggested sending him to a large hospital for diagnosis and treatment.

After several twists and turns, the family finally brought the patient to Tuya Hospital.

After receiving the emergency treatment, he felt that he could not handle it, so he transferred the patient to the cardiothoracic surgery department for further examination and diagnosis.

Director Hu Kan received a report from the doctor below that the patient's condition was very bad.A chest X-ray was performed on the patient.Prompt right hydropneumothorax, right lung compression more than 80%.

Later, a thoracentesis was performed on the patient, and a small amount of non-coagulated blood was drawn out.

The final diagnosis was hemopneumothorax.

Because of the urgency of the situation, Director Hu Kan decided to perform a thoracotomy on the patient.

According to his experience in diagnosis and treatment, it must be inferred that the patient had suffered internal injuries.This kind of hemopneumothorax is very troublesome, especially when the patient takes so long to treat it.

Under normal circumstances, it is easier to find bleeding points and injured parts when you do an examination when you have just fallen.

After a delay of nearly a month, when I checked again, many original lesions disappeared or turned into recessive lesions, which will definitely greatly increase the difficulty of diagnosis and treatment.

Performing a thoracotomy on the patient requires general anesthesia.

About 10 minutes before anesthesia, the official doctor injected scopolamine into the patient by intramuscular injection.

Using this drug can effectively slow down the patient's intestinal peristalsis and reduce the secretion of mucus in the respiratory tract.

Unexpectedly, the patient had just been connected to the life monitoring instrument here, and before the general anesthesia was performed, the patient suddenly began to have symptoms such as restlessness, clammy limbs, and cyanotic lips.

Director Hu Kan remained calm in the face of such emergencies, immediately administered local anesthesia to the patient, and then performed closed thoracic drainage from the midaxillary line of the sixth right intercostal space.

In the end, nearly 1000ml of blood accumulated in the drainage bottle.

Director Hu Kan then administered 2.5ml of 12% thiopental sodium and 100mg of succinylcholine to the patient by intramuscular injection.

Immediately thereafter, the patient is intubated with an endotracheal tube.

About 2 minutes later, the patient resumed spontaneous breathing.

Unexpectedly, the good times did not last long, and it was soon discovered that the patient's respiratory resistance increased. After discussing with the anesthesiologist, Dr. Hu Kan, he gave the patient intravenous injection of fentanyl and let the patient inhale enflurane.

But things didn't get any better.

After a while, I found that the drainage bottle did not bubble up, and the water column in the glass tube did not fluctuate.

Director Hu Kan squeezed the drainage tube with his hands, but still no blisters overflowed.

At this moment, the patient's heartbeat stops.

Director Hu Kan decisively ordered the patient to be rescued by cardiac compression.

The chest was explored from between the ribs, and when the pleura was incised, air bubbles and blood gushed out from the incision.

When Director Hu Kan saw this situation, he said in a distressed voice, "Continue the cardiac compression, intravenous and intracardiac injection..." Before he could finish speaking, he passed out on the ground.

Director Hu Kan is known as the most stable scalpel, and he has never missed it before.

Only the risky operation for the thymoma patient almost had an accident last time.At that time, Director Hu directly caused a heart attack.It was Zhou Can who tried to rescue him behind his back, and finally rescued him.

It is precisely because of this relationship that Director Hu Kan still has a very close relationship with Zhou Can.

Unexpectedly, less than a year later, Director Hu Kan had an accident again.

And this time it happened a little wrong.

The person most responsible should be the anesthesiologist officer, and Director Hu Kan just happened to be involved in this matter.He will pass out in the operating room, and he must have known that the patient will be difficult to rescue.

He tried his best to retain the title of the most stable scalpel in his life, but it was destroyed in one fell swoop.

I was so stimulated that I passed out.

After director Hu Kan passed out, he was rushed to the hospital without mentioning it.Director Xueyan took over the position of Director Hu Kan as the chief surgeon, and continued to rescue patients together with the official doctor.

Under her command, the patient was rescued by intravenous and intracardiac injection of epinephrine and lidocaine.

With the help of these drugs that can make the heart beat again, the patient can start beating again.

Unfortunately, it lasted less than 1 minute, and the patient's heartbeat stopped again.

Since then, they have been working hard to continue to rescue the patients.

After Zhou Can quickly understood what happened, he had a general understanding of the patient's cause and condition.

Stretching out his hand, he found that the patient had no pulse, his body was cold, and his skin was sticky and wet.

There is no body temperature that a normal person should have.

"What could be the problem?"

Zhou Can forced himself to calm down. The patient currently does not have a spontaneous heartbeat and breathing, and relies on artificial cardiopulmonary resuscitation to maintain the most basic exchange of blood and oxygen.At this time, every second counts for rescue.

Most of the patient's body has entered the gate of hell.

Many chief physicians and deputy chief physicians from the Department of Cardiothoracic Surgery participated in the rescue at the scene.Director Liu Xiangqing from the Department of Critical Care Medicine was also invited.

But in the face of the fact that the patient was almost dead, they were all helpless.

At this moment, Zhou Can's emergency medical skills played a huge role.

His mind was extraordinarily calm, and his thoughts on diagnosis and treatment became stronger and clearer than ever.

"Three ribs of the patient were amputated, and the thoracic window was enlarged! The problem is likely to be that there is a blood clot in the chest cavity itself, and the closed chest drainage tube may be very blocked by the blood clot."

Zhou Can said his diagnosis out loud.

After quickly going through his mind twice, he thought that there was only one possibility.

If the patient's heart had a major problem, he would have died when he fell, and he would not be able to live now.

Since a large amount of blood was withdrawn from the patient's chest, even though it was uncoagulated blood, it did not mean that there were no blood clots.

After intramuscular injection of scopolamine, the patient developed irritability and cyanotic lips, which may also be related to the severe impact of blood clots on the lungs.Because the patient's right lung was already compressed by nearly 80%.

After straightening out his thoughts, Zhou Can was even more sure of his guess.

【Pathological diagnosis experience value +1, emergency life wisdom experience value +1.】

[You cleared your mind as quickly as possible during the rescue, found out the cause of the disease, and reached a new level in the application of medical knowledge and clinical experience.Reward pathological diagnosis experience value +100, reward first aid life wisdom experience value +100. 】

After Zhou Can was rewarded with experience points, he was even more sure that his diagnosis was correct.

The rescuers did not listen to him, but looked at Director Xueyan who was in charge of the scene.

"Immediately do what Dr. Zhou Can said and expand the chest opening."

Director Xueyan didn't hesitate at all, it was her absolute trust in Zhou Can.

The patient's situation at this time does not allow for any indecision.

Death has enveloped the patient.

The situation is so dangerous that these chief doctors are rare in their lives.

The current rescue of patients is actually more of a rescue obligation of doctors and nurses, and the symbolic meaning is greater than the actual rescue significance.

At this critical moment, Zhou Can put forward a rescue idea that no one had thought of, maybe thought of but dared not implement, it was regarded as a dead horse as a living horse doctor.Fight to the last.

The patient's thoracic fenestration is enlarged, which means that cardiac compressions need to be interrupted for a while.

This is also the reason why the doctors involved, including Director Liu of the Department of Critical Care Medicine, did not dare to obey Zhou Can's instructions.

Director Liu of the Department of Critical Care Medicine has a deep understanding of Zhou Can's ability, and he has supervised Zhou Can for nearly three months.The personal relationship between the two is also very good.

But when rescuing patients, personal friendship is nothing at all, and everything is the patient's life.

Director Xueyan trusted Zhou Can so much, and decisively followed Zhou Can's suggestion to further open her chest, which surprised Director Liu.

In fact, the conditions are not allowed, and the time is too tight.

Otherwise, according to Zhou Can's idea, it is best to saw the sternum from the middle and then expand it.

This is the most common frontal thoracotomy.

It's just that the patient has no heartbeat and breathing. If this operation is really done, the day lily will be cold.

"I come!"

Zhou Can found that these doctors in the Department of Cardiothoracic Surgery have inherited the stability of Director Hu Kan, the so-called slow work produces meticulous work.Their speed is just too slow.

In desperation, Zhou Can could only do it himself.

Many doctors in cardiothoracic surgery know about his surgical ability.

No one raised any objections.

After changing him for the operation, the speed immediately changed from walking to flying.

Brush brush!
The operation was as fierce as a tiger, and Zhou Can's doctors and nurses were dumbfounded.

Watching Dr. Zhou perform the surgery was really scary.

Many people secretly thought in their hearts, even if the patient's heartbeat has stopped, they can't be treated like livestock, right?

After the patient dies, as long as the family members raise questions, forensic doctors will definitely intervene.

When the forensic medical examiner sees that the surgical wound was caused by rough manipulation, there will definitely be bad comments.

It was only when Zhou Can really completed the expansion of the chest window that everyone realized that although his operation speed was fast, the surgical incision was not rough.It is even neater than the incisions carefully made by doctors in cardiothoracic surgery.

"The straw sucks the blood out of the chest cavity."

There was still some blood in it.

Immediately after it was withdrawn, a blood clot was found, and there was more than one.

It can be clearly seen that the chest drainage tube has been blocked by a blood clot.

This is an important reason for the patient to stop breathing and heartbeat.It was also the chief culprit that caused Director Hu Kan's rescue measures to have an effect, and lasted for less than a minute, and then the heart stopped again.

"The patient appeared to have a severe tumor in the upper right lung, which ruptured and hemorrhaged."

Zhou Can said.

"It should be that the cavity breathing after anesthesia intubation caused the lung lobes to expand, the blood clot moved and blocked the drainage tube, and eventually tension pneumothorax occurred and the heart stopped."

After opening his chest, he found the root of the problem, and no one felt that Zhou Can was messing around.

On the contrary, they admire Zhou Can's diagnostic ability and rescue ideas from the bottom of their hearts.

Under such circumstances, it takes great courage and determination to decisively insist on further thoracotomy.It is necessary to have an in-depth and comprehensive understanding of the patient's etiology and condition before daring to make such a decision.

"Immediately perform pericardial compression! Blood transfusion rescue."

Zhou Can gave orders again.

Every second of this kind of emergency rescue is extremely precious. He really couldn't ask Director Xueyan for instructions first, and then give orders through her mouth.

If you do that, the face project will be done well, but it will delay things too much.

It is also extremely detrimental to rescue.

In medicine, cardiac arrest has a saying of 3 minutes to save gold.

At this moment, it has actually exceeded 3 minutes.

Zhou Can quickly cleaned up the blood clot in the drainage tube.

"It is safer to use a double-lumen endobronchial tube for anesthesia after closed thoracic drainage."

This patient's accident was both accidental and inevitable.

Dr. Hu Kan may have considered the urgency of the situation and only used a single-lumen tube for intubation.

Finally, after the blood clot blocked the single-lumen tube, the patient's breathing and heartbeat stopped again, making the first rescue failure.

There is another point that really caused the patient's near death, that is, the rupture of the lung tumor caused massive hemorrhage.

The bleeding can still be seen continuing.

The pleural hemorrhage had just been taken out, and many more soon appeared.

Zhou Can's all-round advantage is fully revealed at this moment.

He quickly judged the location of the patient's lung bleeding, and then implemented a combination of clamping, ligation, and electrocoagulation to successfully stop the bleeding.

Originally, if conditions permit, the patient's lung tumor should be removed.It may even be necessary to have the entire right lung removed.

Who would dare to do that now?
I dare not do this even if I borrowed his three gallbladders.

Otherwise, you will only get yourself into trouble.

And it could be big trouble.

After a series of effective rescue measures, the patient's heartbeat recovered again, and after massive blood transfusion, the blood pressure slowly rose.

Because the bleeding stopped, the transfused blood no longer had to worry about running away, and the rescue effect was almost immediate.

"It's so dangerous, it almost cost a life!"

Doctor Guan is usually quite calm. When the accident happened just now, his face was extremely pale and he was silent.

It is estimated that he was also scared to death.

"The patient's fate was saved by us. But his right lung has a tumor, and the possibility of it being malignant is high. How to solve this?"

Zhou Can asked Director Xue and others for their opinions.

In the operating room, because the patient's vital signs gradually stabilized, the atmosphere was not as tense as before.

Zhou Can, a small-scale Pearson, has undoubtedly become the core existence of the operating room.

This is the case in the operating room. Whoever can save the patient's life, who has strong surgical ability and diagnostic thinking is the boss.

Even if you are just an intern, you will be the chief surgeon, and other superior doctors will naturally be placed at a considerable height.

"What do you mean?"

Director Xueyan asked him.

When looking at Zhou Can, there was a special light in her eyes.This younger brother is really awesome. After arriving at the scene, he turned the tide and saved the patient from death.

Just now, her heart was already desperate.

I thought the patient would never be saved.

Unexpectedly, a medical miracle happened. After Zhou Can boldly proposed to expand the chest wound, the cause was successfully found and the patient was successfully rescued.

(End of this chapter)