My medical skills add experience

Chapter 365 The embryonic form of the new cardiac surgery team, who will be scolded for meritorious deeds

Several directors and deputy chief physicians are quite calm, at least they can hold their breath and keep calm.Everyone is trying to find the cause of ventricular tachycardia.

The risk of death from thoracotomy is inherently high.

This surgery, which involves atrial resection, ventricular folding, and tricuspid valve replacement, has a higher mortality rate.

A random accident can easily cause irreversible consequences.

"Could it be caused by the tricuspid valve being too narrow?"

Director Xueyan was so anxious that she was about to smoke.

Finally, the chief surgeon performed a highly difficult level [-] major operation, and the entire operation process has been smooth. Who would have thought that such an accident would happen during the intraoperative test.

First of all, it can be made clear that the occurrence of ventricular tachycardia is not directly related to the opening and closing of the tricuspid valve in the irrigation test.

Even without this test, as soon as the heart resumes beating, the problem of ventricular tachycardia will be revealed.

"It shouldn't be a problem with the tricuspid valve. This is really terrible. Where is the problem?"

When Director Hu Kan was in a hurry, the load on his heart became heavier, and he couldn't help covering his heart.

Breathing also became heavy and rapid.

Heart disease patients and hypertensive patients are afraid of being stimulated.

Especially for patients like Director Hu Kan who have suffered from repeated heart diseases for many times, we should pay more attention.

"Why don't we hurry up and seek help from the Department of Cardiovascular Medicine! Surgery is our specialty. They are better at diagnosing the cause of ventricular tachycardia."

Deputy Director Lu always speaks so straightforwardly.

But what he said is right, the difference between surgery and internal medicine is still quite big.

Regardless of the Department of Cardiovascular Medicine and Cardiothoracic Surgery, both are good at treating diseases in the chest cavity and heart area, but the two departments have their own strengths.Cardiothoracic surgery is better at surgery, resection of lung tumors, heart bypass, myocardial infarction...

Cardiovascular medicine is better at treating some heart and vascular diseases that do not require surgery.

Such as abnormal cardiac arrest, ventricular tachycardia, arrhythmia, cardiac insufficiency, cardiovascular embolism and so on.The etiological diagnosis and drug treatment of these diseases are the 'spectrum' of cardiovascular medicine.

"Teacher, look..." Director Xueyan looked at Hu Kan worriedly, not because she wanted to provoke Director Hu, but because she really had no other way.

"Contact the Department of Cardiovascular Medicine immediately and ask them to send the chief physician over for a joint consultation to rescue the patient."

Director Hu Kan made a prompt decision.

Losing face is a minor matter, and the patient's life is more important than anything else.

"Director Dongfang, can you contact the other chief physicians in the anesthesiology department and let them think of a solution together!"

Director Hu Kan looked at Dongfang Luoxue.

As an anesthesiologist, it is our duty to ensure the safety of patients during surgery.

The heart cannot be exposed to the air for a long time, otherwise there will be many serious complications.At that time, things will be more troublesome.

Even at this time, Dongfang Luoxue still held her composure.

His eyes were cold and he looked very calm.

She didn't speak, but she took out her mobile phone and dialed someone directly.

Zhou Can knew almost without guessing that this call for help was probably to Dr. Feng.

"Director Feng, something happened here. The patient is undergoing atrial plication..."

She gave an overview of the patient's situation.

As for what Dr. Feng on the other end of the phone said, no one knew.

Dongfang Luoxue quickly hung up the phone.

He looked at Zhou Can with unemotional eyes.

"Director Feng rushed over from home, and it will take more than half an hour. He asked me to find... you can discuss it first."

She seems to have a natural dislike for dealing with anyone.

Even in her 40s, whether dealing with Zhou Can or other doctors, she has such an unpleasant attitude and tone.

The first half of her sentence was addressed to everyone, and the second half of her sentence was directed at Zhou Can, specifically to him.

Many people in the Department of Cardiothoracic Surgery know that Zhou Can has a close relationship with Director Feng of the Department of Anesthesiology, and has received many pointers from Director Feng.Now that an accident happened, Director Feng asked her to discuss it with Zhou Can first, and they were not surprised.

Zhou Can didn't respond, he stared at the patient's bloody pericardium, with a puzzled expression on his face.

"Hey, did you hear me talking to you?"

Dongfang Luoxue thought that he was deliberately ignoring her in return, and she felt that Zhou Can was too petty.

Zhou Can still didn't respond.

This time, there was a hint of sullenness in her eyes.

"Doctor Zhou is thinking about something, don't interrupt him."

Director Xueyan has cooperated with Zhou Can the most times and spent a very long time together, so she knows Zhou Can quite well.

Dongfang Luoxue heard Director Xue's explanation and didn't say anything more.

She herself is actively looking for the cause of the ventricular tachycardia.

While everyone was looking for the reason, the patient's pericardium trembled.Like a thinly dressed person, shivering in the ice and snow. "No, it's ventricular fibrillation! Get ready for rescue!"

Everyone's hearts are tense, and their nerves are like taut strings.

If ventricular fibrillation is not treated in time, it will soon develop into cardiac arrest.

The danger in the operation is always caught off guard, which is why the family members must sign before the operation.If something goes wrong, it is impossible for doctors and nurses to sweat and cry.

We can only regret to tell the family members that we have tried our best.

"Cache the Mapping Stick and Mapping Ring!"

At this time, Zhou Can seemed to have finally figured out what the problem was.

He has the special medical skill of emergency life wisdom, which can achieve twice the result with half the effort in the process of rescuing patients.This medical skill has now been promoted to the intermediate level, and the effect is even better.

When rescuing patients, not only can the wisdom be multiplied, the mind is highly calm, and the diagnostic thinking can also be improved by 100%.

"What mapping rod and mapping ring?"

The three surgical nurses all looked dumbfounded, not knowing what happened to Dr. Zhou suddenly.

"Xiao Zhou, are you going to do epicardial mapping?"

Director Hu Kan is worthy of being the boss of cardiothoracic surgery, and he understood Zhou Can's intention in an instant.

"Exactly!"

Zhou Can nodded vigorously.

"What are you doing epicardial mapping at this time?"

Dongfang Luoxue was full of doubts. The patient was in ventricular fibrillation, and the situation was getting worse. Defibrillation was the only way to save him.

Director Xueyan seemed to understand Zhou Can's meaning, frowning and thinking.

The others couldn't speculate on Zhou Can's intentions because of their low level.

"If I am not wrong in the diagnosis, the patient should be pre-excitation syndrome. In this case, all rescue measures are to treat the symptoms but not the root cause without cutting off the abnormal conduction signal. After defibrillation, the ventricular tachycardia still exists, and the ventricular fibrillation will still occur. It happened again. Before the operation, I felt that the electrocardiogram was slightly abnormal, but due to insufficient clinical experience, I couldn't figure out the crux of it."

Zhou Can explained to everyone very calmly.

"Just now, the operation was in the final stage. It was just a water injection test. It is impossible to cause such serious problems as ventricular tachycardia and ventricular fibrillation. Director Xue's entire operation process was correct, which shows that there is no problem with the operation itself. Then there is only one It is very likely that this problem existed before the operation. It is just hidden very deeply, or it is intermittent, so we have not been able to find it.”

After listening to Zhou Can's explanation, Director Xueyan and Director Le nodded again and again, both showing expressions of sudden realization.

Deputy Director Lu had bright eyes, full of admiration and admiration when he looked at Zhou Can.

"It's really careless! It's not too late to fix it before it's too late, and deal with it according to pre-excitation syndrome immediately."

Director Hu Kan had already guessed something when Zhou Can asked for a mapping stick and a mapping ring.

After listening to Zhou Can's explanation now, he felt that it was very reasonable, and he immediately agreed to take rescue measures in this regard.

Originally, these should have been completed immediately after the chest was opened.

Because some patients with pre-excitation syndrome are obvious, and some patients are very subtle.

Under normal circumstances, the patient's ECG will show that the PR interval is significantly shortened, and pre-shock waves appear at the same time.However, this disease itself is abnormal atrioventricular conduction, and it may not appear when the ECG is checked, which leads to a missed diagnosis.

At that time, Zhou Can felt that the electrocardiogram was abnormal, but he didn't think about it at all.

And it was only slightly abnormal, there was no pre-shock wave on that electrocardiogram at all.

That's why even Director Hu Kan, Director Xueyan, Dongfang Luoxue and others were not able to diagnose them.It can only be said that doctors are human beings, not gods.

There are omissions, it is really a normal thing.

If the patient has supraventricular tachycardia, he will feel obvious symptoms such as chest tightness and palpitation.

It's a pity that this patient has a serious heart disease, not to mention palpitation, even if the heartbeat stops suddenly, the doctors will never suspect WPWD.

The greatest harm of pre-excitation syndrome is a series of complications.

Generally have syncope, shock, heart failure, sudden death and so on.

In addition to discomfort such as heart palpitations, the patient may suffer from shock, heart failure or even sudden death.

Whether this patient can be rescued is still up for debate.

Director Hu Kan, as the "commander of the three armed forces", only pretended to be calm in order to stabilize the morale of the army, and said it very lightly.

"The mapping stick and the mapping ring are here!"

The patrolling nurse was pretty good, and found what Zhou Can needed from the first-aid supply cabinet in the shortest possible time, and brought it over.

"Give it to Director Xue, my experience is still inexperienced..."

"Can you talk less nonsense, boy? Hurry up! It's this time, and you're still being humble!" Director Hu Kan scolded with eyes widened in anger.

He thinks that Zhou Can is good at everything, but sometimes he is too modest, and he is not at all agile when he makes a move.

It's really worrying to watch.

"Okay ok! Don't blame me for messing up!"

Zhou Can was helplessly kicked out of the shelves.He has learned how to map the epicardium, but to say he is proficient is nonsense.

Originally, this kind of thing should be done by Director Xue and Director Le, they must be more familiar with it.

There are many ways to map the epicardium. The most common way is to divide the ventricular surface into 53 regions, and each region is a mapping point.

The purpose of this is to identify atrial regions with abnormal conduction.

Use the mapping stick and the mapping ring to record the potential of each mapping point synchronously, and compare it with the reference electrode to calculate the potential time difference between each mapping point and the reference electrode point. The unit is mostly in ms, and fill in the mapping Points are drawn according to the heart anatomy, which is the epicardial mapping map.

It can be seen from its mapping principle that this is an extremely complicated process, and it requires the cooperation of the entire team to complete it in a very short period of time.

"I'll draw!"

Director Xueyan volunteered.

"I'll be Dr. Zhou's assistant!"

Director Le also put down his body and went all out.

"During this period, I will do my best to protect the lives of the patients." Dongfang Luoxue's tone was still cold, but her ability to say this on her own initiative also meant her admiration for Zhou Can.

It's like being defeated by an opponent in the arena, and I feel very convinced in my heart.

Director Hu Kan also came over to personally guide Zhou Can.

With the cooperation of everyone, Director Xueyan drew the epicardial map.

Epicardial mapping requires speed and accuracy, and Zhou Can definitely did not choose the wrong person to complete the core operations.

Otherwise, given the sluggish habits of the cardiothoracic surgeons, it is estimated that the patient has ascended to heaven before the map is drawn.

Director Xue has profound knowledge, calculation ability, and knowledge. She is definitely the best candidate for drawing.

This cooperation has inadvertently brought together a strong team in cardiothoracic surgery with Zhou Can as the core.

"Xiao Zhou, you must remember when doing epicardial mapping. Since the conduction of the bypass is faster than that of the atrioventricular node, the earliest activation point of the ventricular muscle is the anatomical location of the bypass."

Director Hu Kan taught him everything he had, and tried his best to pass on what he had learned to him.

"Now that the abnormal conduction area has been found, can I cut it off?"

"Hurry up!"

Director Hu Kan is about to start swearing again.

Director Xue smiled at Zhou Can, and gestured for Zhou Can to stand at the chief knife position.

In terms of operation speed, apart from Dr. Xu, it is difficult to find a second person who is faster than Zhou Can.

After Zhou Can decisively cut off the abnormal conduction bundle of atrioventricular, the patient's ventricular tachycardia returned to normal.

[Experience value of incision +1, because you accurately incision the atrioventricular bundle for the first time, reward incision experience +100.The quick knife method is successfully cast, and the experience value is +1.Due to the perfect integration with the steady knife method, the experience value reward of the quick knife method is +100, and the experience value reward of the steady knife method is +10. 】

Zhou Can was extremely surprised to get so many experience rewards at the same time.

He was just pleasantly surprised, why he only rewarded 10 experience points for the Slow Knife Technique?
Could it be because in the process of using the knife just now, the fast knife method was the main method, and the steady knife method was supplemented?
It should be like this.

The experience value rewarded by the system is generally given when he has made a major breakthrough or has made great progress.When calculating, it is very fair and just.

Playing support is definitely not as good as the main attack.

It's like when a soldier gets more meritorious service than a general in a war, it's definitely not fair.

"The problem has been solved, Xiao Zhou, it's up to you to complete the final finishing work. After the inspection is correct, hurry up and close the chest cavity. The heart cannot be exposed to the outside for a long time."

Director Hu Kan did not relax because of this, but urged Zhou Can to hurry up and complete the operation.

In order to avoid extreme joy begets sorrow, serious complications occur.

……

Half an hour later, the chest cavity was successfully closed.

The vital signs of the patient have been maintained in a relatively safe state since Dr. Feng arrived.However, the ability of anesthesiologists should not be too deified. They are the ones who know the three major circulations of the body best, and the ones who maintain the vital signs the best, but it is difficult for a clever woman to cook without rice.If the patient's pre-excitation syndrome cannot be resolved, no matter how good the anesthesiologist is, it will be useless.

After the operation was completed, Director Hu did not announce the end of the operation.

Because this kind of heart surgery with twists and turns is high-risk in itself, it needs to be observed for a period of time to ensure that the patient will not have postoperative complications or other abnormalities before being transferred to the intensive care unit for care.

After leaving the operating room, if there is an abnormality, it is often too late to push back to the operating room, and the patient will die.

The heart and the brain are two restricted areas for surgery. Due to lack of capacity, many hospitals often invite experts to sit in on operations involving these two restricted areas.Sometimes, even the whole hospital recruits elites from various departments for one operation.

"Today, this patient almost couldn't get off the operating table. The lesson is extremely profound. After you go back, you must carefully summarize and keep in mind the lesson of this time."

Director Hu Kan began to make a postoperative summary while observing the patients.

"Xiao Zhou, although you made a lot of contributions in the operation today, I have to criticize you!"

Zhou Can didn't expect that the teacher would scold him after the surgery was over and the patient was safe.

There is nothing wrong or wrong!

He was very puzzled, but he didn't confront Director Hu Kan face to face.

A teacher is a teacher, and respecting teachers is the most basic criterion.

(End of this chapter)