My medical skills add experience

Chapter 525 High-Level Pharmacology, Director Ming Who Checked the Account

If Zhou Can hadn't insisted on investigating the condition of the pancreas, this small tumor would not have been found at all.

Why is pancreatic cancer scary?
Because the clinical manifestations of pancreatic cancer are not specific, and there is a lack of more accurate direct examination methods, early diagnosis is extremely difficult.Most of those diagnosed with pancreatic cancer have entered the advanced stage and have lost the chance of radical surgery.

Its mortality rate is very high, and its 5-year survival rate is less than 5%, which is why it is called the king of cancer.

Although the other chief physicians also found that the pancreas might be injured through the film, they didn't take it seriously.Because the bleeding is not serious, and the bleeding has stopped.Considering that the patient's body is extremely weak, the operation that can be avoided should be avoided as much as possible.

Including the patient's current legs and right arm fractures, we will not deal with it for the time being.

This is also the basic procedure of first aid.

Deal with fatal injuries first, and then deal with general trauma at an optional time.

Such limb fractures are usually less life-threatening.Can be post-processed completely.

Unless the femoral artery has been punctured, or deep vein thrombosis has formed in the lower extremity, this situation must be treated immediately.

The other chief physicians believed that the injury to the pancreas did not require surgery, which meant that they definitely did not find any major problems with the pancreas.But Zhou Can insisted on investigating the condition of the pancreas. Is this a coincidence, or has Zhou Can discovered something?
Director Gouqiong couldn't help thinking about it secretly.

If Zhou Can could find out that there is a tumor in the pancreas in advance just by looking at the film and auxiliary examination results, that would be too powerful.

Even Director Gouqiong doesn't have such a powerful diagnostic level.

"Director Gou, do you think we can remove the laparoscope?"

Zhou Can asked for instructions.

Removing pancreatic tumors with almost magical top technology, Zhou Can's surgical skills have penetrated into the hearts of every doctor and nurse present.

Including the itinerant nurse who doesn't think highly of him, his attitude towards him is also quietly changing.

The moment the pancreas was found to have a tumor, the itinerant nurse was shocked.

She had to look at this young doctor from Tuya with admiration.

"The operation was done very well, let's remove the mirror!"

After the endoscopes were removed one after another, catheterization was required due to the presence of fluid in the peritoneal cavity.One is drainage, which drains new fluid that may have formed.The other can also be used to observe bleeding in the abdominal cavity.

If the repaired blood vessel ruptures again, the amount of fluid drained out will increase, and the color may be directly red blood.

Seemingly simple drainage and placement, but it also has a lot of attention.

It is necessary to prevent the drainage tube from becoming a bacteria and virus introduction tube.

It will bring certain difficulties to nursing and postoperative management.

The laparoscopic operation was successfully completed, and the next step was the most difficult intracranial hemostasis operation.

The amount of intracranial bleeding was not particularly violent, but there was no way to stop the bleeding automatically, and it was fatal enough.

"Director Ming, can the patient's condition still withstand drilling and craniotomy?"

Whether Director Wu Yongming is willing or not, he must gnaw down this hard bone.

The patient's intracranial hemostatic surgery must be done.

"The patient's current signs are fairly stable, and his breathing has increased a bit. I don't think there should be a big problem with endoscopic surgery."

Director Ming Xin made a comprehensive assessment of the patient's condition.

not bad.

All the signs improved.

Moreover, important signs such as blood pressure and heart rate have become stable, more stable than before the operation.This is pretty good.

It also provides the basis for the subsequent endoscopic surgery.

"Okay, then I'll start work. Director Gou, Dr. Zhou and others have put in so much hard work and won the first battle. I don't have any reason to lose the chain." After Wu Yongming finished speaking, he had already started to touch the patient's head Cut the head cortex at the predetermined position and make a cross incision...

Soon it was time to drill holes in the patient's skull.

The human skull is like a hard turtle shell, which protects the entire brain and the nerves of the head, brainstem, cerebellum and other important tissues.

To perform intracranial surgery, the skull must be sawed open.

The traditional method of surgery is to uncover the skull, which is a major project.Now that science and technology have advanced, doctors can directly drill a small hole in the skull and insert an endoscope into the cranial cavity for surgery.

Not long after the drilling was carried out, the life monitoring instrument issued a piercing alarm.

The patient's blood pressure plummeted, and his heart rate also plummeted, which meant bradycardia.

Director Wu Yongming was so scared that he stopped drilling immediately.

"Is this drilling damage to brain tissue?"

Director Mingxin asked anxiously.

Others also somewhat questioned Wu Yongming's operation.Skull drilling is inherently a very dangerous operation, and requires very high technical requirements for doctors.

"No, the skull hasn't been pierced yet!"

Wu Yongming also looked aggrieved.

It is not the first time to perform endoscopic surgery on a patient. The operation has always been quite satisfactory. How could something go wrong suddenly?

Sometimes, the most feared thing about surgery is this sudden situation.

And have no idea what the problem is.

"The drop in heart rate should be bradycardia caused by hypotension. You can try intravenous injection of 0.5mg atropine to see the effect." After seeing the patient's indicators, Zhou Can combined with the condition to make a diagnosis.

In terms of diagnosis and rescue experience, he may not be as rich as Director Xiang Fei, let alone anesthesiologist Director Ming Xin.

But he has advantages that other doctors may not be able to achieve in their entire lives. Many of his medical skills have been promoted to the sixth level.It is equivalent to both internal and external training, and all of them are of high level.

In addition, there is also the blessing of the special medical skill of emergency life-saving wisdom.

Let him be even more powerful than the chief physician in the rescue work.

In Tuya Hospital, whether it is the operating room, the emergency room, or the intensive care unit, as long as Zhou Can is there, it is equivalent to giving the patient an extra life-saving talisman.

Cardiothoracic surgery has performed many difficult and high-risk surgeries in the past two years. Since Zhou Can participated, there has been no accident.

In fact, it is not that there were no accidents during the operation, but that after the accident, Zhou Can immediately tried to find a way to treat it, and worked together with all the medical staff to finally save the patient from danger.

As his rescue experience has become more and more abundant, the level of various medical skills has become higher and higher, and the success rate of rescue has reached more than 99%.

At this moment, he only checked the patient's condition briefly, and quickly diagnosed the cause.

"Isn't it good to push the vice kidney to strengthen the heart?"

Ru Yaji behind Director Xiang Fei couldn't help asking.

During first aid, for heart failure, cardiac arrest and the like.There are more scenarios where the accessory kidney is used.

"Epinephrine is a drug that constricts blood vessels. It can indeed increase blood pressure and increase the contractility of the heart. But it can also constrict the blood vessels of the heart, liver, and bones, and selectively constrict blood vessels of the skin and mucous membranes, and blood vessels of the limbs. It is more suitable The rescue of shock patients is widely used clinically in the rescue of critical patients. However, it should be used with caution for patients whose blood vessels are too fragile."

Zhou Can glanced at her and gave an explanation.

"The patient had just finished the repair and anastomosis of the splenic artery. His blood vessels are already fragile, and the use of adrenaline can easily cause secondary rupture of the blood vessels."

Director Xiang Fei also gave timely pointers to his lover.

What I fear most when studying medicine is dogmatism and the sameness.This is extremely harmful to patients.

Thousands of people have thousands of diseases, one disease is one party, this is the experience summed up by ancient Chinese medicine.

It seems that they are all critical patients, and the rescue methods may be completely different.

Even with the same drug, there can be big differences in dosage.Some patients need rapid push, and some need slow intravenous infusion.For some patients, only 0.5ml may be enough, and for some patients, it may not work at all.

For example, those who are overweight often need to increase the dose.

In addition, it is also necessary to consider whether the patient is allergic to this type of drug, does not absorb it, whether there is a contraindicated underlying disease, and so on.

For example, patients who have undergone stent surgery should be particularly cautious when using hemostatic drugs.

Under normal circumstances, such patients need to take anticoagulant drugs for life to prevent blood vessel blockage from happening again.

"Understood!"

Ru Yaji nodded receptively, and gave Zhou Can a grateful look.

She couldn't help admiring Zhou Can's clinical rescue ability even more.He deeply felt the strength gap between the two.

I thought there was only a huge gap between Zhou Can and Zhou Can in terms of surgery.

Unexpectedly, Zhou Can was far ahead of her in rescuing critical patients, whether it was diagnosis or medication.

This time, she was completely convinced.

Pang Houzhong next to him was even more sluggish, looking as if he had been hit hard.

After intravenous injection of 0.5 mg atropine, the patient's condition improved.

However, the situation remains worrying.

"Director Ming, do you think it would be risky to transfuse about 150ml of blood to the patient?"

Zhou Can asked.

There were only two people with high-level rescue capabilities at the scene, one was Director Mingxin and the other was Director Xiang Fei.

If you want to discuss it, you must consult with the anesthesiologist in charge.

After all, during the operation, she is responsible for the safety of the patient's life.

"Why is the blood transfusion 150ml instead of more than 200ml?"

she asked back.

"Maybe I have always been too cautious in doing things. Just now I calculated based on the patient's heart rate and blood pressure. 150ml of blood transfusion should be barely enough, just enough to stabilize his vital signs. Supporting the completion of the intracranial surgery. Lost too If there are too many, I am worried that it will cause other unforeseen consequences. It will also increase the difficulty of intracranial hemostasis."

Zhou Can gave his own answer.

Immediately, everyone cast envious and jealous eyes again.

Calculating the amount of blood transfusion is not a particularly brilliant skill.Basically, many doctors can calculate the amount of blood loss based on the patient's hemoglobin level, and then formulate the amount of blood transfusion and fluid replacement.

However, in this kind of clinical first aid, it is necessary to calculate the blood transfusion volume accurately in a very short period of time, just based on the patient's heart rate, blood pressure and other parameters, even Director Xiang Fei would be ashamed.

The difference between 150 and 200 seems to be only 50ml, but after infusion into the patient's body, it may break a certain balance and cause a series of adverse consequences.

Among them, the precise amount of blood transfusion is a real high-level performance.

"Take 150ml of plasma and transfuse the patient immediately."

Director Mingxin gave the order.

During the process of blood transfusion to the patient, Wu Yongming never drilled the patient's skull again.

It really scared him just now.

"Doctor Zhou's ability to rescue critically ill patients is outstanding! Which doctor in Tuya have you studied with? Director Liu Xiangqing of the Department of Critical Care Medicine?"

Director Mingxin took advantage of the time of blood transfusion to inquire about Zhou Can's background.

Because this kid is really outstanding.

"I didn't expect you to know Director Liu. I did study with him for a period of time." Zhou Can still missed the days of regular training in the Department of Critical Care Medicine.I am even more grateful to Director Liu Xiangqing.

It is enough to be lucky to meet such a chief physician who is fully cultivating you in your medical study career.

And as long as you work hard, your talent is not too bad, and you can easily get ahead.

Zhou Can is luckier than others, because there are too many chief physicians who appreciate him.They trained Zhou Can with all their strength and taught them everything they had, and finally created such a young doctor of monstrous level.

Even in a provincial top three hospital like the Provincial People's Hospital, everyone was amazed everywhere.

Let them see the elegance of the Tuya people.

"Famous teachers give rise to great apprentices, no wonder you are so powerful. Who did you learn your surgical skills from? Just now I watched you perform surgery, and I saw the shadow of Tuya's two famous knives. It has the shadow of the most stable scalpel and the Xu Yidaoying, who set a world record, you can get so many professors from top chief physicians, so you must be the second generation of officials, right?"

Director Mingxin's attitude towards him was obviously a lot more friendly.

This question was somewhat of a joke.

"What are you doing? Check your household registration!" Zhou Can responded with a smile. He didn't want to be found out about his old background. "Look, the patient's physical condition has stabilized now, and he should be ready for another operation as soon as possible. Just now, the patient's blood pressure dropped sharply and his heartbeat was slow. In fact, it was just a kind of stress caused by trauma during the opening of the head. It is equivalent to A house that was about to collapse was about to collapse, and a slight vibration caused it to collapse."

Zhou Can quickly changed the subject.

He was smart enough to bring the focus back to the patient.

In this way, this group of people were prevented from being overly curious and inquiring about his origin and details.

"Then let's finish the operation first. After the operation is finished, you have to chat with us. If there are many young doctors in Tuya who are as good as you, our Provincial People's Hospital might as well give you the treatment directly." Got it compiled."

She is another joke.

But it is also true.

It would be terrifying if Tuya could have ten young doctors at Zhou Can's level.

As long as it grows up, it can easily crush almost all hospitals in the province.

That is really the kind of invincible opponent in the province.

Zhou Can smiled wryly and said nothing, silence is golden.

At this time, it is wiser to keep silent.

Surgery continues.

Wu Yongming tried to drill the patient's skull again, and this time there was no problem.

Next, the dura mater was incised, and Director Wu also showed his superb surgical skills.

The chief physicians of these provincial people's hospitals are all very strong.

"Doctor Zhou, how about you help me?"

Unexpectedly, after opening the dura mater, Wu Yongming changed players on the spot and directly invited Zhou Can.

Much to the displeasure of his medical assistant.

This is also impossible.

The patient's condition is extremely dangerous, and the subsequent hemostasis operation will be hell-level difficulty.Accidents are more likely to happen again.

After seeing Zhou Can's outstanding performance in laparoscopic surgery, Wu Yongming finally made the decision to change players on the spot after a battle between heaven and man.Let Zhou Can come to him as an assistant, there are many advantages.

It is more reliable than the existing medical assistance and can bring him a sense of security.

Even if the patient really had some accident again, Zhou Can would directly help to rescue him without him needing to speak.

Also, Zhou Can's blood vessel anastomosis ability is super fast and good.The bleeding point is close to the brainstem, so Zhou Can may be needed to repair the blood vessels.

(End of this chapter)