My medical skills add experience

Chapter 532 The family members who are in trouble again, first control the infection and then operate

"Can this be used as a vascular stent? The expert diagnosis result of the Provincial People's Hospital is the same as yours, saying that it is chronic arterial ischemia. I checked the treatment of this disease on a very professional medical website. If the blood vessel is narrowed or blocked The resulting blood blockage can be opened through a very small minimally invasive surgery by placing a stent in the blood vessel.”

When the veteran cadre's daughter-in-law said this, Zhou Can finally understood why the Provincial People's Hospital didn't operate on patients.

Even Zhou Can was disgusted when he heard how he was directed by his family members to treat his illness. Which of the experts from the Provincial People's Hospital is not a famous figure in the medical field?A family member who thought he knew everything, checked a little information on the Internet, and ordered him blindly.

Due to the identity of this woman, the experts are inconvenient to refute in person.

The best way to do that is soft handling.

Continue to treat the veteran cadres according to the treatment methods that have been tried in the previous hospital and proved to be ineffective.

When the veteran cadres saw it, ah, they thought the experts in the provincial people's hospital were so good, but they were no different from the doctors in prefecture-level city hospitals!Or anti-infection treatment, can that work?
As long as the veteran cadres are not stupid, they promise to obediently change hospitals for treatment.

If the experts from the Provincial People's Hospital say it again in a more serious tone, we are not sure about your disease, so we can try amputation first.

Guaranteed to scare the veteran cadres overnight to ask for a transfer.

Sometimes, patients and family members feel that a certain expert is not good enough, maybe he is not really bad, but deliberately "bad" to make you think he is bad.

"It's rare to do stents in this situation. I suggest you do an angiography first. Because your father-in-law is old and has no history of smoking, the possibility of arteriosclerotic occlusion can be considered."

Zhou Can glanced at the woman lightly, and patiently explained.

Different from myocardial infarction, chronic arterial ischemia of this kind of limbs is rarely caused by a large plaque growing in the blood vessel to block the blood vessel.

Arteriosclerosis causes the inner walls of blood vessels to narrow and become more likely to eventually become completely blocked.

"We agreed to do an angiographic examination. If a problem is found, we still hope to avoid aggressive surgery as much as possible. Instead, we hope to adopt the treatment plan given after consulting experts online, using minimally invasive interventional surgery and placing a stent to solve it."

Women are quite stubborn.

In fact, we often encounter this kind of family members or patients in clinical practice. They only believe in the conclusions drawn by acquaintances, online 'experts', and Baidu searches.Do not want to trust the doctors who treat them.

What's even more frightening is that the attending doctor told them that they couldn't trust the information on the Internet, and that you should treat them according to the method I said. Not only did the family members not listen, but they thought the doctor was trying to cheat him of money.

When encountering such family members and patients, the only way is to let them go to that acquaintance for treatment.

Zhou Can stood up and glanced at Director Xueyan.

The latter winked at him, revealing a cryptic wry smile.

If it weren't for the presence of family members and patients, she would probably shrug her shoulders and show a helpless expression.

"Think about it again. If you agree, you can do an angiography first. The patient's condition is progressing every day, and early treatment will benefit. If it is delayed for a long time, amputation should be the last option."

Zhou Can can only talk about this.

If the family members and patients do not listen, there is nothing he can do.

Doctors can only give the treatment plan that they think is the most beneficial to patients. As for the final choice, patients can only choose by themselves.

"Dr. Zhou is right. I can't procrastinate my illness any longer. I'll listen to you, and I'm willing to listen to you. Can I arrange an angiography now? Don't worry, you don't have to worry about money. As long as the disease can be cured, I don't care." How much will it cost?"

After all, veteran cadres are people who have been in the officialdom for a long time and have rich experience.

He has already noticed a clue from the expressions of Zhou Can and Director Xueyan. When he heard that the limb will be amputated after a long time, this statement is exactly the same as that of the experts from the Provincial People's Hospital.

His heart was full of fear.

A man with a big mouth must have a law, and a woman with a big mouth must have evil spirits.

This daughter-in-law's filial piety is filial piety, but it's a little too strong.

It is normal for the doctor to be disgusted if the hospital insists on treating her according to her request.

If we say, what happened at the Provincial People's Hospital was a bit weird.

Then at the Tuya Hospital at this moment, if they can't change some concepts by themselves, they may encounter 'quack doctors' again.

"Dad, don't worry. A friend of mine who is a doctor told me that doctors like to exaggerate the condition. If it is cured, it is a great achievement. If it cannot be cured, it means that the patient's condition is too serious. The doctor has tried his best. .”

The woman leaned closer to the old cadre's ear and whispered.

"You listen to me, let's discuss the treatment plan with the doctor."

She was worried that her father-in-law was old, he didn't understand the dangers of society, and he was easy to be deceived.

After hearing this, the veteran cadre raised his head and said to Director Zhou Can and Xueyan, "It's okay, please arrange for me as soon as possible, the sooner the better." After speaking, he turned his head to look at his son and daughter-in-law.

"It's getting late, you go back! Anyway, there are nurses here to take care of you. When the time comes, you need to sign for the operation, and I'll find you again."

"Fen, let's go back first!"

The son of the veteran cadre said to his wife.

"Dad, if the test results come out, you must tell us in time! When the time comes to make a surgery plan, you wait for us to come."

The daughter-in-law is still full of worries.

"I have a sense of proportion, go back! Take care of your mother."

The veteran cadre waved at his son and daughter-in-law.

It's almost like driving the two of them home.

Zhou Can saw all this in his eyes, and secretly thought in his heart, big people are really different from ordinary people.After all, I climbed up step by step by my own efforts, and my reaction ability is quite strong.

From the performance of this veteran cadre, most of them have already realized where the problem lies.

Since this person was a key patient personally confessed by Dean Zhu, an angiography was arranged for him overnight.

Unlike cerebral angiography and cardiovascular angiography, angiography of the extremities is relatively less risky.Implementation is also easier.

But the necessary preparatory work must not be less.

In the office, Zhou Can shook his head, "Sister Yan, shall we give this veteran cadre an X-ray examination first, and then do an arterial angiography?"

This can be more targeted.

X-rays can reveal plaque calcifications in the arteries.

Ultimately, however, an angiogram will definitely be required.

Because angiography can determine the location and extent of arterial blockage.

For example, is the artery twisted?Diffuse irregular narrowing of the lumen, or segmental occlusion.

Only by ascertaining the specific conditions inside the blood vessels can the most favorable surgical plan be formulated.

This case is not complicated.

The really tricky one is the patient's daughter-in-law.

There are too many things, and it is inevitable that the doctor will have great concerns.

Originally, X-ray plain film examination should be done in the Provincial People's Hospital, but they didn't do it in a daze.

Even if one more inspection is done, it can generate more income for the hospital.

But other doctors would rather not make this money.

Doctors are paid for their salaries, and they really don’t care if they treat more patients or less patients when they encounter many patients.

In order to treat one more patient, family members and patients complained, even violently confronted each other, sued in court, and threatened personally, it would be better to have one less thing.

Director Xueyan has no objection to Zhou Can's inspection plan.

He readily nodded in agreement.

"This patient is pretty good, but his daughter-in-law has too many things to do. His wife has a lot of thoughts. I was disgusted at the time. Fortunately, his wife has high blood pressure and heart disease, so it is not suitable Stayed in the hospital for a long time and went back."

After hearing this, Zhou Can couldn't help feeling terrified.

The daughter-in-law of a veteran cadre alone is enough to make people overwhelmed. If the patient's wife is even worse, there is really no cure for the disease.

"At that time, the signature of the family members is required to perform the operation. How can we do it? We need to use a soft knife to persuade the patient to transfer to another hospital. The cardiothoracic surgery department is very busy now, and we can't take up too many medical resources because of such a lot of patients."

Zhou Can suggested.

"Let's see the situation first and then talk! If it's really not possible at that time, we can only find a way to transfer the patient."

Director Xueyan was still soft-hearted after all.

As a woman, soft-heartedness is a common problem.

Meeting a cruel and vicious woman is every man's nightmare.

……

By the time Zhou Can finished two operations in the cardiothoracic surgery department, it was already twelve o'clock at night.

The major surgeries I receive now are extremely difficult, and the surgeries usually take three to four hours, or even longer.

Zhou Can felt more and more that time was not enough.

There are too many high-precision operations in cardiothoracic surgery, and many of them are large-scale projects.

Sometimes, in order to anastomose a blood vessel, or cut out a tumor, or repair the mitral valve, extreme care is often required.And do a lot of auxiliary work for the smooth implementation of the operation.

In order to cut off a tumor, not only the chest was opened, but also the pericardium was removed, and extracorporeal circulation was even established to stop the heart.

None of these preparatory steps should be missed.

And every step is walking on the tip of the knife, so you must be extra careful.

After dragging his tired body out of the operating room, Zhou Can now just wants to go home, take a shower and sleep.

Originally, I thought I could get off work early and go home to write a thesis.

Can't do anything now.

After this period of time, he must think of some ways to squeeze out as much time as possible for study, improve his academic qualifications and academic level.

Because many seniors have told him with blood lessons that academic qualifications are too important.

"Zhou Can, the two inspection results of that veteran cadre have come out. I know you are a busy person, why don't you help him read the inspection results before leaving?" Director Xueyan took the inspection report from the bed doctor , called Zhou Can.

If Zhou Can is not asked to help the staff now, I'm afraid he will have to wait until after seven o'clock in the afternoon tomorrow.

"Row!"

Zhou Can did not refuse.

After receiving the inspection report, he stared at it carefully under the dim light in the corridor.

"Hey, I also did an extra color ultrasound examination, not bad!"

Zhou Can found that in addition to X-ray plain film examination and arterial angiography, color Doppler ultrasound examination was also done.

"After the examination results came out, I took a look and found that the patient's popliteal artery and iliac artery were both narrowed, so I applied for another color ultrasound examination on my own initiative."

The doctor in charge of the bed is a young doctor around 30 years old, currently at the attending level.

Most of the newly recruited doctors in cardiothoracic surgery have a doctoral degree, and some are even postdoctoral.

These people have a very big advantage, working for one year directly promoted to attending.

In terms of rank promotion, compared with doctors with ordinary degrees, they are simply rockets.

"It's good, just be flexible."

Zhou Can nodded, appreciating the self-assessment of the bed doctor.

In clinical diagnosis and treatment, the situation of patients is ever-changing, and doctors need to adapt to changes.If it is that kind of dull doctor, it is actually not suitable for clinical front-line work.

It is a good choice to be engaged in administrative positions or medical technology departments.

Of course, more may eventually be forced to change careers.

After carefully reviewing the three examination reports of the patient, Zhou Can already had a bottom line in his mind.

Color Doppler ultrasonography showed obvious stenosis in the abdominal aorta, iliac artery, and popliteal artery.Among them, the abdominal aorta was also narrowed, which Zhou Can did not expect.

This also shows that his diagnostic skills are far from reaching the top.

Of course, even the top experts in the world cannot diagnose some hidden lesions of patients by relying on palpation and some simple auxiliary examinations.

Zhou Can was able to detect the disease of the popliteal artery and even the iliac artery of the patient only by palpation, which is already very powerful.

Color Doppler ultrasound results also showed that there was no blood flow signal below the right superficial femoral artery.

No wonder the popliteal and dorsalis pedis arteries cannot be felt in the right foot.

Then look at the patient's imaging results.

The abdominal aorta and bilateral iliac arteries were extensively irregularly narrowed, and the right common femoral artery could be visualized, but the superficial femoral artery was not.

The results of angiography were basically consistent with the results of color Doppler ultrasound examination.

"From the examination results, it is basically possible to diagnose the patient's right superficial femoral artery sclerotic occlusion."

After Zhou Can read the inspection report, he gave a diagnosis opinion.

In fact, the doctors present can basically give diagnosis results based on these examinations.

Director Xueyan and the doctor in charge of the bed are really looking forward to the treatment plan given by Zhou Can.

"Zhou Can, can you give me a surgical plan now? Or you can go home with the test results and give me a surgical plan tomorrow morning."

In front of other doctors and nurses in the department, Director Xueyan didn't hide it. She likes to hear Zhou Can's opinion on the operation plan for some key patients.

"I'd better give it now! The examination materials are kept in the department, and it can also be used as a reference for other doctors."

Zhou Can felt that the patient's condition was not particularly complicated.

Surgical options are not particularly difficult.

"The patient's angiography results showed that the right deep femoral artery and the right popliteal artery above the knee joint were shown by contrast medium, indicating that there were still blood outflow channels in the arteries of the lower extremities. The patient's lungs had moist rales during auscultation, indicating that it was possible There is a lung infection, and if you want to operate, I am afraid that you need to control the patient's lung infection with drugs first, and then perform the operation. As for the operation plan, I think that a bypass between the right common femoral artery and the popliteal artery can be done. Help the patient regain blood circulation in the right leg."

There are many factors to consider when performing surgery.

For lung infection, especially for such elderly patients, it is definitely necessary to control the lung infection before surgery.

(End of this chapter)