My medical skills add experience

Chapter 535 Accidents caused by anesthesia, a person's strength is limited after all

In the hospital, medical staff must have the two major advantages of geographical advantage and human harmony.

There are many ways to persuade patients to leave.

And everyone is the same interest group, and no one even needs to mention it.When this happens, you basically know what to do.

"You can't go wrong by listening to the doctor. The reputation of Tuya Hospital is so great, and the medical ethics must not be bad. Let's quickly send Xie Chao to the Provincial People's Hospital."

"I also think that people should be sent to the Provincial People's Hospital. After all, it is a large public hospital, and it is more secure in all aspects."

"Before the requested ambulance leaves, contact me quickly."

The family members said something to me, and the matter was quickly settled.

The patient was pulled away by the accompanying doctors and nurses in the ambulance.

To rent an ambulance to transport patients, usually only private ambulances can be rented, also known as outpatient ambulances.The hospital's own ambulance generally does not pick up this kind of work.

At this time, the ambulance driver will contact and hire a car doctor and a nurse.

The cost is usually included in the fare, but the family members need to give doctors and nurses an additional red envelope.

If the family members are not sensible and the red envelopes are not in place, the doctors and nurses who follow the car will be passive and sabotage.

Seeing the patient being taken away, both Zhou Can and Director Lou breathed a sigh of relief.

I can always receive several patients who need to be persuaded to leave every day.

Clearly refusing to diagnose, few large hospitals do this.They all use some soft methods to persuade patients away.

"Xiao Zhou, how low is the survival rate of that patient just now?"

Director Lou asked indifferently.

"If there is no miracle, you will definitely die."

Zhou Can answered firmly.

"So sure?"

Director Lou's level is not low, but in terms of diagnosis level, he is no longer as good as Zhou Can.

"It's a very conservative statement. I'm sure that even if the patient's urine is only thick yellow now, it will definitely turn soy sauce-colored within two days at most. He has already suffered acute renal failure. The upper lobe of the right lung It was resected, and it also induced respiratory failure. Although this patient is not particularly serious now, it is hopeless."

In the past, Zhou Can would not have dared to give such a positive diagnosis.

Even if he was facing his own people, he still didn't dare to be so sure.

Now, his pathological diagnosis has been promoted to the level of a director. In addition, in order to treat Su Qianqian's kidney disease, he devoted himself to learning the diagnosis and treatment of kidney disease.I even studied urology.

So now he can diagnose such patients with a certain degree of certainty.

"After cutting the upper lobe of the right lung, how could the patient's kidney be damaged? The Third Hospital is really bombarded with thunder!" Director Lou has also heard about the Third Hospital.

Mostly negative news.

Especially in the recent period, the third hospital's capital chain has problems, and there is no extra spare money to deal with negative news.

As a result, all kinds of shady stories are continuously posted on the Internet by victims.

It's almost the end of the road, the end of the wall falling and everyone pushing.

"It should not be directly related to the right upper lobe resection. I suspect that it may be caused by anesthesia. I used to think that the Third Hospital invited Japanese cardiologists, and they must be very strong. Now it seems that the strength of a hospital It is not enough for one or two doctors to support it. The Third Hospital lacks foundation and has many shortcomings. This medical accident is likely caused by anesthesia. We will see how the family will deal with it."

Zhou Can's eyes flickered.

I used to think highly of the Third Hospital.

After the patient dies, it is hard to say whether the family members will make trouble with the doctor.

Some family members are more honest, thinking that the doctor has done his best when the patient dies after the operation.Often do not find the hospital trouble.

It is not easy for family members to find trouble in the hospital.

For individuals, hospitals are behemoths.

Family members and patients are relatively vulnerable parties.

"The problem with anesthesia? Analyze it and listen."

Although Director Lou has rich experience and high level, he seems very powerless in the face of some difficult and miscellaneous diseases.This is determined by talent, specialization, and diagnostic thinking.

Regardless of whether he admits it or not, although Zhou Can is very young, because of the teaching of famous teachers in multiple departments, coupled with his own excellent talent, and his continuous accumulation, his ability to diagnose many difficult cases has surpassed Director Lou.

"I think the patient is doing an internal thoracic surgery, usually in a lateral position. This can cause the patient's limbs on the side of the operating table to bear gravity and cause crush injuries. This patient's left shoulder, arm, hip, Obvious soft tissue bruises appeared on the thighs, swelling and blackening, it is likely that during the operation, after general anesthesia, the lower support pad was too hard, resulting in severe compression of the left limb, and ischemic necrosis and fragmentation of the muscles."

"Capillary rupture, blockage, and permeability change. After the operation, the patient returned to the supine position, and the pressure on the side limbs was relieved. At this time, local bleeding occurred, and a large amount of plasma fluid quickly leaked into the interstitial space, which formed muscle swelling. Because there is no If it is treated in time, the increased intermuscular pressure will further aggravate the local blood blockage and ischemia, which will eventually lead to swelling, stiffness, and coldness of the left crushed area."

Zhou Can carefully analyzed the entire injury process of the patient.

Intraoperative crush injuries are easily overlooked by doctors.

This actually requires a high degree of vigilance.

"When I checked the patient just now, I pressed his left swollen area. It was hard, like a stone, and his limbs were cold. This shows that the muscles of the limbs have died, and the best treatment period has long been missed."

When examining the patient, it seemed that he just pressed the button at random, but Zhou Can directly judged the patient's state based on his rich experience in diagnosis and treatment.

"Yes, the analysis is very good. You think the kidney failure is related to the side limb crush, don't you?"

Director Lou nodded in agreement after hearing this.

The young doctors next to him were quietly taking notes, recording Zhou Can's analysis.For later study, and draw lessons from.

"Because of the left muscle necrosis, swelling and hardening, this will cause a large amount of local exudation or bleeding, which will eventually lead to a reduction in systemic blood volume. The patient's blood pressure is so low, which is the best proof. After the systemic blood volume is reduced, the blood in the kidneys The perfusion is reduced and ischemia occurs. At the same time, the crushed necrotic muscle releases a large amount of toxic substances into the circulation, which will further aggravate kidney poisoning. At this time, myoglobin deposits and directly blocks the renal tubules, which leads to acute renal failure in the patient. "

Zhou Can analyzed the complete occurrence process of the entire kidney failure one by one, which was greatly appreciated by Director Lou.

Other doctors and nurses looked at Zhou Can with admiration or admiration.

"It's a pity that the patient is still so young, and a life is so delayed. If there is a problem after the operation, if there is a timely symptomatic treatment, there may be hope of recovery. Now it has entered the stage of irreversible acute renal failure and respiratory failure. There is no way to recover, and the disease is dying."

Zhou Can did not say clearly that the third hospital delayed the patient's life.

However, from his analysis, he could clearly see the dereliction of duty and mistakes in the treatment process of the Third Hospital.

This is a typical serious medical malpractice.

……

In the evening, after the operation in the emergency department, the ward rounds, and the delicious meal delivered by Su Qianqian, Zhou Can hurried to the cardiothoracic surgery department.

There are still a lot of things waiting for him to deal with.

The veteran cadre has already agreed to the operation, but how he persuaded the family members is not clear.

Hospitals are like this. They can only allow family members and patients to adapt to the hospital's diagnosis and treatment model, but it is impossible to act according to the wishes of family members and patients.

Basically, 100% of the treatment expenses of this veteran cadre can be reimbursed, and the family is not short of money.His daughter-in-law wanted to use the safest and 'best' surgical method, placing a vascular stent to solve it.

The doctor couldn't do what she wanted.

How many brackets are there for this?

And it didn't work out well.

Just use an artificial blood vessel to complete the bypass, and everything will be solved.

The cost is much lower, and it saves worry and effort, and there is basically no need to worry about problems with this blood vessel in the future.The only problem with artificial blood vessels is aging and leakage caused by improper anastomosis.

Let me talk about aging first.

The service life of artificial blood vessels is at least ten years or more, and the better ones are more than 20 years.

In fact, there may not be any problems after using it for 30 years.

Because it is sealed inside the human body.

Except for the corrosion of blood and body fluids, there is basically no problem of contact with the outside air.This will undoubtedly greatly extend its service life.

That veteran cadre is already 65 years old, even if he lives to be 35 years old, he will only have [-] years left.

The replacement artificial blood vessel support should be fine by then.

Even if something goes wrong, you can come to the hospital for a new one at any time.

It is generally difficult for patients with arteriosclerosis and systemic lesions to live to the age of one hundred.

Often living to around 80 years old is considered a long life.

Because the patient's abdominal artery, even including cardiovascular, cerebral arteries, etc., will continue to deteriorate.At that time, maybe a cerebral hemorrhage or myocardial infarction will send the person away directly.

In the cardiothoracic surgery operating room, Zhou Can performed the operation on this veteran cadre himself.

The patient's family members wait outside the operating room.

Zhou Can didn't know exactly how Director Xueyan talked to them.I only know that the veteran cadre asked Zhou Can to help him with the operation.

The more distinguished patients are, the more they seek treatment from famous doctors.

After Zhou Can's investigation during the operation, he finally chose an artificial blood vessel with a length of 38 cm and a diameter of about 8 mm, and performed a bypass from the right common femoral artery to the popliteal artery for the patient.

Considering that the fourth toe of the right foot has been necrotic and blackened, it is no longer possible to preserve it.

With the consent of the patient and family members before the operation, amputation was performed.

This has been regarded as reducing the damage to a minimum.

Other hospitals asked him to amputate his right leg to save his life.

For Zhou Can, amputating only one toe is indeed the best result.

After the operation, the blood supply of the right foot, the popliteal artery and the dorsalis pedis artery were all restored.At a speed that can be seen with the naked eye, it can be clearly seen that the skin surface of the patient's right foot has gradually become a little rosy.

Compared with the paleness and coldness before, there is a trace of blood now.

It shows that the blood supply of the right foot has been restored.

With the nourishment and support of qi and blood, the right foot should no longer suffer from necrosis.

"Pay attention to giving him anti-infection treatment after the operation, and closely observe the condition of the right foot. If ischemia occurs and necrosis continues, it must be dealt with in time."

Zhou Can exhorted the itinerant nurse.

"clear."

The itinerant nurse respected Zhou Can very much.

The operating room of cardiothoracic surgery is basically Zhou Can's world.The nurses and doctors here all highly recognize and trust Zhou Can's strength.

After this operation is completed, there are still two major operations waiting for Zhou Can.

One was operated on in a provincial tertiary hospital outside the province, but the postoperative effect was not satisfactory and a second uterine surgery patient needed to be reworked.The other is mitral and tricuspid insufficiency surgery.

This is a major operation, Zhou Can sighed in his heart, and fought until dawn properly.

Now, he felt more and more that a person's power was very limited.Even if he desperately performs surgery, how many can he save from morning till night?
This also made him pay more attention to the cultivation of successors.

As long as there is an opportunity, he will selflessly share his surgical experience, point out newcomers, and even other attending physicians.As for the deputy director and director level, he dare not use the word "pointing", but "communication".

……

I was busy until one o'clock in the morning, and finally called it a day.

A total of three surgeries were performed successfully.The last one with mitral and tricuspid incompetence was performed by Xueyan and assisted by Zhou Can.

It can also be considered as two simultaneous operations.

This is a brand new attempt.

That is, two people operate on the patient at the same time, each doing a part.As long as the cooperation is proper, the operation time can be greatly shortened.

For major thoracotomy, the shorter the operation period, the better.

If it wasn't for two people performing this operation on the patient at the same time, I'm afraid they wouldn't be able to get off work until three o'clock in the morning.

At around ten o'clock the next morning, Zhou Can was busy in the emergency operating room, and Dean Zhu called Dr. Xu.

Because no one answered Zhou Can's operation at all.

"Xiao Zhou, after this operation, you use your mobile phone to call Dean Zhu back. Said that I need to find you."

Doctor Xu came in to inform him.

"Ok."

Zhou Can has guessed a bit.

It is estimated that the medical exchange with the Provincial People's Hospital has been confirmed.

In the operating room, the doctors and nurses couldn't help being envious when they heard Dean Zhu calling Zhou Can in person, and they were a little more in awe of Zhou Can.

This promotion of status is intangible.

Just like a certain related household, colleagues in the department know that his uncle is the vice president, and everyone will consciously give him three points.

After Zhou Can finished the operation in hand, he handed over the suturing task to the two doctors under him. He went to the changing room to get his cell phone and called Dean Zhu back.

Dean Zhu called him twice but no one answered.

Call back immediately.

It will pass after two beeps.

"Dean Zhu, I'm sorry for not being able to answer your call in time. I was undergoing surgery just now and I left my phone in the changing room."

As soon as Zhou Can came up, he quickly explained.

The top leader of the hospital called him but didn't answer the phone, which would definitely make the leader a little unhappy.

"Understood! You didn't bring your mobile phone into the operating room because you wanted to concentrate on operating on patients. This kind of work attitude is commendable. Xiao Zhou, the hospital has already passed a meeting on the medical communication with the Provincial People's Hospital. Please contact me Provincial People's Hospital, see if they can send a leader to discuss this matter in detail?"

I wish the dean didn't mean to be angry.

Instead, he praised Zhou Can.

"Okay, I will have the operation at noon later, and I just go to the hospital to visit Director Lu, and I will ask them when the time comes."

Zhou Can mentioned Director Lu on purpose.

Whether those people can return to Tuya Hospital still needs to be approved by Dean Zhu.

Director Xueyan did not mention this matter to him, which means that there has been no progress.

The leaders of the hospital kept their heads down, and no one could do anything about it.

(End of this chapter)