My medical skills add experience

Chapter 542 Tragic Amputation, The Consequences of Careless Preoperative Examination

"Even the chief surgeon is faster than our boss!"

Yang Zhi smiled beside him.

Because the leader of the team must at least be at the level of deputy chief physician, and at the same time must have the title of professor.Zhou Can has the real power of the team leader, but does not have the title of team leader.

Everyone now habitually calls him the boss.

This title was first called by Luo Shishen.

At that time, the intern Luo Shishen followed Zhou Can and wanted to be Zhou Can's apprentice.It's a pity that Zhou Can thought his talent was too ordinary, so he didn't agree.

So, Luo Shishen began to call Zhou Can the boss.

That kid is currently undergoing regular training, and when the regular training is over, nine out of ten will come to beg to join Zhou Can's team.

I heard that it is doing well, and it has been appreciated by the two chief physicians, and it can be regarded as a part of the key cultivation sequence.

Even now that he is forced to leave Zhou Can's team because of the need for regular training, he still often asks Zhou Can about medical issues through WeChat.Zhou Can treated him kindly, and this kid also knows how to be grateful.

During the holidays, I will call to wish Zhou Can, and I often say good things about Zhou Can in front of outsiders.

"It seems that it is a very wise decision for me to quit my job and go to Dr. Zhou! Now I hope that Dr. Zhou will let me stay. You all help to say good things. I will treat you after get off work."

When she talked about treats, she was very confident.

With an annual salary of at least 30 yuan, it's really nothing to buy a meal or two.

"You are so good, Dr. Zhou must have already passed in his heart!" Qiao Yu smiled and helped her speak.

"Sister Qiao Yu is right, I can see the word satisfaction in the eyes of the boss!"

Ma Xiaolan is also full of affection for Jiang Wei.

I don't know what ecstasy soup Jiang Wei poured into the two of them yesterday?Let them help Jiang Wei speak so willingly.

Especially Ma Xiaolan, she is like the evil mother-in-law in the old days. For newcomers, no matter whether it is a doctor or a nurse, she likes to show off first.This time, it's like a sex change.

"Hurry up and have surgery! Jiang Wei is indeed very good, but it depends on her next performance." Zhou Can did not let go easily, and the gentleman was not joking.He is the boss, so he must be cautious when speaking.

"Jiang Wei, there are three third-level surgeries today. I saw your performance just now. I think you should be able to perform the third-level surgeries. You should perform well then. I don't care about the affairs of the operating room. Doctor Xu must be satisfied. It's a pass."

No matter how evil Zhou Can is, he is still a junior after all.

To do the second and third level surgeries, you need to be affiliated with Dr. Xu, and he himself does not have the authority to preside over the second and third level surgeries independently.

According to the surgical grade system, at least the attending level is required to be qualified to preside over the second-level surgery and start to participate in the third-level surgery.Senior attending doctors can complete tertiary operations under the guidance of the chief or deputy chief physician.

……

At around eleven o'clock in the morning, a male patient in his 40s was pushed into the operating room.

The patient's right lower extremity had been found to have varicose veins six years ago, and there was a certain degree of swelling.But because of his busy work schedule and low income, the financial burden of the family is almost entirely maintained by him working alone.

Afraid of spending money, I have never had surgery.

Not long ago, the pain was unbearable and it was difficult to walk, so I went to the hospital for treatment.

The local central hospital performed high ligation and stripping of the great saphenous vein on the patient.

This operation is also the most commonly used method to deal with superficial varicose veins of the lower extremities and patency of deep veins.The vast majority of varicose veins of the lower extremities occur in superficial veins, and very few patients have varicose veins in deep veins.

After examination, as long as the operation requirements are met, high ligation and stripping of the great saphenous vein can be performed.

The treatment effect is often good, and can greatly improve the swelling and pain of the lower extremities.

After the patient underwent surgery at the local central hospital, the doctor applied elastic bandages from the back of his foot up to the groin.

This is also a commonly used method after surgery.

After all, superficial vein stripping has been done, and pressure is necessary.

As a result, the patient soon found that the toe of the affected limb was very swollen and the pain was very severe.

The family members quickly rang the bell and called the nurse to check.

After the nurse saw it, she didn't dare to deal with it without authorization, so she invited the attending doctor over.

After examination, the attending doctor believed that this situation of the patient was probably caused by the elastic bandage being too tight.

When doing this pressurized bandage, Zhou Can still remembered that Director Liu said that the higher you go, the greater the pressure.

The attending doctor immediately loosened the elastic bandage for the patient and raised the affected limb.

Because the blood circulation of the lower limbs is the farthest from the heart, it is also the most difficult to transport blood.In the case of severe swelling of the lower limbs like this, considering the blockage of blood supply, raising the lower limbs is conducive to blood returning to the heart.

This reduces swelling and quickly relieves foot pain.

After loosening the bandage, the patient still complained that the affected limb was in unbearable pain, and the attending doctor prescribed analgesics for the patient to relieve the pain.

And inform the patient to observe for 48 hours before formulating the next treatment plan.

This is all normal processing.

At least in terms of diagnosis and treatment methods.

Unexpectedly, after more than 30 hours of observation, the skin of the patient's right leg turned dark purple, the fluctuation of the dorsalis pedis artery disappeared, and the skin temperature was extremely low.To put it bluntly, it is the same as when a person dies, the body will quickly become cold.

And the patient's right leg has become more swollen.

At this point, the family members were both sad and angry, and shouted to kill the doctor in charge of treatment.

The doctor in charge was so scared that he didn't even dare to show his face.

The hospital leaders tried their best to persuade the family members to take the patient to a large hospital in the provincial capital city for emergency treatment.Now it must be life-saving.

The family members are also worried that if the time drags on, they will lose their lives.

At this time, I could only hold back my grief, and the ambulance from the central hospital took me to the top three compound in the provincial capital city.

In fact, the central hospital is also a tertiary first-class hospital.

However, in terms of strength, there must be a big gap with provincial top three hospitals like Tuya and Provincial People's Hospital.

The family's son heard about the high standard of Tuya Hospital, and strongly demanded that the patient be taken to Tuya Hospital for treatment.The doctors and nurses who followed the car were afraid of being beaten, so they naturally followed suit.

After the person pulled over, I heard that the doctors and nurses following the car slipped away on the spot.

Everyone is working for the hospital. Looking at the dozen or so family members, each of them is filled with righteous indignation and viciousness. Who is not afraid?
I would rather go back and be scolded by the leader than be beaten to a bone by my family.

So after dropping the patient, they hurried away.

After Tuya's consultation, he examined the patient and found that the patient had developed shock and wet gangrene of the lower extremities.

He told the family members on the spot that amputation must be done quickly to save his life.

When the family members heard about the amputation, they couldn't help feeling extremely sad.A person in his 40s is the breadwinner of his family. He had his right leg amputated. How will he live in the future?
They wanted to settle accounts with the doctors and nurses at the central hospital, but after searching, they found that the doctors and nurses who came with the car had long since disappeared.

Fortunately, the doctors and nurses who followed the car slipped away quickly, otherwise they would definitely become the punching bag of these angry family members.

When a doctor-patient dispute occurs, especially when the patient dies or suffers a major injury, the family members are extremely dangerous at this time.It is easy for them to make some extreme crazy moves.

Some doctors were crippled, almost always under such circumstances.

There is another situation that is also terrible, and that is revenge after the event.

If there is a doctor-patient dispute in person, doctors and nurses can at least take precautions.Some family members and patients, forbearance in person, carried murder weapons, mostly sharp knives, and went to the hospital to find the doctors involved and stabbed them frantically.

In this case, doctors and nurses are easily seriously injured or even killed because they are unprepared.

Why do doctors and nurses get nervous when they see family members with long parcels?

Because no one knows whether the family members will pull out a sharp knife after opening the package.

The family members of the patient had no choice but to sign the agreement to amputate with tears in their eyes after searching for the medical staff of the Central Hospital to no avail.Life-saving is the most important thing.

In the end, this amputation operation fell on Zhou Can.

For patients with such disputes, the second hospital is often very cautious after receiving them.

Let Zhou Can amputate this patient now, which is also trust in Zhou Can.Be optimistic about his surgical ability.

Dr. Xu personally swept the scene.

It could be seen that with Dr. Xu present, Jiang Wei seemed a little nervous.

It shows that Dr. Xu's aura is very strong.

At least she was in front of Zhou Can, Zhou Can's aura couldn't suppress her.

The whole amputation process was simple and brutal, very bloody.

Jiang Wei's performance is as good as ever.

"Xiao Zhou, do you know what caused the patient's amputation?"

Doctor Xu asked lightly.

"Jiang Wei, tell me your opinion first." Zhou Can asked Jiang Wei instead of answering Doctor Xu.

He wanted to see how strong this female nurse was.

At present, he feels that this nurse is unfathomable, and the strength displayed is probably just the tip of the iceberg.

"Judging from his postoperative condition, it is likely to be caused by venous thrombosis."

She answered succinctly.

He didn't even think about it at all, which meant that he had already had this diagnostic conclusion in his mind.

"Qiao Yu, what's your opinion?"

"I... don't know very well." Qiao Yu blushed.

In terms of pathological diagnosis, her experience and level need to be improved.There is no way to compare with a super talent like Jiang Wei.

"Jiang Wei, do you think the patient's thrombus was caused before or after the operation?"

Zhou Can asked again.

"I'm really not sure about this. It feels like it must be caused by the surgery!"

Jiang Wei could know the general cause of the disease, but she couldn't make a more detailed diagnosis.Because this is caused by the different directions of nurses' learning.

It would be amazing if nurses could diagnose specific causes like doctors.

It's like Zhou Can has a very high level in the fields of pathological diagnosis and surgery, but he only has a half-knowledge in nursing.It is far from being able to compare with Qiao Yu and Jiang Wei.

"Teacher, I think the patient's preoperative examination was not meticulous and no thrombus was found, which led to the need for amputation now."

Zhou Can looked at Dr. Xu.

Just now, he finally figured out something about Jiang Wei.

"There is indeed such a possibility. And even if the preoperative examination is not meticulous, there is still a chance of rescue if there is a problem after the operation. The attending doctor is paralyzed and thinks that the elastic bandage is too tight, which caused the tragedy. You guys When practicing medicine, you must be careful and careful, and put the patient's life in your heart."

Doctor Xu warned everyone with a serious face.

After amputating the patient's limb, it was found during the operation that there were thrombi in both the patient's iliac vein and femoral vein.

At this point, the truth is revealed.

This is a typical medical accident, worthy of deep thought and vigilance.

After amputation, the patient underwent a series of anti-shock and anti-infection treatments.When Zhou Can went to check on the patient after his operation at noon, the patient had already woken up.

Just not in a good state of mind.

His face was even paler.

This big brother probably doesn't know yet, but he has already made a round at the gate of hell.

Although his right leg is gone now, his life has been saved.

When a few people were eating in the cafeteria at noon, Yang Zhi couldn't help asking, "Boss, if I encounter a patient like that amputated right limb in the future, how can I avoid accidents?"

Of the two doctors under his command, Yang Zhi has a more cheerful personality, and Pu Dingdong is the honest and humble kind.

He generally rarely asks questions, but takes notes silently.

Only when encountering those who can't understand even after checking the information, will they ask Zhou Can for advice.

There is another phenomenon that is particularly interesting.

Every time he asked Zhou Can for advice, he would lower his head, like a shy elementary school student.

"When encountering such patients, preoperative color Doppler ultrasound, deep vein patency test, and deep venous angiography can all find the problem. The chief surgeon at the Central Hospital failed to detect deep vein thrombosis because of insufficient preoperative examination. The great saphenous vein was stripped, which caused the venous return obstacle of the lower extremities. There were already problems after the operation, but the attending doctor mistakenly believed that the patient's toes were swollen and severe pain was caused by too tight bandages, so he missed it again The chance of remediation eventually led to gangrene of the lower limbs, and the only option was amputation to save his life."

Zhou Can analyzed the pathological mechanism for two of his doctors.

Since his pathological diagnosis level has been raised to level six, various pathological analyzes have fully reached the director level.Yang Zhi and Pu Dingdong could only nod in admiration.

Of course, Qiao Yu and Ma Xiaolan can sometimes learn a lot by being beside them.

There is one more person today, and that is Jiang Wei.

Although Dr. Xu has not finally nodded and agreed to let her stay, Zhou Can has passed this test.Director Lou's test has already passed.The probability of her staying is almost 100%.

While quickly eliminating the food, she listened carefully to Zhou Can's pathological analysis.

It can be seen that there is also an expression of admiration on her face.

Zhou Can is so young, and he is only a resident doctor, but he can have such a high level, which is really amazing.

"Boss, if it is found to be caused by deep vein thrombosis after surgery, what should be done?"

Pu Dingdong asked a little shyly.

He would only ask questions on the spot when he encountered such questions that he was very interested in and desperately wanted to know the answer to.

"It's actually quite simple. Like dealing with other deep vein thrombosis in the lower extremities, first perform a bypass operation of the descending vessels to ensure the blood supply of the lower extremities is restored. Then find a way to perform venous thrombus removal. Interventional angiography is the first choice for thrombus removal. Interventional removal On the one hand, thrombus is minimally invasive and causes little harm to patients. On the other hand, it can also ensure that the thrombus is removed completely. For this kind of venous thrombosis, interventional thrombus removal is a very good first choice."

Zhou Can glanced at Pu Dingdong appreciatively, and then patiently gave a solution.

The oldest thrombectomy is to cut blood vessels, which is a large project, difficult and extremely traumatic.With the continuous advancement of technology, interventional thrombectomy has gradually become the mainstream.

(End of this chapter)