Auto chess in the operating room

Chapter 29 Is This Really an Intern?
0.5% tetracaine was instilled twice for topical anesthesia, while 2% lidocaine was used for retrobulbar anesthesia, orbicularis oculi muscle and subconjunctival infiltration anesthesia.

Seeing Tang Lou's calm movements on the screen, Shen Jun was a little dissatisfied, but sat down quietly.

"Director Shen, let's take a look. The so-called newborn calf is not afraid of tigers."

Cheng Jian also didn't expect Tang Lou to be so confident. The key is that there is nothing wrong with his steps.

Huo Tong was also a little puzzled. Is this Tanglou really an intern?

When he was young, it was half a year after he used lidocaine for the first time. Looking at the tenement building in the operating room, his heart of cherishing talents was aroused again.

Very dissatisfied, he looked at Liu Tong who was aside.

Liu Tong felt as if he had fallen into an ice cave, avoiding Director Huo's eyes, and looked at the operating room with some suspicion: "I don't believe that you can perform a complete iris suture operation."

"It's just preoperative anesthesia, will you open your lids?"

Liu Tong thought that he could be regarded as a talented player in surgery, and it took him several years to encounter this kind of unorthodox operation.

".Blepharoplasty Preparation"

Tang Lou devoted all his attention to the operation. The working principle of the eyelid speculum is similar to the retractor, a necessary tool in surgery.

Or more intuitively, you can use matches to open your upper and lower eyelids when you are sleepy!

The equipment nurse brought up the eyelid opener, and Tang Lou carefully opened and fixed the patient's upper and lower eyelids. The whole eyeball seemed to have a special effect of opening the eyes.

Of course, this is not enough. Tang Lou continued to sew the patient's inferior rectus muscle traction suspension wire to fully expose the surgical field.

Seeing Tang Lou complete the field exposure in a calm manner, several bigwigs in the observation room nodded frequently.

"At least up to this point, Xiao Tang has done very well. You interns who have not been on the operating table should study hard. Don't panic when things happen, and have a peaceful mind."

Shen Jun's voice resounded in the observation room.

"Amazing, as expected of Great God Tang."

Bai Hao and Li Lin leaned in behind, envious and admiring.

"I've never used an eyelid opener before."

"Isn't it? Kneel to the Great God!"

Liu Tong looked gloomy: "You are lucky, the difficulty of suturing the iris lies in the precise search of the corneoscleral limbus and the formation of the anterior chamber. I have never experienced this kind of thing, so it is impossible to handle it well."

As the director of surgery, Huo Tong naturally understood the difficulty of this operation, so he took the microphone and directed: "Xiao Tang, the next step is the incision of the corneoscleral limbus, the location is"

But before Huo Tong could speak, Tang Lou's hand had already moved.

The cornea-sclera limbus is in the transition zone between the cornea and the sclera, with a width of about 1.5-2.0mm. Since the opaque cornea is embedded in the opaque sclera, it gradually presents a transitional state, so there is no clear dividing line on the surface of the eyeball.

If you have never operated it before, you would not dare to do it lightly if you have personally dissected the eyeball for the first time.

However, Tang Lou controlled the scalpel, and at the 12 o'clock position, he cut across it precisely, making an incision of exactly 5mm, fully exposing the limbus of the cornea and sclera to the screen.

"This"

Huo Tong recalled Tang Lou's sharp and decisive cut, and his heart trembled.

So precise!

Cheng Jian was also stunned, and couldn't help applauding: "Beautiful!"

Seeing this scene, Shen Jun was not only happy, but also popularized the length of the incision and the entry point to the surgery novice in the observation room.

It was only then that everyone realized that there were so many technical details contained in Tang Lou's seemingly arbitrary knife.

"Attention everyone, you can't suture immediately after the incision, and you need to stop the bleeding."

Huo Tong picked up the conversation, and when his words fell, Tang Lou in the operating room was holding a cauterization hemostat like a toothbrush, with a round head at the front, and a needle at the front of the round head, which was skewed, a bit like the one in the handicraft class. electric soldering iron.

"The next step is to form the anterior chamber. Who of you know what the anterior chamber is?"

"The cavity in the eyeball between the cornea and the iris, the lens."

Leng Yunze replied in a loud voice, although he has not personally dissected the structure of the eye, he still has a little understanding of it.

Huo Tong nodded in satisfaction: "Yes, in order to have a better operating space, a sufficient anterior chamber must be formed. Do you know how to form it?"

Leng Yunze froze for a moment, trying to remember, but his mind was blank.

Huo Tong was a little disappointed to see Leng Yunze avoiding his gaze, and then looked around at the others, all bowing their heads in shame.

"It's normal if you don't know, you need to undergo surgery to understand this, so let me tell you, you must remember it!"

Huo Tong took the microphone over at the same time.

But before he could yell out, he heard Tang Lou's unsalty voice in the operating room:
".viscoelastic.."

"Dr. Xiao Tang, I. I don't know how." The little nurse said in an embarrassed and timid voice.

".Colorless transparent gel-like solution composed of high-purity sodium hyaluronate and physiological buffer balance salt."

Tang Lou didn't have any complacent voice resounding through the operating room.

Huo Tong: "."

The other people in the observation room also had expressions of beeping dogs.

"I'm also an intern, I can't bear this grievance, what's the matter!"

"Tch, what's wrong with the intern? I'm still a resident, I"

The observation room suddenly fell silent, and everyone shed tears of ignorance in their hearts.

Leng Yunze sat in the first row, feeling even more like he was on pins and needles: "I have always been someone else's child! What kind of monster is this tenement building!"

Cheng Jian's eyes also lit up, and he began to think about how he could take Tanglou to the city hospital. How could such a powerful intern end up in the county hospital?
Tang Lou didn't pay any attention to the situation in the observation room. After completing the suture preparations, he began to adjust the operating microscope.

Accurately align the iris disconnection position.

".Micro blunt intraocular forceps 10-0 polypropylene wire spare"

Under the microscope, Tang Lou used miniature blunt endocular forceps to pull the edge of the severed iris root to the corneoscleral limbal incision.

Use the intermittent suture method with a circular needle, start suturing, and quickly puncture and tie knots in a very small operating space.
After the stitching is complete, return the pupil to center.

".Double cannula suction needle BSS"

Huo Tong held the microphone for a long time, and every time he wanted to give guidance, Tang Lou had already completed the corresponding operation.

"I'm so hard."

It was the first time that Huo Tong was so aggrieved as the instructor beside him. This intern not only did it accurately, but also quickly.

"A double-cannulated aspiration needle was used to perfuse the BSS and remove viscoelastic from the anterior chamber."

Huo Tong finally resigned to his fate, he'd better do the commentary.

Sure enough, Tang Lou's operations were too fast, and the rookies in the observation room couldn't comprehend the knowledge points under these simple instructions.

After his explanation, the interns realized that Huo Tong finally had some sense of accomplishment, but he always felt a little aggrieved.

After removing the viscoelastic agent, Tang Lou began to suture the limbal incision, and the suture was formed perfectly soon.

The next step is to suture the conjunctiva. Tanglou used continuous sutures and performed a VY suture at the larger wound edge.

Clean and crisp!

".Brumycin, dexamethasone mixed with a small amount of 2% lidocaine injected under the bulbar conjunctiva"

Tang Lou continued to order the follow-up steps, and postoperative recovery was of course extremely important.

".Antibiotic eye drops and antibiotic eye ointment, 0.5% tropicamide eye drops monocular pads, bandages"

The final bandaging is done.

"The dressing was changed every other day, and the iris line was removed 5 days after the operation."

Tang Lou's final postoperative arrangements.

In the observation room, Huo Tong finally became a little happier, and caught the mistakes and omissions: "Xiao Tang, there is something wrong with your postoperative arrangement. It is theoretically feasible to change the dressing every other day, but in practice it is better to change it every day, otherwise it may be impossible. There will be infection, although the probability of infection is more than 10%, as for the time to remove the stitches, according to my experience, even if it is done well, it will take at least 7 days, and five days is too short."

The old god Huo Tong was there to guide him, giving him some comfort: the interns still lack experience.

(End of this chapter)