Chapter 365: The embryonic form of a new cardiac surgery team, even though they have made great contributions, they still get scolded
Several chief and deputy chief physicians were relatively calm, at least they were able to keep their composure and remain calm. Everyone was trying to find the cause of the ventricular tachycardia.
The risk of death from open-heart surgery is already extremely high.
This surgery, which involves atrium removal, ventricular folding, and tricuspid valve replacement, has a higher mortality rate.
Any accident can easily lead to irreversible consequences.
"Could it be that the tricuspid valve is too narrow?"
Director Xueyan was so anxious that she was almost fuming.
It was not easy to perform a difficult level 4 major operation, and the entire operation went smoothly. Who could have expected that such an accident would happen during the intraoperative test.
First of all, it is clear that the occurrence of ventricular tachycardia has no direct correlation with the opening and closing of the tricuspid valve in the water filling test.
Even without this test, the problem of ventricular tachycardia will become apparent as soon as the heart resumes beating.
"It shouldn't be a problem with the tricuspid valve. This is really terrible. What is the problem?"
Director Hu Kan became anxious and the burden on his heart increased, and he couldn't help but cover his chest.
My breathing also became heavier and more rapid.
Heart patients and patients with high blood pressure are afraid of stimulation.
Patients like Director Hu Kan who have suffered repeated heart diseases should pay special attention.
"Why don't we hurry up and seek help from the Department of Cardiology? We are good at surgery. They are better at diagnosing the cause of ventricular tachycardia."
Deputy Director Lu always speaks so straightforwardly.
But what he said is not wrong, there is still a big difference between surgery and internal medicine.
Although both cardiovascular medicine and cardiothoracic surgery are good at treating diseases of the chest and heart area, each department has its own strengths. Cardiothoracic surgery is better at surgery, such as removing lung tumors, heart bypass surgery, myocardial infarction...
Cardiovascular medicine is better at treating heart and vascular diseases that do not require surgery.
For example, abnormal cardiac arrest, ventricular tachycardia, arrhythmia, cardiac insufficiency, cardiovascular embolism, etc. The etiology diagnosis and drug treatment of these diseases are all the "disease spectrum" of cardiovascular medicine.
"Teacher, you see..." Director Xueyan looked at Hu Kan worriedly. It was not that she wanted to provoke Director Hu, but she really had no other choice.
"Contact the Department of Cardiology immediately and ask them to send their chief physician to come for a joint consultation and save the patient."
Director Hu Kan made a prompt decision.
Losing face is a small matter; the patient's life is more important than anything else.
"Director Dongfang, can you contact other chief physicians in the anesthesiology department and ask them to come up with a solution together?"
Director Hu Kan looked towards the falling snow in the east.
As an anesthesiologist, it is your obligation to ensure the patient's life safety during surgery.
The heart cannot be exposed to the air for a long time, otherwise many serious complications will occur. At that time, things will be more troublesome.
Even at this time, Dongfang Luoxue still kept his composure.
His eyes were cold and he seemed very calm.
She didn't say anything, but took out her cell phone and called someone directly.
Zhou Can knew without any guessing that the call for help was most likely made to Doctor Feng.
"Director Feng, something went wrong here. The patient is undergoing atrial folding surgery..."
She gave a brief account of the patient's condition.
As for what Doctor Feng said on the other end of the phone, no one knows.
Dongfang Luoxue quickly hung up the phone.
He looked at Zhou Can with emotionless eyes.
"Director Feng is rushing over from home. It will take more than half an hour. He asked me to discuss it with... you first."
She seemed to have a natural dislike of dealing with anyone.
So much so that even in her forties, whether she was dealing with Zhou Can or other doctors, she always had this unpleasant attitude and tone.
The first half of her sentence was addressed to everyone, and the second half was addressed specifically to Zhou Can as she looked at him.
Many people in the Department of Cardiothoracic Surgery knew that Zhou Can had a close relationship with Director Feng of the Department of Anesthesiology and had received a lot of guidance from Director Feng. Now that an accident had occurred, Director Feng asked her to consult Zhou Can first, and they were not surprised.
Zhou Can didn't react at all. He stared at the patient's bloody pericardium with a puzzled expression on his face.
"Hey, can you hear me talking to you?"
Dongfang Luoxue thought he was deliberately responding to her previous indifference. She felt that Zhou Can was too petty.
Zhou Can still didn't respond.
This time, there was a hint of anger in her eyes.
"Doctor Zhou is thinking about something, don't interrupt him."
Director Xueyan has collaborated with Zhou Can the most times and has spent a very long time together, so she knows Zhou Can quite well.
Dongfang Luoxue listened to Director Xue's explanation and said nothing more.
She herself is also actively looking for the cause of ventricular tachycardia.
While everyone was trying to find the cause, the patient's pericardium began to tremble. It was like a thinly dressed person shivering in the ice and snow. "Oh no, it's ventricular fibrillation! Get ready for rescue!"
Everyone felt nervous and their nerves were like taut strings.
If ventricular fibrillation is not treated promptly, it will soon develop into cardiac arrest.
Dangers during surgery always come unexpectedly, which is why family members must sign before surgery. If something really goes wrong, doctors and nurses can't sweat and cry.
We can only regretfully tell the family that we have tried our best.
"Quickly bring the mapping rod and the mapping ring over here!"
At this time, Zhou Can seemed to have finally figured out where the problem lay.
He has a special medical skill called emergency treatment, which can achieve twice the result with half the effort in rescuing patients. This medical skill has now been promoted to the intermediate level, and the effect is even better.
When rescuing patients, not only can your wisdom be doubled and your mind be extremely calm, but your diagnostic thinking can also be improved by 100%.
"What are mapping rods and mapping rings?"
The three operating nurses were all confused, not knowing what had happened to Dr. Zhou.
"Xiao Zhou, are you planning to do epicardial mapping?"
Director Hu Kan is worthy of being the boss of cardiothoracic surgery. He immediately understood Zhou Can’s intention.
"Exactly!"
Zhou Can nodded vigorously.
“Why do you need epicardial mapping at this time?”
Dongfang Luoxue was full of doubts. The patient was in ventricular fibrillation, and the situation was getting worse and worse. Defibrillation was the only way to save him.
Director Xueyan seemed to understand what Zhou Can meant and frowned in thought.
Because of their lack of knowledge, the others were unable to guess Zhou Can's intention.
"If I'm not wrong in my diagnosis, the patient should have preexcitation syndrome. In this case, if the abnormal conduction signal is not cut off, all rescue measures are only temporary solutions. After defibrillation, ventricular tachycardia still exists and ventricular fibrillation will occur again. Before the operation, I felt that the electrocardiogram was slightly abnormal, but due to my lack of clinical experience, I couldn't figure out the crux of the problem."
Zhou Can explained to everyone very calmly.
"The operation was just at the end, and it was just a water injection test. It is impossible to cause such serious problems as ventricular tachycardia and ventricular fibrillation. Director Xue's entire operation was flawless, which means there was no problem with the operation itself. There is only one explanation, which is that it is very likely that this problem existed before the operation. It was just hidden very deeply, or it only appeared and disappeared, so we were not able to discover it."
After listening to Zhou Can's explanation, Director Xueyan and Director Le nodded repeatedly, both with expressions of sudden enlightenment.
Deputy Director Lu's eyes were bright, and he looked at Zhou Can with appreciation and admiration.
"We were indeed careless! It's not too late to make amends now. Treat it as pre-excitation syndrome immediately."
Director Hu Kan had already guessed something when Zhou Can asked for mapping rods and mapping rings.
After listening to Zhou Can's explanation, he felt it made a lot of sense and immediately agreed to take rescue measures in this regard.
Originally, these should be done immediately after opening the chest.
Because preexcitation syndrome is very obvious in some patients and very subtle in others.
Under normal circumstances, the patient's electrocardiogram will show a significant shortening of the PR interval and the presence of pre-excitation waves. However, this disease itself is an abnormal atrioventricular conduction, and it is possible that it does not appear during the electrocardiogram, resulting in a missed diagnosis.
Zhou Can thought that there was something abnormal in the electrocardiogram at the time and didn't think about it in that regard at all.
And it was only a slight abnormality; there was no pre-excitation wave on that electrocardiogram.
Therefore, even Director Hu Kan, Director Xue Yan, Dongfang Luoxue and others were all unable to diagnose the disease. It can only be said that doctors are also human, not gods.
It is normal to have omissions.
If a patient experiences supraventricular tachycardia, he or she will feel obvious symptoms such as chest tightness and palpitations.
Unfortunately, the patient already had a serious heart disease. Not to mention panic, even if his heart stopped beating, the doctors would never suspect pre-excitation syndrome.
The biggest harm of preexcitation syndrome is still a series of complications.
Common symptoms include syncope, shock, heart failure, sudden death, etc.
In addition to discomfort such as palpitations, patients may also suffer from shock, heart failure, and even sudden death.
It remains to be seen whether this patient can be saved.
Director Hu Kan, as the 'commander-in-chief of the armed forces', only pretended to be calm and spoke in a relaxed manner in order to stabilize the morale of the troops.
"The mapping sticks and mapping rings are here!"
The nurse on duty was quite helpful. She found what Zhou Can needed from the first aid supply cabinet and brought it to him in the shortest time possible.
"Give it to Director Xue. I don't have much experience..."
"Can you stop talking nonsense, kid? Hurry up and do it! It's already this time, and you're still being modest!" Director Hu Kan was so angry that he glared at him and cursed.
He felt that Zhou Can was good in every way, except that he was sometimes too modest and not very efficient in his actions.
It's really worrying to watch.
"Okay, okay! Don't blame me if you screw up!"
Zhou Can was forced to do this helplessly. He had learned how to map the epicardium, but it was nonsense to say that he was proficient in it.
Originally, this kind of thing should be done by Director Xue or Director Le, as they are definitely more familiar with it.
There are many ways to map the epicardium. The most common one is to divide the ventricular surface into 53 small areas, with each area being a mapping point.
The purpose of this is to identify the area of the chamber where conduction abnormalities occur.
Use mapping rods and mapping rings to synchronously record the potential of each mapping point, compare it with the reference electrode, and calculate the time difference of the potential recorded at each mapping point and the reference electrode point. The time difference is usually in ms and filled in the mapping points respectively. Draw a map according to the anatomy of the heart. This map is the epicardial mapping map.
It can be seen from its mapping principle that this is an extremely complex process. If you want to complete it in a very short time, the entire team must work together.
“I’ll draw the picture!”
Director Xueyan volunteered.
"I'll be Dr. Zhou's assistant!"
Director Le also humbled himself and gave it his all.
"During this period, I will do my best to protect the patient's life." Dongfang Luoxue's tone was still cold, but the fact that she could take the initiative to say this also meant that she was impressed by Zhou Can.
It’s like being defeated by your opponent in the ring, and you feel very convinced.
Director Hu Kan also came over and personally guided Zhou Can.
With the concerted efforts of everyone, Director Xueyan drew the epicardial mapping map.
Epicardial mapping requires speed and accuracy, and Zhou Can was definitely the right person to complete the core operation.
Otherwise, given the slow nature of cardiothoracic surgeons, the patient would have died before the chart was drawn.
Director Xue is knowledgeable, has strong calculation ability and broad knowledge, and she is definitely the best person to draw the drawings.
This collaboration inadvertently brought together a strong team in cardiothoracic surgery, with Zhou Can as the core.
"Xiao Zhou, when doing epicardial mapping, you must remember that since the conduction of the accessory pathway is faster than that of the atrioventricular node, the earliest point of ventricular myocardial activation is the anatomical location of the accessory pathway."
Director Hu Kan taught him everything he knew and passed on to him everything he had learned.
"Now that the abnormal conduction area has been found, can I cut it off?"
"Hurry up and do it!"
Director Hu Kan is about to start swearing again.
Director Xue smiled at Zhou Can and gestured for Zhou Can to stand in the main operating position.
In terms of surgical speed, apart from Dr. Xu, it is hard to find anyone else who is faster than Zhou Can.
After Zhou Can decisively cut off the abnormal atrioventricular conduction bundle, the patient's ventricular tachycardia returned to normal.
[Incision experience +1, because you accurately cut the atrioventricular conduction bundle for the first time, you will be awarded +100 incision experience. The quick knife method was successfully performed, and the experience value was +1. Because it is perfectly integrated with the steady knife method, the quick knife method experience value is rewarded +100, and the steady knife method experience value is rewarded +10. ]
Zhou Can was extremely surprised to receive so many experience points as rewards at the same time.
But besides being surprised, he was also puzzled as to why the slow knife technique only awarded 10 experience points?
Could it be because the quick knife technique was the main one used and the steady knife technique was the auxiliary one during the knife operation just now?
That should be the case.
The system rewards experience points when he has made a major breakthrough or made great progress. The calculation is very fair and just.
The supporting role is definitely not as good as the main attacker.
It's like in a war, a soldier gets more merits than a general, which is definitely unfair.
"The problem has been solved. Xiao Zhou, you will complete the rest of the finishing work. After checking that everything is correct, close the chest cavity as soon as possible. The heart cannot be left exposed for a long time."
Director Hu Kan did not relax because of this. Instead, he urged Zhou Can to hurry up and complete the operation.
In order to avoid excessive joy and thus sorrow, and serious complications.
…
Half an hour later, the chest cavity was successfully closed.
The patient's vital signs have been maintained in a relatively safe state since Dr. Feng arrived. However, the ability of anesthesiologists should not be overstated. They are the ones who know the three major circulations of the body best and are the best at maintaining vital signs. But a good cook cannot cook without rice. If the patient's preexcitation syndrome cannot be resolved, no matter how good the anesthesiologist is, it will be useless.
After the operation was completed, Director Hu did not declare the operation over.
Because this kind of heart surgery with many twists and turns is inherently high-risk, it requires observation for a period of time to ensure that the patient does not develop postoperative complications or other abnormalities before being transferred to the intensive care unit for care.
Once leaving the operating room, if any abnormality occurs, there is often no time to push the patient back to the operating room and the patient will die.
Heart and brain are two major surgical forbidden areas. Many hospitals are not capable enough to ask experts to take charge of surgeries involving these two forbidden areas. Sometimes, even the entire hospital will draw elites from various departments just for one operation.
"This patient almost died today. This is a profound lesson. Everyone must carefully summarize and remember this lesson when they return."
Director Hu Kan began to make a postoperative summary during the intervals between observing the patients.
"Xiao Zhou, although you have made great contributions in the operation today, I must criticize you!"
Zhou Can didn't expect that after the operation was over and the patient was out of danger, the teacher still scolded him.
There is no mistake or error anywhere!
He was very confused, but did not confront Director Hu Kan in person.
A teacher is a teacher, and respecting teachers is the most basic principle.
