Chapter 380 Level 5 Entry, Urethral Dilation
"You know all about this! It seems like you pay a lot of attention to me!"
Qiao Yu smiled happily.
"When I entered the surgical department to study, didn't you help me put in a good word? The directors of several departments were very respectful to you and took extra care of me. Later, I felt that the skills I had learned were far from enough, and I was also worried that if I didn't work as an instrument nurse for a long time, my skills would become rusty and you would despise me. So I simply begged the directors of cardiothoracic surgery and neurosurgery to let me work overtime for free after get off work and learn more in the operating room."
Where there is a will, there is a way.
Only Qiao Yu herself knows how much effort she has put in to serve as an instrument nurse for Zhou Can.
It is her hard work and efforts that make Zhou Can more optimistic about her and value her.
"Comrade Qiao Yu, thank you for your hard work in order to be my right-hand man during the operation. The first patient will probably be in soon. I look forward to your performance."
Zhou Can highly praised her efforts.
"OK!"
After she finished speaking, perhaps because she felt the conversation was too serious, she covered her mouth and laughed out loud.
After three years, Qiao Yu has obviously become more beautiful and has a more outstanding temperament. She is also very capable in what she says and does, and her eyes are still as clear as three years ago.
During these three years, the two met only a handful of times.
But they often chatted on WeChat and occasionally called each other. Usually, Qiao Yu took the initiative to call him.
"Xiao Zhou, get ready. There will be a urethral dilation surgery for you to preside over soon!"
Dr. Xu came in wearing surgical gown.
"I'm fine, but this operation requires a medical assistant." Zhou Can was quite surprised, as Dr. Xu was known for his strictness and caution.
As soon as I came in today, I arranged a urethral dilation surgery for him. This is not like Xu Yidao's style!
"I'll be the medical assistant! This is a highly difficult second-level operation, and it's also your first battle in the emergency department after three years of training. Don't mess it up. Director Lou and others are watching!"
Xu Yida is still Xu Yida after all. With him personally keeping an eye on Zhou Can, there is no need to worry about any accidents.
Although Zhou Can had gained a certain reputation in all major departments, Director Lou and others in the emergency department were still a little worried because they had not seen him in person.
Yesterday, Zhou Can put forward a lot of conditions, and Director Lou agreed to them one by one.
If he fails to show the corresponding strength today, Zhou Can will feel embarrassed even if Director Lou doesn't say anything.
"Teacher, this type of secondary surgery that requires general anesthesia is usually an elective surgery! Preoperative conversation, anesthesia assessment and conversation, and all preparations take some time. This patient should not have just been admitted, right?"
Zhou Can asked carefully.
It was early in the morning. Even if the patient was admitted last night, it would not be possible to schedule an operation so soon.
"You know it, but why are you asking? I collected it yesterday and left it for you to do."
Dr. Xu glared at him.
Then he handed the patient's information to Zhou Can.
The patient was brought in quickly.
This is a male patient in his twenties. Due to trauma, he suffered from urethral stricture. His current symptoms are extremely difficult to urinate, and even some complications. Although it is just a minor problem of urination, it makes this patient live in extreme pain.
"Doctor, please take care of me. Ever since I got hurt, my girlfriend has been threatening to break up with me. Now every time I urinate it feels like torture. I am living in such pain."
The patient's main confidant is Dr. Xu.
"We will definitely do our best to treat you. Now please lie on the operating table."
After Dr. Xu guided the patient to lie on the operating table, the anesthesiologist began to give him general anesthesia.
Urethral dilation is usually performed under local anesthesia in adults.
Doctors generally conduct a comprehensive assessment of the patient's condition and choose the best anesthesia method. General anesthesia has a greater risk, but the advantage is that the patient's vital signs can be monitored at any time during the operation. When the patient is under general anesthesia, the doctor does not have to worry about the patient's non-cooperation or movement.
There is actually only one disadvantage, which is that it will increase the cost of the operation.
Today, anesthesia technology is very mature, although anesthesia accidents occur every year, even resulting in patient death.
But the risks of general anesthesia are still extremely low.
There is also the myth that local anesthesia is safer and general anesthesia is more dangerous. This is nonsense. Even with brachial plexus anesthesia, deaths have occurred in major hospitals.
And it happened more than once.
There is no safer anesthesia. Any surgery has risks.
Wherever there is risk, there is unpredictability.
While the patient was under anesthesia, Zhou Can continued to check the patient's information and examination reports.
After the anesthesia was successfully implemented, the anesthesiologist said to Qiao Yu, "Nurse, help him insert a urinary catheter! Drain the urine first."
"OK!"
Qiao Yu agreed readily.
Nurses may have to clean up the feces and urine of patients, clean purulent and infected skin and wounds, change dressings, insert catheters, and do almost all the dirty and tiring work.
This requires nurses to have strong psychological qualities.
"Let me do it!"
Zhou Can took the specially made small catheter to avoid some embarrassment for Qiao Yu.
As long as he was present, he would give the nurses and female doctors as much care as possible.
Qiao Yu was his confidante, so he naturally treated her with more care.
Inserting a urinary catheter is a piece of cake for Zhou Can.
However, this patient's condition was quite special. Zhou Can obviously encountered obstacles when inserting the catheter.
Fortunately, he took the initiative to help Qiao Yu, otherwise, she would probably be even more embarrassed.
The level of a nurse inserting a urinary catheter, even if it is a senior nurse, is at best at the level of a chief nurse. For a newbie like Qiao Yu who has only been working for about three years, it is considered good to be able to reach the level of a lower-level resident physician.
After some effort, Zhou Can finally succeeded in inserting the tiny catheter into the bladder.
[Successful catheterization, placement experience +1. Completion of high-difficulty catheterization, reward experience +100. ]
It was quite unexpected that I got an extra reward of 100 experience points.
Is this a case of good deeds being rewarded?
[Congratulations on your successful promotion to level 5 in implantation. Your current experience value is 1/100000, which is the junior level of associate chief physician. You can complete difficult intra-canal and intra-cavity implantation, deep implantation of special medical devices, and implantation of some organs...]
This medical skill may seem useless, but it is of great significance in clinical practice.
It can be said that in many surgeries, the tasks that need to be completed by implantation are basically the finishing touch.
For example, when inserting a stent or a ring, many doctors start to tremble before they even start the operation. Why? Because some malformed hemangiomas are really hard to handle.
Not to mention aortic dissection.
If you are not careful, a life may be lost in your hands. Are you afraid?
In Zhou Can’s previous level 4 implantation skills, when he was at the attending level, he could only try to complete the deep implantation of some special medical devices, but the success rate was not high and it took a very long time.
It’s different now. After being promoted to level five, he already has some confidence even though he hasn’t tried yet.
Plus, the idea of an organ being inserted sounds a bit ridiculous.
In fact, in some major surgeries, it is often used to return an organ to its original cavity or tissue. However, the risk is very high and the difficulty is extremely high, and the technical requirements and experience of the operator are extremely strict.
Many organs and tissues are easy to take out but difficult to put back.
Zhou Can now officially began to possess this ability.
"The patient's vital signs are normal and surgery is possible!"
The anesthesiologist didn't say much.
He just looked at Zhou Can with a little surprise. Under normal circumstances, the surgeon in charge would not care too much about the nurses in the operating room because of his high status.
He could see Zhou Can's care for Qiao Yu.
“Let’s get started!”
Dr. Xu spoke.
Without giving Zhou Can any hint, the operation was deliberately used to test Zhou Can's surgical ability.
Even the knife positions were not drawn in advance.
Zhou Can has to do everything by himself.
"Qiao Yu, are all the urethral probes ready?"
Zhou Can looked at Qiao Yu.
The look she gave Zhou Can was extremely intimate.
"Well, everything is ready!"
It seems that she knew what surgery she was going to undergo before the operation.
"The patient has quite a lot of urine left!"
Zhou Can found that after the tiny special catheter had been sucking urine out of the bladder for such a long time, it was still continuously sucking out urine.
I can also understand why patients feel that life is worse than death.
Urinating is extremely difficult and painful, the bladder is full, and it is difficult to urinate even though you have the urge to urinate. You can imagine how painful this feeling is.
Given his current situation, there is a high probability that he has physiological problems, and it is perfectly normal that he cannot complete sexual intercourse with his girlfriend.
This is probably the main reason why his girlfriend wants to break up.
No woman wants to be a widow at such a young age.
It is unrealistic to use only the word "love" to bind a woman's lifelong happiness.
"Okay, the urine is almost drained! Teacher, can we remove the tube and start the operation?"
Zhou Can sought Dr. Xu's advice.
"Today's surgery is a test for you, so you only need to ask for my advice when you encounter difficulties. At other times, all steps are up to you. Remember, try to solve problems by yourself. Every time you ask me for advice, it will lower your surgery score, and it will affect your future surgeries."
Dr. Xu reminded him.
This operation was deliberately used to test Zhou Can's surgical ability and level. If Zhou Can performed well, operations of this difficulty would most likely be available to him in the future.
If the performance is not good, considering the safety issues of the operation, Zhou Can will have no choice but to be downgraded by surgery.
It is also possible to only provide level one or level two surgeries.
At present, Dr. Xu is still under a criminal record because of the medical accident that year. He still works with invisible "shackles". Dr. Xu is forbidden to perform level 4 surgery.
Therefore, the emergency department can only perform level 3 surgeries at best.
Zhou Can was given an operation that was very close to a level three operation right from the start, which shows how high hopes were placed on him.
"clear!"
Zhou Can did not ask for instructions and directly removed the special urinary catheter from the patient.
Then he took the probe and stood on the patient's left side because the patient was in supine position.
In fact, you can also do this examination while standing on the right side, it all depends on the surgeon's personal preference.
If the patient is in the lithotomy position, the surgeon generally needs to stand between the patient's legs.
The lithotomy position is less common.
Zhou Can held one of the patient's organs with one hand, and the probe slowly entered the external opening of the urethra. This was only the first step, and the next step was to insert the probe into the internal urethra.
This operation is quite difficult. If the operator's skills are not up to standard or he lacks experience, it is very easy to damage the patient's urethra.
During the operation, the probe needs to be kept parallel to the patient's abdominal wall and continue to be inserted inward. After passing through the pendulous urethra, the tip of the probe slides into the bulbar urethra.
After the tip of the probe enters the bulbar urethra, the operator releases his left hand to apply tension to one of the patient's organs.
Then gently push the probe gradually toward the posterior urethra, while lifting the probe from a position parallel to the abdominal wall to a vertical position, so that the tip crosses the membranous urethra and enters the prostatic urethra.
It can be seen that a layer of fine sweat is oozing out of Zhou Can's forehead.
He was very careful throughout the entire operation.
Because this operation is an assessment of his personal surgical ability by the emergency department and is related to the construction and development of his surgical team.
It only performs level one and level two surgeries, is highly replaceable, and has limited development potential.
Only those who perform level three or four surgeries are qualified to have a say in the hospital.
Zhou Can is very clear about this.
After the tip of the probe passes through the membranous urethra, the probe is pushed forward, while being pushed down from a perpendicular position to the abdominal wall to a parallel position.
“Success!”
Zhou Can said to himself happily.
When it is completely parallel, it means that the front part of the probe has entered the bladder, thus completing the entire urethral dilation operation.
The whole process seems simple, but it is actually full of difficulties and there are huge risks in every step.
But one thing can be assured, even if this operation goes wrong, it is impossible to kill the patient.
At most, it will make the patient's condition worse, and he may even find it difficult to become a real man for the rest of his life.
When the emergency department performed surgery on Zhou Can , they also went through careful consideration to ensure that if anything went wrong, no one would be killed.
After the probe entered the bladder, Zhou Can operated the probe to twist it left and right in the urethra and bladder.
Then carefully withdraw the probe, replace it with a larger one and repeat the previous steps.
Doctor Xu stood by and watched with a satisfied expression on his face.
Qiao Yu is a girl after all, and her eyes are mostly looking elsewhere.
More than forty minutes later, Zhou Can put down the spy and looked at Dr. Xu.
"Teacher, the operation is complete, please check it."
"Well, the whole operation was quite remarkable. Your first operation was a good test. However, this operation is only a Class II operation, and the main point is to test your operating skills. The next operation will be a real Class III operation, so you should be prepared."
Dr. Xu did not stop evaluating Zhou Can.
Today, he wanted to see how much his beloved disciple had grown after three years of studying outside.
In particular, Zhou Can's steady and quick knife techniques are what Dr. Xu looks forward to and values the most.
Zhou Can let out a sigh of relief and his expression relaxed a lot.
"I'm going to the bathroom first!"
The patient was under great pressure from the surgery he had just performed. His mind was also in a state of tension.
Now that he's relaxed, he can think about how the next operation will be even more challenging.
Go to the bathroom first to keep your body in peak condition for the next level 3 surgery.
To preside over a level 3 surgery, even the attending physician is not qualified.
A deputy chief physician is needed.
Giving him a level three surgery must have been approved by Director Lou.
