Chapter 397: All kinds of patients, the absolute main force of emergency surgery
"Come on, lie down on the stage! The prone position is more convenient for operation!"
Zhou Can guided the middle-aged man to lie down on the operating table.
The foreign object was cone-shaped.
It's really puzzling how this thing could get into the rectum of an adult.
And judging from the film, the diameter of this foreign body is quite large. There is almost no possibility of swallowing it. Apart from other things, it is impossible for this size to pass through the narrow esophagus and small intestine.
So, it must have been stuffed in.
"Doctor...does this require anesthesia?"
"If surgery is required to remove foreign bodies in the anus and rectum, anesthesia is definitely needed. Spinal anesthesia is often used, which is often called subarachnoid block anesthesia, also known as half-body anesthesia. This operation will be very difficult, and it requires opening the abdomen and then cutting the intestines to take out the foreign body."
Zhou Can patiently explained to the patient.
It also tells the other party the seriousness of the operation.
"Is your method of defecation useless?" Zhou Can asked.
"It didn't work! I even drank half a bowl of cooking oil, but it didn't work at all." The middle-aged man replied weakly. From his expression, it can be seen that he must be in pain at this moment.
My heart is filled with fear.
"You must be careful next time. You are lucky this time that your intestines did not rupture. If your intestines were ruptured and feces entered the abdominal cavity, infection would be life-threatening. Intestinal rupture and heavy bleeding are also dangerous."
They are all adults, so Zhou Can can only remind the other party like this.
There is a certain element of intimidation, but his intention is good.
After the intestine ruptures, the intestinal contents enter the abdominal cavity, which can cause severe bacterial infection or even sepsis, which is life-threatening. Intestinal contents entering the abdominal cavity can cause chemical peritonitis, severe pain, and even shock.
It can indeed be fatal.
Even with current medical conditions, the prognosis of intra-abdominal infection is still poor and death occurs from time to time.
In the early years, there were many cases where intestinal contents accidentally splashed out during abdominal surgery, contaminating the abdominal cavity and ultimately leading to the patient's death.
Zhou Can first used a dilator to expand the patient's anus, and then used a clamp to clamp the tail of the conical foreign body.
Fortunately, the pointed cone part of this thing is facing inwards, otherwise it would be much more difficult to take it out.
"Qiao Yu, slowly inject some lubricant into it."
Zhou Can clamped the foreign object and pulled it out with a little force.
At the beginning, it was stuck very tightly, and the middle-aged man screamed as soon as he applied a little force. Fortunately, after it was slightly loosened, the situation was much better with the help of lubricants.
After a lot of effort, I finally pulled the foreign object out.
Zhou Can checked and found that the intestines were not ruptured, so he breathed a sigh of relief.
"What is this?"
Qiao Yu stared at it curiously.
"Don't ask too many questions, kid." Zhou Can found Qiao Yu to be as pure as a blank sheet of paper.
He helped the middle-aged man put on his pants and wrote some medical advice, which was actually just a box of anti-inflammatory medicine.
"Try to eat more vegetables and fruits after returning home to prevent colon cancer. If you feel any discomfort, seek medical attention in time."
"Okay, thank you doctor!"
The middle-aged man seemed a little embarrassed, and under the guidance of Ma Xiaolan, he hurriedly left the operating room.
"Hey, what you said just now was too much! What do you mean by kid? I'm already 25 years old." Qiao Yu protested somewhat unhappily.
"Sorry! I will be more careful with my words next time. Doctor Luo, don't just stand there, throw that thing into the trash can!"
After Zhou Can apologized to Qiao Yu, he asked Luo Shishen to dispose of the medical waste.
After the first patient was treated, the second one was brought in.
This patient had an intestinal emergency, acute pyloric obstruction, and required emergency surgery.
The main symptoms of pyloric obstruction are nausea, belching, anorexia, and bloating.
Common pyloric obstruction is usually treated with medication.
In this acute pyloric obstruction, the patient had serious adverse reactions, including severe vomiting, dehydration, fatigue, oliguria, thirst, etc. The internal medicine treatment in other hospitals was ineffective, so he came to Tuya for emergency treatment yesterday.
After evaluation, the patient was found to be suitable for surgery.
Emergency surgery was performed on the patient in the emergency department.
An operation like this is a major operation and is usually an elective surgery.
The patient also suffers from gastric ulcer, which may even turn into malignancy if the treatment is delayed.
After the patient enters the operating room, the anesthesiologist follows.
It was Director Dongfang Luoxue of the Anesthesiology Department.
Zhou Can no longer needs to go to the cardiothoracic surgery department to study with Director Hu Kan recently. Therefore, since Director Hu's death, he has begun to fulfill his promise and go to the anesthesiology department after work at least three or four days a week to learn anesthesia techniques and knowledge from Director Feng.
There is less textbook knowledge on anesthesiology, and there is a high degree of overlap with general clinical medical knowledge.
The improvement of anesthesia technology mainly depends on practice and is gained from clinical experience.
Every operation that Director Feng participated in was a level 3 or 4 high-risk major operation. His ability was unquestionable, and he was one of the top anesthesiologists in Tuya Hospital.
Long qualifications, rich experience and superb skills.
Many people think that he has a weird personality and is difficult to get along with, and are afraid to deal with him. However, Zhou Can thinks that Director Feng has an extremely passionate heart for anesthesiology, and has devoted his life's energy to the study, accumulation, and improvement of anesthesia.
In ancient times, people who devoted themselves to martial arts and did not care about worldly affairs were called "martial arts fanatics".
Director Feng is a "medical geek" in the field of anesthesia.
The most terrifying thing in this world is that a person concentrates on doing one thing for his whole life. Ten or even dozens of years of accumulation is very terrifying. They can often achieve extremely high achievements in the field they are studying.
Zhou Can was not very enthusiastic about anesthesiology at first, he just thought it was better to have more skills, so he followed Director Feng to learn.
Later, after learning more, especially after deeply studying the surgical and diagnostic knowledge of cardiothoracic surgery with Director Hu Kan, he gradually discovered the benefits of anesthesiology.
First, anesthesiology has a very thorough understanding and research of the three major circulations of the human body, as well as the internal and external circulations. Secondly, it has in-depth research and practical accumulation on the nine major systems of the human body, especially the nervous system, respiratory system, circulatory system, and motor system, which are extremely in-depth.
It can be said that internal medicine practitioners are the group of people who understand the human body mechanisms and pharmacology best.
But anesthesiologists are the group of people who understand life the best.
When it comes to supporting life and ensuring the maintenance of life, anesthesiologists are second to none.
After learning anesthesia knowledge, Zhou Can can clearly feel the huge benefits in clinical practice. Even the surgical ideas will change because of anesthesia.
He also discovered that the various medical disciplines have a certain degree of interconnectivity.
Medicine is a bit like a circle. If any part of it is missing, the circle will no longer be coherent.
Learning anesthesia medicine well can greatly enhance the depth and consistency of overall medical knowledge.
For ordinary people, it would be great if they could master one medical field in their lifetime.
Zhou Can has a great advantage in this regard because he has an experience value system. What takes others ten years to complete, he can achieve qualitative change through the accumulation of experience points in two or three years, or even shorter.
With this huge advantage, he is destined to have the time and energy to learn more about medical fields.
It is impossible to thoroughly study all fields of medicine.
But it should not be difficult for him to reach a certain level in multiple medical fields.
At least he has now reached a fairly high level in most areas of general surgery, critical care medicine, cardiothoracic surgery, nephrology, gastroenterology and many other fields.
Now I lead the surgical team in the emergency department to perform surgeries crazily, and I am involved in almost all general surgeries.
I believe that as long as he continues to accumulate knowledge, he will continue to reach new heights in more fields of medicine.
Dongfang Luoxue was as cold as ever, like the legendary iceberg beauty.
Because she is over 40, her age is there, and at most she still has some charm.
"Do you need help?"
Zhou Can greeted her with a smile.
"good!"
She answered with only one word, and at the same time, she tried hard to force a smile at Zhou Can in response.
Maybe because I am used to having a stern face, the smile I forced out was particularly stiff.
But for her, this is not easy.
"Director Dongfang looks better when she smiles. She looks more friendly and beautiful!"
Zhou Can was generous in praising her.
In the past year, before Director Hu Kan passed away, he would go to the anesthesiology department at least once a week to learn from Director Feng. Gradually, he became familiar with most of the doctors in the anesthesiology department.
The doctors in the anesthesiology department treated him as half of their own.
Dongfang Luoxue was so friendly to Zhou Can. Although she was a chief physician, she treated a resident doctor as an equal. That was because she had seen Zhou Can's strength.
You have to accept it.
She had no expression on her face when Zhou Can praised her, but her eyes betrayed her. At least it was obvious that she was very happy.
While helping to give the patient general anesthesia, Zhou Can also learned about the patient's condition.
Dongfang Luoxue must have thoroughly understood the patient's condition before signing the anesthesia consent form with the patient. Zhou Can understood it again for his own learning needs.
It is also to ensure that there are no major mistakes in the operation and to eliminate safety hazards.
"Come, lie down! You will be in the supine position during the operation. Relaxing a little is like taking a nap. When you wake up, your disease will have been cured by us."
Zhou Can comforted the patient and guided him to lie down.
Pyloric obstruction surgery is usually performed with the patient in the supine position, with a midline incision in the upper abdomen or a left upper transrectus abdominis incision.
Patients sometimes prefer to sleep on their side because of pain.
The entire general anesthesia process went very smoothly. The patient soon fell into a coma and his vital signs were normal.
"Doctor Luo, the incision for this kind of pyloric surgery must be combined with the actual situation of the patient. Don't copy and paste. You just need to remember one principle, which incision method is more conducive to the convenience of surgery and the prognosis of the patient, then choose that one. When you can't take both into account, weigh the pros and cons and choose carefully. If the technology is not up to the task, then choose the incision that is more conducive to the convenience of surgery."
Zhou Can was very careful in his training and teaching of Luo Shishen.
It's basically a face-to-face lecture.
As for how much he can understand and remember, that is his own business.
Doctor Xu stood by and said nothing, supervising and taking charge of Zhou Can's work.
Now, he is basically in the stage of letting Zhou Can go.
As long as Zhou Can is competent, he will not interfere. It is this bold delegation of power that has given Zhou Can a very valuable opportunity to train and improve himself.
“Stop the bleeding!”
After Zhou Can cut open the patient's abdominal wall, blood gushed out.
In fact, he had already avoided the larger blood vessels.
Bleeding is inevitable in any surgery, especially in open-abdomen and open-chest surgery, where the potential risk of massive bleeding is extremely high.
Surgeons who lack experience and whose surgical skills do not reach a certain level dare not operate on the patient's chest, abdomen and other vital parts.
If you are not sure and try to force it, something will probably go wrong.
Luo Shishen hurriedly applied electrocoagulation to the patient's wound to stop the bleeding.
"Xiao Luo, you need to practice more when you get home. Let me do it!"
Doctor Xu couldn't bear it any longer.
Given his strict requirements for junior doctors, this rash operation was simply a challenge to his bottom line.
This is also the reason why interns are not qualified to be first assistants at all.
If it is just a level one or two surgery, an intern may be able to do the job as a medical assistant.
Level 3 and 4 surgeries are not something that even senior residents, let alone interns, may be able to perform.
After all, evildoers like Zhou Can are still a minority.
Even a returned overseas doctoral student like Du Leng is far inferior to Zhou Can in the field of surgery. To put it bluntly, he is not even worthy of carrying his shoes.
This is not arrogance, but true unworthiness.
It was actually not a wise decision for Du Leng to enter the surgical department.
With his profound medical knowledge, he should go into internal medicine, where he might have better development prospects.
You choose your own path, and sometimes it also depends on a bit of luck.
Now more than three years have passed. Du Leng is already the attending physician of neurosurgery, and it is said that he has been training in general surgery for nine months. Zhou Can is not sure how he is doing now.
It’s true that I’m not as high-profile as before.
Without the ability , the department and doctors would not give him the opportunity to be high-profile.
Several geniuses who entered Tuya Hospital at the same time as Zhou Can are currently working hard to improve themselves. Including Gao Jian who entered the Internal Medicine Department, I heard that he had opened an outpatient number not long ago and started seeing patients.
But compared with Zhou Can, he is definitely not on the same level.
Zhou Can has been practicing pediatrics for more than a year.
Gao Jian could not match Zhou Can's popularity and experience. In terms of diagnosis, medication, treatment plan, prognosis assessment, etc., even if Zhou Can did not make any progress, it would take Gao Jian at least ten years to catch up with him.
I'm not bragging.
The level of pathological diagnosis and pharmacological differentiation is only at the deputy director level, which many doctors will never be able to reach in their entire lives.
Most excellent doctors with some talent would need at least twenty years to reach this level.
Tuya Hospital included Zhou Can, an undergraduate student, in the reserve quota of the famous doctor hall. At that time, Zhou Can was still in the regular training stage and had not even received the regular training certificate. This was enough to show his extraordinaryness.
The hospital has an extremely strict review mechanism for its decisions on matters like this.
Du Leng has such an impressive academic background, but he still hasn't even seen the shadow of getting a reserve spot in the famous doctor's hall.
You can see how difficult it is to become a reserve member of a famous doctor's office.
…
The operation went very smoothly and was completed in less than two hours.
However, because the two most powerful surgeons in the emergency operating room, Dr. Zhou Can and Dr. Xu, were both performing surgery on this patient, there was a backlog of other emergency surgery patients.
In another operating room, Dr. Cui, who was actively seeking a contract to become an attending physician, was performing surgery diligently.
His surgical skills have reached the level of an attending physician.
In terms of speed, he is far behind Zhou Canke.
It is worth mentioning that Dr. Xu's surgery speed is not particularly fast. On the one hand, he is afraid of another accident and has become cautious in surgery. He no longer pursues the speed of surgery blindly. On the other hand, Dr. Xu is old after all, and his physical strength and energy cannot keep up.
After a man reaches the age of 35, his physical strength and energy will be obviously inferior to that of a young man in his twenties.
Men over fifty, called old men, have worse physical strength.
Therefore, Zhou Can is currently the absolute main force in the emergency operating room.
The operation was done quickly and well.
Moreover, it can perform almost all types of surgeries, regardless of whether it is a vegetarian or a meat-based diet.
