Chapter 410: Training newcomers, principles of gangrene debridement

There has been no news coming back.

Dr. Xu went out for about half an hour and then returned to the operating room to continue the operation. He did not mention a word about the gangrene patient.

A teacher is a teacher, he is really patient. At least let me know whether the deal has been concluded or not!

Zhou Can was performing surgery in the inner room and did not go out to ask more questions.

As it was almost time to get off work, Ma Xiaolan took in a patient, who was the man with a split leg wound and gangrene.

This person has dark skin, and marks left by long-term sun exposure can be seen on his forehead, arms and other parts of his body.

Logically speaking, this is a middle-aged male patient with a strong physique and strong immunity.

Perhaps it was because he had not been able to get enough nutrition after the leg injury, and coupled with the long-term illness, his body had begun to become noticeably thinner. This was not a good sign.

His wounds must be cleaned and sutured where necessary before his body is in better condition.

Then with professional medical treatment, he was helped to recover quickly.

Any disease is as terrible as fire.

At the beginning, it may be just a spark, and if it is discovered in time, it can be easily extinguished.

The longer you delay, the more disadvantageous it will be.

If you wait until the fire spreads all over the place, it will be very difficult to put it out.

If you wait until the house is almost burned down before putting out the fire, even if you put out the fire, the house will have been almost completely destroyed.

The same principle applies to treating patients.

We must stop the disease before it causes serious damage to the patient's body.

This is also the principle of Chinese medicine in treating diseases caused by desire.

The patient is now almost terminally ill.

"I have already assessed his condition and will use spinal anesthesia. The prognosis may not be ideal, but this is our part to help! The family strongly requests limb salvage and is willing to try no matter how much it costs. The patient himself also has this wish."

Doctor Xu walked in.

The anesthesiologist followed closely behind, also coming in with her 'treasure box'.

No wonder it took so long to send the patient to the operating room.

After Dr. Xu reached an agreement with the family, he probably consulted department leaders such as Director Lou or Deputy Director Han. Once they agreed, he applied to the Department of Anesthesiology.

The anesthesiology department then sent an anesthesiologist to evaluate, talk to the family and the patient, and get them to sign an anesthesia consent form.

It is quite good that such a series of tedious procedures can be completed so quickly.

Perhaps because it was spinal anesthesia, the person who came in was a female anesthesiologist at the attending level.

This level of anesthesia surgery is far from enough to require a deputy chief anesthesiologist. It doesn't even require a senior attending anesthesiologist.

"Beautiful lady, do you need my help with the lumbar puncture?"

Zhou Can stepped forward and greeted them enthusiastically.

"Great! I'd love to have Director Feng's disciple help me!"

The female anesthesiologist forced a smile at Zhou Can.

It's so rare that I finally met a normal anesthesiologist.

In Zhou Can's impression, most of the doctors in the anesthesiology department have cold and stern faces and never smile. Only Doctor Guan is a bit normal.

However, ever since Dr. Guan almost had a medical accident, he seemed to have gradually become less cheerful and less fond of smiling.

There must be a reason why the Department of Anesthesiology has always been short of staff.

There are a lot of things to do, the work is tiring, the risks are high, the pressure is great, and the income is only acceptable.

Why is it said that the income of anesthesiologists is not as high as imagined? Zhou Can heard such a thing. About seven or eight years ago, the salary and bonus of medical staff were reformed to a certain extent.

As a result, a nurse in a prestigious department received a bonus nearly 2,000 yuan per month higher than anesthesiologists.

The anesthesiologists felt psychologically unbalanced and staged a collective protest.

Later, the hospital leaders had no choice but to hold a meeting and come up with a ridiculous rule: the bonus for nurses can be equal to that of anesthesiologists, but cannot exceed that of the anesthesiologists.

The matter was finally settled.

If this is true, it means that the income of anesthesiologists is not as high as imagined. Otherwise, they would not be so upset when they see nurses getting an extra 2,000 yuan a month in bonuses.

Nurses’ work is actually very hard.

The old hands who don't work are not included. Some lazy nurses are too lazy to even reach for a bottle of saline solution, and just order the new nurses to do the work.

Half-body anesthesia, commonly known as spinal anesthesia.

After local disinfection, a puncture is made at the patient's waist, and a suitable interspinous space of the lumbar spine is selected to inject local anesthetic into the subarachnoid space, causing loss of sensation in the lower body.

It's easier said than done, but it's actually quite difficult to do.

Generally, it is easy for novice anesthesiologists to fail in operations.

Zhou Can's injection skills have reached level five, which is the level of deputy chief physician. Injection skills include puncture.

Zhou Can can perform various chest punctures, lumbar punctures, and abdominal punctures with ease.

The most difficult part of this anesthesia surgery is the lumbar puncture operation.

As a result, Zhou Can completed the lumbar puncture with great ease, which made the female anesthesiologist admire him so much.

"Do you feel anything in your lower body?"

After a while, thinking that the anesthetic had taken effect, the female anesthesiologist conducted a reaction test on the patient.

"I don't feel anything! It's numb!"

"That's right. It means the spinal anesthesia was successfully implemented."

The female anesthesiologist was even more impressed by Zhou Can's skills. For her, the puncture operation was quite difficult, but it was like a piece of cake for Zhou Can. She really envied his ability to do it with ease.

This is a performance that can only be achieved when one's strength reaches a certain level.

No wonder Director Feng likes this young doctor so much!

"Hurry up and clean the wound for the patient! We don't know what's going on inside yet. Judging from the depth, I'm afraid it has already reached the bone."

Doctor Xu looked serious.

The main reason for accepting this patient was because of Zhou Can's face.

Of course, Dr. Xu also felt compassion.

Doctors who have a little medical ethics all have the same belief.

They are all like what their loved ones want, and there are not many doctors who can do this.

Zhou Can currently has level five debridement skills, which is one of the important reasons why he dared to challenge this gangrene debridement surgery.

Only when you have the diamond drill can you dare to take on porcelain work.

Without that ability, just having a compassionate heart as a doctor is far from enough.

"Doctor Luo, please help the patient cut off all the stitches first!"

Zhou Can gave Luo Shishen some appropriate training opportunities.

Performing surgery on gangrene patients is a test of the doctor's psychological quality. Some people are even prone to vomiting during the operation.

The surgical mask was no match for the disgusting stench.

Coupled with the visual impact, it is easy to cause your stomach to churn and then vomit.

Some novice doctors may experience severe psychological discomfort when they see a dead body, a bloody scene, or a disgusting scene for the first time. They may not be able to eat for a day or two.

Zhou Can followed so many chief physicians to perform surgeries, and he himself had performed a large number of surgeries in general surgery, cardiothoracic surgery, and emergency departments, so his psychological qualities had long been well-trained.

Perhaps the place that tests one's mental strength the most is not the operating room, but the intensive care unit of the critical care department.

Some of the patients there, such as burn patients, had their bodies completely bruised.

There may even be phenomena such as scab melting and suppuration on the body surface.

It was really chilling to watch.

Let me say here that scab melting not only brings great pain to the patient, but is also very dangerous.

Especially when large areas of scab are melting, we must find ways to stop it in time.

"I……"

Luo Shishen frowned tightly, wearing gloves and holding the scissors handed to him by Qiao Yu, as if forcing him to jump into a fire pit.

"Hurry up, don't waste time!"

Zhou Can urged impatiently.

Luo Shishen is his subordinate now, so if there are any problems, he will definitely be the one to supervise them.

Doctor Xu wouldn't care about this kind of thing at all.

Qiao Yu had worked as a nurse in the intensive care unit, so she had a strong mental state. Besides, she only had to pass on equipment, so she was calm. Ma Xiaolan also seemed to be unable to bear this disgusting scene. She stood in the audience, not even daring to look at the patient's wound.

The operating room conditions themselves were not good.

If it is a laminar flow operating room, even a class 10,000 laminar flow operating room, it can absorb and discharge the odor around the operating table.

Now, everyone will enjoy the smell of rancid food.

"This, this many sutures! It's really torture!" Luo Shishen's hands were shaking. If he wasn't wearing a mask while operating, you would definitely be able to see a look of disgust on his face.

"Focus."

Zhou Can shouted again.

In this case, as a senior doctor, you must be strict.

Under his deterrence, Luo Shishen could offset some of his inner discomfort.

To remove sutures, usually one knot is cut at a time.

If it is a continuous suture method, you can also just cut it once when removing the stitches. However, under normal circumstances, the nurse will cut each section of the suture once when removing the stitches.

Because it saves more effort when pulling the sutures out of the patient's cortex.

Under Zhou Can's pressure, Luo Shishen cut the sutures one by one and cleaned them up.

Without sutures to hold it in place, the patient's wound became even bigger.

Pus mixed with blood dripped down like saliva.

The rancid smell became more pungent and stronger.

"Xiaolan, don't just stand there, catch it in the trash can."

Zhou Can is a newcomer who is deliberately training the surgical team.

Under normal circumstances, the circulating nurse may have more seniority than the chief surgeon and does not need to be greeted at all.

Ma Xiaolan came over with a trash can and took it, turning her head and seeming to hold her breath.

"Watch it and don't let it leak onto the floor. Otherwise it will be very troublesome to clean up."

This pus contains countless bacteria and even viruses.

Cleaning and disinfection are by no means easy tasks.

"vomit……"

Ma Xiaolan began to dry heave, then covered her mouth and ran to the covered trash can.

Doctor Xu shook his head repeatedly as he watched.

But he didn't say anything.

After all, they are all newcomers.

Perhaps some emotions are really contagious. For example, when we see others yawning, we can’t help but feel the urge to yawn as well.

At this moment, Ma Xiaolan's vomiting seemed to have also infected Luo Shishen.

A grown man actually followed and vomited.

"With this kind of mental quality, you need to work hard on it."

In order not to delay the operation, Zhou Can removed the stitches himself. This is just a small job, and it is not difficult as long as you can overcome your inner fear and discomfort.

All the sutures were removed quickly.

"Give me the suction head so I can suck out the blood and pus inside."

Zhou Can said to Qiao Yu.

"Give!"

Qiao Yu had already prepared it and handed it to him immediately.

Originally, sucking blood and pus should be done by medical assistants.

Taking Luo Shishen's discomfort into consideration, Zhou Can had to do it himself.

"Let me do it!"

Doctor Xu, as a teacher, had seen all kinds of situations. With a calm face, he served as Zhou Can's assistant.

After Luo Shishen and Ma Xiaolan finished vomiting, they looked very embarrassed.

Ma Xiaolan even burst into tears.

It is really uncomfortable when you vomit.

"Just watch from the sidelines! You must learn to adapt and adjust. When you follow me to perform surgeries in the future, you will definitely see bigger scenes."

Zhou Can made a request to the two of them.

The patient looked embarrassed and simply closed his eyes.

If I had known this earlier, it would have been better to give the patient general anesthesia.

After cleaning the blood and pus that had accumulated inside, Zhou Can began to prepare for the patient's wound. The flesh in many places had completely rotted away.

"Xiao Zhou, tell me about your ideas on wound debridement."

What Dr. Xu meant by this was that Zhou Can should not rush into surgery.

"This patient's gangrene is wet gangrene, and the wounds are deep and shallow. I plan to debride the wounds in stages and batches. Today, I will focus on timely debridement of the tissues that have been clearly necrotic, and temporarily retain the tissues that are unclear and difficult to determine whether they are completely necrotic."

Zhou Can gave his own ideas for the surgery.

Many surgeons take it for granted that when cleaning the wound of a gangrenous patient, they must cut all the way through and remove as much border tissue as possible, even including normal tissue.

In fact, this idea is wrong.

If you really do this, it is likely to make the condition worse.

When cleaning the wounds of patients with wet gangrene, one should preserve as much normal tissue as possible, as Zhou Can did. Do not rush the process.

You can't eat hot tofu in a hurry. The same applies to surgery.

All the rotten tissues were cleaned at once, even some normal tissues, to keep the wound clean. I thought, this time the wound is cleaned, it will definitely heal.

That's just wishful thinking on the part of the new cradle doctors.

A truly experienced surgeon will definitely follow Zhou Can's ideas.

"You have a very good idea, start cleaning!"

After listening to this, Dr. Xu not only appreciated Zhou Can even more, but also felt confident in letting him perform the operation.

Zhou Can first cleaned up the obviously necrotic tissues.

Then the wound is preliminarily cleaned and careful identification is started on which parts should be retained and which parts should be removed.

This process is much more difficult than imagined.

This is a test of the doctor's patience and carefulness, and also requires certain knife skills. Some parts are cut directly with scissors.

…

After more than three hours, Zhou Can looked at the patient's wound with a satisfied expression.

The wound that was previously filled with pus has now changed its appearance and looks brand new .

Stop the bleeding where it needs to be stopped.