Chapter 413: The relationship between thrombectomy and debridement, paranoia is the most terrible
"Teacher, I just went to the ward for rounds."
"Yeah, it's good."
"The gangrene patient who just underwent debridement surgery reported a symptom to me. He said that he had experienced free swelling and pain in his right leg from time to time after the injury. Based on his description and the blood flow condition of his right leg when I debride him today, I suspect that arterial embolism may have occurred. And it is very likely that local arterial embolism caused the gangrene in the leg wound."
Zhou Can stated all his inferences and basis.
After listening to his report, Dr. Xu was silent for nearly half a minute before he said, "If there is indeed a local arterial thrombosis in the right leg, then the thrombus must be removed overnight. Let's take a color ultrasound first. If necessary, I will contact the interventional department to perform angiography on the patient."
As an experienced doctor with rich surgical experience, he naturally understands the danger involved.
The biggest danger of arterial thrombosis is that the thrombus breaks free and enters the heart or brain, which can directly pose a life-threatening risk.
I believe that many people have been scared by their parents since childhood, saying that embroidery needles should not be thrown around. If they accidentally pierce into a blood vessel, they will enter the heart or head through the blood vessel and kill the person.
This risk does exist, but the probability of it actually happening is extremely small.
Adults are mainly afraid that children will throw embroidery needles around, especially on beds or fabric sofas, as people can easily get pricked when they sit on them.
After getting permission from Dr. Xu, Zhou Can immediately went to the emergency duty room, borrowed the doctor's computer, logged into his own account, and ordered a color ultrasound examination for the patient in bed No. 22.
Many tests cannot be done at night.
One advantage of the emergency room is that it can perform some emergency examinations even at one o'clock in the morning.
The medical and technical departments of specialist clinics usually only work during the day. Some special examination rooms are even only open one day a week.
The test results came out quickly.
The patient did have a suspected vascular thrombosis in his leg.
Zhou Can was just about to call Dr. Xu when Dr. Xu came back in a taxi.
"It would be better to remove the thrombus by interventional surgery. You are very good at interventional surgery and endoscopic surgery. Are you confident in removing the thrombus?"
He asked Zhou Can.
"I'm about 70 to 80 percent sure!"
Zhou Can didn't dare to say too much.
"I called a doctor from the interventional room to open the door. The blood clot had to be removed overnight. It's no wonder the patient's wound was difficult to heal because of the blood clot in this area! Fortunately, the hidden cause was found in time, otherwise his leg would definitely not be saved."
Dr. Xu was also deeply moved.
All kinds of diseases can happen. Even he, an old doctor with decades of surgical experience, did not find the real cause of the patient's wound gangrene. At that time, everyone's first reaction was that the small clinic's debridement and suturing techniques were poor and the patient's wound was not properly sutured. In addition, the patient recuperated at home to save money, which led to the infection.
Who would have thought that the culprit would be arterial thrombosis.
If the artery is completely blocked, it can be discovered in time, because limb ischemia will directly lead to necrosis.
It just so happens that this blood clot did not completely block the blood vessels, but instead blocked more than 90%.
This means that the artery can still supply blood, but the blood supply is very poor, with only 10% of its blood supply capacity remaining. With such a poor blood supply, it would be a miracle if the wound could heal.
The blood supply can maintain the basic survival of the lower limbs, which also makes it difficult for doctors to discover the existence of this blood clot.
I don't even think about it at all.
In the interventional room, Zhou Can, with his superb operating skills, successfully removed the real culprit that had been harming the patient for many days. It was a blood clot about one centimeter long.
Judging from the appearance, it should be caused by blood coagulation.
It doesn't look like a fat plug.
There are many reasons for the formation of this type of thrombosis, mainly caused by trauma. Even some nurses may cause thrombosis if they use the indwelling needle for the patient for the second time or operate it improperly.
Experienced nurses will usually use a syringe of about 10ml to draw back before using the indwelling needle for infusion for the second time, and will not start the infusion until red is seen.
A common mistake made by reckless novice nurses is to give the infusion directly.
Then I found that the indwelling needle I had just inserted yesterday seemed to be blocked.
Then, the lazy nurse flushed the tube directly with liquid water.
They didn't know that the indwelling needle they had just inserted yesterday was blocked. It was likely that blood flowed back into the needle when the needle was sealed. After one night, a blood clot formed.
In this case, forcibly flushing the tube with saline can easily flush the blood clot into the patient's veins.
In addition to the possibility of blood clots, the remaining infusion solution may form crystals in the needle tube when the indwelling needle is blocked. This is more dangerous.
No matter which one, as long as it is forced into the patient's veins, it may cause serious consequences such as death.
If the indwelling needle is blocked, there are three correct ways to operate.
After determining the cause, use a 10ml empty syringe to gently draw back the clot from the tube.
Alternatively, if the patient's condition permits, you can also dilute the tube with 10ml of 0.9% sodium chloride injection containing heparin sodium (25u/ml) or urokinase (100,000U/ml) for 5 minutes, and then use an empty syringe to draw blood back. If there is no blood return, repeat the operation once. If there is still no blood return after two operations, remove the needle immediately.
In this case, replace the indwelling needle with a new one and reinsert.
After Zhou Can successfully removed the blood clot from the patient, he felt a little scared. If the blood clot had not been discovered in time, the patient's leg wound would have continued to deteriorate. It was estimated that by tomorrow, the patient would most likely have to make the cruel decision to amputate to save his life.
It could be a devastating blow to the family.
After the amputation, the patient will lose the ability to work, and his wife may fall into financial difficulties because of the family's financial problems. The husband will become disabled and cannot accept such a result. Fierce family conflicts will occur, and finally they will choose to divorce.
Her husband may also give up on himself.
In the end, the one who suffered the most was the little boy.
It's just that little bit big.
And I heard from them that they have an older daughter who is in junior high school.
Who will raise the two underage children?
[Pathology diagnosis experience +1, bonus experience +100. ]
[Debridement experience +1, bonus experience +1000. ]
[Special medical skills, benevolence experience value +1, bonus experience value +100. ]
Zhou Can had never expected that just by helping a patient remove a blood clot, he would be able to gain so much medical experience points as a reward.
In particular, the experience points for medical skills of benevolence are extremely difficult to obtain.
He was rewarded with 100 experience points at a time, and he was as happy as if he had won the lottery. This special medical skill has not been upgraded yet.
Its function also remains a mystery.
According to Zhou Can's experience, the more difficult it is to improve a medical skill, the greater its impact tends to be.
For example, if the pathological diagnosis and pharmacological differentiation are promoted to level 4, then he is at the level of a serious attending physician in internal medicine. If he is promoted to level 5, he is at the level of a deputy director.
At present, his two medical skills are both level five, which is definitely the level of deputy director.
This is also the reason why he was often better than the deputy director of the department during his later training. Especially after the training in gastroenterology, this advantage became particularly dazzling.
The attending physicians or even the chief physician of the department would often ask him to join the consultation.
To put it nicely, it's a joint consultation, but to put it bluntly, isn't it just asking him to help?
When pharmacological differentiation reaches level five, it is directly reflected in the ability to prescribe medical prescriptions.
Whether it is temporary medical instructions, emergency medical instructions, hospitalization instructions, postoperative medical instructions, etc., Zhou Can can gain the trust of senior doctors and has the right to act first and report later.
What does it mean?
If he encounters a situation where he needs to write a medical order, he can write it first to save the patient and then ask the senior doctor to sign it afterwards.
"It's just to remove a blood clot, but how come the experience points for debridement are increased? And they even gave me a huge reward of 1,000 yuan for the first time."
He was awarded 100 experience points for pathology diagnosis, which is understandable.
After all, it was he who discovered the highly concealed arterial thrombosis based on some clues. Neither the clinic where the patient first visited, nor the doctors at the Provincial People's Hospital, nor the doctors at Tuya General Surgery and Emergency Departments, could discover the existence of this hidden lesion.
Zhou Can's discovery was a major breakthrough in diagnosis and an accumulation of diagnostic experience.
Debridement and thrombectomy seem to have nothing in common!
After a moment of contemplation, Zhou Can had a glimmer of understanding. It seemed that thrombectomy had nothing to do with debridement, but if the arterial thrombus was not removed, no matter how well he did the debridement of the patient's wound, it would be in vain.
This is somewhat similar to the metaphor often used by entrepreneurs: good health is 1, and the money earned is the zero after 1.
If you don’t have health, it’s useless to earn more zeros.
This arterial thrombosis is directly related to the healing of the wound.
It seems to have nothing to do with debridement, but it determines the prognosis of debridement.
After the medical skills are upgraded to level five, it is no longer a simple improvement in skill operation, but begins to involve deeper pathologies and body mechanisms.
He had a feeling that perhaps when he reached level six, a minor illness might require him to take the lesion as the starting point and consider all aspects of the three major circulations and nine systems.
The human body is originally a whole.
A seemingly small lesion often involves the entire body.
This change in cognition forced him to take a longer-term view and take a global view, rather than being limited to a narrow lesion site or a certain body system affected by the lesion.
After taking off the heavy lead suit, Zhou Can walked out of the interventional room with a smile from the heart on his face.
Nothing makes him happier than successfully treating a patient.
…
The next morning during his ward rounds, he made a point of visiting that patient.
According to the patient, the dull pain in the legs is gone. The wound has also shown some signs of improvement. This is a very good trend.
After finishing his ward rounds, he made a special trip to the cardiothoracic surgery department.
"Doctor Zhou is here!"
"Good morning, Doctor Zhou!"
Although the medical staff here greeted him warmly as usual, he could clearly feel the dull and depressing atmosphere in the air.
There seem to be fewer patients than before.
All signs indicate that this once ace department is declining at an alarming rate.
This forms a sharp contrast to the thriving and rapid rise of the emergency department.
Seeing this situation, Zhou Can felt a dull pain in his heart.
My mentor, Director Hu Kan, spent his entire life creating a cardiothoracic surgery department that was the best in the country. However, due to lack of successors, the department quickly declined.
"Is Director Xue here?"
"It seems like she didn't go home yesterday. She seems to be in a very low mood. Go check her out! She's in the office!"
After hearing this, Zhou Can felt a sense of self-blame.
When I learned yesterday that her surgery had failed, I should have called her immediately.
She locked herself in the office, and one can imagine that she must be very sad.
"Hey, Xiao Zhou hasn't been to our place for some time!" Deputy Director He brought two of his doctors with him. As they walked, there was wind under their feet and light on their faces.
My smile is about to burst out.
"Xiao Zhou" was a way of looking down on Zhou Can. He was also suspected of showing off his status and treating himself as a senior in front of him.
"On our side" means to remind Zhou Can that this is the cardiothoracic surgery department and Zhou Can is just an outsider.
This old guy failed in his bid for the position of department director last time, and I'm afraid he's still hating me.
Now that Director Xueyan is in trouble, instead of helping her to get through the difficult times, she is so happy that she almost sang a little song. It is so infuriating. But that is human nature.
He was naturally happy to see his competitor in trouble.
If Director Xueyan loses the position of department director this time, won't it be his turn to sit in this position again?
"I haven't been here for a while! Director He looks good!"
Zhou Can speaks the truth to different people and lies to different ghosts.
When dealing with people like this, you still have to do the superficial things.
"Haha, thank you for the compliment!" Deputy Director He immediately smiled happily.
"It's just..." Zhou Can dragged out the tone, with an euphemistic look as if he wanted to say something but hesitated.
"Just what?"
Deputy Director He couldn't help but ask.
"It's nothing. I suggest that Director He go for a check-up when he has time." Zhou Can said lightly.
"What do you mean?"
Deputy Director He was obviously a little nervous.
He was well aware of Zhou Can's abilities. Whether it was during consultations or ward rounds in the cardiothoracic surgery department, any patient Zhou Can said had problems would basically be quickly verified.
Now the implication of Zhou Can's words clearly indicated that he was ill.
And judging from He Mo Rushen's tone and expression, he must be seriously ill.
How could this not make Deputy Director He nervous?
"Uh... I'm just giving you a friendly reminder. Director He, don't take it too seriously. Just go get a checkup when you have time. I came to see Director Xue for something. I'll be back to the emergency department soon. Let's talk next time when we have time."
Zhou Can lifted it high and put it down gently.
The purpose is to whet the old man's appetite.
What he hated most was this kind of petty behavior of traitors.
No eggs remain intact when the nest is overturned.
The cardiothoracic surgery department is really doomed. How good can Deputy Director He be?
Where is the family when the country is destroyed?
But some people are particularly stupid. They only care about the immediate interests and do not care about the overall situation. Director Hu Kan refused to hand over the important task of department director to Deputy Director He until his death. It is estimated that he saw through the nature of this old man.
If a department is handed over to such a person, it will be finished sooner or later.
"Hey, hey... don't go, what's wrong with my body?"
Deputy Director He was so anxious that he kept shouting from behind.
Zhou Can stopped and did not turn around. He just turned back and gave Deputy Director He an unfathomable smile.
"Your body is yours. I believe you know better than me where the problem is."
This trick of pretending to be mysterious has been effective for thousands of years.
As long as people suspect that they are ill, they will be in trouble. Even if they are not ill, they can still make themselves ill.
When Zhou Can was in college, every time the teacher introduced a certain disease in class, he always felt that he had the same disease. I believe many medical students have had this feeling.
Once a person starts to doubt, he will be trapped in suspicion until he finds the correct answer.
For example, if a man suspects his wife of cheating, and he sees his wife getting close to a male colleague at the company , he will think, "I don't usually see this Mr. Li sending my wife home, so why are they together today?" There must be something wrong between the two.
When he saw his wife got an extra 1,000 yuan bonus this month, he would wonder if Manager Wang had a crush on my wife? If they didn't have a special relationship, why did he give my wife an extra 1,000 yuan bonus?
…
It is guaranteed that this man will eventually become more and more neurotic and sensitive in the countless doubts. Divorce is almost inevitable.
Zhou Can is now planting a seed in Deputy Director He's heart, telling him that there is something wrong with his health, but without pointing out what the problem is.
Deliberately let Deputy Director He guess it himself.
Deputy Director He is in his fifties. It is impossible for him to be free of pain or itch at this age. He is afraid that he will live in fear and suspicion every day in the future. What on earth is Xiao Zhou, the bastard, referring to as the part of me that is sick?
If he has a stomachache today, he will suspect that he has colon cancer.
Then I will find ways to make an appointment for a colonoscopy and an abdominal CT scan.
