Chapter 422 The causes of bleeding were checked one by one, it was worth it
It seems that this incident has caused great trouble to Deputy Director He.
Once suspicion has its seeds, it will sprout and grow wildly. It will spread endlessly like a vicious weed, and it cannot be burned or cut off.
"Can!"
Zhou Can agreed to his small additional condition.
The two parties reached a verbal gentleman's agreement.
Director Xueyan was delighted to see Deputy Director He, the biggest "villain", bow his head. Without Deputy Director He to oppose her and sing a different tune, the internal friction in the department will soon return to normal levels.
When Director Hu Kan was alive, the cardiothoracic surgery department was quite united and there was basically no internal friction.
The so-called internal friction refers to intrigue and various vicious competitions.
For example, when Doctor B sees that Doctor A's patient has a serious hidden danger, he won't say anything. He waits for the patient to get into trouble, and then Doctor A will suffer. This is a kind of internal friction.
There are also various forms of lip service, passive resistance, and shirking of responsibility, not to mention.
Now through this incident, the biggest troublemaker, Deputy Director He, has been subdued, and cardiothoracic surgery will soon be unified.
The overall strength of the entire department will also be greatly enhanced.
Today is a really good day.
She regained the confidence she had lost on the operating table, and with Zhou Can's full help, she subdued the biggest troublemaker in the department.
"Doctor Zhou, now that we have reached an agreement, can you help analyze the cause of the patient's postoperative bleeding?"
Deputy Director He is very anxious about this matter.
Especially after Zhou Can threatened him, he was particularly afraid that this patient would ruin his life.
After all, he is living a comfortable life now.
Being able to be awarded a senior professional title and then being able to take up an administrative position at the level of deputy director of a department, life can't be that bad. Earning tens of thousands of dollars a month is like playing.
The social status is also very high.
"No problem! Now let's analyze the several reasons why patients have heavy bleeding after surgery."
Zhou Can started to help find the cause of the bleeding on the spot .
"I have carefully examined the surgical site of that patient. There are about five common causes of postoperative bleeding. It would be better if you could show me the surgical records."
He is not a god and cannot tell where the patient is bleeding at a glance. That is nonsense.
If it was so easy to find the cause of the disease, Deputy Director He would not have been controlled by him like this.
"The surgical records are on my work computer. Please move to my office and I will retrieve them immediately." Under normal circumstances, the surgical records could not be on Deputy Director He's work computer.
This means that he has tried to adjust it on his own and tried to find the cause of the disease, but failed.
The three of them came to Deputy Director He's office.
Deputy Director He turned on the computer and opened the surgical records.
"Director Xue, Doctor Zhou, this is the surgical record, please take a look!"
"Sister Yan, please sit down. I'll just stand by and watch!"
After all, Zhou Can is a young man with good physical fitness. Director Xueyan has been working all day, and it is already past midnight. You can see that her face is full of fatigue.
She now has a close relationship with Zhou Can and is not polite to him.
Deputy Director He placed his greatest hope on Zhou Can, because Zhou Can had always been very good at finding the cause of the disease.
"Doctor Zhou, sorry to bother you to sit on this small stool."
He moved a plastic stool and asked Zhou Can to sit on it.
This service is quite considerate.
In the adult world, there are only interests. There are no eternal enemies or eternal friends, but only the exchange of interests.
Not long after I sat down, the nurse on duty ran over in panic.
"Director Xue, Director He, something bad has happened. The family of the patient in bed 12 just rang the bell. I went over to check and found that the patient was showing signs of shock."
What the nurses on duty hate most when they are on duty at night is the constant ringing of the bell.
When you are busy, it is hard to have a chance to take a nap at night.
Sometimes, just when they finished with one bed and sat down to take a rest, another bed would ring the bell. Sometimes two or three beds would ring the bell at the same time, making them extremely busy.
"I'll be right there!"
When Deputy Director He heard that the patient was in shock, he immediately panicked.
Whatever you fear will come true.
We were trying to find the cause of the bleeding, but the patient couldn't wait any longer and showed signs of shock.
Zhou Can had mentioned to him before that the patient was already suffering from severe anemia, which meant that the hemorrhage was getting worse. Now it had come true.
"Doctor Zhou, you are very good at all kinds of rescue. Come over and take a look!"
Deputy Director He felt particularly ashamed when he said this.
He is not only a senior doctor, but also a senior chief physician. Now that the patient is showing signs of shock, he has to ask for help from the young doctor Zhou Can.
If it was an ordinary critical care rescue, he would definitely not panic.
But this patient, who had already learned about his condition in detail, had no idea where the bleeding was, so he had no idea where to start rescuing him.
Heavy bleeding after surgery like this is internal bleeding. If the bleeding cannot be stopped in time, no matter how much blood is transfused, it will be a drop in the bucket.
Moreover, excessive blood transfusion will have many side effects.
After all, the blood transfused is processed plasma and does not belong to the patient. If a large amount of allogeneic blood is transfused in a short period of time, the blood temperature alone will be difficult to control.
There are also many other adverse reactions, such as congestive heart failure and pulmonary edema, sodium citrate poisoning, allergic reactions, etc.
Just imagine, if a patient needs a large amount of blood transfusion, his vital signs will definitely be seriously unstable.
If an adverse reaction to blood transfusion occurs at this time, the patient's life will be like a candle in the wind, which will be extinguished in an instant by the slightest wind or rain.
Deputy Director He has rich experience in rescue operations and is well aware of the danger involved, so he put aside his pride and took the initiative to ask Zhou Can for help.
"Come on, I'll go with you!"
Zhou Can did not refuse. He stood up and followed Deputy Director He out.
When helping others, the worst thing to do is to hurt their face.
This is one's dignity. Once it falls to the ground, it will be shattered.
When helping others, if you don't give them face and act condescendingly, it's better not to help them.
Because even if you help, the other party will not be grateful.
It is very likely that you will hold a grudge afterwards.
Director Xueyan stayed in the office to continue reviewing the surgical records. She had strong theoretical knowledge and had received careful instruction from Director Hu Kan. She might be able to make some discoveries.
Zhou Can followed him to the ward and saw that the middle-aged man had a dull look in his eyes, a paler face, and his body was shaking slightly.
The fluid that was drained out was blood, and the color was not particularly bright.
"Doctor Zhou, what do you think is the safest way to treat it now?"
Deputy Director He's forehead was covered in sweat.
The family members were lying on the edge of the bed sobbing, probably having already prepared for the worst.
"First, give blood transfusion and fluid replacement, and then conservative treatment!"
After reading it, Zhou Can made his own judgment.
"But he can't stop the internal bleeding. No matter how much blood he transfuses, it's like a bottomless pit!"
Deputy Director He didn't expect to get such a result from asking Zhou Can.
Every doctor knows about conservative treatment, so is there any need to ask him?
"We need to save the patient's life first. We will hurry up and find out the cause of the bleeding. Then we can formulate a precise plan."
Zhou Can has seen all kinds of rescue scenes, and he has seen many times those that were ten times more serious than this one.
Therefore, he seemed unusually calm.
People who have seen the world and those who have not seen the world will behave completely differently when encountered things.
Those bosses who remain calm even when facing a catastrophe have been tempered through countless crises.
Three years of regular training experience has allowed Zhou Can to completely transform himself. Maybe he is not yet a big shot, but he has already possessed the calmness and composure that a great doctor should have.
"Okay, I'll give the doctor an order for emergency treatment right away!"
At the same time, a notice of critical illness is also issued, which will be sent to the family members.
According to the hospital's regulations, as long as the doctor determines that the patient's life is in danger, he must inform the family of the critical illness. This is also to let the family members have a psychological preparation.
After blood transfusion and fluid replacement, the patient's vital signs improved.
But this is only temporary.
In Deputy Director He's office, Zhou Can could only read the surgical records as quickly as possible because time was tight. At least he knew which parts were cut and what treatments were done during the operation.
"Since time is very tight, I will directly tell you the five possible causes of bleeding. The first is that the bleeding was not completely stopped after the adhesions between the chest wall, diaphragm and pleura were separated and cut off. After watching the entire surgical record and your usual surgical... style, this is also the most likely reason."
Zhou Can originally wanted to say that Deputy Director He was a bit careless when performing surgeries, but then he thought that was too hurtful, so he changed it to the word "style".
"I also suspected that this step was not done well, but to be safe, I asked the first assistant to check it again. The bleeding point was re-treated. The first assistant at the time was Dr. Yao, who is always meticulous in his work and hemostasis is his strong point, so the probability of problems is very low."
Deputy Director He denied the first cause of bleeding.
Zhou Can nodded and continued, "Excuse me, who did the chest closure and suture?"
"I am one of the attending doctors under my command. His suturing skills are quite good. I also checked after the chest was closed and sutured. The sutures were neat and the skin layers were tightly attached. There should be no problem."
Deputy Director He did not dare to take such a major operation lightly.
It can be seen that he strictly controls every step of the operation.
In fact, no chief physician dares to take any major surgery above level three lightly, after all, human life is at stake. If something goes wrong, it will have a huge impact on the chief physician.
If things go wrong, you might end up in court.
Also, as long as the director's power is not so great that he can do everything, some omissions will be discovered during the investigation.
" If the first cause of bleeding is ruled out, I think it is very likely that the intercostal arteries and veins were injured when the chest was closed and sutured. If this can also be ruled out, then the intercostal arteries and veins were injured when the chest drainage tube was inserted. The color of the drainage fluid is not bright red, so the possibility of injuring the intercostal arteries when the chest drainage tube was inserted can basically be ruled out. If the veins were injured, the amount of bleeding should not have increased so quickly."
"To sum up, I believe that the greatest possibility is that the artery was injured during the chest closure and suture." Zhou Can gave his own analysis.
"I also suspected that the artery was injured during suturing or catheterization. Now after listening to Zhou Can's analysis, I strongly support his point of view. The possibility of injuring the artery during suturing is the greatest. Only in this way can the amount of bleeding increase rapidly."
Director Xueyan has not expressed any opinion.
At this moment, Zhou Can had cut the Gordian knot and directly identified the cause of the bleeding as the suturing of the chest, so she simply expressed her opinion directly.
"So what do we do next?"
Deputy Director He was completely confused and had no idea what to do.
"The only way is to enter the chest along the original incision, quickly remove the blood clot, suck out the blood inside, and repair the damaged blood vessels. In this process, rapid fluid replacement and blood transfusion are required."
Zhou Can gave a solution.
Unless it is absolutely necessary, I will never perform another thoracotomy just over a day after the operation.
Because this will cause great harm to the patients.
This should be the only way to save the patient's life at the moment.
"This... everything else is fine. But it's harder to repair the damaged artery. I'm worried that the repair will take too long and the patient will die before the second chest closure!"
Deputy Director He is well aware of the harm that thoracotomy can cause to patients.
"I'll do it."
Zhou Can offered to help without him asking.
"Thank you! Thank you so much!"
Deputy Director He held Zhou Can's hand tightly.
He knew very well that Zhou Can had been accompanying Director Xueyan to perform surgery until twelve o'clock after get off work, and his body had long been in a state of overdraft.
In this case, he had to participate in the operation again to help him save the patient.
And it was Zhou Can who offered to help.
Humans are not plants or trees, how can they be heartless?
Even if Deputy Director He had a heart of stone at this moment, he was filled with endless gratitude towards Zhou Can.
As for whether he will be fickle and ruthless in the future, no one can say for sure.
…
At around one in the morning, Zhou Can dragged his tired body out of the operating room.
Director Xueyan was yawning continuously and could hardly open her eyes.
In fact, she just stayed on the operating table throughout the whole process and did not participate in the operation personally.
Zhou Can was the lead surgeon throughout the entire process.
In this situation where the chest needs to be opened quickly, cleaned, blood vessels repaired, and the chest closed quickly, Zhou Can's fast surgical speed became the only hope for saving the patient.
The quick surgery style also made Zhou Can realize the importance of surgical speed.
If you are too slow, you will often be hindered.
"Director Xue, Doctor Zhou, thank you for your help!"
Deputy Director He breathed a sigh of relief when he saw that the patient was temporarily safe after the operation.
For safety reasons, the patient was sent to a small ICU.
That is the intensive care unit built by the cardiothoracic surgery department.
Departments such as respiratory medicine, neurosurgery, cardiac surgery, thoracic surgery, and emergency medicine will set up their own intensive care units if conditions permit.
"You're welcome!"
Zhou Can waved his hands, but muttered in his heart, hoping that this old guy would remember the kindness of tonight and do less immoral things in the future.
"Sister Yan, it's so late now and you're extremely sleepy. I suggest you don't go home. Just stay in the hospital for one night."
Zhou Can said to her.
"Yeah, that's what I thought."
Xueyan nodded.
Zhou Can looked at the time. It was almost 1:30 in the morning. He estimated that it would be past two o'clock when he returned to his home in Bajing Lake.
Being a doctor is such a hard life.
Fortunately, we saved so many people today and helped the cardiothoracic surgery department temporarily quell the civil unrest. It was worth it.
