Chapter 498 Reverse Surgery, Congenital Heart Disease Again
Sometimes having too much experience isn't necessarily a good thing.
Doctors with too much experience in diagnosis are prone to blind self-confidence. They are prone to subjective assumptions in diagnosis, which can lead to being slapped in the face.
Director Xueyan was very lucky this time. After all, she just gave a treatment plan too early during the diagnosis.
If the patient had not secretly live-streamed the consultation, she could have even told the patient directly that the previous treatment plan was not suitable and needed to be changed.
This is in line with diagnosis and treatment procedures, and no one can find fault with it.
Now we feel we are in a difficult situation. Ultimately, we are worried that the department’s image will be damaged.
When the patient was diagnosed, there were at least 10,000 viewers online, and the publicity was no less than that of an ordinary local TV interview.
"The patient has coronary heart disease and myocardial infarction, and is physically weak. For cardiovascular intervention surgery, unblocking blood vessels is still the first choice. As for how to perform the surgery, I think we can try reverse thinking."
What Zhou Can is best at is reverse thinking.
"What do you mean?"
She was a little confused.
"Normally, cardiovascular interventional surgery is performed through the femoral artery. If the blood vessel is severely blocked or even calcified, the guidewire may not be able to pass through. Then you can consider entering from the other end of the blood vessel, and reverse opening can have the same therapeutic effect."
Zhou Can talked freely.
From the film taken by the patient, it can be basically determined that the blocked artery of the patient has at least multiple calcified spots. This is also the most common situation of serious cardiovascular disease.
The inner wall of the blood vessel is calcified and blocked, which will seriously increase the difficulty of passing the guidewire.
"Reverse opening?"
Director Xueyan was extremely shocked after hearing Zhou Can's surgical plan.
"When the teacher was alive, it seems that he didn't teach us such a treatment plan?"
She thought she had studied very hard and it was impossible for her to have made any major omissions.
However, every time she encountered a difficult case, Zhou Can was always able to provide treatment plans or pathological dialectical ideas that she was unable to master.
The cardiovascular intervention plan given this time was refreshing to her.
"When I was doing my resident training in cardiovascular medicine, I read in a medical journal that Academician Ge had performed a similar operation. He succeeded, so I think it's at least worth a try. Even if it fails, vascular interventional surgery causes very little trauma to the patient and will not lead to serious consequences such as death."
Zhou Can is full of anticipation for this extremely difficult cardiovascular interventional surgery.
A challenge is often a breakthrough in oneself.
"Great! We finally have a good plan. Come, let's continue discussing the implementation and preparation of the surgical plan."
After hearing this, Director Xueyan showed a relieved smile for the first time on her face.
As the head of a department, I bear much more pressure than other people.
…
After more than half an hour of discussion, the two finally decided on the surgical plan and agreed that Zhou Can would perform the surgery.
When it comes to interventional surgery and endoscopic surgery, Zhou Can does have an extraordinary talent that ordinary people cannot achieve.
And his current strength is already very strong.
Both the implantation and injection procedures were at level five, reaching the level of deputy director. It was more than enough to perform interventional surgeries of general difficulty.
However, this time we are facing an extremely difficult cardiovascular interventional surgery. If the injection and implantation techniques can be upgraded to level six, the chances of success will be greater.
It is impossible for the patient to wait until he is promoted before coming for treatment.
The only way is to go ahead with it.
Fortunately, this type of interventional surgery has low risks, and the worst that can happen is a slap in the face if it fails.
He agreed with Director Xueyan to start the operation at around seven in the evening.
The surgery was chosen at night mainly to accommodate Zhou Can's work schedule.
After returning to the emergency department, Zhou Can immediately plunged into the crazy operation without saying anything.
It's already past two in the afternoon.
Yang Zhi and Pu Dingdong have already started performing some minor surgeries within their capabilities.
Under normal circumstances, Zhou Can sees patients in the morning, and the surgical team members will arrive in the operating room on time around 1:00 p.m.
"Doctor Zhou, please come here!"
Yang Zhi was treating a subcutaneous abscess on a patient, which needed to be cleaned up, and Pu Dingdong was assisting him.
Qiao Yu and Ma Xiaolan, one provided the equipment, and the other patrolled the stage.
They were all very happy to see Zhou Can come in.
Zhou Can is the absolute core of this surgical team.
"It's okay, it's okay, just do your best!"
Zhou Can stood by and watched Yang Zhi operate.
"Your skills are more sophisticated and your speed is faster. There are many patients waiting for you to operate on them. I can't waste any more time. You should do it! I will do it slowly next time when I am not busy."
Yang Zhi's surgical speed is far slower than Zhou Can's.
He wouldn't dare occupy the toilet without taking a shit.
When Zhou Can came in just now, he did see many patients waiting outside for surgery. The pre-anesthesia room was already full, not to mention the corridor outside.
"Okay, then you can assist from the side."
After Zhou Can took over, he quickly sucked out the thick fluid that had not been completely sucked out, and then began to clean the patient's wound.
The purpose of abscess cavity debridement is to remove infected necrotic tissue and allow the patient to recover quickly.
Six-level debridement, plus six-level incision and six-level separation, now it is a piece of cake for Zhou Can to clear this abscess cavity.
In his hands, the scalpel became a magic wand for performing magic.
Wherever it goes, the necrotic tissue in the abscess cavity and the infected part whether to retain or remove are decided in an instant.
Swish, swish, swish!
Every cut goes straight to the flesh, blood vessels are perfectly avoided, nerves are easily separated, and diseased tissue is quickly removed.
[Quick Knife Skills Experience Points +1, +1...]
He entered a state of extreme madness.
With the support of level six debridement, incision and separation, he doesn't even need the steady knife technique to restrain the evil of the quick knife technique to ensure the safety of the patient.
This was not his first attempt. After his separation skills were promoted to level six, he had begun to consciously try it in minor operations.
Continue to practice and explore.
The steady knife method and the fast knife method can be used separately or combined.
So far, Zhou Can is probably the only one who can combine the fast knife technique with the steady knife technique.
Even Dr. Xu can't do it.
Three different knife techniques can be used in different occasions.
It can be carried out according to actual clinical needs.
The operation took six minutes and fifty-eight seconds, almost seven minutes.
"Doctor, have I cleaned my abscess cavity? I hope it won't come back again! The last time I had surgery at the county hospital, it came back not long after."
The patient was given local anesthesia and was awake the entire time.
Seeing Zhou Can take over the operation for him, he didn't say anything.
It’s just that Zhou Can’s surgery was so fast that he couldn’t help but feel suspicious.
It took Yang Zhi nearly half an hour to perform the operation on him before he cut open the abscess cavity and drained and sucked out the pus inside bit by bit.
Now this doctor who looked younger than Yang Zhi actually completed all the operations in just a few minutes. This was really worrying.
"Just relax. Doctor Zhou Can is the leader of our surgical team. If he performs the surgery on you personally, the results will be more than ten times better than if I were to perform the surgery on you. Take good care of yourself after the surgery. I believe you will experience what a quick and effective abscess debridement surgery is."
Yang Zhi was standing by and speaking for Zhou Can.
Although it may seem like he was trying to flatter Zhou Can, what he said was basically true.
There are many patients out there who really come to Zhou Can specifically for surgery.
"If your postoperative results are good, don't forget to recommend our Dr. Zhou Can to your relatives and friends!"
Ma Xiaolan also said.
"Haha, good, good! As long as the operation is successful, I will definitely praise your superb medical skills to others. I came to Tuya for treatment this time because I believe in your medical skills and came to the provincial capital to find you."
The patient was a man in his fifties. Hearing that other doctors and nurses had confidence in Zhou Can's medical skills, he couldn't help but smile happily.
…
It was past seven o'clock when Zhou Can finally finished treating all the surgical patients.
In addition to gaining a lot of medical experience points, he also gained a lot of fatigue. As for gaining gratitude from patients, he had to wait until they recovered.
If the patient develops infection or complications after surgery, he will not receive gratitude but may be questioned and cursed behind his back.
Generally speaking, patients and their families rarely curse in front of him.
At most, some people complained to the medical department behind the scenes.
"Doctor Zhou, could you please work another shift? A six-year-old girl came to the triage desk. Her face was cyanotic and her blood oxygen saturation was only 61%. Her condition looked quite scary."
Most of the nurses in the emergency department are familiar with Zhou Can.
He is also kind.
Sometimes, when they encounter some critically ill patients, they see him and ask him to come over for help.
Zhou Can basically accepts everyone who comes.
"The blood oxygen level is so low, have you checked your upper respiratory tract?"
The acquisition of oxygen depends entirely on the lungs and upper respiratory tract.
When a child's blood oxygen is so low, the first thing to consider is upper airway obstruction.
For example, the baby who had peanuts stuck in his throat that we rescued not long ago.
"Doctor Xie is on night duty today. His experience is limited. He has checked everything he needs to check, but hasn't found the cause yet. I'm particularly worried that something has happened to the child, so please go over and take a look."
"Okay, let's go take a look first!"
Zhou Can followed the nurse to the triage desk and saw a rather young couple bringing a six-year-old girl for treatment.
The little girl's face and lips are now deeply cyanotic, as are the skin on her body.
Very scary.
The patient's mother had a limp in one leg, and her posture was obviously unnatural when she stood there.
Zhou Can immediately realized that the child’s mother was most likely a person with a leg disability.
The patient's father was tall, of normal build, with an anxious look on his face.
Zhou Can squeezed forward, and Dr. Xie immediately felt like he had seen a savior.
"Doctor Zhou, this child's blood oxygen level is only around 60, but there is no evidence of any foreign object stuck in the throat. Please help take a look."
For some doctors who grow slowly, even if they have worked for five or six years, when they encounter such emergency and critical cases, they will still panic like a child who has not grown up.
Because sometimes, the patient's death is just a moment.
"How did the child become like this?"
Zhou Can has started checking on the child.
You can see her chest collapse when she breathes.
It means that breathing in is very strenuous.
The little girl had pretty features. She lay quietly on the flat bed, looking at Zhou Can innocently with her bright eyes.
At this moment, in the little girl's mind, these doctors and nurses in white clothes are the angels who saved her.
“Mmmmm… ah…”
The patient's father gestured with his hands and made indistinct sounds.
It turns out this is a mute.
Zhou Can looked at the patient's mother.
“Eeeeee…”
She is also mute.
Both of the patient's parents are mute and disabled.
I don’t know if their daughter has inherited the gene?
"Little boy, do you feel uncomfortable now?"
Zhou Can asked the little girl gently.
"It hurts! It feels like something is pressing on me!"
When she spoke, her words were clear.
This means there are no problems with hearing or vocalization.
“Mmm…”
The patient's father wrote two sentences in the notebook with the pen he carried with him.
"My child's mother and I are both mute, and I am also deaf. My daughter's face was a little purple when she was born, and she suddenly fell to the ground today. Please save her!"
Only then did Zhou Can discover that the child’s father was wearing a hearing aid.
Just now his attention was all on the child and he didn't notice these things.
Today's hearing aids are mostly designed with skin color, taking into account the feelings of people with disabilities and to minimize the chances of them being discriminated against.
If you wear it on your ear, it is generally difficult to find if you don't look carefully.
The patient's father is deaf-mute, and his mother has a leg disability and is mute. This is a disadvantaged family.
"Don't worry, we will do our best to save your child."
Zhou Can comforted the two of them, then quickly began to give the child a preliminary physical examination.
For patients with poor blood oxygen levels, it is very necessary to percuss the chest sounds and auscultate the breathing sounds of the lungs.
With the help of a stethoscope, Zhou Can found that the patient's lungs had clear breath sounds and no murmurs.
Next, he moved down to listen to the patient's heart sounds.
An indescribable murmur was heard.
This murmur is made every time the heart beats.
His face changed slightly. Misfortune always favors the unfortunate. I thought this child might have some problem with his upper respiratory tract or lungs, but now it seems that the lesion is most likely in the heart.
The patient’s father reported that the child’s face had been a little purple since he was young, which indicated that the disease had been going on for many years.
If nothing unexpected happens, it is most likely a congenital heart disease.
Zhou Can has extensive experience in cardiothoracic surgery and pediatric diagnosis, and has met many patients with congenital heart disease.
Even without any auxiliary examinations, he can preliminarily determine that the patient has a 99% chance of congenital heart disease.
"Don't be afraid, kid. I want to check your chest and ribs. You need to take off your clothes!"
Considering that the patient is a girl.
Before the examination, Zhou Can tried his best to obtain the consent of the patient and his family.
In fact, in the eyes of medical staff, once they enter the hospital, there is really no big difference between men and women. When entering the operating room for a slightly larger operation, they are basically naked, or wear a surgical gown issued by the hospital.
If you are admitted to the ICU, take off all your clothes.
Sometimes the patient may be asked to wear a hospital gown, depending on the situation.
Therefore, if you want to say that male doctors have lewd thoughts when examining female patients' sensitive parts, it is basically impossible. At most, seeing young and beautiful female patients brings some visual enjoyment.
When many male doctors perform electrocardiograms on female patients, they often ask the patients to undress themselves and tell them what to do. The male doctors will deliberately turn around and fiddle with the examination equipment to avoid embarrassing the female patients.
Then, after placing the detection probe on the examination area of the female patient, they will quickly and proactively help them cover their clothes to cover the sensitive areas.
This will reduce the embarrassment of female patients.
