Chapter 525 High-Level Pharmacology, Director Ming Checking the Household Registration
If Zhou Can had not insisted on exploring the condition of the pancreas, this small tumor would not have been discovered at all.
Why is pancreatic cancer so scary?
Because the clinical manifestations of pancreatic cancer are not specific and there is a lack of relatively accurate direct examination methods, early diagnosis is extremely difficult. Most people diagnosed with pancreatic cancer have already entered the late stage and have lost the opportunity for radical surgery.
It has a very high mortality rate, with a 5-year survival rate of less than 5%, which is why it is called the king of cancer.
Although other chief physicians also found possible pancreatic injuries through X-rays, they did not take it seriously because the bleeding was not serious and had stopped. Considering the patient's extremely weak body, they tried not to perform surgery if possible.
The patient's current fractures in both legs and right arm will not be treated for the time being.
This is also the basic procedure of first aid.
Treat fatal injuries first, and then deal with common injuries at a later time.
This type of limb fracture is usually less life-threatening and can be treated later.
Unless the femoral artery is punctured or deep vein thrombosis has formed in the lower extremities, this situation must be treated immediately.
Other chief physicians believed that the pancreas injury did not require surgery, which meant that they definitely did not find any major problems with the pancreas. However, Zhou Can insisted on checking the condition of the pancreas. Was this a coincidence, or had Zhou Can discovered something?
Director Gou Qiong couldn't help but start thinking about this matter secretly.
If Zhou Can could detect the presence of a pancreatic tumor in advance just by looking at the films and auxiliary examination results, that would be amazing.
Even Director Gou Qiong doesn't have such a high level of diagnostic ability.
"Director Gou, do you think we can remove the laparoscope now?"
Zhou Can asked for instructions.
Zhou Can's surgical skills in removing pancreatic tumors with almost magical top-level technology have been deeply rooted in the hearts of every medical staff present.
Even the circulating nurses who looked down on him began to change their attitude towards him.
The circulating nurse was shocked when she discovered the tumor on the pancreas.
She had to look at this young doctor from Tuya with new eyes.
"The operation was done very well, please remove the scope!"
After the endoscope was removed, a catheter was inserted because of the fluid accumulation in the abdominal cavity. One was for drainage, to remove any new fluid that might have formed. The other was also used to observe the bleeding in the abdominal cavity.
If the repaired blood vessel ruptures again, the amount of fluid drained out will increase, and the color may be directly red blood.
Drainage catheter placement seems simple, but it also has many requirements.
It is necessary to prevent the drainage tube from becoming a channel for the introduction of bacteria and viruses.
This will bring certain difficulties to nursing and postoperative management.
The laparoscopic surgery was successfully completed, and the next step was the most difficult intracranial hemostasis surgery.
The amount of intracranial bleeding was not particularly severe, but there was no way to stop the bleeding automatically, and it was enough to be fatal.
"Director Ming, is the patient's condition still able to withstand trepanation?"
Director Wu Yongming has to bite the bullet on this tough issue whether he likes it or not.
The patient must undergo intracranial hemostasis surgery.
"The patient's vital signs are relatively stable now, and his breathing has improved a bit. I think he shouldn't have any problems with endoscopy."
Director Ming Xin made a comprehensive assessment of the patient's condition.
Not bad.
Many physical signs have improved.
Moreover, important signs such as blood pressure and heart rate have become stable, even more stable than before the surgery. This is quite good.
It also provides the basis for subsequent cranial endoscopic surgery.
"Okay, then I'll get started. Director Gou, Dr. Zhou and others have already put in so much effort and won the first battle. There's no reason for me to let them down." After Wu Yongming finished speaking, he began to cut the scalp layer at the predetermined position on the patient's head, making a cross incision...
Soon it was time to drill a hole in the patient's skull.
The human skull is like a hard turtle shell, which protects the entire brain and important tissues in the head, such as the nerves, brain stem, cerebellum, etc.
If you want to perform intracranial surgery, you must saw open the skull.
Traditional surgery involves opening the skull, which is a huge undertaking. But with the advancement of science and technology, doctors can drill a small hole in the skull and insert an endoscope into the cranial cavity to perform surgery.
Not long after the drilling began, the life monitoring equipment issued a shrill alarm.
The patient's blood pressure plummeted and his heart rate also plummeted, which means bradycardia.
Director Wu Yongming was so scared that he immediately stopped drilling.
"Did the drilling damage the brain tissue?"
Director Ming Xin asked anxiously.
Others also had some doubts about Wu Yongming's operation. Cranial drilling is a very dangerous operation and requires very high technical skills from the doctor.
"No, the skull hasn't even been penetrated yet!"
Wu Yongming also looked aggrieved.
This is not the first time I have performed cranial endoscopic surgery on a patient, and the operation has always been normal. How could something go wrong all of a sudden?
Sometimes, the most feared thing about surgery is this kind of emergency.
And I have no idea where the problem lies.
"The decrease in heart rate should be bradycardia caused by hypotension. You can try intravenous injection of 0.5 mg of atropine to see the effect." After looking at the patient's various indicators and combining them with his condition, Zhou Can made a diagnosis.
In terms of experience in diagnosis and rescue, he may not be as rich as Director Xiang Fei, and he is even less than Director Ming Xin, the anesthesiologist.
But he has an advantage that other doctors may not be able to achieve in their entire lives. Many of his medical skills have been promoted to level six. It is equivalent to cultivating both inside and outside, and all of them are of high level.
In addition, there is the blessing of the special medical skill of emergency rescue and life-saving wisdom.
Make him better than the chief physician in rescue work.
In Tuya Hospital, whether it is the operating room, the emergency room, or the intensive care unit, as long as Zhou Can is there, it is equivalent to giving the patient an extra life-saving talisman.
The cardiothoracic surgery department has performed many difficult and high-risk operations in the past two years. Since Zhou Can got involved, there have been no accidents.
In fact, it’s not that no accidents happened during the operation, but after the accident happened, Zhou Can tried to find a way to treat the patient as soon as possible, and worked together with the medical staff to finally save the patient.
As his rescue experience grew and his medical skills became more advanced, his rescue success rate has reached over 99%.
At this moment, he just took a quick look at the patient's condition and quickly diagnosed the cause.
"Can't I push the adrenal glands to strengthen my heart?"
Ru Yaji, who was behind Director Xiang Fei, couldn't help but ask.
During emergency treatment, for heart failure, cardiac arrest, etc., adrenal glands are used more often.
"Adrenaline is a vasoconstrictor drug, which can indeed increase blood pressure and increase the heart's contractility. However, it can also constrict the blood vessels of the heart, liver, tendons and bones, and selectively constrict the blood vessels of the skin and mucous membranes and the limbs. It is more suitable for rescuing patients in shock and is widely used in clinical practice to rescue critically ill patients. However, it should be used with caution in patients whose blood vessels are too fragile."
Zhou Can glanced at her and gave an explanation.
"The patient had just undergone splenic artery repair and anastomosis. His blood vessels were already fragile, and the use of adrenaline could easily cause a second rupture of the blood vessels."
Director Xiang Fei also gave guidance to his beloved disciple at appropriate times.
The most frightening thing about studying medicine is dogmatism and stereotypes, which are extremely harmful to patients.
There are thousands of different diseases for different people, and each disease has its own prescription. This is the experience summed up by ancient Chinese medicine.
Although they all seem to be critically ill patients, the rescue methods may be completely different.
Even if the same drug is used, the dosage may vary greatly. Some patients need a rapid injection, while others need a slow intravenous drip. For some patients, only 0.5 ml of the drug may be enough, while for others, even this amount may not work at all.
For example, people who are too obese often need a higher dosage.
In addition, it is also necessary to consider whether the patient is allergic to or cannot absorb this type of drug, whether he has underlying diseases that contraindicate it, etc.
For example, patients who have undergone stent surgery should be particularly cautious when using hemostatic drugs.
Under normal circumstances, such patients need to take anticoagulants for life to prevent recurrence of blood vessel blockage.
"Understood!"
Ru Yaji nodded in agreement and looked at Zhou Can with gratitude.
She couldn't help but admire Zhou Can's clinical rescue ability even more, and she deeply felt the difference in strength between the two.
I thought the only area where I had a huge gap with Zhou Can was in surgery.
Unexpectedly, when it comes to rescuing critically ill patients, Zhou Can is far superior to her in both diagnosis and medication.
This time, she was completely convinced.
Pang Houzhong, who was standing next to him, looked even more depressed, as if he had suffered a heavy blow.
After the patient was given 0.5 mg of atropine intravenously, his condition improved.
However, the situation remains worrying.
"Director Ming, do you think it would be risky to give the patient a blood transfusion of about 150ml right now?"
Zhou Can asked.
There were only two people on the scene with high-level rescue capabilities, one was Director Ming Xin and the other was Director Xiang Fei.
If you want to discuss it, you must consult the anesthesiologist in charge.
After all, during the operation, she is responsible for the patient's life safety.
“Why is it 150ml of blood transfusion, instead of more than 200ml?”
She asked back.
"Maybe I'm always too cautious. I just calculated based on the patient's heart rate and blood pressure. 150ml of blood transfusion should be enough to stabilize his vital signs and complete the intracranial surgery. If too much is transfused, I'm worried that it will cause other unpredictable consequences. It will also make it more difficult to stop the bleeding in the brain."
Zhou Can gave his own answer.
This immediately attracted everyone's envious and jealous looks again.
Calculating the amount of blood transfusion is not a particularly advanced skill. Basically, many doctors can calculate the amount of blood loss based on the patient's hemoglobin level and then determine the amount of blood transfusion and fluid replacement.
However, in this kind of clinical emergency, one needs to remain calm and accurately calculate the amount of blood transfusion based on the patient's heart rate, blood pressure and other parameters in a very short period of time. Even Director Xiang Fei would feel ashamed of himself.
150 and 200 may seem to be only a difference of 50 ml, but after being injected into the patient's body, it may break a certain balance and cause a series of adverse consequences.
The precise control of the amount of blood transfusion is a true manifestation of high level.
"Bring 150 ml of plasma and give it to the patient immediately."
Director Ming Xin issued instructions.
During the blood transfusion process, Wu Yongming never drilled a hole in the patient's skull again.
He was really scared just now.
"Doctor Zhou is very good at rescuing critically ill patients! Which doctor at Tuya did you learn from? Was it Director Liu Xiangqing of the Critical Care Medicine Department?"
Director Ming Xin took advantage of the break in blood transfusion to inquire about Zhou Can's background.
Because this kid is so outstanding.
"I didn't expect you knew Director Liu. I did study with him for a while." Zhou Can still missed the days of training in the Department of Critical Care Medicine. He was full of gratitude to Director Liu Xiangqing.
It is a blessing to meet a chief physician who will devote all his efforts to cultivating you during your medical studies.
And as long as you work hard and have decent talent, it's easy to make a name for yourself.
Zhou Can was luckier than others because there were so many chief physicians who appreciated him. They trained Zhou Can with all their strength and taught him everything they knew, which eventually led to the creation of such a demon-level young doctor.
Even in a provincial-level tertiary hospital like the Provincial People's Hospital, everyone was amazed at every turn.
Let them see the elegance of the Tuya people.
"A good teacher produces a good student. No wonder you are so good. Who did you learn your surgical skills from? When I saw you performing surgery just now, I saw the shadows of the two famous knife masters Tuya. You have the shadow of the most stable scalpel and the shadow of Xu Yidao who once set a world record. You have been taught by so many top chief physicians. Could you be the son of an official?"
Director Ming Xin's attitude towards him became noticeably friendlier.
This question is somewhat joking.
"What are you doing? Checking the household registration!" Zhou Can responded with a smile. He didn't want to have all his past exposed. "Look, the patient's vital signs are now stable, so we should be able to hurry up and perform another operation. The patient's blood pressure dropped sharply and his heart rate was slow. It was just a stress reaction caused by the trauma during the opening of the head. It's like a house that was about to collapse. It was about to collapse, but it was slightly shaken, causing it to collapse."
Zhou Can quickly changed the subject.
He was very smart and drew everyone's attention back to the patient.
This would also prevent these people from being overly curious and inquiring about his background and details.
"Then finish the operation first. After the operation, you have to chat with us for a while. If there are many young doctors in Tuya who are as good as you, our Provincial People's Hospital might as well recruit you directly."
This is another joke on her part.
But it's true.
It would be terrifying if Tuya could have ten young doctors of Zhou Can’s level.
As long as it grows up, it can easily crush all hospitals in the province.
He was truly invincible in the province.
Zhou Can smiled bitterly and said nothing. Silence is golden.
At this time, it is wiser to remain silent.
The operation continues.
Wu Yongming tried to drill a hole in the patient's skull again, and this time there were no problems.
Next, Director Wu cut open the dura mater and demonstrated his superb surgical skills.
The chief physicians of these provincial people's hospitals are all very strong.
"Doctor Zhou, how about you come and assist me?"
Unexpectedly, after opening the dura mater, Wu Yongming made a substitution on the spot and directly extended an invitation to Zhou Can.
This made his medical assistant quite unhappy.
There is nothing we can do about it.
The patient's condition was extremely dangerous, and the subsequent hemostasis surgery would be extremely difficult. There was a greater chance of another accident.
After seeing Zhou Can's outstanding performance in laparoscopic surgery, Wu Yongming finally made the decision to change the general on the spot after a struggle between himself and himself. Letting Zhou Can assist him has many advantages.
It is more reliable than the existing medical assistants and can give him a greater sense of security.
Even if the patient really had an accident again, Zhou Can would help to rescue him without him saying anything.
In addition, Zhou Can has a strong ability to anastomose blood vessels quickly and effectively. If the bleeding point is close to the brain stem, Zhou Can may be needed to repair the blood vessels.
