Chapter 535: An accident caused by anesthesia. One person's power is ultimately limited.
In the hospital, medical staff definitely have two major advantages: geographical location and human resources.
There are many ways to persuade patients to leave.
Moreover, everyone is a group of people with the same interests, and they don’t even need anyone to remind them. When encountering such a situation, everyone basically knows what to do.
"You won't go wrong if you listen to the doctor. Tuya Hospital is so famous, the medical ethics must be good. Let's send Xie Chao to the Provincial People's Hospital as soon as possible."
"I also think that the patient should be sent to the Provincial People's Hospital. After all, it is a large public hospital with better protection in all aspects."
"Contact them quickly before the ambulance leaves."
The family members discussed the matter one by one and soon settled it.
The patient was taken away by the doctor and nurse in the ambulance.
To rent an ambulance to transport a patient, you can usually only rent a private ambulance, also known as an external hospital ambulance. The hospital's own ambulance generally will not take on such work.
At this time, the ambulance driver will contact and hire a doctor and a nurse to accompany the car.
The cost is usually included in the transportation fee, but family members need to give an additional red envelope to the doctor and nurse.
If the family members are ignorant and the red envelopes are not delivered, the doctors and nurses accompanying the car will become passive and lazy.
Watching the patient being taken away, Zhou Can and Director Lou both breathed a sigh of relief.
Every day we receive a few patients who need to be persuaded to leave.
Few large hospitals would refuse to treat patients openly. They would use soft methods to persuade patients to leave.
"Xiao Zhou, how low is the survival rate of that patient just now?"
Director Lou asked in a cold tone.
"Without a miracle, death is certain."
Zhou Can answered decisively.
"So sure?"
Director Lou’s level is not low, but in terms of diagnostic ability, he is not as good as Zhou Can.
"That's already a very conservative statement. I'm sure that even if the patient's urine is still dark yellow, it will turn into soy sauce color in two days at most. He has already developed acute renal failure. The right upper lobe was removed, and respiratory failure was also induced. Even though the patient's condition is not particularly serious now, he is already beyond help."
If it were in the past, Zhou Can would definitely not dare to give such a confident diagnosis.
Even when facing one's own people, one still cannot be so sure.
Now, his pathological diagnosis has been promoted to the director level, and in order to treat Su Qianqian's kidney disease, he has worked hard to learn the diagnosis and treatment of kidney disease. He even studied urology.
Therefore, he can now diagnose such patients with almost no errors.
"How come the patient's kidneys were damaged by cutting off the right upper lobe of the lung? This Third Hospital is really full of scandals!" Director Lou had also heard about some things about the Third Hospital.
Most of the news is negative.
Especially in recent times, the Third Hospital has had problems with its funding chain and has no extra money to deal with negative news.
As a result, all kinds of scandals were constantly posted online by the victims.
It's almost the end of the road, and everyone is pushing it down when it falls.
"It should not be directly related to the right upper lobectomy. I suspect it was probably caused by anesthesia. I used to think that the Third Hospital must be very strong because it invited a Japanese cardiac surgery expert. Now it seems that the strength of a hospital cannot be supported by one or two doctors. The Third Hospital lacks foundation and has many shortcomings. This medical accident is likely caused by anesthesia. Let's see how the family will deal with it."
Zhou Can's eyes flashed.
I really overestimated the Third Hospital in the past.
It is hard to say whether the family of this patient will file a medical dispute after his death.
Some family members are more honest and think that if the patient dies after surgery, the doctor has done his best and will not cause trouble for the hospital.
It is not easy for family members to cause trouble for the hospital.
To an individual, a hospital is a behemoth.
Both family members and patients are relatively disadvantaged.
"Anesthesia problem? Let me analyze it for you."
Although Director Lou is experienced and competent, he seems helpless when faced with some difficult and complicated cases. This is determined by his talent, expertise, and diagnostic thinking.
Whether he admits it or not, although Zhou Can is very young, he has been taught by famous teachers in many departments, and his own excellent talent has been accumulated. His ability to diagnose many difficult cases has surpassed Director Lou.
"I think the patient had an intrathoracic surgery, which usually requires a side-lying position. This would cause the limbs on the side close to the operating table to bear gravity and be crushed. This patient's left shoulder, arm, hip, and thigh all had obvious soft tissue crushing, swelling, and blackening. It is likely that during the operation, after general anesthesia, the lower support pad was too hard, causing severe compression of the left limbs and ischemic necrosis and fragmentation of the muscles."
"The capillaries were ruptured, blocked, and their permeability changed. After the operation, the patient was placed in a supine position and the pressure on the lateral limb was relieved. At this time, local bleeding occurred, and a large amount of plasma fluid rapidly extravasated into the interstitial space, which caused muscle swelling. Because it was not treated in time, the increased pressure in the intermuscular space further aggravated the local blood obstruction and ischemia, which eventually led to swelling, hardening, and cooling of the left compressed area."
Zhou Can carefully analyzed the patient's entire injury process.
Compression injuries during surgery are easily overlooked by doctors.
This actually requires high vigilance.
"When I examined the patient just now, I pressed the swollen area on his left side and it was hard, like a stone, and his limbs were cold. This shows that the muscles in his limbs have already been necrotic and the best period for treatment has long been missed."
When examining the patient, Zhou Can seemed to be just pressing the buttons randomly, but with his rich experience in diagnosis and treatment, he was able to directly judge the patient's condition .
"Yes, that's a very accurate analysis. You think the renal failure is related to the lateral limb compression, right?"
After listening to this, Director Lou nodded in agreement.
The young doctors nearby were quietly taking notes, recording Zhou Can's analysis for later study and reference.
"Because the left muscle is necrotic, swollen and hard, this will cause a large amount of local exudation or bleeding, and eventually lead to a decrease in systemic blood volume. The patient's low blood pressure is the best proof. When the systemic blood volume decreases, the blood perfusion of the kidneys is reduced, and ischemia occurs. At the same time, the compressed necrotic muscles release a large amount of toxic substances into the circulation, which will further aggravate the kidney poisoning. At this time, myoglobin is deposited and directly blocks the renal tubules, which leads to acute renal failure in patients."
Zhou Can analyzed the entire process of renal failure one by one, which greatly impressed Director Lou.
The other doctors and nurses looked at Zhou Can with admiration or respect.
"It's a pity that the patient was so young and his life was wasted. If there were any problems after the operation, there might be hope of saving him if he could be treated in time. But now he has entered the irreversible stage of acute renal failure and respiratory failure. There is no way to save him. He is in a terminal state."
Zhou Can did not explicitly say that it was the Third Hospital that delayed the patient's life.
However, from his analysis, one can clearly see the negligence and mistakes made by the Third Hospital during the treatment process.
This is a typical serious medical accident.
…
In the evening, after finishing the operation and ward rounds in the emergency department, and eating the delicious meal brought by Su Qianqian, Zhou Can hurried to the cardiothoracic surgery department.
There are still a lot of things waiting for him to deal with.
The old cadre has already agreed to the surgery, but it is unclear how he convinced his family.
Hospitals are like this. They can only let family members and patients adapt to the hospital's diagnosis and treatment model, but it is impossible to act according to the wishes of family members and patients.
The old cadre's medical expenses were basically 100% reimbursed, and his family was not short of money. His daughter-in-law wanted to use the safest and "best" surgical method to solve the problem by placing a vascular stent.
The doctor couldn't do what she wanted.
How many brackets are needed?
And the effect is not good.
Just use an artificial blood vessel to complete the bypass and all problems will be solved.
The cost is much lower, and it saves time and effort. You don’t have to worry about problems with this section of blood vessels later. The only problem with artificial blood vessels is aging and poor anastomosis, which can lead to leakage .
Let’s talk about the aging issue first.
The service life of artificial blood vessels is at least ten years, and the better ones are more than twenty years.
In fact, there won’t be any problems if you use it for thirty years.
Because it is sealed inside the human body.
Except for the corrosion caused by blood and body fluids, there is basically no problem of contact with the outside air, which can undoubtedly greatly extend its service life.
The old cadre is already sixty-five years old. Even if he lives to be a hundred, he only has thirty-five years left.
The replacement artificial blood vessels should be able to support us until then.
Even if something really goes wrong, you can always come to the hospital to get a new one.
Patients with arteriosclerosis and systemic diseases generally find it difficult to live to be a hundred years old.
Living to around eighty years old is often considered a long life.
Because the patient's abdominal arteries, even cardiovascular and cerebral arteries, etc., will continue to deteriorate. By then, a cerebral hemorrhage or myocardial infarction may kill the patient directly.
In the cardiothoracic surgery operating room, Zhou Can personally performed surgery on the veteran cadre.
The patient's family was waiting outside the operating room.
Zhou Can didn't know exactly how Director Xueyan talked to them. He only knew that the old cadre asked Zhou Can to help him with the surgery.
The more prestigious the patient's status, the more likely he or she is to seek treatment from a famous doctor.
After Zhou Can's examination during the operation, he finally selected an artificial blood vessel that was 38 cm long and about 8 mm in diameter, and performed a bypass graft from the patient's right common femoral artery to the popliteal artery.
Considering that the fourth toe of the right foot had already become necrotic and blackened, it could no longer be saved.
The amputation surgery was performed with the consent of the patient and his family before the operation.
This has reduced the damage to a minimum.
Other hospitals required him to perform life-saving surgery by amputating his right leg.
For Zhou Can, amputating only one toe was indeed the best outcome.
After the operation, the blood supply of the right foot was tested and the popliteal artery and dorsalis pedis artery had recovered. At a speed visible to the naked eye, it can be clearly seen that the skin surface of the patient's right foot gradually became slightly ruddy.
Compared with the paleness and coldness before, it now has a hint of blood color.
This indicates that the blood flow to the right foot has been restored.
With the nourishment and supply of qi and blood, the right foot should not suffer from necrosis again.
"After the operation, pay attention to giving him anti-infection treatment and closely monitor the condition of his right foot. If ischemia or necrosis occurs, it must be treated in time."
Zhou Can instructed the circulating nurse.
"clear."
The circulating nurse has great respect for Zhou Can.
The operating room of the cardiothoracic surgery department is basically Zhou Can's world. The nurses and doctors here all highly recognize Zhou Can's ability and trust him very much.
After this operation is completed, there are two more major operations waiting for Zhou Can.
One patient had undergone surgery at a provincial tertiary hospital outside the province, but the postoperative results were not satisfactory and needed to be re-operated. The other patient was undergoing surgery for mitral and tricuspid valve regurgitation.
These are major operations . Zhou Can sighed in his heart and was determined to fight until dawn.
Now, he increasingly felt that the power of one person was very limited. Even if he performed surgeries desperately, working from morning till night, how many people could he save?
This also made him pay more attention to the training of successors.
Whenever he had the chance, he would selflessly share his surgical experience and instruct newcomers, even other attending physicians. As for deputy director and director level, he did not dare to use the word "instruction", but rather "communication".
…
I was busy until about one in the morning and finally finished the work.
There were three operations in total, all of which were completed successfully. The last operation, for mitral and tricuspid valve insufficiency, was performed by Xueyan, assisted by Zhou Can.
It can also be considered as two people performing the surgery at the same time.
This is a brand new attempt.
That is, two people operate on the patient at the same time, each doing one part. As long as they cooperate properly, the operation time can be greatly shortened.
For major open-chest surgery, the shorter the duration, the better.
If two people had not performed the operation on the patient at the same time, they would probably not be able to get off work until three in the morning.
Around ten o'clock the next morning, Zhou Can was busy in the emergency operating room, and Dean Zhu called Dr. Xu.
Because no one answered the phone during Zhou Can's surgery.
"Xiao Zhou, after this operation, use your cell phone to call Dean Zhu back. Tell him that he has something to talk to you about."
Dr. Xu came in to inform him.
"OK."
Zhou Can had already guessed a little bit.
I guess there is definite news about the medical exchange with the Provincial People's Hospital.
In the operating room, the doctors and nurses heard that President Zhu called Zhou Can personally, and they couldn't help but feel envious and had a little more respect for Zhou Can.
This improvement in status is intangible.
Just like a certain person with connections, all colleagues in the department know that his uncle is the vice president, and everyone will consciously give him some respect.
After Zhou Can finished the operation in his hands, he handed over the suturing task to his two doctors. He went to the changing room to get his cell phone to call Dean Zhu back.
Dean Zhu called him twice but no one answered.
Call back immediately.
It works after two beeps.
"Director Zhu, I'm sorry for not answering your call in time. I was performing surgery just now and left my phone in the dressing room."
Zhou Can started explaining as soon as he came up.
The hospital's top leader called him but he didn't answer, which must have made him unhappy.
"I understand! You didn't bring your phone into the operating room so that you could concentrate on operating on the patient. This work attitude deserves praise. Xiao Zhou, the hospital has already passed the meeting regarding the medical exchange with the Provincial People's Hospital. Please contact the Provincial People's Hospital and see if they can send a leader to discuss this matter in detail."
I wish the dean didn't mean to be angry at all.
Instead, he praised Zhou Can.
"Okay, I'll finish the surgery at noon and go to the hospital to visit Director Lu. I'll ask them then."
Zhou Can mentioned Director Lu deliberately.
Whether those people can return to Tuya Hospital depends on the approval of Dean Zhu.
Director Xueyan did not mention this matter to him, which means there has been no progress.
The hospital leaders refused to agree and there was nothing anyone could do.
