Chapter 542 Tragic amputation, the consequences of inadequate preoperative examination
"Even the chief surgeon can't be faster than our boss!"
Yang Zhi said with a smile beside him.
Because the team leader must at least be an associate chief physician and have the title of professor. Zhou Can has the power of a team leader, but he is not called a team leader.
Now everyone is used to calling him boss.
This name was first coined by Luo Shishen.
At that time, intern Luo Shishen followed Zhou Can and wanted to be his apprentice. Unfortunately, Zhou Can thought that his talent was too ordinary and did not agree.
So, Luo Shishen began to call Zhou Can "Boss".
That kid is currently undergoing regular training. When the training is over, he will most likely come and beg to join Zhou Can's team.
I heard that he is doing well and has been appreciated by two chief physicians, and has been included in the key training sequence.
Even though he was forced to leave Zhou Can's team because of his regular training, he still often consulted Zhou Can on medical issues through WeChat. Zhou Can treated him well, and this guy also knew how to be grateful.
He would call Zhou Can to wish him a happy New Year and other festivals, and would often speak well of Zhou Can in front of outsiders.
"It seems that it was a very wise decision for me to quit my job and seek help from Dr. Zhou! Now I just hope that Dr. Zhou will let me stay. Please help put in a good word for me. I will treat you after get off work."
She was very confident when she talked about treating us.
With an annual salary of at least $300,000, treating one or two meals is really nothing.
"You are so outstanding, Dr. Zhou must have already approved of you in his heart!" Qiao Yu spoke up for her with a smile.
"Sister Qiao Yu is right. I saw satisfaction in the boss's eyes!"
Ma Xiaolan also has a good impression of Jiang Wei.
I don't know what kind of magic potion Jiang Wei gave them yesterday, making them so willing to help Jiang Wei speak.
Especially Ma Xiaolan, she was like the evil mother-in-law of the old times, who always liked to show her power to newcomers, whether doctors or nurses. This time, it was like she had changed her nature.
"Hurry up and do the surgery! Jiang Wei is indeed very good, but we have to see how she performs next." Zhou Can did not give in easily. He is the boss, so he has to be careful when speaking.
"Jiang Wei, there are three level 3 surgeries today. I saw that you performed well just now, so I believe you should be able to perform level 3 surgeries. Perform well then. I don't have the final say on matters in the operating room. I have to satisfy Doctor Xu before I can approve them."
No matter how talented Zhou Can is, he is still a junior after all.
All level 2 and 3 surgeries must be registered under the name of Dr. Xu, and he himself does not have the authority to independently perform level 2 and 3 surgeries.
According to the surgical hierarchy, a doctor must be at least an attending physician to be eligible to conduct a second-level surgery and begin to participate in a third-level surgery. Senior attending physicians can complete a third-level surgery under the guidance of a chief or deputy chief physician.
…
Around eleven o'clock in the morning, a male patient in his forties was pushed into the operating room.
The patient's right lower limb was diagnosed with varicose veins six years ago, and there was a certain degree of swelling. However, due to his busy work and low income, the family's financial burden was almost entirely supported by him working part-time.
I was afraid of spending money, so I never had the surgery.
It was not until recently that the pain became unbearable and he had difficulty walking, so he went to the hospital for treatment.
The local city center hospital performed high ligation and stripping of the great saphenous vein on the patient.
This surgery is also the most commonly used method to treat superficial varicose veins in the lower limbs and clear the deep veins. The vast majority of varicose veins in the lower limbs occur in the superficial veins, and very few patients also have varicose veins in the deep veins.
After examination, as long as the surgical requirements are met, high ligation and stripping of the great saphenous vein can be performed.
The treatment effect is often good and can significantly improve swelling and pain in the lower limbs.
After the patient underwent surgery at the local city center hospital, the doctor used an elastic bandage to apply pressure from the dorsum of his foot up to the groin.
This is also a common method used after surgery.
After all, superficial venous stripping has been performed, so pressure is necessary.
As a result, the patient soon discovered that the toes of the affected limb were significantly swollen and the pain was severe.
The family members quickly rang the bell and called the nurse to check.
After checking the patient, the nurse did not dare to handle the case on her own, so she asked the attending doctor to come over.
After examination, the attending physician believed that the patient's condition was most likely caused by the elastic bandage being too tight.
When applying the pressure bandage, Zhou Can still remember Director Liu saying that the higher you go, the greater the pressure should be.
The attending physician immediately loosened the elastic bandage for the patient and elevated the affected limb.
Because the blood circulation of the lower limbs is the farthest from the heart, it is also the most difficult to transport blood to the lower limbs. In cases like this where the lower limbs are severely swollen, considering that the blood circulation is blocked, raising the lower limbs is beneficial for the blood to return to the heart.
This reduces swelling and can also quickly relieve foot pain.
After the bandage was removed, the patient still complained of severe pain in the affected limb, so the attending physician prescribed analgesics for the patient to relieve the pain.
And inform the patient to observe for 48 hours before formulating the next treatment plan.
This is all normal processing procedure.
At least the diagnosis and treatment methods are compliant.
Who would have thought that after more than 30 hours of observation, the patient's right leg skin turned dark purple, the dorsalis pedis artery pulse disappeared, and the skin temperature was extremely low. To put it bluntly, it was just like a body cooling down rapidly after a person dies.
And the patient's right leg has become more swollen.
At this point, the family members were both sad and angry, and shouted that they wanted to kill the doctor in charge of the treatment.
The attending doctor was so scared that he didn't dare to show up.
The hospital leaders had to persuade the family to take the patient to a large hospital in the provincial capital for emergency treatment. Saving his life was the top priority.
The family members are also worried that if time goes on , even their lives may be lost.
At this time, he could only hold back his grief and the ambulance from the city center hospital took the person to a top-level hospital in the provincial capital.
In fact, the City Central Hospital is also a Class-A tertiary hospital.
However, in terms of strength, there is definitely a big gap between it and provincial tertiary hospitals such as Tuya and Provincial People's Hospital.
The family member's son heard that Tuya Hospital was of high quality and strongly requested that the patient be taken to Tuya Hospital for treatment. The doctors and nurses who followed the car were afraid of being beaten, so they naturally did as they were told.
After the person was pulled over, I heard that the doctor and nurse who were following the car ran away on the spot.
We all work for the hospital. Looking at the dozen or so family members, each of them filled with righteous indignation and looking ferocious, who wouldn't be afraid?
I would rather go back and be scolded by my boss than be beaten and have my bones broken by my family members.
So after abandoning the patient, they ran away quickly.
After Tuya received the patient, she examined him and found that he was in shock and had wet gangrene of his lower limbs.
The family was told on the spot that amputation surgery must be performed immediately to save the patient's life.
The family members were extremely sad when they heard that the child was going to have his leg amputated. He was only in his forties and was the mainstay of the family. How was he going to live after his right leg was amputated?
They wanted to settle accounts with the doctors and nurses at the City Center Hospital, but after searching they discovered that the doctors and nurses who came with the car had long disappeared.
Fortunately, the doctors and nurses who followed the car ran away quickly, otherwise they would have become the scapegoats of these angry family members.
When a medical dispute occurs, especially when the patient dies or suffers serious injuries, the family members are in extreme danger and are prone to make some extreme and crazy moves.
Some doctors were beaten to disability, almost always in such circumstances.
There is another situation that is also very scary, which is revenge after the fact.
If a medical dispute occurs in person, doctors and nurses can at least take precautions. Some family members and patients keep silent in front of the doctor, but later bring weapons, usually knives, to the hospital to find the doctor in question and stab him crazily.
In this situation, doctors and nurses can easily be seriously injured or even die because they are completely unprepared.
Why do doctors and nurses get nervous when they see family members holding long packages?
Because no one knows whether the family will pull out a sharp knife after opening the package.
After the family members of this patient looked for medical staff of the Central Hospital in vain, they could only tearfully sign and consent to the amputation. Saving his life is the most important thing.
In the end, the amputation surgery fell on Zhou Can.
For patients like this who have disputes, the second hospital will often be particularly cautious after seeing them.
Now letting Zhou Can perform the amputation surgery on this patient is also a sign of trust in Zhou Can and confidence in his surgical ability.
Dr. Xu was personally on the scene.
It can be seen that with Dr. Xu present, Jiang Wei seemed a little nervous.
This shows that Dr. Xu has a very strong aura.
At least when she was in front of Zhou Can , Zhou Can's aura couldn't suppress her.
The entire amputation process was simple, rough and bloody.
Jiang Wei's performance is as excellent as ever.
"Xiao Zhou, do you know what caused the patient's amputation?"
Doctor Xu asked calmly.
"Jiang Wei, tell me what you think first." Zhou Can did not answer Dr. Xu, but asked Jiang Wei instead.
He wanted to see how strong this female nurse was.
His current feeling was that this nurse was unfathomable, and the strength she had shown was probably just the tip of the iceberg.
"Judging from his postoperative condition, it is likely caused by venous thrombosis."
She answered simply.
He didn't even think about it, which means he had already reached the diagnosis in his mind.
"Qiao Yu, what's your opinion?"
"I... am not sure." Qiao Yu blushed.
In terms of pathological diagnosis, her experience and level need to be improved. She is far from being comparable to super talents like Jiang Wei.
"Jiang Wei, do you think the patient's blood clot was caused before or after the operation?"
Zhou Can asked again.
"I'm really not sure about this. I think it was caused by the surgery!"
Jiang Wei could roughly understand the cause of the disease, but she couldn't make a more detailed diagnosis because this was due to the different training directions of nurses.
It would be amazing if nurses could diagnose the specific cause of the disease like doctors.
For example, Zhou Can has already reached a high level in the fields of pathological diagnosis and surgery, but has only a superficial understanding of nursing. He is far from being able to compare with Qiao Yu and Jiang Wei.
"Teacher, I think the patient's preoperative examination was not thorough and no blood clots were found, which led to the current situation where amputation is required."
Zhou Can looked at Dr. Xu.
Just now, he finally figured out some of Jiang Wei's background.
"It is indeed possible. Even if the preoperative examination is not thorough and something goes wrong after the operation, there is still a chance for rescue. However, the attending doctor was careless and thought that it was caused by the elastic bandage being tied too tightly, which led to the tragedy. When you practice medicine, you must be very careful and take the patient's life to heart."
Doctor Xu warned everyone with a serious face.
After the patient's limb was amputated, blood clots were found in both the iliac vein and the femoral vein during the operation.
At this point, the truth is revealed.
This is a typical medical accident that deserves our deep thought and vigilance .
After the amputation, the patient received a series of anti-shock and anti-infection treatments. When Zhou Can finished the operation at noon and went to check on the patient, the patient had already woken up.
I'm just not in a good mental state.
His face was extremely paler.
This big brother probably doesn't know that he has already been to the gates of hell.
Although his right leg is gone, his life is saved.
At noon, when several people were eating in the cafeteria, Yang Zhi couldn't help asking, "Boss, if I encounter a patient like that who had his right limb amputated in the future, how can I avoid accidents?"
Among his two doctors, Yang Zhi is more cheerful, while Pu Dingdong is more honest and dull.
He rarely asks questions, but takes notes silently.
Only when I encounter something that I really cannot understand even after looking up information will I ask Zhou Can for help.
There is another phenomenon that is particularly interesting.
Every time he asked Zhou Can for advice, he would lower his head like a shy elementary school student.
"When encountering such patients, color Doppler ultrasound, deep vein patency test, and deep venography can reveal problems before surgery. The surgeon at the City Central Hospital did not perform adequate preoperative examinations and failed to find deep vein thrombosis, but stripped the great saphenous vein, which caused venous reflux obstruction in the lower limbs. Problems had already occurred after the operation, but the attending doctor mistakenly believed that the patient's swollen toes and severe pain were caused by the tight bandage, thus missing another opportunity to remedy the situation, which eventually led to lower limb gangrene and the only way to save his life was to amputate."
Zhou Can analyzed the pathological mechanism to his two doctors.
Since his pathological diagnosis level was upgraded to level 6, his various pathological analyses have completely reached the director's level. Yang Zhi and Pu Dingdong could only nod in admiration.
Of course, Qiao Yu and Ma Xiaolan can also learn a lot of knowledge sometimes.
There is one more person today, that is Jiang Wei.
Although Dr. Xu had not yet given the final nod to let her stay, Zhou Can had already passed the test. Director Lou had already passed the test. The probability of her staying was almost 100%.
While she quickly finished her food, she listened carefully to Zhou Can's pathological analysis.
It can be seen that her face also showed an expression of admiration.
Zhou Can is so young and just a resident doctor, but he can achieve such a high level. It is really amazing.
"Boss, if it is found after surgery that it is caused by deep vein thrombosis, how can we remedy it?"
Pu Dingdong asked the question somewhat shyly.
He would only ask questions on the spot when he was extremely interested in them and was eager to know the answers.
"It's actually quite simple. Just like treating other deep vein thrombosis in the lower extremities, we first do a bypass surgery on the descending blood vessels to ensure blood flow to the lower extremities is restored. Then we can find a way to do a venous thrombectomy. Interventional angiography is the first choice for thrombectomy. On the one hand, interventional thrombectomy is minimally invasive and causes little harm to the patient. On the other hand, it can also ensure that the thrombus is completely removed. For this type of venous thrombosis, interventional thrombectomy is a very good first choice."
Zhou Can looked at Pu Dingdong with appreciation, and then patiently gave a solution.
The oldest method of thrombectomy is to cut open the blood vessels, which is a huge project, difficult and extremely traumatic. Now, with the continuous advancement of technology, interventional thrombectomy has gradually become the mainstream.
