Chapter 564: Calming down the situation, a false alarm
Zhou Can examined the patient carefully, hoping to find a way to save him.
To be honest, if there is a problem with the lungs, even using an extracorporeal membrane oxygenator may not necessarily save the patient. ECMO is by no means a panacea. Its use is only to temporarily replace the work of the heart and lungs to help the patient complete breathing and circulation.
It cannot replace the work of the heart and lungs for long periods of time.
Not to mention extracorporeal lung membranes, even if it is just a simple ventilator, it cannot be used for too long. Otherwise, the patient's body will easily become dependent on it and the probability of infection will increase significantly.
For patients who undergo complete lung removal on one side, their lung function is suddenly reduced by 50% after the operation, and their respiratory and circulatory systems will be under tremendous pressure. This is equivalent to two people lifting a 200-pound weight together, and suddenly one of them slips away. The remaining person will be exhausted to death.
Therefore, the mortality rate and complications of unilateral total lung resection surgery are very high.
Removing part of a lung lobe is relatively less risky.
In addition, the quality of life of patients who have undergone complete lung removal on one side will also be greatly affected. They used to be able to climb to the third floor easily, but now they may be out of breath and exhausted after climbing half a floor.
If the patient is younger, they may not even be able to lead a normal married life.
When formulating the surgical plan for this patient, Zhou Can considered it carefully and decided to remove the patient's left lung to save his life as there was really no other way.
The patient had surgery two days ago and today is the third day.
Currently, the face and lips are cyanotic, including the nails, which are an abnormal cyanotic color. This is an obvious manifestation of hypoxia.
The patient had difficulty breathing, had a lot of pink foamy sputum, and his heart rate was significantly higher than normal, reaching 150 beats per minute.
The blood oxygen saturation level has dropped to the bottom and has long fallen below the minimum warning line.
When the blood oxygen saturation is lower than 95%, obvious discomfort symptoms will generally occur, which will alert doctors. The patient's blood oxygen saturation has fallen below 80% at this moment, and this is the result after various rescue measures.
Zhou Can's face was as gloomy as water, and several chief doctors in the ICU looked at him with serious expressions. They were really at a loss, so they could only pin their hopes on him to see if he could come up with a way to save the patient.
"Sister Yan, can I borrow your stethoscope?"
Zhou Can said to Director Xueyan.
Percussion hammer and stethoscope should be the most commonly used equipment for cardiothoracic surgeons, because these two things may be needed at any time.
However, this is a sterile management area and items from outside cannot be brought in easily.
Director Xueyan’s stethoscope should have been provided in the intensive care unit.
Although the patient looked like he might die at any time with every breath he took, Zhou Can was as steady as a rock. He held the stethoscope and pressed it against the patient's lungs to listen to the sound.
"The patient is full of moist rales and bubbling sounds. Combined with the various symptoms and signs the patient has now, it must be pulmonary edema. He is still well on the first day after surgery, which means that the patient's lung condition worsened yesterday, or even this morning. Show me the infusion and medication list."
Zhou Can's pharmacological differentiation has now reached level six, and he is now able to approach the problem from multiple aspects when diagnosing and treating such critically ill patients.
Including pharmacology, pathology, disease symptoms and so on.
In the past, he seemed powerless and had difficulty getting involved in matters related to medical instructions and medication, especially for patients with complicated medications.
There seems to be only half a level difference between associate chief physician and chief physician, but the levels are worlds apart.
Especially in the two core items of pharmacology and pathology, the differences are even more obvious.
Before Zhou Can's pharmacological differentiation skills were advanced, he was even worse than nurse Jiang Wei in many areas of medication.
Director Xueyan's theoretical level has always been outstanding, and her pharmacological differentiation has long been at the level of Level 6. Even now, Zhou Can is slightly inferior to her.
At most, it can be said that Zhou Can is now qualified to "discuss the truth" with her.
It's like everyone is at this level, she's just a little stronger.
Although Xueyan, Deputy Director He and others had already checked the patient's infusion and medication, Zhou Can still wanted to check it again. Even if no problems were found, he could have a clearer understanding of the patient's treatment and medication.
Zhou Can can be given good feedback on which medicines were used, how much, and the effects after use.
After checking it out, his frown relaxed a lot.
"The main rescue measures currently being implemented for patients are oxygen inhalation through masks and intramuscular injection of sedatives."
Maybe people are afraid to use medicine rashly when there is a disagreement on the diagnosis.
"Zhou Can, judging from your expression, you have found the cause of the patient's pulmonary edema, right?"
Director Xueyan has worked with him for a long time and has a deeper understanding of some of his behavioral habits.
Seeing Zhou Can’s frown relax, she felt a lot more relieved.
This is a trust built through long-term cooperation.
Zhou Can would only show this expression when he felt he had a high degree of confidence in the rescue work.
“I guess so!”
Zhou Can nodded.
"In fact, after our discussion just now, we also thought that the patient was likely to have pulmonary edema, but seeing the pink sputum and the unknown pathological mechanism, we did not dare to act rashly. The rescue measures were also conservative."
Deputy Director He's words were somewhat meant to save face.
After all, in the field of thoracic surgery , he is considered a veteran in the department.
For a long time after Director Hu Kan's death, he regarded himself as the leader in the field of thoracic surgery.
It is undeniable that Deputy Director He is indeed capable and has extremely rich experience.
Pink sputum indicates hemorrhagic exudate or bleeding in the lungs.
Except for Director Xueyan, no one else really knew how the operation was performed. However, everyone was quite confident in Zhou Can's surgical skills.
"I performed the surgery, and I am indeed more familiar with the patient's condition. It is very steady that you and several directors called me over to handle it."
Zhou Can praised the other party and then continued.
"I just checked the medications for the past three days and there is nothing wrong with them. The patient suddenly developed pulmonary edema, which should be related to the complete removal of his left lung. To put it bluntly, this postoperative complication cannot be avoided. After one side of the lung is completely removed, the hydrostatic pressure in the blood vessels will increase due to the reduction in pulmonary blood vessels, and the permeability of the capillaries will also increase. A large amount of water will infiltrate from the pulmonary capillaries into the alveoli, eventually causing acute pulmonary edema."
Zhou Can told his pathological analysis to the doctors and nurses present.
When we are rescuing various critically ill patients, it is also a process of mutual learning and improvement.
Everyone has different medical knowledge, clinical experience, clinical application of knowledge, and ideas. Listening to other people's opinions can help you learn from their strengths and make up for your weaknesses. The next time you encounter a similar case, it can serve as a good reference.
Even better doctors can directly give different diagnosis and treatment opinions during this operation and work together.
Avoid missed diagnosis and misdiagnosis.
Sometimes, when a patient in a department got into trouble, more than a dozen doctors and nurses would surround them. The family members didn’t understand and thought they were there to start a fight.
Actually, it’s not.
In the hospital, if doctors feel there is danger, more than a dozen doctors will definitely not confront the family members together.
Unless the family members are already committing violence and beating people, the doctors will stand shoulder to shoulder to stop the family members from continuing to commit violence in order to protect the female doctors and nurses.
When rescuing critically ill patients, a large group of doctors and nurses are sent to rescue the patients, which shows their respect for the patients' lives.
On the other hand, we also want to gather the wisdom and strength of the group to save lives together.
This can also ensure a higher rescue success rate.
"So how are you going to solve it now?"
Director Xueyan couldn't help feeling a slight fever on her face when she thought about how she almost saved the patient's life with the extracorporeal lung membrane.
Haste leads to chaos.
Chaos means confusion.
Not long ago, she saw a patient's condition suddenly worsen and he looked like he might die soon, and she was really scared.
The other chief physicians were equally anxious.
If an oxygen mask doesn't work for an ordinary patient, a ventilator can be considered. This patient's situation is very special, and everyone agreed that an external lung membrane was the safest.
At least that was the case at the time.
Even now, if Zhou Can had not calmly analyzed the patient's condition to everyone and told them that there was no abnormal bleeding in the patient's lungs and heart, and that it was just acute pulmonary edema, they would probably still be as nervous and anxious as before.
All the doctors present have rich experience in rescue.
They are well aware of how fragile the patient's life is.
Sometimes, something may be fine one second and gone the next.
"I think the patient's heart rate is still a little too fast, so I gave him 10 mg of morphine intramuscularly for sedation, and then used cardiotonic and diuretic drugs to control acute pulmonary edema. Also, the infusion of crystalloid fluid must be reduced, which is also related to the patient's sudden acute pulmonary edema."
When Zhou Can said this, he looked at the head nurse.
Medical orders are written by doctors, and nurses have the responsibility and obligation to review the medicines when they are used.
If the patient had been more attentive during the nursing process and if any signs of trouble had been discovered and reported to the attending physician promptly, he would not have developed acute pulmonary effusion.
Of course, we can’t blame the nurse.
It was impossible for Zhou Can to say such words directly.
"Okay, I will pay extra attention to this patient in the following care."
She is not stupid since she can become the head nurse.
I immediately understood what Zhou Can meant.
"I'm sorry to bother you, Teacher Chang! When this patient's condition gets better, I'll treat the sisters at the nurses' station to some milk tea."
Zhou Can was very satisfied with the head nurse's statement.
What is needed is a correct attitude.
There are only two head nurses in the ICU , and once one of them gives the order, there's security.
"Director He, there is one more thing we need to pay attention to. You need to be extra vigilant when this patient turns over. After a complete lung removal on one side, it is very easy for the mediastinum to gradually shift to the side. This patient is especially prone to this because of his severe pulmonary edema."
Zhou Can then reported to the chief physician of the intensive care unit.
Director He was promoted to the position after two chief physicians of the ICU changed jobs. He is now the chief physician of the cardiothoracic surgery ICU.
He is quite conscientious and responsible in his work, but his level is not as good as the two directors who were poached.
Now the two chief physicians who had jumped ship have returned, but the position of chief manager of the intensive care unit no longer belongs to them.
As an adult, you will definitely have to pay the price for doing something wrong.
After complete lung removal on one side, the lateral lying position is very important.
It can be understood in this way: originally the two lungs just fill up the lung space in the chest cavity. After the other lung is removed, a space will be left.
At this time, the lung on the other side is squeezed inward, causing the mediastinum to shift.
Don't take it lightly.
When the lateral displacement of the mediastinum is more serious, it will cause the surrounding structures to compress the healthy bronchus.
If the patient is young, in his twenties or thirties, the bronchial wall is soft and will become narrow and deformed after being compressed, which will cause breathing difficulties due to airway obstruction.
Experienced doctors often call this phenomenon post-pneumonectomy syndrome.
There is also a particularly interesting phenomenon that this syndrome often occurs after right-sided complete lung resection.
If this situation really happens, it is equivalent to curing one disease for the patient and creating a new disease.
At this time, because the patient has difficulty breathing, the ideal solution is to place a stent in the squeezed and deformed bronchus.
Although this patient is old, the bronchial wall is much harder than that of young people. At the same time, the left lung was removed, not the right one. However, there is still a chance of postoperative syndrome.
Especially in the case of acute pulmonary edema, the volume and weight of the remaining right lung will increase sharply. If clinical care is not paid attention to at this time, the patient will develop a second disease again.
According to the treatment method given by Zhou Can, after a series of medication and rescue efforts, the patient's condition gradually improved.
Everyone breathed a sigh of relief.
At this time, the atmosphere in the intensive care unit had obviously become much more relaxed.
No matter whether they are doctors or nurses, it is a relief and happiness to not have such life-threatening patients. Especially when they are on duty at night, nurses are afraid of too many patients coming to see the doctor, and they are also afraid of problems with the patients they have already admitted.
Being a medical professional is actually quite difficult.
It is hard, dangerous and most importantly, mentally exhausting.
"It seems that it was the right decision to invite Dr. Zhou for a consultation. He performed the surgery on the patient and he knows the patient's condition best. I was worried that the patient had a pulmonary embolism just now!"
Director He smiled easily.
"Old He, let alone you, even I tend to think it's a pulmonary embolism. If the family members hadn't disagreed, I would definitely have agreed to use ECMO on the patient. Fortunately, it was just a false alarm."
After hearing this, the others also smiled.
Everyone feels a sense of accomplishment and is very happy to see a critically ill and dying patient being brought back to life.
"Zhou Can, are the two major surgeries still going to be performed tonight?"
Director Xueyan is more concerned about this matter.
The crisis has been resolved, and there is new work waiting for her.
If a department wants to remain strong, it must tackle tough problems every day.
So far, Zhou Can is still the sharpest scalpel in cardiothoracic surgery, no doubt about it.
In terms of surgical skills, Zhou Can is indeed worthy of the title.
He can use both steady and fast swords.
He can also combine the two with ease.
Whether it's maintaining union, stopping bleeding, ligation, dissection... he can do almost everything.
It is almost impossible to find a doctor with such a comprehensive range of surgical skills.
In the past, Director Hu Kan was much better than Zhou Can in terms of steadying the knife. However, in other areas, he was basically at the level of a director, and even some of his surgical skills were still only at the level of a deputy director until his death.
"Yes, of course! I will be there on time after get off work."
Zhou Can looked very motivated.
This made everyone smile again.
Now is the critical moment of secretly competing with the Third Hospital, and Zhou Can is trying his best to put pressure on them. The more difficult surgeries he performs, the better his reputation becomes, and the greater the pressure on the Third Hospital.
