My Medical Skills Give Me Experiences Chapter 148

"It hasn't started yet!"

Dr. Zou and Tang Li answered in unison.

The attending doctor's rounds are usually conducted after 7:40. However, it is not fixed and can be flexibly arranged according to the schedule of the attending physician.

In principle, a ward round is required every morning.

Because only the doctor on duty handles it at night.

On the one hand, there is not enough manpower, on the other hand, the doctors on duty are often low-level, lacking in experience and level.

This will lead to the situation that some patients' emergencies are not handled properly.

When the attending physician makes rounds in the morning, he can check for omissions and make up for vacancies, so as to avoid the expansion of risks.

"Well, then hurry up and do your ward rounds. The first operation will start on time at 8:30 in the morning. You may not take a break in the middle, and finish all the two operations today in one go. I will take three graduate students to do scientific research experiments at 4:00 pm , when the time comes, it will only be left to you to stare at.”

Many professors in various departments have teaching tasks.

Or just work part-time in a hospital.

In addition to bringing their own projects and doing scientific research, they also have to go to school to teach.

will be very busy.

The two attending physicians acted separately during ward rounds.

Zhou Can followed Tang Li, a resident doctor, and three graduate students to make rounds.

Dr. Zou took two senior residents to check the beds he was in charge of.

All the beds in Shenwai are under the responsibility of doctors. Many interns only need to stare at two to three beds. Gui Peisheng generally stares at about five beds. The resident doctors who specialize in managing the beds stare at ten to fifteen beds.

There will be more beds stared at by the attending doctor, and one person may need to be responsible for about 2,530 beds.

It must be explained that the beds these people stared at overlapped.

For example, Zhou Can stared at beds 21-25, and Jiang Xiaohua stared at beds 26-31.

Cheng Gang, their superior doctor, was in charge of beds 21-31.

Here you can find that the bed that the junior doctor is staring at, the superior doctor needs to stare at again.

It's just that as the level of doctors increases, the number of beds in charge also increases.

At the level of Director Dewen, it is often necessary to be responsible for all patients in the entire group.

At the director level, check the room once a week. Some patients who are discharged quickly may not be able to see the chief physician for ward rounds.

"Doctor Zhou, the number of patient beds in our group is not fixed. You may not be clear when you just came here."

Tang Li pointed Zhou Can as she walked forward.

It is said that women have a powerful sixth sense.

Maybe it is.

Tang Li must think that Zhou Can has a bright future, so she will lower her figure to befriend him.

"There are two attending physicians in our team, Dr. Zou and I. Usually, I check the ordinary beds in the group. Dr. Zou is older than me and has more experience. He checks the ICU ward."

The attending physicians in the group conduct ward rounds with a clear division of labor, which is conducive to assigning responsibilities to individuals.

And it can better serve patients according to the doctor's personal ability and level.

Dr. Zou is about five years older than Tang Li.

Definitely more experience.

The patients in the ICU ward are all critically ill.

It will be safer for an experienced doctor to check the ICU ward.

"Good morning, Doctor Tang!"

Cheng Gang had been waiting early in the ward under his jurisdiction.

Seeing Tang Li leading someone up to him, he immediately greeted her with a smile.

"morning!"

Tang Li seemed quite cold towards him, she just responded casually, and then began to check on the patient in charge.

Cheng Gang looked at Zhou Can who was following Tang Li, and couldn't help feeling complicated.

It can be seen that after Zhou Can was transferred to Director Wen's group, he received a very good salary.

This kid is really lucky, why don't I have such good luck?

Cheng Gang was really envious.

"Doctor Zhou, this patient is undergoing an operation this afternoon. Dr. Zou performed the operation. Her skull was fractured and sunken in quite deeply. Fortunately, the brain was not injured."

Tang Li took the initiative to introduce to Zhou Can the patients who will be operated on today.

The purpose is to let Zhou Can know what he knows in advance.

Zhou Can found that the injured woman was in her thirties, with multiple bruises and bruises on her face and hands.

How did you get hurt?

It feels like being beaten by domestic violence.

Her head wound had been bandaged with gauze. The nurse should come over two hours before the operation to shave her hair and clean the surgical site. And measure basic signs such as blood pressure.

"How did you get hurt?"

Zhou Can couldn't help asking.

"I just accidentally fell."

The woman's eyes dodged a little.

"This fall is considered a blessing in misfortune, because according to the results of the examination, if you go down a little bit, it may cause serious damage to the brain tissue. The lightest is paralysis and mental retardation. If it is more serious, it may directly kill you." gone."

Zhou Can didn't point it out, but just told her the possible consequences.

It is not possible to be so lucky every time.

There are only zero and countless times of domestic violence.

Generally speaking, it is impossible for parents and brothers to be so cruel.

Most likely it was the woman's husband.

However, during Zhou Can's internship, he was beaten up by that woman for taking care of such bad things. So, he didn't ask too much.

Just to the point.

The woman is in her thirties and is an adult. Only she can make her own choice.

After checking the woman with skull fracture, continue to check other patients in charge of this group.

After checking in a circle, the condition of some patients is shocking.

But I didn't see the car accident patient who needed surgery today.

It is estimated to live in the ICU to save his life.

Some of the injured are so serious that they cannot meet the surgical requirements for the time being and may need to stay in the ICU for a period of time. Save your life first, then do surgery.

In another case, the patient's injury was extremely serious and his condition was complicated.

To be on the safe side, doctors need to go through multi-department joint consultation. After discussion, a surgical plan will be formulated.

After checking the room, Tang Li issued some new medical orders. The medications of some patients were also adjusted.

After the treatment was completed, Zhou Can and others were brought into the operating room.

At this moment, the patient has been carried onto the operating table.

The anesthetist is carefully examining the patient.

Dr. Zou was watching with two residents.

"Your speed is so sluggish!"

Tang Li smiled.

"There are only a few patients in the ICU. After the investigation, the three of us directly brought the patients to the operating room."

Doctor Zou shrugged.

There are only 20 beds in the ICU, and there should not be many critically ill patients assigned to their group.

In addition, the ICU has always had a dedicated attending physician on duty, so ward rounds are relatively a process.

Zhou Can looked at the patient on the operating table, and saw that there were tubes inserted all over his body, and dried blood could still be seen.

The most severely injured area should be the head.

The patient is currently in a coma.

At this time, Director Wen finally arrived.

"Is the patient okay? It is estimated that this craniotomy will take at least four to eight hours. Can he bear it?"

Director Wen's words were obviously asking the anesthesiologist.

"The situation is relatively ideal. His surgical tolerance is relatively low. However, if the intracranial hematoma is not removed, his life may not be saved. Therefore, I personally think it is very meaningful to perform surgery as soon as possible."

The patient is in a coma and has not recovered until now.

That alone is enough to illustrate the seriousness of the problem.

ICU can only give some basic life support, but it does not mean that it can always save life.

In the ICU ward of Tuya Hospital, patients often die.

And most of the time, it is quite normal for three or four people to die a day.

Of course, some deaths were due to family members insisting on extubation.

After all, the cost of ICU for one day is too high.

If it is an elderly person, or a patient with little hope, who spends too much money on rescue, the family members may feel that it is not worth the loss of money and life. So the hospital will be asked to extubate.

"Get ready for the craniotomy to remove the hematoma!"

Director Wen spoke.

The examination report of the car accident patient indicated that the person had a severe intracranial hematoma. It shows that the intracranial hemorrhage is quite serious.

Craniotomy to stop bleeding and remove hematoma is a very active treatment.

The patient is very young, only in his twenties.

It is said that he was racing with others in the middle of the night and had a tragic car accident, which is why he was seriously injured.

Zhou Can has seen the patient's film, and the situation is not optimistic.

Because this person is bleeding under the curtain.

Generally speaking, surgery is required for supratentorial hemorrhage of more than 30ml. As long as the subtentorial hemorrhage exceeds 10ml, it meets the surgical index.

After the patient was under general anesthesia, Director Wen selected the location for the craniotomy, cut open the patient's scalp to expose the skull, and then went directly to the chainsaw.

Not long after the craniotomy started, the anesthesiologist hurriedly stopped.

"Director Wen, the patient's vital signs are declining rapidly. If he persists in the craniotomy, I'm afraid he won't be able to get off the operating table."

The patient's blood pressure, respiration, body temperature, heart rate, and blood oxygen index are all dropping rapidly.

This is a very dire omen.

During craniotomy, the patient's condition may be further aggravated due to various reasons.

The patient at this time is like a candle in the wind.

The wind that blows is slightly stronger, and the fire of life is extinguished.

Director Wen's face sank like water.

The critically ill patients in the neurosurgery room are really difficult to save, not only some, but also quite a lot of mistakes.

Doctors do their best to reduce the mortality rate as much as possible.

Because it is related to multiple assessments, as well as personal reputation.

Just imagine, a certain chief doctor performed a hundred operations, and seven or eight people died. Who dares to let this doctor use a knife?

Although the hospital knew that the patients who died were extremely critically ill.

But during the assessment, such a high death rate will still be criticized by the vice president and even the president in person at the meeting. It is possible to give a warning, or reduce the surgical authority.

Excessive rescue mortality not only has a serious impact on the doctor himself and his team, but also has an impact on the comprehensive evaluation of the hospital.

"It seems that the patient's condition is more serious than I thought! This matter is a bit difficult!"

Director Wen stared at the rapidly declining vital signs on the screen of the life monitor, feeling appalled.

Even if the operation is stopped now and the patient is transferred back to the ICU, it will be difficult to survive.

"The intracranial hematoma must be removed, otherwise he will not be able to survive. Traditional surgery does a lot of harm to the patient. Before the operation, I had prepared for the worst and prepared a second surgical plan."

Director Wen actually made two-handed preparations.

No wonder he is calm in the face of danger, when the patient is in danger, he can still be so calm.

"Drill the hole and do endoscopic surgery! This should be the only way to save him!"

Endoscopic surgery only needs to drill a small hole in the skull, the wound is small, and the damage to the patient is also small.

It's just that compared with traditional surgery, endoscopic surgery is extremely difficult to operate.

Tuya's neurosurgery department is actually very short of talents in this area.

Director Wen's talent for advanced surgery is average, which is also the main reason why he gave priority to traditional craniotomy.

Traditional surgery pursues a large surgical field of view.

The whole operation process is simple and direct.

Endoscopic surgery is a test of a doctor's manipulation skills.

"Endoscopic surgery...is not our strong point. The patient has subcurtain hemorrhage, and the operation is extremely difficult. Will it..." Tang Li hesitated to speak.

Not to mention her, even Dr. Zou looked worried, with a sad expression between his brows.

"There's nothing I can do if I'm not good at it! If it's impossible, I can only ask Director Zhang of the Department of Obstetrics and Gynecology for help. Among the chief physicians in our hospital, she is the only one who is good at minimally invasive surgery."

Director Wen has already figured out his way out.

It is a routine practice for each department to seek help from other departments when they encounter critical or difficult cases.

This time, the patient's skull was directly drilled, the bone flap was broken, and a 1cm incision was drilled. A cross incision is then made in the dura.

During the whole process, Director Wen was careful.

Even if the patient's vital signs dropped again and again, he still dared not stop.

At this time, we must race against time to save the patient's life.

Fortunately, he has rich experience in surgery, and according to the CT images, the location of the hematoma is fairly accurate.

The next step is to carry out the most critical operation.

A 68mm diameter rigid endoscope needs to be guided into the center of the intracerebral hematoma.

This is a test of the operating technique of the chief surgeon.

Because the brain is full of important tissues, a slight mistake may cause serious consequences.

Director Wen carefully manipulated the endoscope to explore inside.

It was just getting into the hematoma center that he had difficulty with.

Nearby is the brain stem area, which brought him great psychological pressure.

Sweat continued to ooze from his forehead, and the nurse helped to wipe the sweat.

Director Wen's hands trembled uncontrollably.

At this critical moment of racing against time, every second of delay will increase the patient's risk of death a lot.

The more this happened, the greater the pressure on Director Wen.

Not to mention him as the chief surgeon, even Dr. Tang Li and Dr. Zou next to him, including several residents, are all worried. He held his breath, not even daring to let out the air.

"Director Wen, can you let me try? I should be more than 80% sure."

At this time, Zhou Can did not choose to sit and watch.

Actively challenge.

Although such behavior may appear a little arrogant and rude to outsiders.

"Are you sure you're 80% sure?"

Director Wen stopped operating and turned to look at him.

"Sure!"

Zhou Can's eyes are firm, full of confidence, and appear extremely calm.

"That's fine, try it!"

Director Wen also knew that Zhou Can was quite skilled in minimally invasive operations. In this last resort, I decided to take the risk and let him try.

He himself stood nervously watching, ready to stop at any time.

Zhou Can took the joystick of the endoscope, adjusted the angle slightly, and then manipulated the endoscope to penetrate deeper.

The whole operation process is very stable.

And very precise.

The long-term practice of implantation has given him a lot of help.

"Okay! We have successfully reached the hematoma area. Do you want to draw out the accumulated blood now?"

Zhou Can asked.

As soon as he finished speaking, the doctors and nurses in the operating room all heaved a sigh of relief. Joyful smiles appeared on everyone's faces.

The most difficult hurdle was finally passed.

"Draw it!"

Director Wen should be the most excited person.

Looking at Zhou Can, it was like looking at a treasure.

Zhou Can manipulated the catheter of the endoscope to perform suction. The accumulated blood in the cranial cavity was drawn out.

After the intracranial pressure was relieved, the patient's vital signs improved rapidly.

"Up, up! The patient's vital signs are all up. Great!"

The anesthetist is more than happy.

The good news was announced in time.

Chapter end