My Medical Skills Give Me Experiences Chapter 175

Pathological diagnosis experience value 1.

After Zhou Can gained 1 diagnosis experience point, he was more sure that his judgment was correct.

Then you must tell the two superior doctors in time.

Congratulations, your pathological diagnosis has been upgraded to level 4, the current experience value is 110,000, and the level of attending is lower. Various complex diseases can be diagnosed, there is a certain probability of identifying hidden diseases, and there is a small probability of identifying comorbidities.

Zhou Can did not expect that at this moment, the pathological diagnosis would be upgraded.

Originally, his pathological diagnosis was only at the middle level of a resident doctor. It was only because of eight months of hard work in the emergency department, orthopedic surgery, and neurosurgery that it was raised from the low level of resident medicine to the middle level.

He was able to advance to Level 4 this time, thanks to the successful diagnosis of three super-difficult cases in the Department of Intensive Care Medicine, plus several normal-difficulty cases. These include recessive cases.

Complications are the same symptoms, and there may be multiple lesions at the same time.

Multiple diseases are the most difficult to diagnose.

Even senior resident doctors can easily miss the diagnosis when encountering such cases.

"Pathological diagnosis has finally been upgraded to the level of attending. Counting the time, the one-year training period will be over, and you can apply for the licensed doctor certificate."

According to the requirements, one year of work experience after graduation is required for the examination of medical license.

Zhou Can has been trained for eleven months, and he is estimated to be able to pass the medical examination during the period of cardiothoracic surgery.

At this time, the pathological diagnosis has been upgraded to level four, which will be of great help to him in his examination of the medical license.

Then practice skills test, he is even more easy.

Three months of regular training in the intensive care unit, coupled with surgical experience in multiple departments, is enough for him to easily pass the medical license examination.

Examing this certificate is simply a natural barrier for many regular trainees.

Many people fail the exam, and in the end they are forced to change careers or take up administrative positions.

It is exactly that sentence, those who are difficult will not, and those who will meet will not be difficult.

Zhou Can suppressed the joy of being promoted to the fourth level of pathological diagnosis, and looked at Dr. Zhao.

"etc!"

It is related to the safety of patients, Zhou Can must remind.

"What's your business?"

Dr. Zhao just stood at the chief surgeon's position and was interrupted when he was about to finish the finishing work, looking very unhappy.

"You seem to be overdoing the electrocoagulation to stop the bleeding. I am worried that it will cause tissue ischemia and necrosis."

Zhou Can bit the bullet and asked this question.

Upon hearing this, Dr. Zhao's face changed suddenly.

It had been only a little cold just now, but now it was overcast and frighteningly dark.

Even Doctor Duan didn't say anything, this Gui Peisheng picked on him, it was too presumptuous and arrogant.

"How did you judge that it was going to be ischemic and necrotic? You just opened your mouth. A novice like you just likes to see more things and worry about nothing." Dr. Zhao was quite annoyed.

He almost pointed at Zhou Can's nose and cursed.

It is very dangerous to pick on the fault of the superior doctor.

If Zhou Can hadn't been really helpless, he really wouldn't mind this kind of business.

Doctor Duan did not express his opinion in a hurry, but stared at the patient's wound.

"Although the electrocoagulation technique is a bit rough, there is no obvious problem. As for the damage to a little normal tissue, this is a normal phenomenon, and there is no need to make a fuss. The principle of electrocoagulation to stop bleeding is to use the principle of high temperature to make blood vessels form. Scab formation, so as to stop the bleeding. It is inevitable that there will be improper handling during the operation, which will cause damage to the surrounding tissues. Our human body has a very strong recovery ability, and it will recover soon, so don't worry."

Doctor Duan's tone was quite gentle.

He even patiently explained the principle of electrocoagulation to stop bleeding to Zhou Can.

He never imagined that this young man's level of hemostasis is still higher than his.

"However, this patient has damaged a lot of tissue, so if he just stitches it together, if there is ischemic necrosis, the consequences will be very serious."

Zhou Can accentuated his tone.

"Okay, okay, facts speak louder than words. After two days, when this patient is discharged from the hospital, you will understand. As doctors, we must have awe of life and be bold and careful. If you are afraid of hands If you are afraid of your feet, you can't be a good doctor.”

Doctor Duan stopped Zhou Can from entangled in this topic.

"Sew it up!"

He directly asked Dr. Zhao to suture the wound.

It can also be seen from this incident that the level of each doctor is different. Cognition will also be different.

Zhou Can clearly pointed out the problem, and Dr. Duan seemed to be blind, unable to find it at all.

On the one hand, he thought that Zhou Can was just a Gui Peisheng with no experience in surgery, and his comments were completely fussy. On the other hand, in Dr. Duan's perception, this has always been done. It was fine before, and it will be fine this time.

Dr. Zhao's suturing skills are not bad, and he looks like an average resident doctor.

It is still a little short of the excellent level of resident medicine.

After the wound was stitched, Dr. Duan checked it and nodded with satisfaction.

"Well, the stitches are good. After waking up from the anesthesia, you can just send it back to the ward for recuperation."

The surgery has been done and it can be withdrawn.

"Xiao Zhou, in order to prevent you from making a fuss next time, I punish you to stay in the operating room all day today and help the nurses clean up. It also happens to give you a little bit of insight, to see how the operation is done, so as not to make you laugh. "

Dr. Zhao was annoyed at Zhou Can for picking on him, so he decided to punish Zhou Can a little bit to make Zhou Can remember better.

Punish him to stay in the operating room to clean up, killing two birds with one stone.

It can not only impose punishment, but also allow Zhou Can to observe other doctors' operations.

Doctor Duan didn't care about this matter, and left without saying anything.

Zhou Can stayed in the operating room to clean up.

Because there is only one instrument nurse for this operation, and there are no patrol nurses and hand washing nurses, all the cleaning tasks are left to Zhou Can alone.

After Zhou Can finished cleaning, it didn't take long for doctors and nurses to rush the patient to the operating table.

"Yo, why is it a male nurse?"

The chief surgeon was a thirty-eight or nine-year-old male doctor with gray hair, a rather elegant demeanor, and a particularly energetic person.

Seeing a strange young man standing in the operating room, he froze.

"He's not a nurse, he seems to be a newcomer, Gui Peisheng. Dr. Zhao asked him to stay in the operating room to clean up for a day, and watch other doctors perform operations by the way, gaining insight."

The surgical nurse was the same as last time.

She quickly explained a few words.

The way the other doctors and nurses looked at Zhou Can changed immediately.

Everyone is a human being.

Gui Peisheng was arranged by the superior doctor to clean up the operating room, even a fool would understand that this was punishment.

Only the anesthetist carrying the box looked at Zhou Can with a surprised expression.

He even nodded slightly at Zhou Can as a greeting.

"Hurry up, lift the patient to the operating table! Doctor Guan, give the patient anesthesia immediately."

Judging by the situation, the condition is critical.

Zhou Can also walked over to help. Anyway, it's just an operation, and the surgeon will never mind if there is one more person to help.

Zhou Can knew this anesthesiologist named Doctor Guan.

Because Zhou Can has already performed many operations, and he has also performed a lot of major operations above the third level.

General anesthesia for some major operations often sees this official doctor.

Anesthesiologists are actually the same as ordinary doctors, divided into three levels: resident doctor, attending doctor, and director. Different anesthesia procedures require different qualifications.

At the same time, anesthesiologists will also lead apprentices like ordinary doctors.

Anesthesia for various operations with serious heart, brain, lung, endocrine and other system complications or for surgical anesthesia with high risks in preoperative evaluation requires the director or deputy director anesthesiologist to preside over it.

They evaluated the risks of the entire perioperative period, and believed that the safety factor met the requirements before the surgeon could perform the operation.

Otherwise, even Wu Baihe and Hu Kan, the leaders of the weighted department, formulated a surgical plan for the patient, and the anesthesiologist felt that the risk was too high after evaluation. Then it can only be shelved.

Or wait until the patient meets the surgical criteria before elective surgery.

Therefore, the status of anesthesiologists is not low.

Moreover, they understand the human body's breathing, nervous system, blood system, and the operation of various organs.

All of them are hidden masters.

The only criticism is that the anesthesiology department is a sub-department, and the treatment cannot be compared with that of doctors in weight departments.

They seem insulated from fame.

No matter how powerful a director-level anesthesiologist is, the most famous person in the industry knows it. As for the patients and family members, they only know the name of the surgeon who performed the surgery.

Who the anesthetist is, they rarely care.

Official doctors should at least be senior attending anesthesiologists. The anesthesia operation that allowed him to do it himself showed that the difficulty was not low.

At least the stakes are high.

What disease is this patient? It seems that the patient's face is pale, restless, cold sweat keeps coming out of his forehead, and he has difficulty breathing, which shows that the patient is in extreme pain at this time.

After uncovering the cloth on the patient's body, obvious trauma can be seen between the ribs.

Zhou Can immediately understood that the patient was likely to have pleural hemorrhage accompanied by a large amount of pleural effusion.

This disease is very dangerous, and it is best to perform emergency surgery to stop the bleeding before the patient goes into shock.

Doctor Guan quickly connected the life monitoring probe to the patient.

Originally, if possible, it was even necessary to establish central venous pressure monitoring. Now the situation is urgent, just monitor heart rate, blood pressure, respiration, body temperature and so on.

"Doctor Zhou, can you help me insert the trachea and put on the ventilator?"

The official doctor is alone, and the patient's condition is getting worse and worse.

In order to save anesthesia time, he had to ask Zhou Can for help.

Others don't know Zhou Can's ability, but Doctor Guan knows it very well.

In particular, Zhou Can's glorious deeds in the Department of Critical Care Medicine are known not only to the doctors and nurses in the Department of Critical Care Medicine. Most doctors in anesthesiology have also heard about it.

Because many doctors in the Department of Critical Care Medicine are transformed from anesthesiologists.

For example, Dr. Shi used to be an anesthesiologist, but later switched to life sciences. He was focused on how to provide better life support for the patient, and how to save the patient when the patient was dying.

If there is any news, it is very easy to reach the ears of former colleagues in the anesthesiology department.

The other doctors and nurses were all surprised when they heard that Dr. Guan asked Zhou Can to help.

It seems that Dr. Guan is very familiar with the punished Gui Peisheng!

Endotracheal intubation is not too difficult, but it is still a little difficult to complete quickly and accurately.

The operation of the ventilator is relatively easy to learn, but the adjustment of the parameters is a test of a doctor's level and experience.

Under the suspicious eyes of everyone, Zhou Can stepped forward quickly, and then performed tracheal intubation on the patient.

At this moment, it would have been very difficult to intubate the patient in a restless state.

Zhou Can completed the endotracheal intubation with ease.

Endotracheal intubation is the insertion of a special endotracheal tube through the mouth and into the trachea through the glottis. It can also be inserted through the nasal cavity, depending on the specific situation.

The patient's current state is more suitable for oral intubation.

At least a little more comfortable than nasal insertion.

The patient is already restless, and it is not easy to get him to cooperate.

After the intubation was completed, Zhou Can began to skillfully adjust the parameters of the ventilator. The three months in the intensive care medicine department were not in vain, and now he is able to operate these instruments with ease.

Experience is also very mature.

For the adjustment of various parameters, it can be clearly understood.

There is no such thing as a wasted journey in life, every step counts.

He trained in the intensive care medicine department for three full months, and only after he came out did he realize that the benefits were huge.

Can be used in many occasions.

Moreover, the high level of mental tension when working in the intensive care unit was a very good tempering for his character.

"alright!"

Zhou Can retreated calmly to the most inconspicuous onlooker position under the operating table.

Just now for the intubation of the patient, he earned 1 point of experience in implantation.

As long as you stay in the operating room, you can always get some points.

"What a cow!"

"This Gui Peisheng's operation just now is too coquettish!"

"It turns out that endotracheal intubation can be so simple! I have to try again next time!"

The other doctors and nurses were all dumbfounded.

Zhou Can's performance was very eye-catching, and even gave people the illusion that endotracheal intubation is particularly easy.

"The anesthesia was successfully implemented and the operation can be performed."

As the official doctor's voice fell, the chief surgeon had already stood at the chief surgeon's position and made an incision in the patient's ribs. Then cut it layer by layer until the pleural membrane can be seen.

There was a lot of blood in it.

"It's better to **** off some of the accumulated blood first. The bleeding point should be in the intercostal area."

The chief surgeon was speaking while operating on the patient.

He was looking for the bleeding point quickly.

It's just that the environment in the chest cavity is complicated, and there is residual blood accumulation, so it is not easy to find the bleeding point.

The incision site chosen by the chief surgeon was checked before the operation, and the bleeding point was roughly locked in this position.

It turned out that a window was opened in the chest cavity, and the bleeding point was much harder to find than expected.

The chief surgeon was already sweating on his forehead.

In the blink of an eye, the patient's bleeding quickly caused a large amount of blood to accumulate in the chest cavity.

"The patient's blood pressure is dropping rapidly! Breathing is also giving an early warning, and the operation must be accelerated!"

The anesthesiologist looked worried for a while.

According to the examination results, the type of pleural hemorrhage in this patient should belong to chest wall vascular injury.

The bleeding points of this type of injury are mostly in the intercostal arteries, veins and internal thoracic vessels.

Because it belongs to systemic circulation and high pressure, most of them are continuous bleeding.

There is almost no possibility of automatic hemostasis without surgery.

Zhou Can picked up the patient's examination report and checked it carefully. At this time, he was trying his best to rescue the patient, and no one cared about him.

The patient underwent coronary angiography, but no bleeding points were found.

X-ray chest examination showed pleural effusion shadow on the injured side, the mediastinum shifted to the healthy side, the combined pneumothorax showed fluid level, and even the lung collapsed.

The incision site is on the injured side.

Where will the bleeding point be?

After reading the examination report, Zhou Can calmly inspected the patient's wound.

It has a mid-level hemostasis at the attending level, plus the bonus of 50 first-aid life wisdom, and the newly promoted pathological diagnosis at the attending level. The combination of the three medical skills doubled Zhou Can's diagnostic ability and quick thinking.

No bleeding is visible, but pleural effusion is rising.

It shows that the bleeding point is relatively hidden.

The amount of bleeding is definitely not small.

"Doctor Long, the patient's blood type is special, and the plasma preparation is not enough. According to the amount of bleeding, the prepared three bags of plasma are not enough."

The assistant sends a reminder to the chief surgeon.

This is tantamount to adding insult to injury.

The hemp rope is specially broken at the fine point, and misfortunes never come singly.

This operation, which was originally risk-controllable, faced a huge risk of death in an instant.

If this kind of intrathoracic bleeding is large and the bleeding cannot be stopped in time, the patient will die soon.

"Fuck, after doing so many thoracotomies to stop bleeding, I encountered a problem today."

The chief doctor, Dr. Long, cursed.

The person under the most stress during surgery is the surgeon.

Sometimes, the chief surgeon seems to have taken gunpowder, sullenly in the operating room, scolding whoever is caught.

Can't blame them either.

Because of the problem with the operation, they were under too much pressure.

In this case, some minor mistakes made by assistants and nurses will be infinitely magnified in the eyes of the surgeon, so the phenomenon of scolding and crying people will occasionally appear.

Many doctors and nurses who have participated in major operations say that the chief surgeon is the barometer of the operating room~www.mtlnovel.com~ This is not an exaggeration at all.

The chief surgeon is in a bad mood, and other people usually reduce their sense of presence to avoid scolding.

"The bleeding point may be in this rib

At the risk of being scolded, Zhou Can revealed his diagnosis.

"You Ji Peisheng, don't make trouble here!"

The assistant doctor winked at Zhou Can, telling him not to scold him.

The equipment nurse looked at Zhou Can sympathetically.

This new doctor is really an idiot. He had already been punished for the previous operation, and now he comes out to talk a lot.

When a superior doctor performs an operation, how can a Gui Peisheng be able to dictate?

"The patient has a lot of bleeding, and the plasma is not prepared enough, so he can reinfuse his own blood!"

Zhou Can made another suggestion.

In some major bleeding operations, autologous blood can be completely reinfused if the bleeding is not contaminated.

Tuya Hospital must have this kind of equipment.

The blood salvage machine can collect, filter, separate, clean, and purify the blood lost by the patient during the operation, and then input it into the patient's body. The risk of transfusion of own blood is much lower than transfusion of allogeneic blood.

Allogeneic blood transfusion may cause hepatitis and HIV infection.

In addition, allogeneic blood transfusion will suppress the patient's immune function, increase the risk of wound infection after surgery, and is not conducive to the healing of body wounds.

"Get the blood recycling machine over here immediately!"

After hearing this, the chief doctor, Dr. Long, made a decisive decision.

The patient was bleeding profusely and was critically ill, which made him a little dizzy.

Zhou Can's words really awakened the dreamer.

"Are you sure the bleeding is on this rib

Helping the doctor to intubate the patient and put the ventilator on the patient shows extraordinary strength.

The autologous blood reinfusion just proposed at a critical moment is also extremely clever.

Chapter end