My Medical Skills Give Me Experiences

Zhou Can carefully examined the patient, hoping to find a way to save the patient.

To be honest, if there is a problem with the lungs, even the use of extracorporeal lung membranes may not be able to save it. ecmo is by no means a panacea, its use is only to temporarily replace cardiopulmonary work and help patients complete breathing and circulation.

It cannot replace cardiorespiratory work for long periods of time.

Not to mention the extracorporeal lung membrane, even if it's just a simple ventilator, it can't be too long. Otherwise, the patient's body can easily form dependence and greatly increase the probability of infection.

For patients with pneumonectomy on one side, the lung function will be reduced by 50% after surgery, and the respiratory and circulatory systems will be under tremendous pressure. It is equivalent to two people carrying a weight of two hundred catties together, and suddenly one person slips away, and the other person will be exhausted to death.

Therefore, the mortality and complications of pneumonectomy on one side are very high.

Removing part of the lung is relatively less risky.

In addition, the quality of life of patients with pneumonectomy on one side will be greatly affected. I used to easily climb up to the third floor, but now I may be out of breath and exhausted after climbing half a floor.

If the patient is younger, it may even be impossible to live a normal married life.

When formulating the operation plan for this patient, Zhou Can thought carefully, and there was really no other way, so he chose to cut the patient's left lung to save his life.

The operation performed by the patient two days ago is the third day today.

At present, the face and lips are cyanotic, including the abnormal cyanosis of the nails, which is an obvious manifestation of hypoxia.

The patient had difficulty breathing, a large amount of pink frothy sputum, and a heart rate that was significantly higher than normal. Reached 150 times/min.

The blood oxygen saturation has dropped to the bottom, and has already fallen below the minimum warning line.

When the blood oxygen saturation is lower than 95%, there will generally be obvious symptoms of discomfort, and it will arouse the vigilance of doctors. The patient's blood oxygen saturation has dropped below 80%, which is the result of various rescue measures.

Zhou Can's face sank like water, and several chief physicians in the intensive care unit all looked at him solemnly. Everyone is really hopeless, and can only place their hopes on him to see if he can think of a cure.

"Sister Yan, let me borrow your stethoscope!"

Zhou Can said to Director Xueyan.

Percussion hammer and stethoscope should be commonly used equipment for cardiothoracic surgeons. Because these two things may be needed at any time.

But here is aseptic management, and items from outside cannot be brought in easily.

Director Xueyan's stethoscope should be equipped in the intensive care unit.

Although the patient looked scary as if he might die at any time every time he took a breath, Zhou Can was as steady as Mount Tai. Hold the stethoscope and listen to the patient's lungs.

"It is full of moist rales and vesicle sounds, combined with the patient's current symptoms and signs, it must be pulmonary edema. It is still good on the first day after surgery, indicating that the deterioration of the patient's lung condition occurred yesterday, and it may even be This morning. Show me the infusion and medication list."

Zhou Can's pharmacological syndrome differentiation has also been upgraded to the sixth level. When diagnosing and treating such critically ill patients, he has the ability to start from multiple aspects.

Including pharmacology, pathology, symptoms and so on.

In the past, it was difficult for him to intervene in matters related to doctor's orders and medication, especially for some patients with complicated medication.

It seems that the deputy chief physician and the chief physician are only half a level behind, but the level is very different.

Especially the two core items of pharmacology and pathology, the difference is even more obvious.

Before Zhou Can's pharmacological syndrome differentiation was promoted, he was even inferior to nurse Jiang Wei in many areas of medication.

Director Xueyan's theoretical level has always been outstanding, and her pharmacological syndrome differentiation has long been at the sixth level. Even now, Zhou Can is slightly inferior to her.

At most, Zhou Can now has the qualifications to 'discuss' with her.

It is equivalent to that everyone is at this level, she is just stronger.

Although Xueyan, Deputy Director He and others had already checked the patient's infusion and medication, Zhou Can still wanted to check again. Even if no problems are found, a clearer understanding of the patient's medication status can be obtained.

Which medicines are used how much and how effective they are after use, all of which can give Zhou Can a good feedback.

After checking, his originally frowning brow relaxed a lot.

"At present, the main rescue measures that have been implemented for patients are mainly face mask oxygen inhalation and intramuscular injection of sedative drugs."

Maybe everyone dare not take medication rashly when the diagnostic opinions are not unified.

"Zhou Can, looking at your expression, you have already found the cause of the patient's pulmonary edema, right?"

Director Xueyan has worked with him for a long time, and has a deep understanding of some of his behaviors and habits.

Seeing Zhou Can's brows relaxed, she felt a lot more relaxed.

This is a trust built over a long period of cooperation.

During Zhou Can's rescue work, he only showed this expression when he felt that he had a high level of confidence.

"It counts!"

Zhou Can nodded.

"Actually, after our discussion just now, we also thought that the patient might have pulmonary edema, but we didn't dare to act rashly when we saw pink sputum and the pathological mechanism was unclear. The rescue measures were also conservative."

Deputy Director He's words were more or less intended to save face.

After all, in the field of extra-thoracic surgery, he is considered a veteran of the department.

For a long time after the death of Director Hu Kan, he always regarded himself as the boss in the field of chest surgery.

It is undeniable that Deputy Director He's strength is indeed good, and his experience is extremely rich.

Pink sputum indicates hemorrhagic exudate or bleeding in the lungs.

Except Director Xueyan, no one else really knew how the operation was performed. However, everyone is quite confident in Zhou Can's surgical skills.

"I performed the operation, and I am indeed more familiar with the patient's condition. You and several directors called me over to deal with it, which is very prudent."

Zhou Can praised the other party, and then continued.

"Just now I saw that there was nothing wrong with the medication for the past three days. The patient's sudden pulmonary edema should be related to his left pneumonectomy. To put it bluntly, this postoperative complication cannot be avoided. One side of the lung was completely removed. Finally, due to the reduction of pulmonary blood vessels, the hydrostatic pressure in the blood vessels will increase, and the permeability of capillaries will also increase, and a large amount of water will seep into the alveoli from the pulmonary capillaries, eventually causing acute pulmonary edema.”

Zhou Can told the doctors and nurses present about his pathological analysis.

When everyone is rescuing various critically ill patients, it is also a process of learning and progressing together.

Everyone has different medical knowledge, clinical experience, clinical application of knowledge, and ideas. Listen to the opinions of others, you can learn from each other. It will serve as a good reference for the next time you encounter a similar case.

Even better doctors can directly give different diagnosis and treatment opinions in this operation, and work together.

Avoid missed diagnosis and misdiagnosis.

Sometimes, when a patient in a department has a problem, more than a dozen doctors and nurses surround him. The family members didn't understand and thought it was a fight.

Actually not really.

In the hospital, the doctors felt that there was danger, so a dozen doctors would not confront the family members together.

Unless the family members are already committing crimes and beating others, the doctor will stand shoulder to shoulder in order to protect the female doctor and nurse to prevent the family members from continuing to commit violence.

When rescuing critically ill patients, there is a large group of doctors and nurses at once. On the one hand, they attach importance to the lives of patients.

On the other hand, it also wants to gather the wisdom and strength of the group to save lives together.

This can also ensure a higher rescue success rate.

"Then what are you going to do now?"

Director Xueyan thought of almost using an extracorporeal lung membrane to save the patient's life, and couldn't help but feel a slight fever on her face.

If you are in a hurry, you will be chaotic.

Chaos is unknown.

Not long ago, she was really frightened when she saw that the patient's condition suddenly deteriorated and he looked like he might die soon.

The other chief physicians were also anxious.

If it is not effective for ordinary patients to wear an oxygen mask, you can also consider using a ventilator. This patient's situation is very special, and everyone agrees that the upper lung membrane is the safest.

At least that's how it was then.

Even now, if Zhou Can is not very calm to analyze the patient's condition and tell them that there is no abnormal bleeding in the patient's lungs and heart. It's just acute pulmonary edema, they might still be as nervous and anxious as before.

All the doctors present have rich experience in first aid.

They are very aware of how fragile a patient's life is.

Sometimes, what was fine one second, will be gone in the next second.

"I think the patient's heart rate is still a little too fast. I will give 10mg morphine intramuscular injection for sedation, and then treat with cardiotonic and diuretic drugs to control acute pulmonary edema. In addition, the input of crystalloid fluid must be reduced, which is also related to the patient. There is an association with sudden acute pulmonary edema."

When Zhou Can said this, he looked at the head nurse.

The doctor's order is issued by the doctor, and the nurse has the responsibility and obligation to review the medicine when taking the medicine.

If during the nursing process, you can be more careful about this patient, and if you find something is wrong, report it to the attending doctor immediately, and you should not suffer from sudden acute pulmonary edema.

Of course, blaming the nurse is definitely not to blame.

It was impossible for Zhou Can to say such words directly.

"Okay, in the next nursing care, I will pay special attention to this patient."

She is not stupid if she can be the head nurse.

Immediately understand the meaning of Zhou Can's words.

"I can only trouble Teacher Chang! When the patient's condition improves, I will treat the sisters in the nurse's station to drink 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 intensive care unit, and one of them has spoken, which is guaranteed.

"Director He, there is one more thing to pay attention to. This patient must be extra vigilant when turning over. After pneumonectomy on one side, it is very easy for the mediastinum to gradually shift sideways. Especially this patient is currently suffering from severe pulmonary edema and is more likely to occur."

Zhou Can then explained to the chief physician of the intensive care unit.

Director He was newly promoted after the two chief physicians in the intensive care unit switched jobs. His professional title is Deputy Chief Physician, and he is currently the head of the cardiothoracic surgery intensive care unit.

The work is still serious and responsible, but there is a gap between the level of the two directors who were poached.

Now the two job-hopping chief physicians have returned, but the position of the head of the intensive care unit no longer belongs to them.

As an adult, there must be a price to pay for doing something wrong.

After pneumonectomy on one side, the lateral position is particular.

It can be understood in this way that originally the two lungs just filled the lungs in the thoracic cavity. When the lung on the other side is cut away, a space is left.

At this time, the lung on the other side is squeezed in the middle, which will cause the mediastinum to shift.

Don't take it lightly.

When the mediastinal displacement is severe, it will cause the surrounding structures to compress the uninjured bronchi.

If the patient is young, in his 20s or 30s, because the bronchial wall is soft, stenosis and deformation will appear after compression. At this time, dyspnea after airway obstruction will appear.

Experienced doctors often refer to this phenomenon as post-pneumonectomy syndrome.

There is also a particularly interesting phenomenon that this syndrome mostly occurs in right pneumonectomy.

When this happens, it is equivalent to curing one disease for the patient and creating a new one.

At this time, because the patient has difficulty breathing, the ideal solution is to place a stent in the compressed and deformed bronchi.

Regardless of the age of this patient, the bronchial wall is much harder than that of young people. At the same time, the entire left lung was removed, not the right. However, there is still a chance of postoperative syndrome.

Especially acute pulmonary edema will lead to a sharp increase in the volume and weight of the remaining right lung. At this time, if the clinical care is not careful, it will lead to the patient's second disease again.

According to the treatment method given by Zhou Can, after a series of rescue medication, the patient's condition gradually improved.

Everyone breathed a sigh of relief.

At this time, the atmosphere in the intensive care unit became significantly more relaxed.

No matter whether it is a doctor or a nurse, it is a kind of relief and happiness not to have such a terrible patient. Especially on duty at night, nurses are not only afraid that there will be a lot of patients coming to see the doctor, but also afraid that the patients who have already been admitted will have problems.

The bowl of food for doctors and nurses is actually quite unpalatable.

It is hard work, dangerous, and the key is tiring.

"It seems that the decision to invite Dr. Zhou over for a consultation is the right one. He knows the patient's condition best when he performs the operation on the patient. I was always worried that the patient had a pulmonary embolism just now!"

Director He smiled easily.

"Old He, not to mention you, even I am more inclined to pulmonary embolism. If the family members did not agree, I would definitely agree to use ecmo for the patient. Fortunately, it was just a false alarm."

After hearing this, the others all smiled.

Seeing a critically ill and dying patient being brought back, everyone feels a sense of accomplishment and will be very happy.

"Zhou Can, are you still doing the two major surgeries tonight?"

Director Xueyan is more concerned about this matter.

The crisis is over, and there is still a new job waiting for her.

If a department wants to remain strong, it must insist on gnawing hard bones every day.

So far, Zhou Can is still the sharpest scalpel in cardiothoracic surgery, bar none.

In terms of surgical prowess, Zhou Can is indeed well-deserved.

Steady knife, fast knife~www.wuxiax.com~He can use it.

With the fusion of the two, he can also be handy.

Then whether it is maintenance, hemostasis, ligation, dissection... he can do almost everything.

It is almost difficult to find a doctor with such comprehensive surgical skills.

The former director Hu Kan far surpassed Zhou Can in terms of stability. However, in other fields, it is basically at the level of the director, and even some surgical skills are still only at the level of the deputy director until death.

】

"Do, of course! I'll be on time for my appointment after get off work."

Zhou Can looked high-spirited.

It made everyone smile again.

Now is the critical moment of the secret rivalry with the Third Hospital, and Zhou Can is desperately trying to put pressure there. The more difficult operations he performed and the better his reputation, the greater the pressure on the Third Hospital.