Chapter 122 Eye-catching hemostasis and suturing, status rises sharply
"You two can actually be more confident, because your diagnosis is correct. The patient has a ruptured extensor tendon. As for the rheumatoid arthritis you mentioned, it is still in the early stages. Symptoms unique to synovitis can be seen, and the degree of cartilage destruction is mild. Can anyone tell me about the treatment plan?"
Dr. Shan already has a basic understanding of the diagnostic abilities of these interns.
Zhou Can and another trainee performed well, while the others performed averagely.
The pathology and cause have been diagnosed.
Next comes treatment.
Diagnosis and treatment are equally important.
The clearer the treatment ideas and the better the treatment plan, the greater the potential of the trainee.
"I think we should just operate on the patient and sew up the ruptured tendon."
“In addition to suturing the tendon, I think rheumatoid arthritis should also be treated.”
Several people gave their treatment opinions one after another.
Zhou Can remained silent.
Several competitors breathed a sigh of relief.
Fortunately, this evildoer did have a weakness. He didn't seem to be very good at healing.
Doctor Shan was puzzled and looked at him and asked, "They have all expressed their opinions on treatment, why don't you say anything? Are you unfamiliar with the treatment of this type of disease?"
Everyone has areas of expertise.
However, it should not be difficult to provide some basic treatment options.
"I can't provide a treatment plan because there is too little information about the patient. Only after comprehensive consideration of the patient's age, physical condition, whether there are underlying diseases, the patient's tolerance and the patient's own wishes can the best treatment plan be formulated. It is too one-sided to formulate a treatment plan based on just a few examination reports."
Zhou Can has his own opinion.
Medicine must be rigorous and prudent.
It is extremely irresponsible to hastily formulate a treatment plan without even understanding the patient's condition.
After listening to this, Dr. Shan's facial expression became a little stiff.
She indeed neglected this point.
She was somewhat annoyed at being lectured on safety issues in public by a trainee.
"What Doctor Zhou said makes sense. We should indeed formulate the most appropriate treatment plan based on all the patient's information. However, Doctor Shan only wanted to test your treatment ideas, so he deliberately asked you to only provide a treatment plan based on the diagnosis results."
Dr. Tang excused Dr. Shan.
With such good conduct, this young man will definitely have a bright future.
"Take the patient into the operating room and prepare for surgery!"
Doctor Shan was unwilling to continue discussing this topic.
The patient was quickly taken into the operating room.
This is a woman in her fifties , with tanned skin and wrinkles all over her face. The ten fingers of her hands have become bent due to rheumatoid arthritis.
Ordinary people's fingers can bend or straighten at will.
Her ten fingers could only remain bent and could not be straightened.
His right hand was tied with a bandage and hung around his neck.
Judging from her dress and temperament, she should be a rural woman. After the tendon ruptured, she may have received the initial diagnosis at the local township health center.
Township health centers simply do not have the capacity to treat this disease, and patients can only seek treatment at county-level hospitals or large hospitals like Tuya.
For the doctors at Tuya Hospital, it was just a minor operation.
It’s not difficult.
"In cases like this, general anesthesia is generally not needed, only brachial plexus anesthesia is needed."
While Dr. Shan was explaining to several people, he was directing Dr. Tang to give the patient an anesthetic injection.
Zhou Can looked at it with envy, feeling sorry for wasting four injection experience points.
If he injects the anesthetic, he will give the patient at least four injections.
At this time, the intern who went outside to apply the plaster came back with Dr. He.
Dr. Shan has instructed Dr. Tang to perform a secondary skin cleansing on the patient's surgical area.
Then draw the incision position, mark the location of the tendon rupture with a red line, and finally carefully cut the epidermis of the hand.
Blood gushed out immediately.
“Stop the bleeding!”
She shouted to Dr. Tang.
Zhou Can stood by and rubbed his hands. He felt itchy when he saw the surgery.
Stopping bleeding is his strong point.
I really can't praise Dr. Tang's ability to stop bleeding. At best, he is at the lower level of a resident doctor, which is far worse than his lower level as an attending physician.
On the contrary, Dr. Shan’s surgical skills are quite impressive.
When cutting the patient's hand skin, he was slow, steady and accurate, avoiding large blood vessels and nerves.
It's like peeling the bark off a big tree.
Her incisions must have reached the level of a chief physician.
No wonder the orthopedic surgery department let her lead the team to perform level one and level two surgeries. It was indeed a serious matter.
Doctor Tang's speed in stopping bleeding is really slow.
The bleeding from the patient's wound has blocked the subcutaneous tissue.
Zhou Can took the blood sucker and sucked out the accumulated blood.
Dr. Tang looked at him with gratitude, while Dr. Shan looked at him with admiration.
The operating room needs people like Zhou Can who can take the initiative.
The other trainees could only watch stupidly.
"This bleeding spot is a bit difficult to deal with! Why can't it be stopped?"
Dr. Tang applied electrocoagulation to one of the bleeding spots several times, but the effect was very poor.
"It's probably a blood vessel that's retracted. I happen to have experience in this area. How about letting me do the operation?"
Zhou Can had wanted to volunteer for a long time.
After finally getting the chance, he spoke immediately.
"Can you...?"
Doctor Tang hesitated.
This hemostasis point is quite difficult. Even he can't do it, how can Zhou Can, a resident trainee, do it?
Thinking of Zhou Can's excellent performance in puncturing the knee joint cavity before, he finally chose to trust Zhou Can once.
After taking the electrocoagulation knife, Zhou Can took the sharp tweezers, pulled apart the fat around the bleeding point, and then inserted the electrocoagulation knife with incredible precision.
Sizzle!
The whole process was smooth and neat.
The bleeding was finally stopped successfully.
This master-level operation level stunned everyone around.
This is just one of the bleeding points.
There are still at least five or six bleeding points that have not been resolved.
The main reason is that Dr. Tang’s efficiency in stopping bleeding is too low.
Zhou Can held the electrocoagulation knife in his hand, like the legendary acupuncture master.
Every detail is accurate.
It only took five or six seconds to get everything done.
It’s really fast and good.
"When did the trainees who graduated from the emergency department become so strong? Isn't it said that the doctors in the emergency department are weak?"
Everyone was shocked and couldn't help but think of Zhou Can's background.
He came from the emergency department.
So far, I have only been trained in the emergency department. But I am already abnormally strong.
"alright!"
Zhou Can returned the electrocoagulation knife to Dr. Tang.
This time, Dr. Shan quit.
She is not blind. Zhou Can's ability to stop bleeding is so excellent that she naturally chooses to let Zhou Can continue to stop the bleeding.
To ensure higher surgical efficiency and shorten operation time.
In addition, good hemostasis has an additive effect on the prognosis of surgery, allowing the patient's wound to heal faster and reducing other tissue damage during the electrocoagulation process.
"Zhou Can, you will be the assistant. Doctor Tang, please take a rest first."
She made the substitution on the spot.
"OK!"
Dr. Tang had no objection, but was just a little disappointed.
He must have felt uncomfortable being outdone by a new intern.
Doctor He, who was standing under the operating table, looked at Zhou Can with surprise and envy. If Zhou Can's performance in front of Director Shen yesterday was considered as careful observation, then his performance in the operating room today was definitely a display of strength.
He couldn't help but sigh that this trainee was so strong.
He may very well be the strongest one among the 18 trainees in this period.
Zhou Can didn't act pretentiously. He nodded to Dr. Tang and stood in the assistant position that Dr. Tang had given up.
Dr. Shan continued to cut open the subcutaneous tissue to search for the ruptured tendon.
Blood gushed out again, and this time it was Zhou Can who was in charge of stopping the bleeding. Compared with Dr. Tang, he was on a completely different level.
Zhou Can performed electrocoagulation to stop bleeding with incredible precision, quickly and effectively.
The total amount of bleeding was pitifully small.
There is no need for aspirators, because there is no blood to be sucked out.
“The broken tendon seems to be coming out!”
Zhou Can spotted the ruptured tendon with his sharp eyes.
The situation is still relatively ideal.
Without any instructions from Doctor Shan, he took the flat hook from the nurse and opened the surgical wound.
Provide sufficient vision for Dr. Shan's subsequent repair surgery.
"Did you see it? This is the patient's ruptured tendon."
Dr. Shan was worried that other interns might not recognize it, so he pointed it out to them.
"What we need to do is find the proximal and distal ends of the severed tendon. In this case, we can use the tip of a 5ml syringe to fix them."
After fixation, Dr. Shan began to suture the tendon.
"This usually uses No. 4 absorbable sutures, and the cross suture method is more stable."
Subcutaneous sutures are now mostly made of absorbable sutures.
The advantage is that there is no need for a second surgery to remove the stitches.
Her suturing skills are also at the lower attending level, not as high as Zhou Can's.
The ruptured tendon was quickly sutured.
“After the suturing, the area around the stump of the tendon must be continuously reinforced.”
While she was suturing, she was also teaching other junior doctors.
The suture is completely completed and the tendon repair is finished.
After checking everything is correct, you can finish.
"Doctor Shan, can you let me do the rest of the skin stitching?"
Zhou Can was not coveting the opportunity to sew the leather.
For him, if he wants to sew skin, he just needs to work overtime in the emergency department's operating room after get off work. This gives him plenty of opportunities to practice.
Actively strive for this opportunity to sew the skin in order to show off your suturing skills.
Next time there is tendon suture and vascular anastomosis, he will have a chance to fight for it.
The risk factor for sutures on the hands is very low.
Dr. Shan readily agreed to Zhou Can's request.
But she was still a little worried and kept a close eye on Zhou Can's movements.
Zhou Can took the needle holder and the needle and thread, and then began to sew the wound on the patient's hand.
After finishing two stitches, Dr. Shan’s eyes almost popped out.
I was worried that Zhou Can wouldn't sew it well.
Unexpectedly, Zhou Can was much better than she thought. He could sew better than her.
“So strong!”
Both resident doctors, Dr. Tang and Dr. He, felt their faces getting hot .
Because their suture skills are far inferior to Zhou Can's.
"How can a resident doctor be so strong? Has this guy been practicing suturing since his freshman year?"
Even the attending doctors and resident doctors were so shocked.
As for the other five trainees, that was not the case. As they felt desperate, the only thing they could think of was "evildoer".
Zhou Can finished sewing quickly and neatly.
"Doctor Shan, please help me check it!"
“It’s very well sewn.”
Dr. Shan praised him generously.
"You're too kind! Is her rheumatoid arthritis treated with both anti-inflammatory and rheumatic drugs?"
Zhou Can knew very well that the patient's tendon was ruptured and lifting heavy objects was just a trigger.
The real cause was rheumatoid arthritis in the hands.
Suturing the tendon is only a temporary solution.
Her rheumatoid arthritis must be treated with medication to cure both the symptoms and the root cause.
"I will prescribe the medicine, push the patient out of the operating room, and prepare to arrange the next operation!"
Her attitude towards Zhou Can changed significantly.
Speak very politely.
It’s almost the tone of a conversation between peers.
Strength is always the easiest hard condition to win respect.
Zhou Can not only has strong surgical skills, but can also accurately provide drug treatment plans, which shows that he has no shortcomings in treatment.
At present, he is far ahead of the other five trainees.
But this is just the beginning.
Although this operating room is the worst one in orthopedics, the number of surgeries performed per day is still astonishing.
The fourth patient's examination report appeared on the screen again.
The photo shows a patient's knee joint.
Two examinations were performed, namely X-ray and B-ultrasound.
"This is a typical suppurative knee infection!"
The intern who was very good at watching movies answered the question first.
"I agree with his diagnosis. An incision and drainage irrigation may be necessary." Zhou Can has dealt with similar purulent infections in the emergency room and has rich experience in treatment.
"They are all amazing! This patient does have a suppurative infection in the knee joint. The surgical plan is what Doctor Zhou said. It requires incision and lavage."
Doctor Shan found that the two interns were very eye-catching and a happy smile appeared on her face.
The vast majority of senior doctors actually very much hope to see successors.
After all, people like Dr. Lu in the emergency department who are extremely selfish are a minority.
The patient was wheeled in quickly.
Zhou Can was delighted.
The opportunity to perform has come again.
At the same time, you can also earn a lot of experience points.
Since it was a competition, he didn't bother to be polite.
Ask Dr. Shan directly for treatment authorization, including incision.
With his excellent performance in the three medical skills of hemostasis, suturing and puncture, he has initially established a foundation of trust in Dr. Shan's mind.
If I ask for permission for a medium-risk surgery at this time, she probably won't refuse.
"Let me do the cutting! You can do the rest!"
She didn't dare let Zhou Can do it.
Almost all senior doctors are the same. Open surgery carries the highest risk, so they will not easily delegate authority to their subordinates.
Zhou Can was not discouraged.
It’s already great to be able to grab the remaining exercise opportunities.
As for higher-risk and more difficult surgical opportunities, as long as you can get a place in the operating room for regular training, there will be plenty of opportunities to strive for them in the future.
…
In this way, they performed almost twelve level one and level two operations in the morning.
At lunchtime, Zhou Can once again deeply felt the busyness of the operating room. Everyone took turns eating in batches. There was no rest time.
"Zhou Can, Doctor He, and nurse Wang Xiaohong, please stay and continue the operation with me. The rest of you should hurry up and eat and return to the operating room as soon as possible."
Dr. Shan made arrangements.
She didn't keep Dr. Tang, but kept Zhou Can.
It seems that she is planning to let Zhou Can be her assistant forever.
But it's understandable.
After all, with a powerful assistant assisting in the surgery, the surgeon's work is not only much easier, but the surgery is also very efficient.
Just like Zhou Can particularly likes performing surgery with Qiao Yu.
It’s nothing else, it’s just because she cooperates well and the work of the instrument nurse is very professional.
Dr. Shan did n't keep resident Dr. He as his assistant.
Instead, he was responsible for applying plaster to patients and doing odd jobs in the operating room.
She would definitely not feel comfortable letting other interns apply plaster alone.
She felt relieved to leave this matter to Dr. He.
Zhou Can's status in the operating room also rose sharply, and the number of surgical tasks he could perform continued to increase.
