Chapter 140: Young people, but not young skills. The situation gradually opens up
When Ichisuke heard this, he immediately flew into a rage.
What does this mean?
Isn't this just a roundabout way of mocking him for being incompetent and unable to help?
"Do you think stopping bleeding is that easy? Just clamp the blood vessel with a hemostatic forceps? Young man, let me tell you, reading a book and actually doing it are two completely different concepts."
Ichisuke sneered and taught Zhou Can, the novice, in a connoisseur's tone.
I'm probably cursing in my heart, these young people who always want to stand out and show off every day.
He doesn't even consider his own worth.
"Doctor Ou, can you let me try the hemostat? If it can help you, that would be the best. If it doesn't help, the destructive power of the hemostat can be controlled." Zhou Can looked at Doctor Ou.
At this moment, Dr. Ou was very distressed.
The patient's blood vessels were gushing blood, and he tried to press directly with his hands on the blood vessels in multiple locations, but unfortunately with little effect.
The current situation is extremely unfavorable.
It's basically a dead end.
The bleeding could not be stopped, and the constantly gushing blood obscured his vision, making it impossible for him to find out the real reason why electrocoagulation could not stop the bleeding.
When performing surgery, doctors fear the most damage to important nerves, unexplained bleeding, and complications.
All three situations could have extremely disastrous consequences.
If the nerves are affected, the result may be paralysis at the mildest, or respiratory arrest, cardiac arrest, or even death at the worst.
Unexplained bleeding also results in death, and if the bleeding cannot be stopped, the patient is in grave danger, especially internal bleeding.
Complications may occur during or after surgery.
Before surgery, why do doctors ask about allergy history, high blood pressure, heart disease, diabetes, etc.? This is to fully consider whether other complications will occur during the surgery.
Some heart patients have extremely low tolerance for surgery.
He might have had a heart attack as soon as he was put on the operating table before the operation. Then, the doctors would not have to perform the operation, but would have to rush to save the patient.
As for postoperative complications, they were not taken seriously in the past.
Now more and more surgeons list postoperative complications as the number one killer.
Take spinal epidural hematoma for example, it may be caused by the patient himself, or it may be caused by .
It couldn't be discovered at that time.
After the operation, the patient was found to be paralyzed . Upon examination, it was discovered that he had a spinal epidural hematoma.
The location of the hematoma is exactly the location of the spinal anesthesia.
This is the simplest postoperative complication.
Not to mention post-operative lung infection, kidney failure, cardiopulmonary failure, etc.
When Dr. Ou was at his wit's end and was about to ask his senior doctor for help, he heard Zhou Can volunteer. For the first time, he took a serious look at this courageous intern.
Zhou Cangang was able to say that the patient was bleeding profusely because it was possible that he had injured the blood vessels beneath the spinal dura mater when he removed the abnormal blood vessels, or that he had just cut the bifurcation of the blood vessels.
Neither of these two ideas can be proposed by ordinary people.
Dr. Ou also had a higher opinion of Zhou Can's abilities.
"Chen Yue, let him try!"
Doctor Ou said to Ichisuke.
Basically, we just take the attitude of trying everything possible.
As Zhou Can said, the destructive power of the hemostatic forceps is minimal. At most, it will injure the blood vessels. But if it can help him stop the bleeding, it will avoid asking for help from senior doctors.
The face is saved and the problem can be solved.
Asking a senior doctor to come and put out the fire is not something you can do whenever you want; it comes at a price.
This results in losing points in the eyes of senior doctors, reduced weight of surgery, and questioning of surgical ability.
These will have very bad effects.
We often see in the news that a medical accident occurred in a certain hospital. The doctors involved concealed the incident, avoided the main issues, and failed to report the problem to their superiors in a timely manner as required after discovering it, which led to the accident.
Such a low-level mistake can be made.
Do you think the doctor involved is stupid?
In fact, he is very smart.
He just hoped that he could handle it himself, so he didn't report it to his superior doctor.
This eventually led to an accident.
Dr. Ou had spoken, and Yizhu had to give up his seat obediently, regardless of whether he was willing or not.
Zhou Can took the hemostatic forceps handed to him by the nurse and first carefully looked for the blood vessels at the bleeding point.
However, he also encountered the same problem as Dr. Ou.
The blood that kept gushing out seriously interfered with the vision of the spinal dura mater. It was useless even if the accumulated blood was sucked out continuously.
The bleeding was too fast.
In addition, to find blood vessels, one must start from the location of the bleeding point.
Zhou Can had already developed a skill long ago.
The bleeding point can be found through the blood ripples. Now, the bleeding point is very clear, and what he needs to do is to find the dragon and cut off the vein through the blood ripples.
All things in the world are connected, which is similar to the geomancy in Feng Shui.
"The proximal end of the bleeding blood vessel should be here."
As he finished speaking, he clamped an inconspicuous submembranous blood vessel with a hemostat.
A magical scene appeared.
The bleeding stopped immediately.
“It’s amazing, it’s really amazing!”
Dr. Ou shouted happily.
Yizhu looked at Zhou Can, who was in the limelight, with a face full of shame.
In the operating room, all you need is real skills and no pretense.
Zhou Can successfully stopped the bleeding, which shows that his ability to stop bleeding is indeed better than his.
Even stronger than Dr. Ou.
"The blood vessels cannot be clamped for too long, otherwise it will easily damage the blood vessels and the spinal dura mater. I have tried electrocoagulation to stop the bleeding many times, but it has failed. Do you think it is possible to ligate the bleeding?"
Anyway, it is a blood vessel with the terminal choroid capillary network cut off, so ligation to stop the bleeding should be a better solution.
"Wait a minute, let me check!"
Doctor Ou was much more polite when speaking to Zhou Can.
First, drain the accumulated blood to avoid obstructing your vision.
Without the distraction, he quickly found the problem.
"I ruptured the malformed blood vessel when I was removing it. No wonder electrocoagulation can't stop the bleeding. This blood vessel is severely deformed and has affected the blood vessels under the spinal dura mater."
The reason has been found.
Dr. Ou was very happy.
Sometimes it's like this, until the problem is found, anything is possible. Only when the fog is lifted and the real cause is found, it suddenly dawns on you. Oh, it turns out that the reason for the bleeding is so simple.
"We have to continue to explore downwards, remove all the diseased blood vessels, and then ligate them. Otherwise, it will be a time bomb sooner or later."
Dr. Ou said.
"In this case, it is necessary to cut open the dura mater and get to the bottom of it. This will completely solve the hidden danger."
According to regulations, some necessary records need to be kept during the operation.
It was originally just a spinal epidural hematoma removal surgery, but now the dura mater needs to be cut open, which is equivalent to an upgrade of the surgery.
A reasonable explanation must be given.
Generally, the first assistant records the operation process, and the surgeon signs it after reviewing it.
It can also be written by the surgeon himself within 24 hours.
Doctor Ou cut open the dura mater and after some examination, he found that although the blood vessel was not very thick, the disease was quite serious.
It extended nearly 3cm and became deformed and hardened.
After it was removed, the end of the blood vessel segment was ligated according to Zhou Can's suggestion.
"Okay, you can release the hemostat now."
Doctor Ou said to Zhou Can.
Zhou Can tried to slowly loosen the hemostat, and the bleeding stopped.
Everyone showed a happy expression.
"By the way, what's your name? You're pretty good at stopping bleeding."
While suturing the spinal dura mater, Dr. Ou asked Zhou Can's name.
If Zhou Can had not performed so outstandingly, Dr. Ou might not have remembered his name after two months of training.
Maybe they won’t even ask.
Now, he felt that Zhou Can was qualified to make him remember his name.
"My name is Zhou Can! I have just started my neurosurgery training. I hope all the senior doctors will take good care of me in the next two months."
Zhou Can had some unpleasantness with his assistant not long ago.
He succeeded in stopping the patient's bleeding, which was equivalent to punching Ichisuke in the face.
Lowering the posture now can be considered as easing the relationship between the two sides.
Then again, he would still fight for the opportunity he deserves. If he were to do it again, he would still try every possible way to show up.
Only by demonstrating your strength can you gain the attention of senior doctors.
Only then will you have a chance to get started.
Take Jiang Xiaohua for example, he and Zhou Can are both trainee students.
Now Zhou Can wants to take the opportunity to suture the skin, and Dr. Ou is likely to agree. But Jiang Xiaohua may not agree.
This is the difference between showing your face and not showing your face.
"Well, you did a good job just now. Keep up the good work."
Dr. Ou obviously had never heard of Zhou Can's name.
After praising him for a few words, he began to concentrate on the operation.
"Xiao Zhou, you have never practiced suturing a patient's surgical incision, right? Stand by and watch Chen Yue suturing the patient's incision. When you have learned it, if the situation allows, I will consider giving you some opportunities to practice."
Doctor Ou spoke to Zhou Can in a gentle tone.
Senior doctors are basically the same, so if a resident performs particularly well, they will train as many of them as possible.
"thank you!"
Zhou Can quickly thanked him.
His ability in sewing skin has now reached the excellent level of a chief physician, and he only needs more than a thousand experience points to be promoted to the level of deputy director.
However, he was still very low-key and followed Dr. Ou's words.
"Look carefully, there are strict requirements for suture alignment and needle size selection. The way to hold the needle holder and the coordination of the pointed forceps also require extremely advanced skills. I also practiced for many years before I achieved a little success."
Doctor Chen Yue just lost face while stopping the bleeding, and now he finally has a chance to redeem himself.
I saw him explaining the basic method of skin suturing with great confidence, and then he began to calmly suture the patient's skin incision.
His suturing skills are not bad, and are at the average level of a resident doctor.
There is still a big gap between this and the excellent level of resident doctors.
Zhou Can watched silently from the side.
Jiang Xiaohua just glanced at it casually and then looked away. He seemed to be familiar with the seam leather.
For trainees, skin sewing is still a rare training opportunity.
Even many residents are scrambling to do this.
After watching carefully, Zhou Can found that the suturing techniques seemed to be different in different departments.
Just like the martial arts sects, even if they all wield swords, their styles are very different.
Zhou Can's suturing technique should be inherited from the general surgery lineage, and later incorporated some of Dr. Xu's style. After three months of training in orthopedic surgery, he also incorporated some of the suturing .
In general, he is more like integrating the strengths of various schools, constantly absorbing the advantages of others and improving suturing techniques.
He found that whether it was Dr. Ou or Dr. Chen, their suture styles tended to be delicate.
The movements are neither fast nor slow, the force is relatively gentle, and neatness is the goal when suturing.
It may have a lot to do with the surgical direction of the department.
Neurosurgery is a high-tech operation, not as rough as orthopedic surgery. When suturing, a little too much force may cause the anastomosis of blood vessels or nerves to fail.
Operations on the brain and spinal areas are like dancing on the edge of a knife, and must be done with extreme caution.
Director Wu Baihe, the top scalpel in neurosurgery, is famous for his precise and meticulous surgical style.
After more than twenty minutes, Chen Yue finished sewing.
Zhou Can watched and learned the whole process, absorbed the other party's strengths, and then thought, if it were him who was to do the stitching, how would he do it?
I feel that I have gained a lot.
Chen Yue originally had a lot of opinions about Zhou Can.
However, during his suturing process, Zhou Can was always by his side, watching and learning carefully, which was very helpful to him.
"Do you see clearly? This is how skin suturing is done. It's simple and difficult at the same time. The higher the suturing skills, the faster the patient's wound will heal, and there will be fewer ugly scars. I heard that some chief surgeons can even suture without scars. Learn it well. You are still young and have a long way to go!"
When Chen Yue said these words, although he still used the tone of an old senior, his gaze towards Zhou Can was obviously not as cold.
"Okay, thanks for your advice!"
Zhou Can raised the corner of his mouth slightly. Is seamless suture so amazing?
He seemed to have learned it and used it many times on his patients.
Although not as good as Dr. Xu, his skills are pretty good and he sews the wound properly.
"Are the patient's vital signs all right?"
Dr. Ou looked at the anesthesiologist.
This operation, although it seems to be quite risky, is actually a level 2 operation.
Medium difficulty.
"The vital signs are stable. Can I wake up from the anesthesia?"
The anesthesiologist asked.
"Take him to the recovery room for observation. If there is nothing wrong, you can be transferred back to the general ward."
Dr. Ou took off his gloves and looked at Zhou Can and Jiang Xiaohua.
"You two will push the patient back in a moment. Observe him in the recovery room for about half an hour, paying special attention to his breathing and whether he is conscious. Within 24 hours after the operation, closely observe the patient's condition. This type of surgery can sometimes easily cause secondary hematoma, so be vigilant."
After explaining the precautions, he and the two residents left one after another.
The number of neurosurgery surgeries is relatively small.
Not as busy as general surgery and orthopedics.
Three thousand surgeries are performed a year, which means that on average, the entire department only performs about eight surgeries per day.
…
More than forty minutes later, Zhou Can and Jiang Xiaohua worked together to push the patient back to bed No. 24.
After all, the nanny was a paid employee.
He didn't even wait outside the operating room, but just lay on the patient's bed to rest.
To put it bluntly, even if the patient died it was none of her business.
If it is a family member, they will definitely wait anxiously outside the operating room. As soon as the patient is pushed out of the operating room, the family members will immediately surround him to ask about the results of the operation.
The babysitter was fast asleep.
Zhou Can had no choice but to pat her shoulder to wake her up.
"Auntie, Mr. Hao has now completed the operation and everything went well."
"Oh! The operation went well, right? I'll call his son to tell him."
The nanny took the cell phone and walked away to make a call.
Zhou Can and Jiang Xiaohua worked together to lift the patient onto the bed. They waited for the nanny to come back after finishing her phone call, gave her some instructions, and then left.
We have to notify the nurse to come and give the patient an IV.
It was still the head nurse named Hu Shuiling who was sitting behind the nurses' station.
The head nurse usually does less work when there are people under her command to do her bidding.
Only some patients with serious conditions will go and perform the operation in person if they are worried that ordinary nurses will mess it up.
"The patient in bed 24 has been transferred back to his original bed after surgery. Has the doctor's order been given?"
Zhou Can asked.
"Well, I'll go over right away and give him an IV and take his blood pressure and heart rate."
The arrogant female nurse looked up and saw that it was Zhou Can.
The originally cold face showed a hint of warmth.
It seems she still knows what is good for her.
Before, she had a quarrel with the female nanny. If Zhou Can hadn't helped her in time, she would have been complained about.
There may even be worse consequences.
So, she should be grateful to Zhou Can in her heart.
"You two, one of you will go to bed 31. The nurse said the patient just vomited violently. One of you will go to bed 22 with me."
Dr. Cheng hurried out of the office.
"Dr. Cheng and I will go to bed 22!"
When Jiang Xiaohua heard the patient vomiting, she frowned slightly and immediately pushed the job to Zhou Can.
