Chapter 148: Female patient suffering from domestic violence, first endoscopic surgery
“It hasn’t started yet!”
Doctor Zou and Tang Li answered in unison.
The attending physician usually conducts ward rounds after 7:40. However, this is not fixed and can be flexibly arranged according to the attending physician's own schedule.
In principle, ward rounds should be conducted once every morning.
Because there is only a doctor on duty at night to deal with it.
On the one hand, there are not enough staff, and on the other hand, the doctors on duty are often of low rank and lack experience and skills.
This may result in some patients' sudden critical situations not being properly handled.
The attending physician can identify and fill in the gaps during morning rounds to avoid further risks.
"Well, then you guys hurry up and do the rounds. The first surgery will start on time at 8:30 this morning. We may not take a break in the middle, and we need to complete both surgeries in one go. At 4 pm, I will lead three graduate students to do scientific research experiments, and you will have to watch over them then."
Many professors in various departments have teaching tasks.
Or just work part time in a hospital.
In addition to leading their own projects and doing scientific research, they also have to go to school to attend classes.
It will be very busy.
…
The two attending physicians acted separately during their ward rounds.
Zhou Can made ward rounds with Tang Li, a resident doctor, and three graduate students.
Dr. Zou took two more experienced residents to check the beds he was in charge of.
All beds in the neurosurgery department are supervised by doctors. Many interns only need to supervise two to three beds. Residents in training generally supervise about five beds. Resident doctors who specialize in beds supervise ten to fifteen beds.
The attending physician will be responsible for more beds, and one person may be responsible for around 25-30 beds.
I must explain that the beds these people are eyeing overlap.
For example, Zhou Can is on beds 21 to 25, and Jiang Xiaohua is on beds 26 to 31.
Their superior doctor, Cheng Gang, is in charge of beds 21 to 31.
It can be seen here that the beds that are monitored by junior doctors need to be monitored again by senior doctors.
However, as the doctor's level increases, the number of beds he is responsible for also increases.
At the level of Director De Wen, one is often responsible for all patients in the entire group.
The chief physician makes rounds once a week. Some patients who are about to be discharged may not see the chief physician's rounds.
"Doctor Zhou, the number of patient beds in our group is not fixed. You just arrived, so you may not know."
Tang Li walked forward while giving Zhou Can some advice.
It is said that women have a powerful sixth sense.
Maybe that's true.
Tang Li must have felt that Zhou Can had a promising future, which was why she was willing to lower herself to befriend him.
"There are two attending physicians in our group, me and Dr. Zou. Usually, I check the ordinary beds in the group, and Dr. Zou is older than me and has more experience, so he checks the ICU ward."
The attending physicians in the group have clear division of labor during ward rounds, which helps to assign responsibilities to individuals.
Moreover, the doctor can provide better services to patients based on his/her personal ability and level.
Dr. Zou is about five years older than Tang Li.
The experience must be richer.
The patients in the ICU ward are all critically ill.
It would be safer to have a more experienced doctor check the ICU ward.
"Good morning, Dr. Tang!"
Cheng Gang was already waiting in the ward under his jurisdiction.
Seeing Tang Li and her group approaching, he immediately smiled and greeted them.
"morning!"
Tang Li seemed quite aloof to him. She just responded casually and started to check on the patients she was in charge of.
Cheng Gang looked at Zhou Can who was following behind Tang Li and couldn't help feeling complicated.
It can be seen that after Zhou Can was transferred to Director Wen's group, he was treated very generously.
This kid is so lucky, why don’t I have such good luck?
Cheng Gang was really envious.
"Doctor Zhou, this patient had surgery this afternoon. Doctor Zou was in charge. Her skull was fractured and sunken quite deep. Fortunately, her brain was not damaged."
Tang Li took the initiative to introduce to Zhou Can the patient who was about to undergo surgery today.
The purpose is to let Zhou Can know what is going on in advance.
Zhou Can found that the injured woman was in her thirties and had multiple bruises and purple spots on her face and hands.
How did he get injured?
It feels like being beaten by domestic violence.
Her head wound has been bandaged with gauze. The nurse should come two hours before the operation to shave her hair, clean the surgical area, and measure basic vital signs such as blood pressure.
"How did you get hurt?"
Zhou Can couldn't help but ask.
"I just accidentally fell and got hurt."
The woman's eyes were somewhat evasive.
"This fall is a blessing in disguise, because according to the examination results, if it had been a little bit longer, it would have caused serious damage to the brain tissue. The lightest damage would have been paralysis or intellectual disability, and if it was more serious, it might have been death."
Zhou Can didn't point it out, but just told her the possible consequences.
It's not possible to be so lucky every time.
There are only zero times and countless times of domestic violence.
Generally speaking, parents and brothers would not be so cruel.
It is most likely done by the woman's husband.
However, when Zhou Can was an intern, he was blamed by the woman for meddling in such trivial matters. Therefore, he did not ask too much.
Just a little bit.
The woman is in her thirties and is already an adult. She has to make her own decision.
After examining the woman with a skull fracture, we continued to examine other patients that our team was responsible for.
After a round of checking, I found that the conditions of some patients were shocking.
However, I did not see the patient who was in a car accident and needed surgery today.
He is probably staying in the ICU to save his life.
Some of the injured are in very serious condition and cannot be operated on for the time being. They may need to stay in the ICU for a while. Save lives first, then do the operation.
There is another situation where the patient's injuries are extremely serious and the condition is complicated.
To be on the safe side, doctors need to consult with multiple departments and then formulate a surgical plan after discussion.
After the ward rounds, Tang Li wrote some new medical instructions and adjusted the medications for some patients.
After the treatment was completed, he took Zhou Can and others into the operating room.
At this moment, the patient has been carried onto the operating table.
The anesthesiologist is carefully examining the patient.
Dr. Zou and two residents were watching on the side.
"You guys are quite fast!"
Tang Li said with a smile.
"There were only a few patients in the ICU. After checking, the three of us took the patient directly to the operating room."
Dr. Zou shrugged.
There are only twenty beds in the ICU, and there should not be many critically ill patients assigned to their group.
In addition, there are always dedicated attending physicians on duty in the ICU, so ward rounds are relatively just a formality.
Zhou Can looked at the patient on the operating table. He saw tubes inserted all over his body and dried blood.
The most seriously injured part would be the head.
The patient is currently in a coma.
At this time, Director Wen finally arrived.
"Is the patient in good condition? I estimate that this craniotomy will take at least four to eight hours. Can he withstand it?"
Director Wen was obviously asking the anesthesiologist.
"The situation is still relatively ideal. I rate his tolerance to surgery as low. However, if the intracranial hematoma is not removed, his life may not be saved. Therefore, I personally think it is still meaningful to perform surgery as soon as possible."
The patient was in a coma and has not regained consciousness till now.
This in itself is enough to illustrate the seriousness of the problem.
The ICU can only provide some basic life support, which does not mean it can save lives forever.
Patients often die in the ICU ward of Tuya Hospital.
And when the number of cases is high, it is normal for three or four people to die in a day.
Of course, some deaths occur because family members insist on removing the tubes.
After all, the cost of one day in the ICU is too high.
If the patient is elderly or has little hope, the family may feel that it is not worthwhile to spend too much money on rescuing the patient, and they will ask the hospital to remove the tube.
"Prepare for craniotomy and hematoma removal!"
Director Wen has spoken.
The examination report of this patient in the car accident showed that he had severe intracranial hematoma, which means that the intracranial hemorrhage was quite serious.
Craniotomy to stop bleeding and remove hematoma is a very active treatment method.
The patient was very young, only in his twenties.
I heard that he was racing with someone late at night and got into a tragic car accident, which led to his serious injury.
Zhou Can looked at the patient's X-rays and the situation was not optimistic.
Because this person had subtentorial hemorrhage.
Generally speaking, if the amount of hemorrhage above the tentorium is more than 30 ml, surgery is required. If the amount of hemorrhage below the tentorium is more than 10 ml, surgery is considered acceptable.
After the patient was under general anesthesia, Director Wen selected the craniotomy site, cut the patient's scalp, exposed the skull, and then used the electric saw directly.
Not long after the skull cut began, the anesthesiologist hurriedly called a halt.
"Director Wen, the patient's vital signs are rapidly declining. If we insist on opening the skull, 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 were all dropping rapidly.
This is a very scary sign.
During craniotomy, the patient's condition may worsen due to various reasons.
The patient at this time is like a candle in the wind.
If the wind blows a little harder, the flame of life will be extinguished.
Director Wen's face was as gloomy as water.
It is really difficult to save the critically ill patients in the neurosurgery department. Not only do we have failures, but they happen quite often.
When doctors perform surgery, they will try their best to reduce the mortality rate.
Because this involves multiple assessments and personal reputation.
Imagine that a chief doctor performs 100 operations and seven or eight people die. Who would dare to let this doctor operate?
Even though the hospital knew that the patients who died were extremely critically ill.
However, during the assessment, this high mortality rate will still be criticized by the vice president or even the president himself at the meeting. It is possible that a warning will be given or the surgery authority will be reduced.
An excessively high rescue mortality rate not only has a serious impact on the doctor himself and his team, but also has an impact on the overall evaluation of the hospital.
"It seems that the patient's condition is more serious than I thought! This matter is a bit difficult to handle!"
Director Wen stared at the rapidly declining vital signs on the life monitor screen and felt terrified.
Even if the operation is stopped now and the patient is transferred back to the ICU, it will still be difficult for him to survive.
"The intracranial hematoma must be removed, otherwise he will not survive. Traditional surgery does great harm to the patient. Before the operation, I had prepared for the worst and prepared a second surgical plan."
Director Wen actually made preparations for both scenarios.
No wonder he remained calm in times of crisis and remained so composed when the patient was in danger.
"Let's drill a hole and do endoscopic surgery! This should be the only way to save him!"
Endoscopic surgery only requires drilling a small hole in the skull, which causes little incision and little harm to the patient.
However, compared with traditional surgery, endoscopic surgery is extremely difficult to perform.
Tuya's neurosurgery department is actually very short of talent in this area.
Director Wen’s talent for advanced surgery is mediocre, which is the main reason why he prioritizes traditional craniotomy.
Traditional surgery pursues a broad surgical field of view.
The entire surgical procedure is simple and straightforward.
Endoscopic surgery is a very demanding operation on a doctor's part.
"Endoscopic surgery...is not our strong point. The patient has subtentorial bleeding, and the operation is extremely difficult. Will it be..." Tang Li hesitated to speak.
Not to mention her, even Dr. Zou looked worried, with a sad look on his face.
"There's nothing I can do if I'm not good at it! If it really doesn't work, I can only ask Director Zhang from the Department of Obstetrics and Gynecology for help. Among the chief physicians in our hospital, she is the best at minimally invasive surgery."
Director Wen has already thought of a way out.
Seeking help from other departments is a common practice when departments encounter critical or difficult cases.
This time, the patient's skull was drilled directly, the bone flap was broken, and a 1 cm incision was made. Then a cross incision was made on the dura mater.
Director Wen was very cautious throughout the whole process.
Even if the patient's vital signs continued to drop, we still dared not stop.
At this time, we must race against time to save the patient's life.
Fortunately, he had extensive surgical experience and was able to accurately locate the hematoma based on the CT images.
The next step is to carry out the most critical operation.
A rigid endoscope with a diameter of 6 to 8 mm needs to be introduced into the center of the intracerebral hematoma.
This is a great test of the surgeon's operating skills.
Because the brain is full of important tissues, any slight mistake can lead to serious consequences.
Director Wen carefully operated the endoscope to explore inside.
It was just that he had trouble getting into the center of the hematoma.
The brain stem area is nearby, which brings him great psychological pressure.
Sweat kept oozing from his forehead , and the nurse helped wipe it off.
Director Wen's hands were shaking slightly uncontrollably.
At this critical moment when time counts, every second of delay will increase the patient's risk of death.
The more this happened, the more pressure Director Wen felt.
Not to mention him, the chief surgeon, even Tang Li, Doctor Zou, and several residents beside him were all worried. They held their breath and dared not even breathe.
"Director Wen, can you let me try? I should be more than 80% sure."
At this time, Zhou Can did not choose to sit back and watch.
Actively volunteer.
Although such behavior may seem a bit arrogant and rude to outsiders.
"Are you 80% sure?"
Director Wen stopped operating and turned to look at him.
"Sure!"
Zhou Can's eyes were firm, full of confidence, and he appeared extremely calm.
"Okay, then, try it!"
Director Wen also knew that Zhou Can was very skilled in minimally invasive surgery. Under such circumstances, he decided to take a risk and let him try.
He himself stood by and watched nervously, ready to stop it at any time.
Zhou Can took the joystick of the endoscope, adjusted the angle slightly, and then manipulated the endoscope to go deeper.
The whole operation process is very stable.
And it's very accurate.
Long hours of practice in implantation helped him a lot.
"Okay! We have successfully reached the hematoma area. Shall we drain the blood now?"
Zhou Can asked.
As soon as he finished speaking, the doctors and nurses in the operating room all breathed a sigh of relief. Joyful smiles appeared on everyone's faces.
The most difficult hurdle was finally passed.
"Go ahead!"
Director Wen should be the most excited person.
The look he gave Zhou Can was like looking at a treasure.
Zhou Can manipulated the catheter of the endoscope to perform suction, and the blood accumulated in the cranial cavity was drawn out.
After the intracranial pressure was relieved, the patient's vital signs improved rapidly.
"It's rising, it's rising! All of the patient's vital signs are rising. That's great!"
The anesthesiologist was happier than anyone else.
Announce the good news in a timely manner.
