Chapter 175 This training is not ordinary, autologous blood transfusion
[Pathological diagnosis experience value +1. ]
After Zhou Can gained 1 diagnostic experience point, he became more certain that his judgment was correct.
Then we must tell the two senior doctors in time.
[Congratulations on your pathological diagnosis reaching level 4. Current experience value: 1/10000, lower level of main treatment. You can diagnose various more complex diseases, with a certain probability of dialectically identifying hidden diseases and a small probability of dialectically identifying complications.]
Zhou Can did not expect that the pathological diagnosis would be upgraded at this moment.
Originally, his pathological diagnosis was only at the middle level of a resident doctor. It was only after eight months of hard work in the emergency department, orthopedics, and neurosurgery that he was able to improve his pathological diagnosis from the lower level of a resident doctor to the middle level.
He was able to advance to level 4 this time thanks to the successful diagnosis of three extremely difficult cases in the critical care department, plus several ordinary difficult cases, including hidden cases.
Comorbidity means that there may be multiple lesions at the same time under the same symptoms.
One disease can represent many illnesses and is the most difficult to diagnose.
Even senior residents can easily miss such cases when they encounter them.
"Pathological diagnosis has finally been upgraded to the attending physician level. Calculating the time, the one-year regular training period will be completed, and I can apply for the practicing physician certificate."
According to the requirements, to take the medical license exam, you need one year of work experience after graduation.
Zhou Can has been undergoing regular training for eleven months now, and it is estimated that he will be able to obtain his medical license during his time in cardiothoracic surgery.
The pathological diagnosis has now been upgraded to level four, which will be of great help to him in taking the medical practitioner certificate exam.
Then the practical skills test was even easier for him.
Three months of regular training in the critical care unit, coupled with surgical experience in multiple departments, was enough for him to easily pass the medical license examination.
For many trainees, getting this certificate is like a chasm.
Many people fail the exam and are eventually forced to change careers or work in administrative positions.
It's just like the saying goes, it's not difficult for those who can do it, and it's not difficult for those who can do it.
Zhou Can suppressed his joy at having his pathology diagnosis upgraded to level four and looked towards Doctor Zhao.
"etc!"
Since it concerns the patient's safety, Zhou Can must remind them.
"What do you want?"
Doctor Zhao had just stood at the operating table and was about to complete the finishing work when he was interrupted. He looked very unhappy.
"You seem to have overdone the electrocoagulation to stop bleeding. I'm worried that it will cause tissue ischemia and necrosis."
Zhou Can raised this question reluctantly.
Upon hearing this, Dr. Zhao's expression changed immediately.
It was just a little cold just now, but now it is cloudy and frighteningly dark.
Even Doctor Duan didn't say anything, but this resident trainee actually found fault with him. How presumptuous and arrogant!
"How do you determine that it will suffer from ischemia and necrosis? You just speak without thinking. Newbies like you like to be surprised by things that are not even real and worry about things that may not happen." Doctor Zhao was quite annoyed.
He almost pointed at Zhou Can's nose and scolded him.
Finding fault with your superior doctor is very dangerous.
If Zhou Can hadn't really had no other choice, he really wouldn't have cared about such matters.
Doctor Duan did not rush to express his opinion, but stared at the patient's wound.
"Although the electrocoagulation technique was a bit rough, there was no obvious problem. As for the damage to some normal tissue, this is a normal phenomenon, and there is no need for you to make a fuss. The principle of electrocoagulation hemostasis is to use the principle of high temperature to form scabs on the blood vessels, thereby stopping the bleeding. It is inevitable that there will be improper control during the operation, causing damage to the surrounding tissues. Our human body has a very strong recovery ability and will recover quickly, so don't worry."
Doctor Duan's tone was relatively gentle.
He even patiently explained to Zhou Can the principle of electrocoagulation hemostasis.
He would never have imagined that this young man's hemostasis skills were better than his.
"But this patient has a lot of damaged tissue. If we just sew it up like this, if it causes ischemia and necrosis, the consequences will be very serious."
Zhou Can emphasized his tone.
"Okay, okay, facts speak louder than words. You will understand after this patient is discharged . As doctors, we must have a reverent respect for life and be bold and careful. If we are timid, we cannot be a good doctor."
Doctor Duan stopped Zhou Can from dwelling on this topic any further.
“Sew it up!”
He asked Dr. Zhao to suture the wound directly.
This incident also shows that every doctor has a different level and different perceptions.
Zhou Can had clearly pointed out the problem, but Dr. Duan was like a blind man and couldn't find it at all.
On the one hand, he thought Zhou Can was just a resident intern with no surgical experience, and his suggestions were totally out of order. On the other hand, in Dr. Duan's opinion, this was how he had always done it. It was fine before, and it would be fine this time.
Dr. Zhao’s suturing skills are OK, probably at an average level for a resident doctor.
It's still a little short of the excellent level of residency.
After the wound was sutured, Dr. Duan checked it and nodded with satisfaction.
"Well, the stitches are done well. After you wake up from the anesthesia, you can be sent directly back to the ward to recuperate."
The operation has been completed, so we can leave.
"Xiao Zhou, in order to prevent you from making a fuss next time, I will punish you to stay in the operating room all day and help the nurses clean up. This will also give you some experience and let you see how performed, so you don't make a fool of yourself."
Doctor Zhao was annoyed that Zhou Can found fault with him, so he decided to give him a light punishment so that Zhou Can would remember it.
Punishing him to stay in the operating room to clean is like killing two birds with one stone.
It can not only impose punishment, but also allow Zhou Can to observe other doctors' operations.
Doctor Duan ignored the matter, said nothing, and just left.
Zhou Can stayed in the operating room to clean.
Because there was only one instrument nurse for this operation, and no patrol nurse or hand-washing nurse, the task of cleaning was entirely given to Zhou Can alone.
After Zhou Can finished cleaning, it wasn't long before doctors and nurses rushed to the operating table pushing the patient.
"Hey, why is it a male nurse?"
The surgeon in charge was a male doctor in his 38s or 39s with gray hair. He looked quite elegant and energetic.
He was stunned when he saw a strange young man standing in the operating room.
"He's not a nurse. He seems to be a new intern. Doctor Zhao asked him to stay in the operating room to clean for a day and watch other doctors perform surgeries to gain some experience."
The operating nurse was the same one from last time.
She quickly explained.
The other medical staff's eyes immediately changed when they looked at Zhou Can.
We are all very smart people.
The intern was assigned by the senior doctor to clean the operating room. Even a fool would understand that this was a punishment.
Only the anesthesiologist carrying the box looked at Zhou Can with a somewhat surprised expression.
He even nodded slightly at Zhou Can as a greeting.
"Quick, get the patient onto the operating table! Doctor Guan, give the patient anesthesia immediately."
Judging from the situation, the condition is very critical.
Zhou Can also went over to help. After all, it was just a free operation, so the surgeon definitely wouldn't mind having one more person to help.
Zhou Can knew this anesthesiologist named Dr. Guan.
Because Zhou Can has performed many operations, including many major operations above level three.
Dr. Guan can often be seen performing general anesthesia for some major surgeries.
In fact, anesthesiologists are divided into three levels, just like ordinary doctors: resident, attending, and director. Different qualifications are required for different anesthesia surgeries.
At the same time, anesthesiologists will also take apprentices like ordinary doctors.
Various surgeries with serious complications of the heart, brain, lung, endocrine system, or other systems, or surgeries with high risks according to preoperative assessment, require the chief or deputy chief anesthesiologist to preside over the anesthesia.
They assess the risks of the entire perioperative period and only perform the operation when they believe that the safety factor meets the requirements.
Otherwise, even if Wu Baihe and Hu Kan, the bigwigs of the department, developed a surgical plan for the patient, the anesthesiologist would find the risk too high after evaluation, and the surgery would have to be shelved.
Or wait until the patient meets the surgical criteria and then perform elective surgery.
Therefore, the status of anesthesiologists is not low.
Moreover, they are well aware of the human body's breathing, nervous system, blood system, and the functioning of various organs.
Each of them is a hidden master.
The only thing that people criticize is that the Department of Anesthesiology is a sub-department and its salary cannot be compared with that of doctors in important departments.
They seem to be insulated from fame.
No matter how great a chief anesthesiologist is, he is only known to people in the industry. As for patients and their families, they only know the name of the surgeon in charge.
They seldom care who the anesthesiologist is.
Doctor Guan should be at least a senior anesthesiologist. The fact that he could personally perform anesthesia surgery meant that it was not easy.
At least the risk is high.
What disease did this patient have? The patient looked pale, restless, with cold sweat pouring out of his forehead and difficulty breathing, indicating that the patient was in great pain.
After removing the cloth from the patient's body, obvious external injuries can be seen between the ribs.
Zhou Can immediately understood that the patient was most likely suffering from chest bleeding, accompanied by a large amount of fluid in the chest cavity.
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 patient to a life monitoring probe.
Originally, there was a need to establish central venous pressure monitoring. Now the situation is urgent, so we only monitor heart rate, blood pressure, respiration, and body temperature.
"Doctor Zhou, can you help me insert the trachea and put me on the ventilator?"
Dr. Guan was overwhelmed and the patient's condition was getting worse.
In order to save anesthesia time, he had to ask Zhou Can for help.
Others may not know Zhou Can's abilities, but Dr. Guan knows them very well.
In particular, Zhou Can's glorious deeds in the Department of Critical Care Medicine were known not only to the medical staff in the Department of Critical Care Medicine, but also to most doctors in the Department of Anesthesiology.
Because many doctors in the critical care medicine department are transformed anesthesiologists.
For example, Dr. Shi was an anesthesiologist before, but later switched to life science. He was always thinking about how to provide better life support for patients and how to save patients at the critical moment of life and death.
Any news can easily reach the ears of former colleagues in the Department of Anesthesiology.
The other medical staff were all surprised when they heard Dr. Guan ask Zhou Can for help.
It seems that Dr. Guan is quite familiar with this resident intern who was punished!
Tracheal intubation is not too difficult, but it is still a little difficult to complete it quickly and accurately.
The operation of a ventilator is relatively easy to learn, but the adjustment of parameters is a test of a doctor's level and experience.
Amid the confused gazes of the crowd, Zhou Can quickly stepped forward and intubated the patient.
At this moment, intubation is a very difficult task when the patient is in an agitated state.
Zhou Can completed the tracheal intubation with ease.
Tracheal intubation is to insert a special endotracheal tube into the trachea through the mouth and glottis. It can also be inserted from the nasal cavity, depending on the specific situation.
The patient's current condition is more suitable for oral intubation.
At least it's more comfortable than nasal insertion.
The patient was already restless and it was not easy to get him to cooperate.
After the intubation was completed, Zhou Can began to skillfully adjust the various parameters of the ventilator. The three months of work in the critical care department were not in vain, and now he is able to operate these instruments with ease.
The experience is also very mature.
You can clearly understand the adjustment of various parameters.
There is no wasted journey in life, every step you take counts.
He underwent three months of regular training in the Department of Critical Care Medicine, and only after graduation did he discover the enormous benefits.
It can be used in many occasions.
Moreover, the high mental tension when working in the intensive care unit is a very good training for his character.
"alright!"
Zhou Can calmly retreated to the most inconspicuous spectator position under the operating table.
He had just intubated the patient and earned 1 insertion experience point.
As long as you stay in the operating room, you can always get something.
“So cool!”
"The intern's actions just now were too coquettish!"
"It turns out that tracheal intubation can be so simple! I must try it again next time!"
The other medical staff were all stunned.
Zhou Can's performance was so eye-catching that it even gave people the illusion that tracheal intubation was particularly easy.
"Anesthesia was successfully administered and surgery can be performed."
As Dr. Guan finished speaking, the surgeon had already stood at the operating position and made an incision between the patient's ribs. Then he cut open the layers one by one until the pleural membrane could be seen.
A lot of blood has accumulated inside.
"Let's drain some of the blood first. The bleeding point should be between the ribs."
The surgeon spoke as he performed surgery on the patient.
He was quickly looking for the bleeding point.
However, the environment inside the chest cavity is complex and there is residual blood, so it is not easy to find the bleeding point.
The surgeon selected this incision site after a preoperative examination, and the bleeding point was roughly located at this position.
After opening a window in the chest cavity, we discovered that the bleeding point was much harder to find than we had imagined.
The surgeon was so anxious that sweat broke out on his forehead.
In just a 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! His breathing is also giving warnings. We need to speed up the operation!"
The anesthesiologist looked anxious.
According to the examination results, the type of chest bleeding in this patient should be chest wall vascular injury.
The bleeding points of this type of injury are mostly in the intercostal arteries, veins and intrathoracic blood vessels.
Because it belongs to the systemic circulation and has high pressure, bleeding is mostly continuous.
Without surgery to stop the bleeding, it is almost impossible for the bleeding to stop automatically.
Zhou Can picked up the patient's examination report and looked at it carefully. At this time, everyone was trying their best to save the patient, and no one cared about him.
The patient underwent coronary angiography, but no bleeding was found.
X-ray chest examination showed a pleural effusion shadow on the injured side, the mediastinum shifted to the healthy side, and a fluid level was visible in the combined pneumothorax, and even the lungs appeared collapsed.
The incision is made on the injured side.
Where will the bleeding point be?
After reading the examination report, Zhou Can calmly checked the patient's wounds.
He already had the mid-level hemostasis skills of the attending physician, plus the 50% bonus to emergency life intelligence, and the newly promoted attending physician-level pathological diagnosis. The combination of these three medical skills doubled Zhou Can's diagnostic ability and made him quick-witted.
No bleeding was visible, but the pleural effusion was rising.
This indicates that the bleeding point is relatively hidden.
The amount of bleeding must be considerable.
"Doctor Long, the patient has a special blood type, and we don't have enough plasma. Given the amount of bleeding, the three bags of plasma we have prepared are simply not enough."
The assistant reminded the surgeon.
This is like adding insult to injury.
The hemp rope breaks at the thinnest part, and misfortunes never come singly.
This operation, which originally had controllable risks, suddenly faced a huge risk of death.
If the amount of intrathoracic bleeding is large and cannot be stopped in time, the patient will die soon.
"Fuck, I've done so many open-chest hemostasis surgeries, and today I encountered a tough one."
The surgeon, Dr. Long, cursed.
The person who suffers the most stress during surgery is the surgeon.
Sometimes, the surgeon seemed to be in a state of rage, with a gloomy face in the operating room and scolding whoever he caught.
You can't blame them.
They were under too much pressure because of the problems with the operation.
In this situation, some minor mistakes made by assistants and nurses will be infinitely magnified in the eyes of the surgeon, and the surgeon may occasionally scold or even cry.
Many doctors and nurses who have participated in major operations say that the surgeon is the barometer of the operating room.
This is not an exaggeration at all.
When the surgeon is in a bad mood, others will usually reduce their presence to avoid being scolded.
"The bleeding point may be under this rib! The bleeding is so heavy and rapid, the most likely possibility is an artery rupture."
Zhou Can risked being scolded and shared his diagnosis results.
"You're a trainee, don't make trouble here!"
The assistant doctor winked at Zhou Can, telling him not to get scolded.
The instrument nurse looked at Zhou Can with sympathy.
This new doctor is really stubborn. He was punished for the last operation and now he comes out to talk too much.
How can a resident intern give orders when a senior doctor is performing surgery?
"The patient is bleeding heavily and the plasma is insufficient. You can use your own blood for transfusion!"
Zhou Can made another suggestion.
In some surgeries involving heavy bleeding, autologous blood can be transfused if the bleeding is not contaminated.
Tuya Hospital must have such equipment.
The blood recovery machine can collect, filter, separate, clean and purify the blood lost by the patient during surgery, and then transfuse it into the patient's body. Transfusing one's own blood has much lower risks than transfusing allogeneic blood.
Allogeneic blood transfusion may cause infection with hepatitis, HIV, etc.
In addition, allogeneic blood transfusion will suppress the patient's immune function, increase the risk of postoperative wound infection, and is not conducive to the healing of wounds in the body.
"Bring the blood recovery machine here immediately!"
After hearing this, the surgeon, Dr. Long, made an immediate decision.
The patient was bleeding heavily and was in critical condition, which made him a little dizzy.
Zhou Can's words really woke people up.
"Are you sure the bleeding point is under this rib?" Doctor Long felt that this unremarkable resident trainee was somewhat unfathomable.
He showed his extraordinary ability when he helped Dr. Guan intubate and put the patient on a ventilator.
The autologous blood transfusion proposed just now at the critical moment is also extremely wise.
