Chapter 176: Slowness can really cost lives.
It may be difficult for patients and their families to tell whether a doctor is truly capable.
But for doctors, they are all experts and can infer each other's strength after just a little contact.
The strength that Zhou Can showed slightly made the surgeon, Dr. Long, look at him with admiration.
I will never dare to treat him as an ordinary trainee again.
"I can't say for sure, but I'm at least 70% sure. If you want to be 100% sure, you can push the endoscope over here and take a look."
Zhou Can didn't dare to say anything too definitive.
It's always good to leave some room for everything.
Using an endoscope to explore unknown conditions in the chest and cranial cavities is definitely much safer than directly opening a large surgical window.
Temporarily adding endoscopic examination items during surgery means that the cost will increase.
There are many types of endoscopes, including electronic enteroscopes, small enteroscopes, capsule endoscopes, fiberoptic bronchoscopes, etc. Among them, the most expensive examination is capsule endoscopes.
In addition, the plan proposed by Zhou Can itself breaks the convention.
Using an endoscope to perform an examination after the thoracotomy is completed can easily lead to suspicion among family members.
Dr. Long was a little hesitant and was thinking about the feasibility of Zhou Can's suggestion.
"If the bleeding point is really under this rib, I'm afraid we need to remove this rib to complete the hemostasis surgery. Endoscopic examination is both efficient and foolproof."
Zhou Can watched the patient's blood pressure drop rapidly and felt worried for Dr. Long.
People who are indecisive are actually not suitable to be surgeons.
During the operation, the situation changes rapidly and any dangerous or emergency situation may occur.
There may only be one or two minutes of golden time to save a patient's life. If you delay for too long, by the time you come up with a foolproof plan, the patient may have already passed away.
I believe that when the patient goes to heaven, he must be complaining in his heart, thinking how unlucky he is to meet such a slow doctor.
"Check the endoscope immediately!"
After Zhou Can's strong persuasion, Dr. Long finally stopped fussing and made the necessary decision.
The two assistants watched all this with extremely complicated feelings.
It's ridiculous that the chief surgeon was actually directed by a resident trainee.
Moreover, the two of them felt that it was right for the surgeon to follow the advice of the intern.
The endoscope was pushed over.
After turning on the machine, a series of preparations were carried out and then the bleeding in the chest cavity was quickly checked.
Dr. Long's technique of operating the endoscope was obviously a bit immature.
Compared with Zhou Can, it's far behind.
Like a baby taking his first steps, he manipulated the endoscope probe to carefully explore the chest cavity.
Zhou Can felt depressed again.
Fortunately, this patient has a strong life, otherwise he would have died long ago.
"The bleeding point should be in this section!"
Zhou Can had no choice but to help Dr. Long narrow the scope of the investigation again.
Dr. Long would definitely lose face.
However, the patient's life was already hanging on the edge of a cliff, and Dr. Long's nerves were highly tense. At this time, Zhou Can pointed out the specific range of bleeding to him, which was like a bright light, guiding him on the way forward.
He carefully operated the endoscope and moved it slowly towards the target location.
There are many important organs in the chest cavity, such as the liver, heart, and lungs. Injuring any of them could lead to irreversible consequences. He had a reason to be so careful.
It’s not entirely because of my poor technical skills.
“Swish!”
A red curtain appeared on the screen.
It was like blood raining down on the endoscope probe.
Doctor Long was overjoyed, "Found it, found it! The bleeding point is right here!"
The other medical staff all breathed a sigh of relief, with relieved smiles on their faces.
Only Zhou Can was indifferent to this result.
Because he had already diagnosed it, the endoscopic examination now was just to reassure the surgeon, Dr. Long.
"The blood vessel seems to be severely ruptured. I'm afraid it needs to be re-anastomosed."
Zhou Can stared at the endoscope screen, and after looking at it, he made a treatment plan in his mind.
This blood vessel is so thick, the area it supplies must be quite large.
If the bleeding is stopped by direct and rough ligation, the area it supplies will suffer from severe malnutrition even if ischemia and necrosis do not occur.
It is equivalent to cutting off one of the important main roots of a tree, which will definitely affect the growth of the tree.
In reality, the human body is more complex and much more fragile than a tree.
In terms of tenacity of life, plants are more than ten times stronger than humans.
"Damn it, if I had known the bleeding point was here and that the rib needed to be removed, I should not have made the incision here." Doctor Long cursed while marking the bleeding point.
The wound was then rapidly enlarged and the ribs sawed off.
Removing this rib is not as easy as it seems. Separating the rib from the surrounding tissue is a delicate job.
Dr. Long's separation technique barely touches the threshold of attending physician, and in fact has not yet reached the level of attending physician.
Seeing him separating the surrounding tissues so slowly and carefully, one knife at a time, Zhou Can became anxious again.
Even with autologous blood transfusion, it still takes time.
It is even more impossible to input infinitely.
If the bleeding is not stopped in time, the patient will become increasingly dangerous, and the risk of postoperative complications will also increase significantly.
The human blood system is very amazing. For example, for patients with high blood pressure, many people who do not understand medicine would naively think that high blood pressure is just too much blood in the blood vessels.
If we cut a wound on the patient and let out some of the blood, wouldn't it return to normal?
If you encounter a doctor who advocates this kind of treatment, do not hesitate to call the police immediately. In all likelihood, he is a charlatan, a fake miracle doctor.
The human body's blood accounts for about 8% of body weight.
A 100-pound adult has about 4,000 milliliters of blood. If a 200-pound fat person has 8,000 milliliters of blood in his body, it's not surprising.
The normal blood volume of most adults is around 5,000 to 6,000 milliliters.
Taking an adult with 4000 ml of blood as an example, only about 70% of the blood in his body is actually involved in circulation, and at most no more than 80%.
The remaining 30% of the blood is stored in various tissue cells in the body.
When our body is injured and loses 500 ml of blood, do you think the blood in the blood vessels will decrease?
Won't.
When the body's blood system senses that the blood in the blood vessels has decreased, it will quickly mobilize body fluids to replenish it.
Most of our human body is water.
The water content of newborns may be as high as 80%, while that of adults is slightly lower, at around 60%.
Therefore, theoretically, even if the body loses 4000 ml of blood, if this process is not in a very short period of time, our body can replenish the lost blood and always maintain it at 4000 ml.
Of course, since it is body fluid replenishment, the total amount of blood has not changed, but the blood concentration has been diluted.
There will definitely be problems with your body.
The loss of red blood cells, white blood cells and platelets, albumin, globulin, coagulation factors, electrolytes and other trace elements cannot be replenished quickly by body fluids.
This will cause disruption to the body's entire circulatory system.
The consequences are very serious.
Theoretically, donating about 200 ml of blood each time is harmless and beneficial to the body. Donating more than 400 ml of blood at a time may cause certain harm to the body.
Frequent blood donation in a short period of time also has many harmful effects.
According to scientific judgment, it is harmless for adults to donate blood once every six months or so.
The patient on the operating table was bleeding profusely and had already lost a lot of blood, so his condition was actually quite dangerous.
Dr. Long must have realized this, as sweat kept pouring down his forehead as he separated the tissue around the ribs.
Time passed by little by little, and Zhou Can was able to do better and faster than Dr. Long.
However, his status as a trainee and a newcomer meant that he had to sit back and wait for the opportunity.
If you try to show off in front of a senior doctor, you will only be asking for trouble unless you get the approval of that senior doctor.
"The patient is dying! How long will it take to stop the bleeding?"
Doctor Guan remained silent.
At this moment, seeing that the patient's vital signs were getting weaker and weaker, like an oil lamp that was about to go out, Doctor Guan was really anxious.
"It's very difficult to separate this rib from the surrounding tissue. If we rush, we might damage important blood vessels and nerves. Doctor Guan, please find a way to hold on for a while."
The surgeon and the anesthesiologist are like comrades fighting side by side.
One person is responsible for covering and the other is responsible for charging.
"Ask the blood center if they can get two more bags of plasma?"
Doctor Guan said to the nurse on duty.
"I'll ask right away!"
The nurse called to urge the plasma to be drawn.
Sometimes when we encounter some rare blood types, there is really not much plasma in stock.
This is a provincial tertiary hospital like Tuya. If it were a small hospital, it would have called around to borrow money.
After about a minute, Dr. Long's expression became extremely solemn and his movements almost completely stopped.
When Dr. Long saw this situation, he almost stamped his feet in anxiety.
The medical staff nearby were also nervous when they saw this.
The surgeon, Dr. Long, seemed to have encountered a problem.
Under normal circumstances, it doesn't matter if the surgery is done slowly.
Because slow work produces fine results.
But now the patient is suffering from severe chest bleeding, time is life, and I am afraid the patient cannot afford to waste it.
The medical staff didn't even dare to breathe, and just hoped that Dr. Long could quickly overcome the difficulties in the operation.
"Damn it, the more you fear something, the more likely it is to happen . There are so many blood vessels and nerves here that it's too difficult to separate them. Normally, I would be able to do it successfully if I took my time. Now I'm under so much pressure and I'm so nervous that I can't perform at my best. I'm afraid I can only ask Director Hu for help."
Doctor Long cursed while trying to save his face.
Gave a fairly plausible explanation.
Director Hu Kan is the stabilizing force in the hearts of all doctors in the cardiothoracic surgery department.
Whenever we encounter problems during an operation, the first thing we think of is asking Director Hu Kan for help.
Known as the 'steadiest scalpel', it has never disappointed cardiothoracic surgeons.
"Director Hu was invited by the Department of Obstetrics and Gynecology to preside over a joint operation. I'm afraid he can't make it now." said the operating nurse.
This news made Dr. Long feel like he was falling into an ice cellar.
My heart was sinking.
The better surgeons in the cardiothoracic surgery department have inherited Director Hu Kan's characteristic of "steady knife".
While pursuing stability, the surgical process will inevitably become slower.
There are no perfect people or things in the world.
Where there are advantages, there must be disadvantages.
"I remember that Dr. Zhou seemed to do a very good job of separation."
At this critical moment, Dr. Guan spoke again.
Everyone's eyes turned to Zhou Can again. Who was this punished trainee?
The anesthesiologist seemed very optimistic about him.
Dissection is recognized as one of the most difficult surgical skills to master.
Incision and suturing are just common surgical skills, but separation is classified as an advanced medical skill.
Not many doctors can do it well.
"As a resident intern, he's lucky to get a chance to sew skin. He's pretty good at separating important tissues, blood vessels, and nerves."
Doctor Long's face was full of disbelief.
I almost told him that if this intern could successfully and safely separate the most difficult part of the rib, I would twist his head off and use it as a chamber pot for him.
"I saw him successfully perform difficult nerve and blood vessel separations in level 3 and 4 surgeries. He even performed surgeries near the brain stem. Do you think he has the ability to do this?"
Dr. Guan never pushed Zhou Can out because he wanted to save Dr. Long's face.
The operation has now encountered a major setback. If Zhou Can is not allowed to take action, the patient will be at great risk of death.
So he didn't dare to delay any longer.
"Doctor Guan, you can't cheat me!"
Dr. Long was somewhat skeptical.
"It's as if the patient's problem has nothing to do with me! Let him go quickly, it will be too late if you delay any longer."
Doctor Guan rolled his eyes.
With his status, does he need to lie?
Besides, this matter involves human life, who dares to take it lightly?
"Young man, don't just stand there, come here quickly. First separate the tissue that is adhered to the ribs and let me see." Dr. Long gritted his teeth and decided to let Zhou Can give it a try.
This decision is ridiculous.
If it were any other time, I would never be able to imagine it.
Zhou Can walked forward, without any further ado, asked the nurse to help him put on sterile gloves, took the scalpel, and started separating directly.
Swish!
After two cuts, Dr. Long's eyes were wide open.
Damn, this is not even the level of a trainee. It's not much worse than the director's ability.
The expressions of the other doctors and nurses were even more exaggerated.
They thought he was a rookie, but he turned out to be a bronze player. When they thought Zhou Can was a bronze player, he showed his king-level strength at the critical moment.
The shock it brought to them was truly astonishing.
After witnessing Zhou Can's stronger surgical skills, the operating nurse suddenly thought of the patient with chest wall laceration in the previous operation.
Zhou Can clearly stated at the time that the patient was prone to large-scale tissue ischemia and necrosis.
Neither Dr. Duan nor Dr. Zhao listened to him.
Doctor Zhao was so angry that he punished Zhou Can to stay here and clean the operating room.
She couldn't help but worry about the patient. Now it seemed that the level of doctors Duan and Zhao was probably not as good as Zhou Can , so they failed to find the problem.
By then, if something happens to the patient, doctors Duan and Zhao will probably regret it to death.
Because it was a medical emergency.
The doctors involved must take responsibility.
"Keep going, keep going! I've never seen anything like this before. How could someone this talented be just a regular trainee?"
Doctor Long no longer cares about face at all.
After witnessing Zhou Can's separation ability, all that is left is worship and respect.
Many people think that strength is respected only in the jungle law environment. In fact, in society, those with strength are often more likely to gain the respect and worship of their colleagues.
Zhou Can was not polite either, because the patient's condition was critical.
With a few cuts on his hands, Zhou Can easily separated the tissue part that Dr. Long considered to be a "major difficulty".
After the ribs were removed, Zhou Can took a look at the bleeding blood vessels.
A very thick artery.
Blood was still gushing out.
"Needle holder, No. 7 thread. Pointed forceps."
Zhou Can said to the nurse.
When the operating nurse looked at him now, there were many little stars in her eyes.
Without saying a word, he followed Zhou Can's instructions, prepared the required equipment and handed it over.
Doctor Long had no intention of stopping it.
After witnessing Zhou Can's amazing knife skills and superb separation techniques, Dr. Long knew that there was a huge gap between the two.
He wants to see what Zhou Can will do next?
A thread this thick is definitely not for anastomosis.
The sutures used in surgery are generally sizes 1, 4, and 7.
The larger the number, the bolder it is.
Zhou Can took the thread and directly ligated the proximal end of the ruptured artery. The whole action was smooth and easy, just like drinking water or eating.
Although the operation seems to be "careless", the effect of ligation is very good.
It is neither loose nor tight, just right to hold the blood vessels and prevent the blood from flowing out.
Moreover, the traction on surrounding tissues when tying the knot is almost negligible.
How good is Zhou Can's separation technique? They may not know the depth of it because their own separation technique is too poor. They only know that Zhou Can's separation technique is better than Dr. Long's.
Suturing and knot tying are basic skills that every surgeon must learn.
The skills I practice the most are knotting and suturing.
Surgery is all about cutting and repairing.
The lesion was removed and the wound was sutured.
Therefore, once you have mastered suturing, you can use it at any time. In addition, knotting and suturing can be practiced with a variety of props, and compared to other medical skills, they are generally of a higher standard.
They think their knot-tying skills are pretty impressive.
When they compared themselves with Zhou Can, they realized how big the gap was.
The highest level of any surgical skill is not how gorgeous the surgical movements are, how neat the incisions are, or how accurate the suture holes are arranged like computer prints.
But just right, just right is the highest state.
Too much is too little, and too little is inferior.
Just right is the highest state.
Zhou Can's ligation location, tightness of the knot, and pulling force are all just right. This kind of surgical effect is the ideal state pursued by doctors, and the harm to the patient after the operation is minimal.
