Chapter 179 Successfully helped the patient escape danger. Sorry, I am very unprofessional
This type of extracorporeal circulation is not an artificial membrane lung, that is called ECMO, which is much more complicated to establish.
It will only be considered for use when the heart and breathing have stopped.
The extracorporeal circulation that Zhou Can is now setting up for the patient is a form of life support that can maintain blood supply to tissues and organs throughout the body during open heart surgery.
Its principle is to use a series of special artificial devices to drain out of the body, manually exchange gases, adjust the temperature and filter it, and then return it to the body's arterial system.
This extracorporeal circulation machine is mainly used when the heart stops beating during surgery, or when both the heartbeat and breathing need to be suspended.
It was also because Director Xue considered the surgery costs too much for the patient, otherwise she should have established this extracorporeal circulation system from the beginning to ensure the patient's life safety.
If Zhou Can's operation speed had not been much faster than others this time, the consequences would have been difficult to predict.
Zhou Can connected the instrument and waited until the patient's nasopharyngeal temperature dropped to about 28°C. He then used a blocking forceps to block the ascending aorta below the innominate artery and injected cold cardioplegia solution into the root of the ascending aorta to stop the heart.
Dr. Guan was finally able to stop pericardial compression at this time.
Next, if the operation takes too long, cardioplegia solution is continuously perfused retrogradely through the coronary sinus approximately every 20 minutes to maintain the heart in a state of deep hypothermia.
It shouldn't take that long to just clip an aneurysm.
Zhou Can breathed a sigh of relief after successfully establishing extracorporeal circulation.
The patient's life is temporarily protected.
"Director Xue, you can hurry up and treat that venous aneurysm."
Zhou Can reminded kindly.
"Oh! OK!"
She began to clip the aneurysm in a hurry.
The extracorporeal circulation machine only simulates part of the heart's functions. It can supply oxygen and blood to tissues and organs in a short period of time, but it is definitely not enough for a long time. It will cause damage to the organs.
Once the artificial membrane lung is established, it can theoretically replace human heart and lung functions for a long time.
Therefore, ECMO is more advanced than the extracorporeal circulation machine and its startup fee is more expensive.
Its circulation system is more complicated to establish and requires multiple medical staff to operate simultaneously. They must also be highly skilled.
If a novice does this, the probability of something going wrong is extremely high.
After the patient's life was guaranteed, Director Xue was no longer so nervous during the operation. Her mentality became stable, and the clipping operation progressed much more smoothly.
Before long, she had successfully clipped this relatively complex heart aneurysm.
This is equivalent to cutting off its blood supply, and it will naturally no longer cause harm to the blood vessels.
Some people believe that clipping an aneurysm will cause vascular stenosis, which is pure nonsense. As long as the operation is done well, it will not affect the patency of the blood vessels at all.
After clipping the hemangioma, repeated blood flow tests are generally required to confirm that the aneurysm is completely clipped and the arteries are unobstructed before the chest can be closed.
She checked carefully several times and made sure there was no problem, then looked at Doctor Guan.
"Doctor Guan, the operation has been completed, but we need to clear the blood to check the effect of the operation. Do you think you can make the heart beat again now?"
"Okay! I'll try!"
Doctor Guan began to warm up the heart.
Gradually, the heart beats again and blood circulation in the body slowly recovers.
Fortunately, the patient's ventricular fibrillation had long disappeared and his heart was beating normally. The clipping of the aneurysm was also very successful.
After blood flow, it can be confirmed that it is completely clamped.
It can also be determined that the blood flow in this section of artery is unobstructed and has not been significantly affected.
Everyone breathed a sigh of relief, and their hearts were finally at ease.
Deputy Director Lu felt like he had been reborn from a calamity, his back was already soaked.
After all, the patient's heart problems were caused by him blocking blood flow to the brachiocephalic trunk twice in a short period of time.
"It's finally okay, let's close the chest!"
Director Xue was also quite frightened.
I guess she won’t take such a big risk when having surgery in the future.
All doctors are the same. Before something happens, they always think that it will be OK and there will be no problem.
Then after one or two incidents, I became less courageous.
They are acting more and more cautiously.
Deputy Director Lu and the second assistant worked together to close the patient's chest.
The sawed-open sternum needs to be re-fixed with steel nails.
Zhou Can watched them operate and felt very envious.
It's just that something happened, and now if I ask Director Xue for the opportunity to practice closing my chest, I'm afraid it will be difficult to get it.
He is not in a hurry.
This time, I left a very good impression on Director Xue, Deputy Director Lu and others, and I also showed some of my abilities. Are you still worried that you won't get the opportunity to practice in the future?
After the patient has finished closing his cavity and all the examinations are complete, start giving the patient anesthesia.
I don’t think he will wake up for a while.
The patient can only be pushed to the anesthesia recovery room and wait for him to wake up on his own.
Before Director Xue left, she turned and looked at Zhou Can.
"Dr. Zhou, thank you for today! If you are willing, I will transfer you to my team tomorrow, and I and the doctors in the team will take care of you."
Director Xue’s work reveals a woman’s considerateness.
She did not take Zhou Can away directly, which was a kind of respect for Dr. Zhao.
Although she was the chief physician and Dr. Zhao was just a resident physician at the bottom of the list, she still gave Dr. Zhao enough face.
When a leader maintains the dignity of other leaders, it does not necessarily mean mutual protection, but rather a form of self-cultivation.
Dr. Zhao is now Zhou Can's leader.
He punished Zhou Can. If Director Xue wanted to intervene, she only needed to say one word and Dr. Zhao would do as he asked.
But what would Dr. Zhao think?
Uncomfortable for sure.
Because of this incident, he might hate both Director Xue and Zhou Can at the same time.
So, her way of handling things is like a spring breeze and very smart.
Zhou Can would naturally be willing to work with a chief physician.
No matter which department he enters, if he can be personally guided by a director-level doctor, he can learn much more than other doctors.
This is also an important reason why he left other trainees far behind within a year.
"I do!"
Zhou Can agreed decisively.
"Okay, you'll report to my doctor's office tomorrow."
She was very happy to see Zhou Can agreed.
Because Zhou Can's ability is there, bringing him along to perform surgeries in the future is equivalent to having an additional senior anesthesiologist in the team who can provide life support for patients.
Doctor Zhao's order to punish Zhou Can was already irreversible. He looked at Zhou Can with a very complicated look, but ultimately did not withdraw the order.
…
The next day, Zhou Can went to report to Director Xueyan without saying anything.
In the large office, Director Xue had already made arrangements for Zhou Can's transfer.
"The patient who underwent the heart aneurysm clipping surgery yesterday has regained consciousness. All his vital signs are currently stable and the operation was very successful." Director Xue must have deliberately told Zhou Can about the patient's postoperative condition.
The patient is out of danger, and when she talked about it, a happy smile naturally appeared on her face.
"I need to go to the outpatient clinic to see a specialist this morning, and I have to attend a study session in the afternoon. I'm afraid I can't take you with me. I've already told Deputy Director Lu to take care of you."
Director Xue has arranged everything for Zhou Can.
It also took a lot of thought.
"thank you!"
Zhou Can was sincerely grateful to her.
Generally speaking, it was good enough that the chief physician agreed to take him in. How could he be so attentive and considerate in making all the arrangements?
Zhou Can was really touched by her sincerity towards him.
"Since you are new to this group, you can take a look at all the cases in this group first. If you have any questions, you can ask me or Deputy Director Lu in time. If we are not here, you can also ask Doctor Long and others."
Doctor Long, who was not far away, said quickly, "I should ask Doctor Zhou for advice. He is much better than me."
"Just be naughty!"
Director Xue smiled and rolled her eyes at him.
Doctor Long really wanted to tell Director Xue that Zhou Can was extremely capable in all aspects.
Even better than him, the attending physician.
His lips moved, but in the end, no words came out.
Because Director Xue wouldn't believe it even if I told her.
"Time is almost up. I have to check the medical advice of several important patients and then rush to see them. Doctor Long, please teach him the daily work of the department!"
After saying that, Director Xue began to hurriedly open the computer to check the medical instructions of important patients.
The medical instructions for ordinary patients are generally the responsibility of the attending physician and the chief physician.
In actual practice, it is basically the intern or resident physician who prescribes the medical orders, and then the attending physician will take time to check them at both work and home hours.
Any unreasonable or problematic medical instructions should be modified.
The only medical orders that the chief physician can personally handle are those for key patients, such as those who are in critical condition, have just undergone major surgery, or have many underlying diseases.
Only such important patients require the supervision of a chief physician.
It is much easier to prescribe medical advice for other patients, but all aspects need to be taken into consideration when prescribing medical advice for these types of key patients, and there are very few opportunities for trial and error.
So we must be extremely careful.
"Doctor Long, I'm sorry to trouble you!"
Zhou Can walked to Dr. Long and asked for advice humbly.
The daily work and focus of each department are different, so it’s always a good idea to learn more about them.
"Don't be so polite! We are all in the same group, so we should help each other. Let me first give you a brief introduction to the daily life of our cardiothoracic surgeons!"
Dr. Long was very polite to Zhou Can.
"In the morning, you are generally required to arrive at the hospital department around 7:30 and check the medical records, examination reports, treatment methods, medications, etc. of the patients in this group through the HIS system. Review what needs to be reviewed and prepare what needs to be prepared. You don't have a single surgical task now. For me, I need to be responsible for the surgery of some patients. For those whose conditions are not complicated, I will make a surgical plan and give it directly to Director Xue or Deputy Director Lu for review. For those whose conditions are complicated or difficult, I will take the initiative to consult them and work together to make a surgical plan."
Basically, every department has a similar workflow.
This was the case in the neurosurgery and orthopedics departments where Zhou Can had his internship.
"The anesthesia for the first surgery will probably be completed before 7:50, so if there is a patient you are following whose surgery is scheduled to start at around 8 o'clock, you must get the patient into the operating room around 7:40."
If you are sent to the hospital late, the anesthesiologist will rarely scold you, but it is hard to say for the surgeon.
If I'm in a bad mood, I can scold you until you bury your head in your pants.
"We do ward rounds around 7:50. Director Xue takes the lead in making ward rounds once a week, and they are all checking the cases of our group. Sometimes, Director Hu Kan may lead the ward rounds in person, so basically we have to follow and learn. During the ward rounds, the attending physicians and directors will listen carefully to the doctors in charge of the patients' conditions, so you must know the beds you are in charge of. Before the senior doctors make ward rounds, it is best to prepare all the examination results and medical records."
One of the most important tasks for the attending physician every day is to promptly and accurately report the patient's condition when the senior doctor makes rounds.
"After the ward rounds, around 8:10, the doctor handed over his shift. After handing over, he had to hurry up and write medical advice and discharge certificates for the patients he was responsible for. If he followed the resident doctor to stay in the ward, he would be responsible for preparing for surgery, changing dressings, and other tasks. If he followed the resident doctor into the operating room, it goes without saying that he would cooperate with the chief surgeon to complete the surgery."
Zhou Can basically understands these daily tasks.
"It is worth mentioning that an operation in our cardiothoracic surgery department usually takes a long time. It is common to start the operation around 9 am and end at 1 pm. After the first operation, there will be a short break for lunch before the next patient is operated on. There is also the handover of ICU patients, or sometimes there are emergency patients in a department who need ECMO , or CCU patients who give up treatment and ask to remove ECMO, and we have to rush over to help."
ECMO installation is usually done by the collaboration of surgeons and anesthesiologists.
Thanks to Zhou Can's three months of working in the critical care department, he has mastered the skills of installing ECMO and is fully capable of cooperating with the anesthesiologist to complete the task.
"As for you, you are very capable in all aspects. If the doctors in the team are too busy, you may be sent to the internal medicine department or emergency department for consultation."
This is considered a good start.
There are actually quite a lot of consultations that the cardiothoracic surgery department needs to participate in, and the staff here is often short of staff.
The consultation requires the participation of excellent doctors.
For consultations that are not too difficult, we often send an excellent resident doctor to take part.
Although Zhou Can is only a resident intern, his ability is there. If he is sent for consultation, he is no worse than an excellent resident.
Of course, he had just entered the cardiothoracic surgery department and had not even been trained for two days, so he would definitely not be sent for a consultation now.
If something goes wrong or becomes embarrassing, it will bring shame to the cardiothoracic surgery department.
After introducing the daily work tasks for the day, Dr. Long helped Zhou Can log into the HIS system and taught him how to check the cases of this group.
…
Zhou Can was eager to learn and carefully looked through the case records of this group.
This is the fastest way to learn.
Because there are the most authentic records of every patient's symptoms, cause of disease diagnosis, examinations done, treatments used, and treatment effectiveness.
For each case he reads, his pathology diagnosis experience value increases by 1.
Deputy Director Lu also had a consultation duty in the morning, and Zhou Can stayed in the inpatient department to manage the patients in his group. The morning passed quickly.
After lunch, he went to the ward to check on the conditions of the patients in the group and heard the family of the patient in bed 19 shouting there.
"Nurse, nurse, my son still feels pain in his chest after the operation. Can you please prescribe some painkillers for him?"
"Didn't you just use painkillers this morning? You can't keep using them! Your son is a real man. It's normal for him to feel some pain after waking up from the anesthesia. Let him bear with it!"
Nurses do not have the right to prescribe medicines; medicines must be prescribed by a licensed doctor.
And as she said, painkillers can't be used all the time.
This is a safe dosage.
If you really want to use it, you have to wait until the body has gone through a metabolic period before asking a doctor to prescribe painkillers.
She almost told the family members directly to tell their son to stop being so spoiled.
After hearing this, Zhou Can looked at the family members and the patient with some sympathy.
It is normal to feel pain after waking up from anesthesia. However, the pain experienced by this patient is not necessarily normal. It may be abnormal pain caused by tissue ischemia and necrosis.
This kind of pain is like cutting flesh with a slow knife, which is very torturous.
The patient's beautiful wife was operating her mobile phone constantly, checking the medical records from time to time.
Zhou Can almost fainted.
She also used Baidu to solve the problem on her own.
Are women with big breasts really brainless?
Her behavior is really ridiculous.
But it's good to let her learn a lesson, so that she won't be willing to trust Baidu instead of the doctor next time.
When Zhou Can finished checking on the patients in this group and came out, the patient in bed 19 was in so much pain that he was throwing a tantrum.
He is the only son in the family and his family conditions are also very good.
She has been pampered since childhood.
Now that he has suffered so much, it is inevitable that he is a little manic.
"Doctor, doctor, my son is in so much pain, please help me!"
When the patient's mother saw Zhou Can passing by, it was like she had grabbed a life-saving straw.
The patient's beautiful wife seemed to realize at this time that Baidu was unreliable and could not solve the problem at all.
She also stood up and was willing to cooperate with the doctor for the first time.
Unfortunately, Zhou Can is no longer responsible for this patient.
Moreover, this woman would complain and make accusations all the time, so Zhou Can was even more unwilling to offend her.
"I'm sorry, I'm just a resident doctor and I'm not very professional. I can't handle it, and I'm not responsible for the patient in this bed. I can help you notify the nurse."
Zhou Can refused directly.
Are you kidding me? Last time you told me to go away, I did. Now you want me to come back, sorry, I'm going to go away.
If you have any problems, please ask the attending physician or nurse to handle it yourself!
"What kind of attitude do you have? My husband is in so much pain, but you are shirking responsibility like this. Believe it or not, I will file a complaint against you right now."
The patient's beautiful wife was furious.
"Very unprofessional" was how she evaluated Zhou Can when she complained to Dr. Zhao.
Now Zhou Can used this as a shield, and she was not stupid, so she naturally understood that Zhou Can was deliberately speaking back at her.
So she was very angry.
Maybe this woman acts a little arrogantly because she relies on the power and good financial conditions of her husband's family.
Almost all people with a little power have this problem.
When they encounter something they think is 'unreasonable', they always get angry.
Zhou Can stared at her pretty face with a serious expression, and then his eyes met her bright eyes.
"It's your right to complain. I have other patients to deal with. Bye!"
Different times, different circumstances.
Zhou Can is now appreciated by Director Xue and others, and this patient is indeed not his responsibility. He is really following the procedures in doing this, and no one can find fault with him.
