Chapter 217 Electrocoagulation perception ability, changes brought about by level 3 anesthesia
Zhou Can carefully felt the benefits brought by upgrading the hemostasis technique to level five.
At level 4, electrocoagulation hemostasis is more precise and flexible, and the patient has a preliminary ability to analyze the cause of bleeding.
At this moment, he found that electrocoagulation hemostasis was not only more accurate, but also during the hemostasis process, he could actually feel more clearly whether the bleeding had been controlled.
It may seem like just a small improvement, but it can provide him with an extra layer of safety when performing electrocoagulation hemostasis on patients.
There is no need to worry about the electrocoagulation time being too short, the bleeding not being stopped or the bleeding not being stopped firmly, and bleeding again after the operation.
There is no need to worry about excessive electrocoagulation causing necrosis of blood vessels and surrounding tissues.
In either case, secondary harm will be caused to the patient.
Needless to say, excessive electrocoagulation can cause tissue necrosis, which happens from time to time. It can cause the wound to not heal for a long time, and infection and suppuration are considered mild.
It would directly lead to multiple postoperative complications and even sepsis in patients, which would be terrifying.
I believe everyone has heard that when a limb becomes necrotic, amputation is required immediately.
In fact, any tissue in the body that shows significant necrosis should be removed immediately.
Otherwise, the massive absorption of necrotic toxins will often affect the loss of function of other organs. Respiratory failure, liver and kidney failure, etc. can easily take the patient's life.
Therefore, improving the ability of electrocoagulation to stop bleeding during surgery is of great benefit.
The tragedy of tissue ischemia and necrosis caused by excessive electrocoagulation will not occur.
In addition, incomplete electrocoagulation may lead to further bleeding after surgery, which is also a very serious hidden danger.
For example, a laparotomy was performed to remove a tumor in the abdomen.
Larger blood vessels will definitely be ligated to stop bleeding, but small blood vessels are mostly electrocoagulated to stop bleeding.
During the operation, the bleeding of medium and small bleeding points in the abdominal cavity was successfully stopped through electrocoagulation.
The doctor closed the patient's abdominal cavity and the operation was successful.
The patient and his family were very happy after hearing this.
But after one night, the patient's condition suddenly deteriorated. The doctor was confused because the operation was obviously successful! After a lot of trouble, he could not find any problem.
After taking the X-ray, it was found that the patient had peritoneal effusion.
The experienced chief doctor was horrified when he saw the patient. He rushed the patient to the operating room for emergency treatment. When he opened the abdominal cavity, he found it was full of blood. After investigation, he found that the electrocoagulation was not thorough, resulting in unstable hemostasis. Postoperative intraperitoneal bleeding occurred.
After strenuous rescue efforts, the patient was finally saved.
All the doctors breathed a sigh of relief.
In the future, they will be extra careful when stopping bleeding in the abdominal, thoracic, and cranial cavities.
This is just one of the most common examples.
The patient was very lucky to survive.
Some patients died directly from postoperative bleeding.
There have also been cases where patients became disabled and turned into a vegetative state due to bleeding after surgery.
This is why many high-risk surgeries require the surgeon to be an associate chief physician or chief physician.
Because the surgical skills of doctors who have reached the deputy director level or above are completely different from those of attending doctors. Only doctors at the deputy director level or above can ensure the safety of level 3 surgery.
Zhou Can's hemostasis skills have been upgraded to level five. In addition to the improvement of electrocoagulation hemostasis ability, there has also been a qualitative improvement in the analysis, diagnosis of the causes of bleeding, and selection of hemostasis methods.
For some bleeding spots, he only needs to take a look to roughly determine the cause of the bleeding, which part of the blood circulation system has a problem. How to solve it?
He has a very clear and intuitive understanding.
Some patients may have internal bleeding, such as intracranial hemorrhage, uterine hemorrhage, abdominal hemorrhage, etc. Zhou Can used to rely on examination methods to diagnose it.
Now, even if the patient does not take an X-ray, he can accurately infer where the patient's bleeding point is based on the symptoms described by the patient, the color of the local skin, whether the patient has blood in the stool, vomiting blood, and other symptoms.
It can even be used to infer what caused the bleeding.
In addition to the improvement in the hemostatic ability in the above-mentioned aspects, he has a more comprehensive and profound understanding of the entire blood circulation system of the human body.
Many things that were difficult to understand or didn’t make sense to me before are now clear to me.
This should be considered an improvement in theory.
After his hemostasis skills were upgraded to level five, Zhou Can did not become complacent, but continued to concentrate on performing surgery on patients.
It seemed like just an upgrade of basic surgical skills, but it made him more comfortable and at ease during surgery.
Surgery involves operating a knife on the patient, and bleeding is a problem that must be solved during the operation.
Having a powerful hemostatic technique is equivalent to having a strong safety guarantee.
This also made Zhou Can more confident and confident during the operation.
After completing this operation, another more special patient was sent in soon .
He is a 21-year-old boy.
There is a huge lipoma on the left side of my face. Because it was not treated in time, the tumor is now too large and has caused a series of serious symptoms.
Not only did the boy's left face look like a monster, but his left eye was almost blind.
The teeth in the mouth were also severely damaged, with only a few left.
According to the patient, even eating has become a problem.
He couldn't eat anything that was a little bit hard to chew, and he didn't dare to eat fish or meat with bones.
Because this huge tumor presses on his mouth, it is easy for him to be stabbed in the mouth by sharp food while eating, causing severe pain.
In addition, the tumor would compress his respiratory tract when he slept, causing difficulty breathing.
He couldn't sleep on his side, so he had to sleep on his back.
Any unconscious turning over at night could pose a huge danger to him.
Even when he entered the operating room, the young man wore a mask on his face. The tumor made his face extremely ugly and hideous, causing him to have a serious inferiority complex.
"Doctor, after the operation, will my face return to normal?"
The young man asked Mr. Liu hopefully.
"You can basically recover to normal, or at least be much better than you are now. But your facial lipoma is particularly large, so the risk of surgery is very high. It may bring a series of complications, even endangering your life, so you need to be mentally prepared for this."
Elder Liu said seriously.
The removal of superficial lipoma is usually just a minor surgery.
Many junior surgical residents like to encounter this type of patients because they can practice with them.
Removal of superficial lipomas is a relatively easy and risky procedure.
Senior doctors are also happy to leave training opportunities to their rookies.
The operation being performed was a level 3 major operation of extremely high difficulty, close to level 4.
Most deputy chief physicians do not dare to perform such operations.
Dr. Liu is a senior associate chief physician with extremely rich surgical experience and high surgical skills.
Although his title is associate chief physician, his surgical skills are at the director level.
"This tumor has been with me since I was a child. At that time, because my family was poor, I never received treatment. Now I like a girl, and she also likes me very much. But after the girl's family knew my situation, they firmly disagreed with their daughter being with me. I haven't made much money in these years. With the help of the media, caring people donated money to me, which gave me the opportunity to have this surgery. Even if the operation is risky, I am willing to try. My life now is a kind of pain, and it is worse than death."
The doctors and nurses felt deeply sympathetic after hearing the young man's story.
How many people, their biggest wish is just to be an ordinary person, to be able to live like a normal person.
Physical disabilities, physical defects, or incurable chronic diseases make patients live in pain. They need to face various discrimination, ridicule, and even bullying from society.
Studying, finding a job, and dating are much more difficult than for ordinary people.
As medicine continues to advance and technology becomes more and more advanced, the methods for solving these patients' physical defects or diseases are gradually becoming more abundant.
People who have lost their legs can get prosthetic limbs if it is just a low amputation.
After a long period of training, they are able to walk like normal people or pick up things with prosthetic limbs.
Not everyone is born with plenty of food and clothing.
Like this young man, because of his poor family background, if the media reporters hadn't helped him and reported his story, he might have had a hard time changing his fate in his life.
"Now that you've made up your mind, let's start the operation! Our doctors will definitely do their best to treat you."
Dr. Liu asked the patient to lie down on the operating table.
The anesthesiologist prepares to perform general anesthesia on the patient.
Zhou Can's anesthesia skills were only one point away from reaching level three, so this was a very good opportunity. He immediately went over to help.
Although this operation was only a level three operation, the anesthesiologist was Zhou Can's half-master, the silent and serious Dr. Feng.
This is enough to illustrate the danger of this operation.
Generally, anesthesia surgeries that require Dr. Feng to perform personally have extremely high risks.
"Lipomas are never simple diseases. They are usually closely related to internal organs. When performing anesthesia, we must take into account the various risks during surgery. For example, respiratory and cardiac arrest caused by anesthesia accidents, damage to surrounding large blood vessels during surgery, causing heavy bleeding, endangering life, etc."
Dr. Feng taught him some very practical knowledge.
A truly excellent anesthesiologist is like Dr. Feng, who not only does his job well, but also has a comprehensive prediction of various accidents that may occur to patients during surgery.
Even the official doctors are much lower in level than Doctor Feng.
During anesthesia surgery, Dr. Guan can only predict some common surgical risks.
I am far from being as skilled as Dr. Feng. Dr. Feng always has unique insights into any major operation.
It can provide a lot of very practical knowledge, allowing Zhou Can to prevent various surgical risks in advance in future operations.
He studied very seriously.
He is also very diligent in helping with the work.
Soon, the preparations for intubation and establishing an extracorporeal circulation channel were completed.
"Can I give the patient anesthesia?"
"Um!"
Doctor Feng nodded slightly and snorted, which was considered as his agreement.
Zhou Can had already gotten used to his 'unique' conversational style.
The patient was immediately and carefully given inhalation general anesthesia.
Fortunately, nothing unexpected happened until the patient lost consciousness, and no terrifying incidents of respiratory or cardiac arrest occurred during the anesthesia process.
[Anesthesia experience +1. ]
【Congratulations on your promotion to level three in anesthesia. You can independently provide general anesthesia or spinal anesthesia for ordinary patients, ensure the stability of patients' vital signs during anesthesia, and perform cardiopulmonary and cerebral resuscitation, mechanical ventilation, and special management of critically ill patients in case of surgical accidents. You can perform rescue operations such as shock, perioperative acid-base imbalance, acute heart failure, multiple organ dysfunction syndrome, sepsis, acute renal failure, oxygen therapy, cardiac defibrillation and cardioversion, and pacing.】
Promotion as an anesthesiologist is probably the most difficult.
Because the areas involved are too broad.
Many anesthesiologists say that being promoted to attending physician is extremely difficult.
Zhou Can was not sure how difficult it was to be promoted to chief physician.
It took him nearly a year to advance from the internship level to the resident level.
And up to now, he feels that what he has learned in the field of anesthesia is still very little, and can only be said to have learned some basics.
If you want to reach the level of Doctor Feng, it will probably take ten or twenty years to achieve.
Fortunately, this is just a side job, not a necessary medical skill.
So he was not in a hurry.
The upgrade of anesthesia still brought him many unexpected benefits.
For example, the ability to predict danger during surgery.
At this moment, when he reviewed the patient's surgery again, he actually felt a palpitation.
I can’t explain it, I just feel an inexplicable psychological and mental pressure.
You know, before his anesthesia skills were upgraded to level three, he was very confident about this operation.
Now I feel a little scared.
It’s not that he has become timid, but the upgrade of anesthesia technology has made him have a deeper respect for life and become more keen in predicting danger.
"If there is no problem, start the operation!"
Elder Liu obviously did not sense the danger, but was ready to hand over the operation to Zhou Can as usual. He would only take action when Zhou Can encountered a part of the operation that he was not competent for.
"Master Liu..."
Zhou Can was somewhat hesitant.
His abnormal condition was also discovered by Wu Ziyu.
Women are considerate and often very sensitive to other people's moods and changes in mentality.
She just looked at Zhou Can curiously.
I don’t understand why Dr. Zhou, who has always been full of confidence, suddenly became as if he was on the edge of an abyss or a cliff, and seemed to be a little afraid to move forward.
This was the first time she had noticed Zhou Can showing such emotions since she had come into contact with him.
"What's wrong?"
Old Liu stared at Zhou Can, his eyes full of questions.
"This operation is very risky. Please keep an eye on it for me. If there are any parts of the operation that are too risky, you may need to perform them yourself."
Zhou Can said with some uneasiness.
"Of course. If you feel unsure at any time during the operation, stop immediately and let me do it. Safety comes first in any operation."
Mr. Liu had said these words to him countless times.
Safety first is the phrase that senior doctors say most often.
Because an accident occurred during the operation, the person who bears the responsibility is not the junior doctor, but the surgeon himself.
For example, in this operation, the actual surgeon was Zhou Can, but the nominal surgeon was Mr. Liu.
If something goes wrong, Zhou Can will be implicated to a certain extent, but the one who will suffer the most is Old Liu.
Senior doctors are willing to give junior doctors some opportunities to practice surgery, so you must cherish them. Don't be unethical and think that if something goes wrong, the senior doctors will take the blame.
This trust is actually very precious.
Many surgeons, who have been residents for more than three years, are never allowed to hold a knife by their superiors. At most, they are only given the opportunity to practice using retractors and suturing skin.
In fact, it’s not that the senior doctor has any prejudice against this person.
Rather, it was because this person performed poorly in his daily work, which made the senior doctors afraid to delegate authority.
Zhou Can took two deep breaths to calm his slightly nervous mood, then asked the nurse to help him put on sterile gloves and start operating on the patient.
It must be mentioned here that before the operation, the doctor may need to wear sterile gloves when performing some special operations or examinations.
If this doctor happens to be the surgeon in charge, at the beginning of the operation, he will feel that the sterile gloves on his hands are contaminated.
Then you must replace it with a new one immediately.
