Chapter 247: Finishing work is also very important, the first rescue doctor order

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"Thank you, thank you!"

Zhou Can showed a flattered expression on his face, but he didn't feel much in his heart.

This was not the first time that the chief physician served as his assistant.

He has long been used to it.

I saw him first disinfect the patient's abdomen, and then draw the knife position for the window.

Endoscopic surgery only requires two small incisions.

The entire abdominal window opening process was completed by him alone.

Internal medicine doctors, especially chief physicians, actually have certain surgical capabilities, but they are definitely not comparable to chief physicians in surgery.

In their opinion, opening a small window in the abdominal cavity is a high-risk and difficult operation.

Zhou Can completed it easily.

The surgical skills displayed were enough to amaze Director Shang and Director Shi. They felt much more relieved facing Zhou Can's operation.

At least I don't have to worry as much as before.

After opening the window, Zhou Can inserted the endoscopic operating arm and, with the help of the visual function of the endoscope, carefully began the operation.

First, the fistula is cleaned and incised to a certain extent.

Because after the fistula is formed, a healing layer has already been formed, and direct suturing is useless.

This is one of the reasons why fistulas are difficult to repair.

For example, breast duct fistula, many surgeons cannot perform this operation well, which always leads to recurrence in patients.

Zhou Can's debridement is currently level four, which is still some distance away from level five.

The main thing is that in most cases, the debridement is ordinary debridement, and you can only earn 1 experience point at a time.

The upgrade speed will naturally become slow.

This was the first time that the fistula was debrided using endoscopic surgery.

Based on his experience, he should be rewarded with additional experience points.

As to whether it will be 10 points or 100 points, it is hard to say for now. You will know only when you get it.

Under Zhou Can's careful operation, the fistula was finally cleaned successfully.

[Debridement experience +1.]

[You have completed a relatively difficult endoscopic fistula debridement for the first time, and will be awarded +100 experience points. ]

Zhou Can was extremely happy after successfully receiving 100 debridement experience points as a reward.

The effort and reward are completely proportional, and this is the best reward he expects.

After completing the debridement and removing the accumulated fluid and tissue residue from the wound, he carefully checked the fistula again to confirm that there was no problem before starting to sew.

"Wow, what a strong level of stitching."

Director Shang's eyes widened instantly. This was the first time he had witnessed Zhou Can's suturing ability.

To be honest, Zhou Can's suturing skills as deputy director are extremely impressive in any department of internal medicine.

In less than twenty minutes, Zhou Can had successfully completed the suturing of the fistula.

"Director Shang, do you think this is okay?"

"It's perfect! Good boy, I didn't know you were so good at surgery. I was so nervous at the beginning. I was wondering whether I should let you complete the fistula repair surgery!"

Director Shang was beaming with joy, as if he had picked up a super treasure.

There are quite a few interventional surgeries that need to be performed in internal medicine.

Especially in gastroenterology, the removal of various intestinal polyps and tumors requires interventional surgery.

However, there is a severe shortage of talented surgical personnel in the Department of Internal Medicine.

Including these chief physicians, their surgical skills are just so-so and are far from being amazing.

He is also capable of handling some routine surgical issues.

However, when encountering some unexpected situations or the operation is extremely difficult, internal medicine often needs to ask surgeons for help.

Director Shang now realizes that Zhou Can’s surgical skills are so strong, and he thinks that if he encounters some difficult surgical problems in the future, he may be able to solve them without hiring anyone.

Asking for help is like swallowing a three-foot-long sword. Asking doctors from other departments to cooperate in surgery often results in some unnecessary irritation.

As for the interns in our own department, we can naturally order them around at will.

The more he looked at Zhou Can, the more he liked him, and he felt particularly happy.

Zhou Can lived up to expectations and cleaned the fistula tract. He then made some adjustments to the drainage tube before removing the endoscope and closing the two small wounds in the patient's abdomen.

As for the drainage tube, it can only be removed after the patient has recovered from the operation and has no more ascites or pleural effusion.

"Doctor Zhou, you just adjusted the drainage tube that was already inserted. Is there any deeper meaning behind this?"

Luo Jingyi watched Zhou Can's surgical operation and was amazed.

She only now realized that Dr. Zhou, who had excellent diagnostic abilities, also had incredible surgical skills.

Such talent, it's amazing.

When she looked at Zhou Can, countless little stars were already shining in her eyes.

The other two graduate students, Xie Lin and Qiu Chengyu, also admired Zhou Can's abilities.

They haven't even learned the four major punctures yet, but look at Zhou Can, who can already perform laparotomy and complete difficult endoscopic surgeries independently.

Why is the gap so big?

"The position of the drainage tube must have been problematic. I even suspect that the formation of esophageal anastomotic fistula after the patient's first surgery to remove the entire stomach was related to the fact that the drainage tube was not properly placed."

Zhou Can has extensive surgical experience and is familiar with chest, abdominal and cranial drainage.

During the operation, he discovered that the drainage tube was not properly installed.

"When I was performing the endoscopic surgery just now, I specifically checked the preset position of the drainage tube. The previous doctor set the drainage point too high. If the patient could stand for a long time, it might not have much impact. But the patient has been bedridden after the operation, which resulted in some pleural effusion being unable to be discharged. The effusion soaked in the anastomotic end of the esophagus and jejunum, eventually causing the wound to become infected and festered, and it could not heal well. Eventually, an esophageal anastomotic fistula was formed."

Zhou Can expressed his point of view again.

When handling the drainage tube, Director Shang did not say anything, but instead showed an expression of approval.

This shows that there is absolutely no problem with his operation.

"So that's how it is, I understand!"

Luo Jingyi nodded in agreement.

"Zhou Can's explanation of this problem just now is very accurate. This is also a mistake that many novice surgeons often make. I guess this drainage tube was not installed by the surgeon in charge. It is very likely that the surgeon left the rest of the work to his subordinates after the operation. It just so happened that a novice with little practical experience installed this drainage tube. In the end, it led to a tragedy."

Director Shang seized the opportunity to educate his three graduate students.

The three of them nodded repeatedly after hearing this, indicating that they would keep it in mind.

The surgeon did a good job on the surgical part, but there are many medical cases where problems arise in the finishing work.

Some surgeons are very busy and after completing the key parts of the operation, they just leave the operation room to the doctors under them and go to the next operation or do other things.

When the final finishing work is completed, problems can easily arise due to lack of supervision.

"Well, this operation was a complete success. If the patient's anastomotic leak does not occur again, the patient will become a normal person again. The problem that has troubled the patient for more than half a year will be gone forever. Send him to the recovery room, and when there are no problems, he can be sent directly back to the ward for care. However, the family must follow the doctor's instructions. There must never be another incident like the patient in bed 73 being infected with Salmonella."

Director Shang warned.

The patient in bed 73 was lucky, otherwise he would have easily died as he had just undergone a major operation, was severely damaged, and had wounds in his body.

"I'll be extra careful."

Zhou Can expressed his position on the spot.

This patient is his responsibility and he will definitely do a good job of postoperative management.

"Director Shang, the wife of the patient with the brain infection of sparganosis asked me not long ago when he can have the surgery. How do you think we should respond to them?"

"I'll go back to the office and call the neurosurgeon to discuss this. As for the family members, just tell them that arrangements will be made as soon as possible."

Director Shang was going to ask someone for something, and he didn't dare to tell an exact time.

"There is also a patient with stomach cancer in bed 77, whose family has already rushed to the hospital. In the morning, I talked to the family and the patient, and they agreed to the surgery. The patient's mother said she would sell everything she had to save her daughter."

He must report to Director Shang in a timely manner on the patients under his care.

The patient's treatment should not be delayed.

"That stomach cancer patient is a miserable woman! Okay, I'll arrange for her to have surgery later. If it can be scheduled, the earliest surgery will be tomorrow morning. Her disease will be more dangerous if she delays for a day, so it's better to treat her as soon as possible."

Director Shang has a lot of patients.

The few people Zhou Can is in charge of alone are enough to make him overwhelmed.

Add to that the tasks of seeing patients, teaching, and scientific research, and you can imagine how busy he is.

In addition, he also serves as the director of the department and is responsible for all matters within the department.

Fortunately, there are two deputy department heads to help share the burden, otherwise he would definitely be overwhelmed.

… …

Zhou Can returned to the office, wrote the medical record, and then studied the postoperative medical instructions given by Director Shang to the patient in bed 71.

He found that the medicines prescribed by internal medicine were obviously more accurate than those prescribed by surgery.

I also learned a lot of knowledge about medication from it.

When he finished studying the postoperative medical instructions.

[Pharmacological differentiation experience +1.]

This is not the first time that I have learned medical prescriptions to increase my experience in pharmacological diagnosis.

His pharmacological differentiation is currently at level three, which is the level of a resident physician. He can already write ordinary minor medical instructions on his own, but he cannot write postoperative medical instructions for complex surgeries like this one.

For such an important medical skill, we must find a way to improve it.

Zhou Can set a small goal for himself. He would spend the remaining year or so in the internal medicine department anyway. He hoped to successfully upgrade his pharmacological differentiation to level five.

By the time he has the pharmacological differentiation skills at the deputy director level, he will have no problem returning to the emergency department to set up his own team.

Although this ideal is a bit ambitious, he has confidence in himself.

"Doctor Zhou, Doctor Zhou, the vomiting patient you were caring for just fainted. Please go over and take a look!"

The young nurse ran into the doctor's office with a panicked look on her face and waved at Zhou Can.

"Weren't you fine this morning? Why did you suddenly faint?"

Zhou Can quickly saved the unfinished medical record, stood up and walked out.

"How would I know? I had just put him in bed 11 and was about to take his blood pressure when his eyes suddenly rolled up and he passed out."

The nurse's working hours should be very short.

When she was describing what happened, her hands were still shaking, and she must have been very scared.

"Has the patient's temporary bed been removed?" Zhou Can thought to himself, changing from a temporary bed to a formal inpatient bed is a good thing!

Did the patient faint because he was too excited?

"Didn't Director Shang specifically say hello? Today, after the patient in bed 11 completed the discharge procedures, the head nurse personally gave that patient priority in arranging bed number 11."

Director Shang’s personal greeting was quite effective.

Even the head nurse has to give her face.

It’s just that the patients are not able to enjoy it!

"Did the patient's head hit something during the bed change?"

Zhou Can thought about it and the only reason he could think of was this.

"No, absolutely not. His wife carried him on her back, and Sister Wang and I supported him on both sides to place him in bed 11. During this time, I am sure that the patient did not bump into anything."

The young nurse almost patted the immature body to give a guarantee.

Since the head was not hit, the possibility of disturbing the sparganum is small.

As long as the parasites don't drill deep into the patient's brain cavity and madly destroy the patient's brain stem, it will be fine.

However, this accident also sounded a wake-up call for Zhou Can.

The patient's condition is very critical and cannot be delayed any longer.

We have to find a way to perform surgery on the patient as soon as possible to remove the parasites.

If the patient's disease is cured, it will be a great achievement for Zhou Can.

When I arrived at the ward, I immediately saw the skinny male patient lying motionless on the bed with his eyes rolled up. His wife cried bitterly as if the world had fallen on her.

"Sister, don't cry, don't cry! His vital signs were stable this morning. Even if he is unconscious now, it won't be a big deal."

Zhou Can comforted the patient's wife while quickly examining the patient.

At this moment, the older nurse is measuring the patient's heart rate, breathing and other key vital signs.

“What is the patient’s blood pressure?”

Zhou Can felt the patient's pulse and felt it was weak and extremely frail.

It's like a lamp that's about to run out of oil.

It can be predicted that the patient's blood pressure must be very low at this moment.

"Systolic blood pressure is 95 mmHg, diastolic blood pressure is 65 mmHg. Blood pressure is low."

The blood pressure reading reported by the nurse was really unusually low.

According to international standards, a systolic blood pressure below 100 is considered a serious problem.

"Why did his blood pressure drop so much? Did he eat anything this morning?"

"I drank some water, but I vomited it all. I haven't eaten anything since then."

The patient's wife replied with tears in her eyes.

Zhou Can checked the patient's symptoms again and saw sweat oozing from his forehead and body trembling slightly. Seeing this, he had a clue in his mind.

"It seems that he is not seriously ill. It is probably just low blood sugar caused by hunger. Immediately give him 50ml of 50% glucose solution intravenously."

Zhou Can gave oral medical instructions.

It’s different if you have a medical license.

In the past, if you encountered this kind of situation, you had to ask a senior doctor to come and deal with it.

[Pharmacological differentiation experience +1.]

[You have issued a medical prescription to save a life for the first time, and you will be rewarded with +100 pharmacological differentiation experience points. ]

Zhou Can felt as if he was hit by a huge bomb of happiness.

Happiness comes so unexpectedly.

Not only that, after receiving so much pharmacological diagnosis experience points at once, he realized that his ability to differentiate and understand pharmacology seemed to have improved significantly.

After checking the attributes, it turned out that the pharmacological and dialectical medical skills had been upgraded from the lower level of residents to the middle level of residents.

Although it was only a small improvement, the benefits gained were real.

The use and understanding of drugs seems to have reached a new level.

"Great! If I get a few more rewards like this, I can directly upgrade my pharmacological differentiation to level four."

He was so eager to raise his knowledge of pharmacological differentiation to level four.

As long as you are promoted to the level of attending physician, there will be no problem in writing medical orders of general difficulty.

The nurse took the glucose solution and injected 50 ml into the patient.

Everyone looked at the unconscious patient nervously.

Giving medication to such patients whose bodies are already extremely weak makes nurses and doctors feel anxious and nervous.

The family members also watched with great nervousness.

My hands unconsciously clasped together.

“Hmm…”

The patient made a low humming sound, which sounded like great news to the medical staff.