Chapter 34 The Third Advanced Medical Skill
The emergency department of Tuya Hospital is always so busy. Before eight o'clock, the corridors are already crowded with patients seeking treatment.
Many patients who should have made appointments for specialist clinics flocked to the emergency department in order to see a doctor earlier or because all the specialist appointments for the day were sold out.
This has also exacerbated the staffing shortage in the emergency department.
"Doctor Zhou, please go to the operating room and help. There is a patient who has been in a car accident and needs emergency surgery."
When Ye Tingting saw Zhou Can, she immediately asked him to go to the operating room for support.
I have a feeling that her professional title shouldn't be too low.
Definitely not at the junior nurse level, but at least a junior nurse technician.
She seemed to have a special liking for Zhou Can and took good care of him in the operating room yesterday.
Jin Mingxi, who entered the emergency department with Zhou Can, did not receive this treatment.
"Okay, I'll be right there!"
When Zhou Can heard that there was surgery available, he immediately became excited.
After changing into surgical clothes, I went into the operating room.
I saw Dr. Xu, an unfamiliar resident, an anesthesiologist, and instrument nurse Tang Ling, a total of four people, making preoperative preparations for the patient.
"Good morning, Dr. Xu! Good morning, all of you!"
Zhou Can took the initiative to greet the four people.
The patient's thighs were bloody and his pants had been cut off.
Perhaps due to lack of staff, the instrument nurse has to take on multiple roles and is currently disinfecting the area where the patient is about to undergo surgery.
Although in the eyes of doctors, there is no distinction between men and women.
But she was obviously embarrassed when she was disinfecting the patient's perineum.
"Let me do it!"
Zhou Can took the pliers from her hand and used the sterile cotton to disinfect the patient.
"Thanks!"
Tang Ling gave him a grateful smile.
"polite!"
Zhou Can did this kind of thing a lot when he was an intern, and now he is very skilled in doing it.
It was done very quickly.
"Put a urinary catheter in the patient."
Dr. Xu ordered.
This is usually a job for nurses. Tang Ling held the catheter and looked at Zhou Can for help.
"In the future, when I'm around, just leave this kind of work to me."
Zhou Can took the catheter without her asking and inserted it into the patient with skillful movements.
For patients with serious injuries like this, inserting a urinary catheter serves multiple purposes.
For example, obtaining urine samples for testing, monitoring the patient's normal urination in real time after surgery, etc.
[Congratulations on obtaining the implantation skill. Current experience value is level 3 1/1000. You can implant special equipment or drugs such as vascular stents, bone nails, springs, etc. into the corresponding tissue parts of the patient. ]
Zhou Can was stunned for a moment, then he was ecstatic.
Implantation is a high-level medical skill.
Its practice is extremely difficult.
However, it is widely used in various difficult and precise surgeries, such as heart stent implantation, vascular balloon implantation, etc.
It was directly level three, equivalent to the lower level of resident doctor, which made Zhou Can very satisfied.
If he could master this medical skill, he would be able to shock everyone when he returns to surgery someday.
He was pleasantly surprised that the catheter was successfully inserted .
It seems that I can rush to do these insignificant chores in the future.
You can get 1 insertion experience point by inserting a catheter, which is really cool.
It's as exciting as picking up hundred-dollar bills on the street.
Currently, he already has three advanced medical skills. If he can upgrade them all to the chief physician level, he will be able to take on some difficult surgeries.
"The patient 's legs were severely fractured internally. Our emergency department can only deal with the injury initially, ensure the patient's life safety, do our best to save his legs, and then transfer him to the surgery department."
Dr. Xu set the tone for this operation.
The emergency department simply does not have the conditions to perform a full surgery on this type of patient.
Its job is to rescue critically ill patients and do its utmost to save lives.
"Doctor Lin's suturing and ligation skills are much better than Xiao Zhou's, so Doctor Lin will be my assistant, and Xiao Zhou will be responsible for assisting me and working part-time as a nurse on duty."
After Dr. Xu arranged the division of labor, everyone took their positions.
"Ouyang, are the patient's vital signs okay?"
"It can be operated on."
You must listen to the anesthesiologist's opinion before surgery.
The patient's blood pressure is obviously low and his heart rate is too fast, indicating excessive blood loss.
The thigh contains the femoral artery, which can cause rapid blood loss and death.
Judging from the current situation, the femoral artery is likely to have ruptured.
Many people may not know how dangerous a femoral artery rupture is. I believe everyone knows that if a cut is made on the neck, a person can easily die.
In fact, if the trachea in the neck is cut, a person will not die immediately.
But if the carotid artery is cut, blood will spurt out immediately.
The femoral artery, like the carotid artery, leads directly to the coronary arteries.
This kind of heavy bleeding is very terrible.
Second only to having the heart pierced by a sharp weapon.
On the contrary, the bleeding from wrist-cutting suicides, which is common in TV dramas, is actually not that scary. In some environments with strong coagulation function or low temperatures, bleeding is likely to stop automatically.
Dr. Xu carefully cleaned the wound on the patient's leg .
I saw a stream of blood gushing out like a spring.
"Hemostat!"
Before Dr. Xu finished speaking, Zhou Can had already clamped the proximal end of the bleeding blood vessel with hemostatic forceps.
The intermediate level of hemostasis skills of residents are not given for nothing.
Assistant Doctor Lin looked at Zhou Can with a little surprise.
"I heard that the emergency department had recruited two capable people, but I didn't quite believe it. But now that I've seen Dr. Zhou's ability to stop bleeding, I believe it now."
A master can tell whether you have it or not with just one move.
Zhou Can showed off his skills in stopping bleeding and immediately won the respect of Dr. Lin.
Surgery is not like writing a paper. Many attending physicians will spend money to buy papers or even research projects in order to achieve associate senior professional titles. Or they may use various means to reduce the difficulty of evaluating associate senior professional titles.
Even if it is finally accepted, you can imagine its level.
It's just a false name, but in reality it's useless.
But surgery cannot be faked.
If it works, it works. If it doesn’t, it will be exposed immediately.
"I don't deserve the title of Gan Jiang. I hope Dr. Lin will take good care of me in the future."
Zhou Can tried to keep a low profile as much as possible.
As a newcomer, the more low-key the better.
As long as he quietly earned experience points, it wouldn't be long before he could leave opponents like Dr. Lin and Jin Mingxi far behind.
"Since the bleeding point has been found, Doctor Lin, you clean the wound over there. Xiao Zhou, keep the bleeding position, and I will do the vascular anastomosis."
This is a femoral artery anastomosis. Although it is not too difficult, it is a test of the doctor's anastomosis skills.
Dr. Xu was not very confident and handed it over to Dr. Lin.
Choose to match in person.
Zhou Can was jealous, but unfortunately his current anastomosis skills were only at the lower level of a resident doctor. If he could improve to the excellent level of a resident doctor, he should be able to anastomose the femoral artery.
The patient's other leg had damaged muscles and bones, but the skin was still attached.
Dr. Lin carefully cut open the epidermis.
I saw that the muscles under the skin had rotted away.
There were hematomas and bruises everywhere.
There were even bone fragments.
It's so miserable.
The injured person was probably run over by the rear wheels of a large truck over his legs.
On the other side, there was a hole in the femoral artery.
Blood is spurting out.
Zhou Can had to do two things at once, freeing up his left hand to hold the hemostat and control the bleeding point.
"Thanks!"
Without Zhou Can's help, Dr. Lin would not be able to operate alone.
This ruptured femoral artery needs to be repaired.
"Doctor Xu, the femoral artery here is also ruptured. The situation is not bad. Can you let me repair it?"
When Dr. Lin asked this, Zhou Can roughly guessed his suturing skills.
At best, it won't exceed the excellent level of a resident doctor.
It seems that the gap between him and Dr. Lin is not that big.
Zhou Can's current suturing skills are at the lower level of an intern. If he works in the operating room for a month or so, he may surpass Dr. Lin.
Others can only improve their medical skills step by step, and the progress is slow.
For most surgical residents, it takes at least five years to improve their suturing skills from poor to excellent.
This is assuming there is sufficient surgical volume.
If you only get a chance to sew once every three or four days, and you are not very diligent in private practice, you may not reach an excellent level even after seven or eight years.
So in comparison, Zhou Can still has a big advantage.
"You can try. The sutures must be spaced closely together, and arterial pressure must be fully considered."
Dr. Xu agreed.
On the one hand, he was too busy.
On the other hand, as long as the risk is not particularly high, he will try his best to delegate power to his doctors and help them grow quickly.
"clear."
Dr. Lin nodded and quickly began to repair the ruptured femoral artery.
Fortunately, with the protection of skin and flesh, the damage to the femoral artery was not particularly serious.
Otherwise, just repairing the blood vessels would be very troublesome.
"Dr. Lin's suturing skills should be at the mid-level of a resident doctor."
After seeing Dr. Lin’s vascular repair, Zhou Can felt more relieved.
It seems that it won’t take long to surpass Dr. Lin in suturing skills.
If you are more proactive, you may be able to surpass him in ten days or half a month.
"Xiao Zhou, when anastomosing the aorta, in addition to ensuring that the suture gap is fine, you must also pay attention to whether the blood vessel is damaged. In this case, it must be cut off. If the two sections of the blood vessel are far apart after cutting, the pulling force is too great, and you must not force the anastomosis. You can take a section of the great saphenous vein or use an artificial blood vessel instead."
"It is generally best to consider using the patient's own blood vessels. Although the technology of artificial blood vessels is very mature, it is still a landmine. Especially when operating on young patients, we have to consider that they still have decades to live. We have to be cautious when using any artificial organs or tissues as substitutes."
While operating, Dr. Xu carefully passed on his valuable surgical experience to him.
“I remember.”
Zhou Can nodded, his attitude extremely sincere.
One of his greatest strengths is his humility and eagerness to learn.
In the operating room, Jin Mingxi and Doctor Lu came in one after another.
It's time for the shift change.
Dr. Lin was on the night shift, while Dr. Xu and Tang Ling came to help after receiving a call from the hospital.
More than 20 minutes later, Dr. Xu had successfully anastomosed the severed femoral artery.
Dr. Lin is still busy.
The speed of surgery will vary greatly depending on the level.
A great surgeon not only keeps the operation time short but also ensures that the quality of the operation is extremely high.
"Xiao Zhou, let go of the hemostat here and try to circulate blood."
Zhou Can slowly loosened the hemostat.
Instead of loosening it up directly in a frizzy way.
From this point, we can also see that his hemostasis level is quite good. The real high level is not only reflected in the perfect technique, but also requires attention to many details.
In the case of a large artery like this, the hemostat is suddenly released just after a successful anastomosis.
It is equivalent to suddenly opening all the gates to release floodwater.
It is easy to cause adverse consequences.
