godfather of surgery

Chapter 933 The gastric tube gone astray

About ten minutes, the reward of intraoperative freezing: consider tuberculous granulomatous inflammation.

It's like an intestine with a handful of pearl rice sprinkled on it, it's really nodular!

But what to do now? Surgery can only treat intestinal obstruction. From the exploration, local intestinal loops in the small intestine have been deactivated and necrotic. Director Fang is planning to perform partial small intestinal resection and intestinal anastomosis. As for these miliary nodules, there is no need for surgical treatment, and there is no way to perform surgical treatment. They can only be washed and followed by anti-tuberculosis treatment after surgery.

Anti-tuberculosis treatment takes a relatively long time. The shortest plan is half a year. There are also different plans such as one year and two years depending on the condition. After the patient is discharged from the hospital, it is free to go to the tuberculosis prevention and control center to receive anti-tuberculosis drugs, but other tests, such as liver There is a fee for kidney function.

The diagnosis was made, Director Fang thanked Yang Ping, and surgery was urgently needed.

Tuberculosis is now rare in hospitals in big cities, but it still exists. On the contrary, there are more tuberculosis patients in some remote areas, so the treatment of some tuberculosis in big city hospitals seems unfamiliar.

Whether you have rich experience in treating diseases actually depends on the hospital’s case resources.

There are many hand surgery hospitals in the Pearl River Delta and the Yangtze River Delta. Hand surgery is extremely developed. The surgical skills of any young hand surgeon are instantly better than those of doctors from mainland hospitals. This is because there are many factories and many hand injuries.

The burn department of Liuyang Hospital has rich treatment experience and has gained the reputation of being the hometown of fireworks.

Many hospitals in Yunnan are very good at treating mushroom poisoning, and it’s not just because the villagers there love wild mushrooms.

However, these hospitals are rich in experience and have not made much academic achievements. They are just the accumulation of experience and cannot be sublimated. They can only repeat it in place. Academics still depend on the professors and doctors from the top hospitals in the country. Only they can sublimate their experience into academics. , and finally drive the progress of medicine.

Therefore, it is understandable that Director Fang lacks rich experience in intestinal tuberculosis. If he does not encounter a few cases of intestinal tuberculosis throughout the year, where can he get the experience? Naturally, he felt unsure after seeing this "pearl intestine" and asked Yang Ping to come over and check it.

Now that everyone is here, Yang Ping decided to take a walk around the center's operating rooms to see what surgeries can be performed in various departments.

Director Gao is busy in the operating room of the Sports Medicine Center. Now Director Gao's skills have gradually matured. All the surgeries he performs are top-notch, and he is receiving some foreign athletes for surgery one after another. This is incredible. It is the rhythm of going international.

Director Gao is currently performing an operation on a Bundesliga player. It is said that he was recommended by a friend of August. Gao's path is getting wider and wider.

"professor!"

Director Gao was very surprised. Why did Yang Ping suddenly come over to see the surgery? Could it be that August guy felt that he was not good enough and asked the professor to come over and check it.

"The general surgery department just had an operation for me to take a look at, so I stopped by to take a look. What operation was performed?" Yang Ping walked around the operating table and stood in front of the arthroscope screen. The observing doctor immediately brought a stool.

''Thank you, no, I'll stand and watch for a while and then leave. "Yang Ping declined the doctor's kindness.

Director Gao immediately introduced: "A patient from Europe, a player from the Bundesliga, was undergoing multi-ligament reconstruction of the left knee joint."

Okay, sports medicine has already been erected, and trauma and orthopedics have also been erected to a similar extent. Other departments must follow up.

Director Gao waited for Yang Ping to give guidance, but Yang Ping didn't say anything, and didn't even mention August or the patient. Director Fang felt that he had made a mistake in his judgment. The professor really made a mistake in his judgment. According to the professor's temper, there was no way he would turn around. I'll tell you directly what's going on.

"Would you like to come on stage to give guidance?"

Director Gao invited Yang Ping to have a hand addiction.

Yang Ping shook his head: "You do it slowly, I'll just watch it for a while, and I'll go back for a walk later."

Now Director Gao's level of performing this kind of surgery can be ranked among the top four in the world. This is a truly world-class level. Lao Gao still maintains the habit of going to the surgical institute when he has time. He goes there to help, listen to lectures, and follow... Yang Ping asked some questions, and sometimes rolled up his sleeves and picked up the dressing bowl to help change the dressing.

Yang Ping is watching the surgery on the arthroscopic screen. Director Gao is very skilled at the various positioning openings under the microscope and has mastered the essence of Yang Ping's surgery.

A graduate student came into the operating room with a mysterious look. After muttering a few words, several young doctors immediately gathered around him.

It seemed that they were talking about an operation being performed by the neurosurgery department, saying that the gastric tube was inserted into the skull and spinal canal. Yang Ping thought he had heard it wrong. The anesthesiologist asked the graduate student who spread the news: "The gastric tube is inserted into the skull and spinal canal? How?" "Go in?"

This was the first time the anesthesiologist had heard of such a strange thing. If he hadn't been responsible for his duties and couldn't leave the operating room at will, he now wanted to run to the neurosurgery operating room to see what the peep show was.

The physiology researcher said confidently: "It's true, I just saw the CT scan of the head. It's true that the gastric tube was inserted into the cranial cavity and bent into the cervical spinal canal. I don't know how it was inserted."

''Did the nurse in our hospital insert it? "The anesthesiologist asked. The middle-aged uncle also had a curious heart.

The graduate student said, "I don't know. I didn't ask. I just stood there for a while and was kicked out by the circulating nurse."

"You don't want to take a photo to see."

The anesthesiologist complained that there was no picture and no truth. Isn't this just annoying?

Yang Ping felt that it was not surprising. Not to mention inserting a gastric tube into the skull, it was also possible to insert a gastric tube into the heart. It was rare but it did not mean that it was not possible. Yang Ping remembered that in order to educate the nurses to strictly abide by the operating procedures, Head Nurse Cai gave a lesson on gastric tubes and urinary tubes that went astray. The surgery here was not interesting. Director Gao was very familiar with it, and Yang Ping decided to go to neurosurgery for a visit.

Silently, Yang Ping was already standing in front of the reading light screen. On the CT image, the eye-catching tubular foreign body entered from the nasal cavity, passed through the sellar area at the base of the skull, was directly inserted into the skull, and then bent through the brain and The brain stem enters the cervical spinal canal from the foramen magnum, and there is a large amount of liquid-solid mixture with uneven density in the cervical spinal canal, which causes certain compression on the cervical spinal cord.

This CT film makes people's hair stand on end. This can be a fatal mistake at any time. The part of the brainstem where the gastric tube passes is the center that controls life.

When this kind of problem occurs, the nurse who inserted the gastric tube at the time was most likely a veteran who was very confident in his intubation skills and even skipped the step of extracting gastric juice for examination.

Yang Ping touched his chin and judged based on these CT films: there was local bone loss in the sellar area of ​​the skull base, radial metal artifacts in the skull, dilation of the ventricles, and accumulation of blood/fluid/gas.

It seems that the intracranial sellar area must have undergone tumor resection recently, so there is a bone defect. Otherwise, why is there a bone defect in that place? A gastric tube is used to break through the normal skull base bone in the sellar area. Still unrealistic. In many cases, tumors in the sellar area are surgically removed through the nasal cavity-sphenoid sinus approach, which can avoid craniotomy and remove the tumor with a relatively minimally invasive surgery.

There is a very thin piece of skull between the top of the nasal cavity and the cranial cavity. During the operation, this piece of skull is removed to create a window through which instruments can pass through the nasal cavity and enter the skull to remove tumors in the sellar area. .

Maybe the nurse didn't pay attention to the patient's recent surgical history of sellar area tumors, and still inserted the gastric tube as usual. As a result, the gastric tube went directly into the skull along the gap. The nurse still inserted it at the usual length until it reached a satisfactory length. As a result, The gastric tube goes directly into the cervical spinal canal.

A gastric tube cannot be inserted into the brain casually. If there is no bone defect between the nasal cavity and the cranial cavity, a gastric tube cannot enter the cranial cavity anyway. Therefore, the prerequisite for the gastric tube to enter the skull is the lack of bone at the base of the skull. , it is possible for the gastric tube to take advantage of the situation.

In fact, this is not the first time. Yang Ping has heard of cases in which the gastric tube entered the skull before. He also had a recent history of sellar area tumor resection. However, in that case, the tube did not continue to enter the cervical spinal canal, but made a circle inside the skull. lock up.

One of the relative contraindications to gastric tube insertion is skull base fracture. In other words, if there is a fracture at the base of the skull, the gastric tube can easily enter the brain, so every clinical operation clause is imprinted with blood and tears.

After the gastric tube is inserted, you still need to check whether the gastric tube is in the stomach. There are several methods: use a syringe to aspirate the gastric tube. If there is gastric juice or gastric contents withdrawn, it proves that the gastric tube has entered the gastric cavity, and other places must be Unable to remove gastric juice or gastric contents.

Place the stethoscope under the xiphoid process and use a syringe to inject 10-30ml of air into the gastric tube. If the sound of air passing through water can be heard, it indicates that the gastric tube has entered the gastric cavity.

Put the end of the stomach tube into the water. If you see a lot of bubbles overflowing from the mouth of the tube, it means that the stomach tube has mistakenly entered the airway and should be pulled out immediately and reinserted.

The first of these is the most reliable.

Everyone was busy with the operation and did not notice the arrival of Yang Ping. The operation was simple but not simple, because the area where the gastric tube passed through was the brainstem. Generally, operations involving the brainstem were not simple. In addition to removing the gastric tube, this operation also required Remove liquid substances from the cervical vertebrae and intracranium, less from the intracranium and more from the cervical spinal canal.

Director Shi of the Department of Neurosurgery was chatting with his assistant: "Why is it the fourth appendix again? Wasn't Director Qian of the fourth appendix arrested?"

"When you find a cockroach, there is actually a pot of cockroaches hiding there. Director Qian has been running rampant for so many years. You think you are lucky." I don't know which doctor said more.

Director Shi said: "You can't say this nonsense. Young people must be responsible for their words."

''It's not like I'm in Appendix 4. Are they going to punish me across the hospital? "

"That won't happen."

It turned out that this patient was from the Fourth Affiliated Hospital. I heard that after the gastric tube was inserted, the patient developed high paraplegia for no reason. Because he had undergone tumor surgery in the sellar area of ​​the skull, the leader of the medical team at that time immediately arranged for the patient to review his head. CT to see if there was any problem with the original surgery. The results showed that my baby's stomach tube was inserted into the brain and bent into the cervical spinal canal. There was also an unknown liquid-solid mixture with uneven density in the cervical spine and skull. .

The eldest brother in charge of the team pulled the nurse over and asked. The nurse was very beautiful, but had a bad temper. She pursed her lips and looked unhappy: "I usually insert it like this, and nothing has ever happened. How could it be the same as the gastric tube?" related."

The team leader hung up the CT film and said: "The stomach tube is inserted into the brain, the patient is paralyzed, and you are so awesome and coaxing, how can you be confident?"

The nurse immediately became frightened, and the team leader asked, "Did something get inserted into the stomach tube after it was inserted?"

The nurse hesitated for a moment and did not dare to hide it: "I didn't know that I inserted it wrongly. I thought it was in the stomach and injected nutrient solution into it."

The eldest brother in charge of the team had weak legs and was completely confused: "After checking the gastric tube, did you not take back the test?"

"There was withdrawal, and there was liquid at that time. It was clear and a little red. I thought it was gastric juice. Didn't the patient eat less." The nurse recalled the scene at that time.

The team leader fully understood that it was over. The blood-stained cerebrospinal fluid was extracted. Isn’t this deceptive? How will this end?

"Attachment 4, it's time to rectify the situation. The Municipal People's Hospital is not in good shape now. It was a mess before. The smiling service made me laugh to death." Director Shi continued the conversation to prevent these young people from getting angry. Complain.

The first assistant is a deputy chief physician, and he also knows about the famous "smile service" back then: "I heard that they set up a special inspection team, which is all about helping people who don't do serious work and are idle. They make secret visits every day to see which doctor treats the patient. He and the patient's family kept a straight face and did not smile, and immediately registered and deducted the money. The tactics were very cunning. I have a classmate who is in the Municipal People's Hospital. I heard that for every 500 inspections, the inspection team can get a commission. "

''It's really confusing. I had a master's degree classmate who was there at the time. His instructor had just rescued a patient who died of liver cancer. The patient was not rescued. The instructor announced the death to his family, and the inspection team did not distinguish between them. He said that he had a straight face and secretly made a note of deducting 500 yuan. He went to appeal, but the people in the inspection team didn't look down on him at all. He said that this was the rule, and my classmate slammed the table and scolded me. "

''Not only service with a smile, they also carried out targeted convenience activities in the past! "

''What is a targeted and convenient activity? "

"The nurse gives the patient injections and infusions. Only one injection is successful. If a second injection is required, the injecting nurse will deduct 30 yuan. The third injection will continue to deduct money. This will add up. A sign welcoming complaints is also placed in the ward. The infusion room and other departments are slightly better, but the nurses in the pediatric department are complaining all day long, and I don’t know how much they are being charged a day.”

"It's not enough to just leave. How can we become a hospital for him?"

It started with Appendix 4, and then the topic moved to the Municipal People's Hospital. Yang Ping was looking at CT pictures with his body on his back, but no one paid attention.

When Yang Ping was about to evacuate, a young doctor saw him: "Professor Yang!"

At this time, all the doctors and nurses looked over. Even the surgeon, Director Shi, looked up and searched around for Professor Yang. In Sanbo Hospital, they usually call each other director XX, doctor XX, or Mr. XX, Xiao XX, etc. He won’t be called professor, but he is a clinician after all, so when he hears the title Professor Yang, everyone knows who he is.

Director Shi saw Yang Ping at the door: "Professor Yang, I'm sorry, I didn't see you just now."

''I'm in the sports medicine department and stopped by to see your surgery. "Yang Ping stopped and said a few words.

Director Shi said: "It is strange for a special patient to have a gastric tube inserted into the cranial cavity and cervical spinal canal."

"I just watched it."

"The nurse didn't know, so she put a tube of nutrient solution inside."