medical simulator

Chapter 320 Is it worth it? ! (seeking subscription)

Zhou Chengcheng is almost drunk, is this person an intern?

This is in the operating room. The patient is under general anesthesia and intubation. She is in shock and low pressure, not in cardiac arrest. There is an open venous access. The operation is in progress. She said that she is going to call the teacher. Why don't you give me a quick rehydration at this time?
Have you ever read a book?

All the first aid processes in the hospital are basically moving closer to the current good infrastructure, tracheostomy and venous access are all ready-made now!
Hearing Zhou Cheng's words, she turned her head anxiously.

"Epinephrine, 1mg, intravenous injection! Hurry up!" Zhou Cheng increased his voice, urging!
This voice called her back.

Anesthesiologists in the Department of Anesthesiology, during the operation, dopamine, norepinephrine, and epinephrine are always on hand, and both dopamine and norepinephrine are continuously pumped.

But now, this continuous pumping, the dose is not enough, and it must be administered intravenously!
"Traveling, speed up the intravenous infusion immediately, pressurize the colloid and crystal infusion at the same time, and raise the room temperature in the operating room to 25 degrees Celsius."

"Director Hu, Director Mo, pay attention to find the bleeding point in the abdomen." Zhou Cheng moved away while talking.

At this time, the patient suddenly went into shock, and the senior anesthesiologist was not there, so someone had to stand up.

Neither Mo Youcheng nor Hu Kaihua stood up, so Zhou Chengcheng could only stand up.

"Device, you step down, go and call the head nurse, and ask her to send someone to help immediately, and urge the blood bank to send plasma products and adult blood."

"Notify the anesthesiologist, come to the operating room immediately, and draw blood gas for analysis immediately." Zhou Cheng's eyes were fixed on the patient's vital signs.

At present, the heartbeat is fast and the blood pressure is very low, which definitely exceeds the shock index.

Zhou Cheng is looking to see if there is ventricular tachycardia or ventricular fibrillation.

Although the first aid for shock in the operating room belongs to the category of the anesthesiology department, but this anesthesiologist is really unreliable, so he can only stand up.

However, for the rescue of patients in the hospital, doctors in all clinical departments have the right to order doctors. In the surgical ward, when a patient is in shock, it is the surgeon who assumes the role of issuing doctor's orders! !

"Take off the gloves, don't care about the clothes!" Zhou Cheng looked at the equipment nurse, ready to undress, and cursed.

The other party hurriedly took off the gloves, and then walked to the timing panel in the operating room before making a call.

Zhou Cheng returned his gaze to the monitor, and then calmly issued orders: "Dopamine 20mg, intravenous injection!"

Dopamine can be injected intravenously, and the general dose is 20 mg directly injected intravenously, or it can be treated by intravenous drip.When dopamine is intravenously dripped, the dosage is different, and its effect is also different.Dopamine is a neurotransmitter that is used to help cells transmit impulses.

Low-dose dopamine can relatively selectively dilate visceral and renal arteries, and can be used in patients who do not respond to diuretics to increase renal blood flow and maintain glomerular filtration rate; it can also directly act on renal tubules, to achieve a diuretic effect.

Moderate doses of dopamine can increase the activity of adrenergic receptors in the heart and strengthen the contractility of the heart muscle.

Large doses of dopamine can cause extensive vasoconstriction, which has a pressor effect.

While restoring the blood volume, a large dose of dopamine is added to effectively allow the blood to ensure the supply of vital organs.

The itinerant nurse immediately responded and went to help the doctor in the anesthesiology department to carry out the doctor's order.

At the same time, after the resigned equipment nurse made a phone call, the anesthetist who was doing the blood gas analysis hurried over, his face turning pale.

Then I saw that Zhou Cheng was staring at the vital signs monitor, while Mo Youcheng and Hu Kaihua were quickly looking for bleeding points.

"What's the matter?" he asked quickly.

"Now the patient's blood pressure has risen slightly, but it is still very low. It is estimated that the blood volume is still insufficient. What is the result of the previous blood gas analysis? Is there any high potassium?" Zhou Cheng did not turn his head, seeing that the heart rate had risen to 130, he calmed down ask.

Fortunately, the blood oxygen level is still normal for the time being, that is to say, there is no shortage of blood oxygen in the peripheral blood supply for the time being, and it should only be stress-induced hypovolemic shock, not other shocks.

The anesthesiologist saw that the patient's high blood pressure was only 40+, and immediately adjusted the dose of norepinephrine and dopamine pumped into the vein, and then said: "There is a slight high potassium level, and insulin and glucose are prepared for intravenous infusion."

"Remove the compound sodium chloride first and replace it with soda water."

While speaking, he hurried to squeeze the hanging whole blood into the patient's body.

Then he quickly accepted Zhou Cheng's instruction: "Epinephrine, 1mg, intravenous injection!"

The itinerant nurse hurriedly repeated: "12:14 epinephrine 1mg, intravenous injection."

The equipment nurse began to take notes.

Mo Youcheng and Hu Kaihua looked up: "There is no active bleeding in the abdominal cavity. We have already done all the blood vessels that should be cut off."

Seeing that the patient's blood pressure had risen a bit, Zhou Cheng said: "It should be that when the hematoma was just cut, a large amount of blood was lost, which greatly reduced the internal circulation and caused stress."

"Teacher anesthetist, you have worked hard. At this time, you must be very careful to pay attention to the pulmonary edema."

When the anesthesiologist came, Zhou Cheng didn't overstep his bounds, and waited until the blood pressure rose above 60mmHg before coming to the operating table again.

The operation continued.

At this moment, Mo Youcheng and Hu Kaihua didn't dare to speak anymore. The situation just now was really scary. Fortunately, Zhou Cheng stepped forward immediately. Otherwise, the anesthesiologist would have run away. This operation is absolutely GG!

But Zhou Cheng, a real tiger, can cut even such a hematoma. Although he has made thorough preparations to minimize blood loss, the undetectable vascular injury is still a large amount of blood loss, causing irritation.

The patient is on the verge of shock.

After a while, the roving nurse and the nurses in the operating room helped to open up the bilateral venous access, and the blood transfusion started on both sides, and the patient's blood pressure was completely stabilized.

Then, the anesthesiologist began to diss to his subordinates: "What on earth were you thinking? At that time, how could you think of running out and calling someone?"

"You are a deserter. If you run away, what will the patient do? Who will accept your job?"

"Teacher, me!" The little girl was about to cry right now.

Zhou Cheng and the others didn't speak. The girl's performance just now was really unprofessional. Maybe she was really scared, but as a doctor, if you are afraid of this, you should change careers as soon as possible.

This hurdle must be overcome.

After that, the anesthesiologist didn't dare to go outside again, and his students were asked to take blood gas analysis and other operations, and he didn't dare to leave the anesthesia table for half a step!
Time passed slowly.

More than two hours passed.

Zhou Chengcai finally sewed up all the blood vessels, and after a careful inspection again, he said, "Director Mo, this patient should be very cautious. If heart failure and thrombosis occur again, routine anti-inflammatory drugs are required after surgery." Coagulate."

"Although anticoagulation will lose part of the blood, if a thrombus falls off, the consequences will be unimaginable. In addition, because of shock, you must be extremely careful about cerebral edema, and consult a neurosurgeon."

"After surgery, it is even more important to monitor the brain CT regularly."

Although the temporary life was saved, if the follow-up care or doctor's orders are improper, problems will easily occur again. If there is a problem after the operation, no matter how good the current operation is, it will not help.

No matter how good the operation is, what's the point of doing it when people are gone?

"Understood, Doctor Zhou, today, it's fortunate that you came, otherwise, this operation would be really hard to explain!" Mo You said with lingering fear.

He had checked the entire abdomen before, but no hematoma was found. He closed the abdomen, but there was still a retroperitoneal hematoma.

However, even if he found out the first time, he didn't dare to touch this thing.

He didn't have Zhou Cheng's ability, if he moved, he would die.

Of course, if you don't move it, let it exist, continuous blood loss, and the final prognosis of the patient is still catastrophic.

It can be said that the reason why this patient survived was all due to Zhou Cheng.

When the shock happened, Zhou Chengbu stood up immediately, and the patient still couldn't escape this death!
Hu Kaihua also said: "Zhou Cheng, you have worked hard today! On behalf of the patients and their families, I would like to express my gratitude to you."

Hearing this, Zhou Cheng saw that the current operation was over, so he asked one more question: "Director Hu, this patient's injury is very special, why did you consider calling me?"

Zhou Cheng knows how to do vascular surgery, not many people know about it, and he rarely takes the initiative to perform vascular surgery, mainly because he is not professional and afraid of accidents.

So far, only Yang Yifeng, Lu Bin and others are known.

Cai Dongfan, who was far away in Shashi, also knew about it.

Hu Kaihua then explained: "Doctor Zhou, it's like this. We originally wanted to invite Dr. Yang to come, but Dr. Yang has something to do and can't come, but he suggested that I ask if you can come down."

"He said, this operation is not easy, it might be better for you to come."

When Hu Kaihua said this, he saw Zhou Cheng staring at him with a meaningful expression.

Then he hurriedly explained: "Well, Doctor Zhou, please tell me, the patient in this operation is my child's teacher. She is a very good teacher, but it's a pity that she is not nice to others."

"My child has graduated for several years, but we have been talking about her kindness. Naturally, I don't want to ask too much about her family affairs, but this time I was injured, so I also healed it and asked more shamelessly."

"I asked her mother to go to the Chinese medicine hospital to find you in person, but it was a helpless move. Doctor Zhou, don't take it to heart!"

Hu Kaihua's explanation warmed Zhou Cheng's heart.

There is true love in the world, and Hu Kaihua's ability to put so much thought into his child's teacher is enough to show that this teacher is a person worthy of respect.

Indeed, her experience is worthy of sympathy, but there is nothing to be done about it.It is not easy for outsiders to intervene.

After the operation, Hu Kaihua pulled Zhou Cheng aside, and then took out a big envelope, intending to hand it to Zhou Cheng.

He also said: "Doctor Zhou, this is my personal wish. Teacher Zu is indeed a respectable person, so I didn't tell her family members about it."

"If it is another patient, I may not be able to do this, but it is a little thought to help, please accept it."

Hu Kaihua can also speak. It is true that this patient's family has such a difficult time. At this time, he still charges such a large amount of fees for throwing knives. In fact, Zhou Cheng is a little bit entangled.

However, if Hu Kaihua gave it in private, then Zhou Cheng could take it anyway.

Zhou Cheng opened the envelope, took out a few, and handed it back: "Director Hu, I took these, you can take back the rest, it is not easy for everyone to earn money, if you think Teacher Zu is a good person, you Just pay her hospital bills."

"I have received both the heartfelt and practical thanks, and I will go back first!"

Zhou Cheng took five hundred.

Mainly, flying knives do not take money, which is a violation of the rules.

Fees based on knowledge earn hard money, so it is not appropriate to not take it. Of course, it is okay to take all of it, but there is no need for Hu Kaihua to spend money.

It is impossible for Hu Kaihua to help all patients, and the same is true for Zhou Cheng, so let's take it as a good deed.

Hu Kaihua naturally shirked with Zhou Cheng for a while, but Zhou Cheng still insisted, and then went straight down to the underground parking lot, and went back to Changshi with Master Gu without even eating.

After arriving in Changshi, Zhou Chengcheng asked Master Gu how much the bus fare was.

But Master Gu said: "Doctor Zhou, Director Hu has already paid for the fare. I'm only responsible for delivering it to your destination. You don't need to worry about the rest, Doctor Zhou."

While speaking, it seemed that he was more familiar with the market of this consultation.

"That's hard work, Master Gu." Zhou Cheng didn't say much.

He traveled from Changshi to Jinshi, and it was not easy for him. He was exhausted, so he went to find a place to eat first.

Just as I was going to the operating room, Director Lu Bin called.

"Doctor Zhou, thank you for your hard work today. It's like this. The patient in the emergency department a few days ago was out of danger, and now he is waking up in the ICU, so I hope we can go to the ICU for a consultation. .”

"Because Dr. Zhou performed the operation, the director of the ICU means to let Dr. Zhou go for a consultation in person. What do you think?" Lu Bin's words were full of politeness.

Zhou Cheng frowned when he heard this, he knew that the patient was Fang Miaomiao.

"Director Lu, what about the consultation? Do I have to go there?" Zhou Cheng asked rhetorically.

The main reason is that what Xu Kairan said earlier made him feel a little uncomfortable.What exactly is Lu Bin positioning him as?

I can't say whether Fang Miaomiao is right or wrong, but what I learned from Zhang Zhengquan is that Fang Miaomiao was not the first to be rescued from a car accident, but the first to reach the hospital!

This incident made Zhou Cheng feel as if there was a thorn in his heart, which made him feel a little uncomfortable!

When Lu Bin heard this, his tone continued to flatter: "Doctor Zhou, the main reason is that you performed the previous operation, so the director of the ICU thinks it would be better for you to go and see it yourself."

"You also know that there is almost no precedent for such an operation before. I'm afraid we can't see why it happened in the past. There are not even any other reference signs."

"Doctor Zhou, why don't we go together? I'll learn with you. I don't think you need to bother Dr. Zhou in the future."

Hearing this, Zhou Cheng couldn't refuse anymore. At this time, if he refused again, it would seem a little unreasonable, so he nodded and agreed.

Then, Zhou Cheng and Lu Bin arrived at the gate of the ICU. Maybe Lu Bin called ahead of time, so when Zhou Cheng arrived, many people were there.

Among them, Fang Miaomiao's family member, Mu Yin, thanked Zhou Cheng very warmly after seeing Zhou Cheng, and without further delay, the group, including Mu Yin, all wore isolation suits and entered the ICU in.

After entering the inside, the girl is still full of all kinds of tubes.

At this moment, his expression was very sluggish, his lips were pale and dry, and his face was bloodless.Although the endotracheal tube in his mouth was removed, he was still inhaling oxygen.

Covered with a quilt, he tried hard to open his eyes, his mouth was trembling as he wanted to say something, but he couldn't.

"Doctor Zhou, the patient's vital signs are relatively stable for the time being, but this leg is basically numb. What should I do?" the director of the ICU asked directly.

Zhou Chengcheng glanced at him and didn't answer. Instead, he probed the patient's peripheral blood supply. He could feel the pulsation of the dorsalis pedis artery. Although it was slight, it was still palpable.

As for activities?

Zhou Cheng first took the initiative to twist the skin around the ankle, but the patient felt nothing. Then, Zhou Cheng checked the pathological symptoms again, which was negative.

This shows that at least there is no neurological problem at present.

"Nerve repair takes a certain amount of time. Moreover, it is not certain whether the nerves can recover their activities and sensory functions after they are sutured together."

"If the neurological function fails to recover after surgery, neurological atrophy will gradually occur, but at least now there is a chance."

"Now, the patient's blood supply is good. Next, we can only look at the condition of the nerve repair. If it really doesn't work, it will be difficult to deal with it. Let's see if we can find a way later." Zhou Cheng frowned slightly He frowned and said so.

Hearing this, Fang Miaomiao's mother frowned and asked, "Doctor Zhou, is it possible that this nerve will not grow well? Could it be during the operation?"

Hearing this, Zhou Cheng's heart sank, and he replied: "After the nerve is severed, if it is sutured again, there will be a certain loss of function. This is a major limitation of the current medical level."

"Limb transplantation is a palliative rescue plan. You can expect to restore some functions, but it's best not to expect too much. You want to fully restore the normal motor and sensory functions of your lower limbs."

"That's also unrealistic."

"Are you Fang Miaomiao's family member? I don't know how to explain the rest, but under the circumstances at that time, I have done everything I can, and I have done my best."

Zhou Cheng didn't know if she was accusing herself, but Zhou Cheng still wanted to tell the truth clearly.

They are all amputated, and you still want to restore them perfectly as if they were not amputated. How is that possible?If you really want to trouble me because of postoperative complications or sequelae, then Zhou Cheng doesn't care, just follow the normal procedure.

Upon hearing this, Mu Yin immediately said, "Doctor Zhou, you misunderstood me."

"What I mean is, if you have other options, Dr. Zhou, you must ask Dr. Zhou to explain to us that we are willing to take risks as long as Miaomiao's leg can get better. I also ask Dr. Zhou to think of more ways, We must cooperate!"

Muyin is not stupid, through contact with friends and personnel in the medical field in the past two days, basically everyone is saying that this Miao Miao operation can be regarded as a miracle.

This kind of technique, not to mention unique in the whole world, is absolutely rare.

It is all thanks to Zhou Cheng that he was able to keep his legs and not amputate them directly.

It's just that people are greedy. When there is not enough greed, it is natural to hope that all functions are preserved as comprehensively as possible.

As for making trouble for Zhou Cheng, she dared not think about it.

If you want to find it, you are also looking for trouble with Lu Bin and the others. If you have amputated your limb without understanding what the situation is, are you capable?
When Zhou Cheng heard this, his heart moved a little: "It depends on the follow-up recovery situation. Now, the blood supply is good, and the nerve repair will take a while. At that time, we will discuss the follow-up treatment according to the degree of residual function."

"Director Jing, for this patient, the postoperative anticoagulant and hormone should continue to be used for a few days until seven days after the operation, when the swelling of the nerves has mostly subsided. You can reduce the dosage as appropriate, and then stop."

Director Jing, who is also the director of the ICU, hurriedly said: "Hey, okay, Doctor Zhou, this patient won't be able to stay in our department for a few days, and will be transferred to your orthopedics department in a few days."

"At that time, Dr. Zhou, you can come and arrange the follow-up diagnosis and treatment plan yourself. Dr. Zhou, your technique is indeed brilliant!"

This is not a commercial boast, but a real admiration. He has been here for many years, and he has never heard of the situation of amputation and then transplantation, which is unheard of.

But Zhou Cheng can still do it, this is Gao Ming.

After checking the room, Zhou Cheng felt that there was no need for him to come here.

After leaving the ICU, Zhou Cheng was stopped by Fang Miaomiao's mother, Muyin. He first thanked him again, and then asked some questions about Fang Miaomiao's situation in private, before he breathed a sigh of relief.

"Doctor Zhou, I have really worked hard on you this time. I have always wanted to thank you in person, but I have never had the chance. Therefore, my husband and I plan to treat Dr. Zhou to a light meal and express our thanks. Please Doctor Zhou must not refuse."

"Miao Miao's follow-up treatment, I hope that Dr. Zhou can take more care of you."

As the saying goes, reach out and don't hit a smiling face.

Zhou Cheng smiled: "Let's stop eating. Surgery is my job. No matter who is in such a situation, as long as I have the ability and time, I will try my best to help."

"I have received your kindness. Thank you for your kindness." After speaking, Zhou Chengcheng wanted to leave.

Seeing this, Muyin continued to smile and said, "Doctor Zhou, this is really just a simple meal, so it's not considered a violation of the rules? Doctor Zhou, this is just normal human behavior. Doctor Zhou, don't be too polite."

"Mrs. Fang, I know what you mean, but I really don't need to eat. Whether I eat or not, I will definitely do my best. Thank you for your kindness. I still have something to do. I'm sorry." Zhou Cheng clasped his fists, and leave.

Some people's food is edible, but some people's food is absolutely not so delicious.

(End of this chapter)