medical simulator

Chapter 404 Multidisciplinary and multi-skilled!

Professor Fang Jingsheng's words made the other professors drop their jaws in shock!
Although they didn't speak, they all looked at Fang Jingsheng, the vascular surgeon, with questioning eyes. The meaning contained in those small eyes seemed to be saying, big brother?

Are you serious?Do you really want to call so many of us, and just listen to such a kid with no hair yet?
Can you be responsible?
"I also believe in Xiao Zhou." One of them, who looked young and wore thick glasses, said suddenly.

"This person should be Zhou Cheng and Xiao Zhou who had stayed in the Ninth Hospital of Shanghai for a while. It's hard to say about other fields, but in orthopedics, he is indeed a very good teacher."

"Director Tong of our department has many words of praise for him!"

"Professor Fang, Professor Du! Professor Ni!" Although Zhou Cheng didn't know the person who spoke, he knew the others.

Tong Dawei, as the director of the Trauma Surgery Department, they were all at the professor level during the emergency surgery and had the most contact with them.

As long as Fu Youhan has a bit of a brain, he won't pull the banner of Tong Dawei's reputation for Zhou Cheng!
"Professor Ni, you can open the abdomen directly, Professor Du, you continue to deal with the intracranial hematoma. After I embolize the artery, I will open the arteriovenous fistula and restore the external circulation. In this way, the amount of bleeding in the limbs will decrease. If it decreases or even disappears, the blood pressure should also rise." Fang Jingsheng also said with certainty.

When Zhou Cheng was in Shanghai No. [-] Hospital, he had also been exposed to vascular surgery, so he was very confident in Zhou Cheng's thrombus removal.Now that Zhou Cheng is here, the whole embolism after the embolism is not so scary!

Being able to save one's life, and perhaps one or two limbs in the end, is already an excellent result!
What are you still struggling with?
The patient is about to die, emergency and emergency, life-saving is the most important thing!
Where is there so much time to make choices and hesitate?
If it's an elective surgery, what if we gossip together for three days and three nights?

He knew that Zhou Cheng must have said such a relatively basic explanation in order to avoid quarrels.

Zhou Cheng completely ignored the question of how to explain after the operation, and searched for traces of various branches in a frantic manner.

and!

However, under such circumstances, Zhou Cheng, who knows both orthopedics and vascular surgery, is indeed the best candidate.

real or fake?

Now that I can't think of a better way in a short period of time, I can only bite the bullet and treat the dead horse as a living horse doctor.

In the actual medical treatment process, unless there is a problem with the brain, people will not think about embolizing all the major arteries of a person's limbs first. The first reaction is whether the patient can live and stop the bleeding?Amputation can save life?

According to his understanding, if it wasn't so urgent this time, and the patient hadn't been ordered to die by the hospital, he really wouldn't dare to let Zhou Cheng do this.

If you say you can't, I'll beat you right now!

Do you know where the splenic artery is?
Fang Jingsheng was really a little scared!

This operation is similar to Zhou Cheng's operation of blocking the splenic artery to stop bleeding.

But, after all, it was just a game of chess, and the sacrifice was nothing but a loss in the end.

Professor Chu from the Department of Anesthesiology heard this, what else could he say?

Such an opportunity is fleeting.

Are you still playing?

But this operation, no matter who it is, can't be dealt with casually when it comes to the stage. This is the professionalism of a doctor. At the same time, Zhou Cheng is trying his best to control his emotions.

Splenic artery embolization is much more commonly used than femoral artery embolization, but it is usually used as a first-line treatment for large spleen and hypersplenism.

Central venous pressure (CVP) is the pressure at the place where the superior and inferior vena cava enter the right atrium. It is measured through the superior and inferior vena cava or the right atrium built-in catheter. It reflects the right atrial pressure and is one of the main indicators for clinical observation of hemodynamics. .It is more suitable for the monitoring of critically ill patients than the pressure measured from the limbs.

Du Li thought of me right then!
If you fucking wanted to say it earlier, why should I open such a big scalp flap?

He didn't want to talk, quarrel, or pretend to be aggressive, he just wanted to save people.

And even if you want to use an endoscope, you have to open a bone flap!
It's just that the opening method may not be consistent with the current one.The head needs to be shaved in advance and then positioned.

This is very risky, there is no vision at all, and you can only rely on the feel!There is also the control of the anatomical distance.

Now he honestly looks like a younger brother on stage, not like an associate professor of orthopedics at all.

Sometimes, it doesn't mean that the more minimally invasive, the faster the surgery, the better!
It depends on the situation that can be handled and the postoperative recovery.

The time spent, this operation, the fastest optimal solution!

Zhou Cheng felt that the distal end of the catheter went in a certain direction after reaching the celiac trunk.But it is necessary to control the catheter to the celiac trunk, pass through the first left gastric artery and the second common hepatic artery, and come to the position of the splenic artery!

First of all, although the limbs may not be preserved.

And this is the scope of neurosurgery, you should throw the problem to Du Li of neurosurgery, don't throw it to me, okay?

Du Li looked at Zhou Cheng seriously, then pursed his lips, and asked, "Can you do operations?"

After all, laparotomy is for surgery, not for stabbing people. Just take the knife and draw it directly into the stomach.

This is an emergency operation, and 3 minutes is enough to kill, making the difference between life and death.

If it is under the monitoring of interventional surgery, Zhou Cheng can accurately send the catheter or guide wire to the splenic artery.

Fang Jingsheng just finished the operation, and Zhou Cheng completed a relatively large project.

"Wait, what did you just say?"

Seeing Zhou Cheng take over, Fang Jingsheng immediately went to the opposite side to embolize other arteries, and Zhou Cheng left the arterial catheter sheath that Fang Jingsheng had just made.

It's just that after hearing Zhou Cheng's words, the professor of the anesthesiology department stopped playing with everyone——

And Zhou Cheng's idea of ​​embolizing the limbs before also sent away the orthopedic surgeon Fu Youhan who was invited to evaluate whether to perform amputation.

When playing chess, there are such ways as throwing away the car to protect the handsome, and abandoning the thirteen moves.

Patients with high blood pressure or cerebral aneurysm can undergo minimally invasive interventional surgery after arterial rupture and bleeding, but it is all done under interventional monitoring!

If you do it blindly, you are really playing with fire on the line of life.

This is the same truth!

Du Li can't do it himself. If you push me to such a point, and you don't come up to do it yourself, and then ask me to try, then you are really going to be beaten, young man, I want to tell you in advance clear.

This trick is called throwing your legs and hands to save your life!
However, under normal circumstances, if a person is alive without any limbs, then think about it again, where is the quality of life of this living body itself?
What is the meaning of his life? Besides being able to bring psychological comfort to his family, does he himself have to endure psychological suffering that is more terrifying than death for the rest of his life?

It seems that this is a basic operation that everyone knows!
Fundamental affairs 6, 6 must be titled!
In fact, Zhou Cheng was really speaking calmly, mainly to avoid quarrels, and to avoid confrontation and explanations with others.

Don't say that you are a medical student, laymen know that wherever there is a leak, it will be plugged, and if the clothes are torn, they will be mended.

"Ah?" Fang Jingsheng was on the opposite side!
Hearing Zhou Cheng's words, the whole person was shocked.

And without the extremely fatal factors such as extremity arterial bleeding and spleen rupture, at least the life window can be extended from a few minutes to a few 10 minutes, and there is longer time to deal with it!

In the art of war, there are green mountains left to worry about no firewood.

When Du Li heard this, he suddenly felt like a good guy.

It's as if the person who should be one of the protagonists has let go of his hands and feet and prepared the most exquisite acting skills.As a result, when he arrived on the set, he immediately became a dispensable supporting role...

Am I not understanding basic anatomy and anatomy?

Zhou Cheng shook his head and said, "What I mean is that after the hole is drilled, a guide wire is used to add a hose, and after the hose is sent to the center of the hematoma, the hematoma is directly sucked."

Zhou Cheng started the operation position at that time. Although he can't see the direction of the blood vessels in the abdomen now, he can only see the blood vessels of the lower limbs, but with this vision, he can also insert the metal catheter to the common iliac artery. The common artery flows backwards, passes through the abdominal aorta, and reaches the position of the celiac trunk.

It can also achieve the effect of hemostasis.

Zhou Cheng's speech was inappropriately calm!

okay.Still not satisfied yet, Zhou Cheng finally started working on neurosurgery again.

……

People in the general surgery department have plenty of time to prepare for spleen removal or suturing.

"Endoscopic treatment is actually not suitable for this type of disease." Du Li felt that he still had to tell the pros and cons of the matter first.

Can you perform interventional surgery without interventional monitoring? ? ? ?

It's not easy in such a professional place.

Zhou Cheng's suggestion is theoretically feasible, but patients with ruptured aneurysms are all relatively large aneurysms. Under monitoring conditions, embolization can be done to prevent further bleeding, and then released. Detachable spring coil.

In the operating room, the surgeon only treats the disease, and it is the anesthesiologist who really hangs the patient's life.Do you really think highly of me?
"Professor Chu, let's monitor CVP directly! I'll prescribe it to you!" Fang Jingsheng said.

Fang Jingsheng didn't ask any further questions, and left the catheter sheath behind.

"No? Professor Fang, I didn't mean to disturb and interrupt you? It's just that you clinically blocked the arteries of all four limbs? How can I monitor blood pressure?"

But although these words do not hurt much, they are extremely insulting!
After splenic rupture and bleeding, embolization of the splenic artery can stop the bleeding.

What are you talking about?

The equivalent is to say.

"Okay!" Since Fang Jingsheng knew Zhou Cheng, he also recognized Zhou Cheng!In addition, people in orthopedics also have a certain understanding of him.

"If the splenic artery is embolized in advance, it can reduce the amount of bleeding and buy us a lot of time for rescue." At this time, Zhou Cheng thought that Fang Jingsheng didn't understand, so he explained it this way to avoid too many disputes.

And Fang Jingsheng was the one who knew Zhou Cheng quite well!

Fang Jingsheng felt that he was violated again!

With no vision, Zhou Chengcheng probably felt the position of the lumen of the blood vessel, and then frantically tested it, finally!

Fang Jingsheng is from the Department of Vascular Surgery. It is not difficult for him to place the monitor himself.

Zhou Cheng didn't use any tools directly, but relied on the catheter.

About ten minutes later.

Fang Jingsheng dared not speak. Although he is a vascular surgeon, the blood vessels in the brain have always been treated by neurosurgery!
Even today, when there is an interventional department dealing with intracranial hematoma, it is the professor of neurosurgery who performs the surgery himself.The interventional department dare not operate intracranial hematoma alone.

Because of intracranial hemorrhage, the patient's death is generally not caused by insufficient blood flow!

Being able to monitor CVP is naturally more standard and more reassuring.

It's not too obscure, but it's not as smooth as other operations, and it's always a little awkward.

Not to mention Fang Jingsheng, from the moment Professor Fang Jingsheng heard Zhou Cheng say that he was going to embolize the splenic artery, his expression was dumbfounded...

You embolized the splenic artery, and now I go in through the laparotomy, can I still call the emergency laparotomy to save the patient's life?
Originally, a ruptured spleen would kill a person, but now that you do it like this, Professor Ni will only become a part-time job!
It seems that his laparotomy is performed faster and slower, it is always just an operation, and has nothing to do with the patient's life or death!

At most, the bifurcation in the celiac trunk is relatively small.

The operating room has indications.

Originally, Du Li also needed to perform craniotomy to remove the hematoma + craniotomy to stop the bleeding, and it was also very urgent.

It is to open the window for drainage, or even open the skull to stop the bleeding.To stop the bleeding and clean up the hematoma, it was done directly with a trip to the water.

It's just that if he is not allowed to monitor his blood pressure, then he wants to run away on the spot.Damn, I'm going to be anesthetized, and you won't let me monitor my blood pressure, how can I play with you?

When Fang Jingsheng had just opened a catheter sheath port for the femoral artery, Zhou Cheng happened to take over here, and Fang Jingsheng also put an embolism made of gelatin sponge particles.

Fang Jingsheng looked up at Professor Ni from the General Surgery Department, and then asked Zhou Cheng, "Is the splenic artery blocked?"

For normal people, even if the spleen is completely removed, it will not affect the quality of life too much. It is a life-saving situation!
At this time, the ruptured splenic artery was blocked, which is naturally a very good thing.

Anesthesiology, general surgery, vascular surgery, and orthopedics, Zhou Cheng basically 'worked' four at once.

Although why Lu Ganzhou was injured, Zhou Cheng didn't know.

Zhou Cheng sent the tip of the catheter to the position of the splenic artery, and it crossed the left gastric artery and the common hepatic artery!
While preparing to put the embolism, he said to Fang Jingsheng over there: "Mr. Fang, should I embolize the splenic artery first?"

In fact, in the past, this kind of arterial embolization for hemostasis was mostly used for internal iliac artery embolization of postpartum hemorrhage, and it was used for non-bleeding!
He has never used this method of directly embolizing the femoral artery to stop bleeding. It is a variant amputation to save his life.

"I can prepare a mirror, but are you sure you can get rid of the bleeding? This kind of multiple bleeding spots, even after the hematoma is removed with an endoscope, there is a great possibility of bleeding again."

After Zhou Cheng finished all this, he did not seek merit, but continued to read the current diagnosis of Lu Ganzhou, and then suggested: "Mr. Fang Jingsheng, and Mr. Du? Do you think we can treat the ruptured cerebral aneurysm now?" way, to deal with the hematoma in the brain?"

But the blood that comes out exists in the brain, which is a very terrible thing in itself.If a brain herniation is formed, how fast can he die? He can die faster than you.

But now, Professor Ni, who was obviously rushing to save his life, chose the upper left abdomen approach very anxiously, and then cut the subcutaneous part, and was dealing with the muscle layer.

However, upon hearing Zhou Cheng's words, Fang Jingsheng trembled and raised his head.Then Fu Youhan was also stunned, and looked at Zhou Cheng.The mouth covered by the mask opened slightly, choking on the words of swearing!
Malago Dogecoin Stuff!
What do you think you are here for?After finishing the vascular surgery, you want to teach the professor of neurosurgery?

Some people will develop psychological stress disorder just by amputating a leg.There are all kinds of mental abnormalities, all of which are gone, and it takes a person of great courage to live to accept such a result.

He thought there was something wrong with his ears, but just now Zhou Cheng seemed to say that he was going to embolize the splenic artery.

Zhou Cheng said: "There is MRA here, as well as conventional MRI. We can actually try a minimally invasive method to release a few hematomas inside."

Zhou Cheng's voice was still very steady!

"Of course you are on stage. Hurry up and wash your hands!" At first, Fang Jingsheng only cared about his own affairs, so he forgot that Zhou Cheng was not from Huashan Hospital. To be on the operating table, he had to be approved by at least one chief surgeon, such as Fang Jing Lift.

Even branch arteries from the splenic artery to the splenic hilus.

Zhou Cheng kid?
This patient can delay you to death, you know?
When Professor Ni heard Zhou Cheng's words, he looked at Neurosurgery Professor Du Li.

Today's young people are really not ready to be human!
When you enter the door, you will directly kick the job of the anesthetist who monitors the vital signs. You don't need to monitor the arteries of the limbs, but directly monitor the CVP.You have no choice.

Zhou Cheng immediately ran out of the operating room, washed his hands, put on a surgical gown and went on stage.

Zhou Chengcheng stepped forward and asked, "Teacher, can I also come to the stage to help?"

I am asking how you can find the splenic artery, not why you need to embolize the splenic artery.

I can only nod and say yes!
This is a better monitoring standard.

There are several bleeding points, can you put them in?

The cause of this project is similar to an operation that Zhou Cheng experienced when he was in Changshi.

Indications for CVP detection: 1. Critically ill patients with severe trauma, various types of shock, and acute circulatory failure. 2. All kinds of major and medium operations, especially major operations on cardiovascular, brain and abdomen.

It took him a while to figure out the direction of the blood vessel.

Therefore, Du Li's words were not polite, even a little threatening.

This is where everyone is most vulnerable.

It proves that this young man really has something!

"Professor Fang, you continue your work."

The tip of the guide wire was sent to the splenic artery!
Is this believable?Can you believe this?
But in a situation like now, what can you do if you don't believe it?
Is the distance from the femoral artery to the splenic artery the guide wire is longer than the distance from the femoral artery to the dorsalis pedis artery?
The arterial bifurcations to be encountered in the middle are relatively large!

Then Fang Jingsheng could believe it, but now?

Finally, after a certain moment.

The anesthesiology department should not interfere with clinical treatment options. That’s right, and I didn’t push too much, but I want to monitor and monitor the whole process, and adjust the patient’s vital signs at any time. If you don’t show me the patient’s blood pressure, I will play with you. A chicken feather?
I don't know anything about his death.

His movements were already very swift, but he couldn't bear Zhou Cheng's misbehavior. Before he even got in, he took care of the most terrible movements.Because the first thing he did when he cut the spleen was to tie up the splenic artery.

This blind feeling?

Then, the operation started step by step.

Now this?

Zhou Cheng didn't want to waste any more time, he just wanted to do a good job of this operation.

It's different to directly tie the aorta to this Q thing!

Even if Zhou Cheng is a bit capable.

But at least, it will not add trauma and stress to the patient that is equivalent to amputation.

Then, he embolized the splenic artery of the ruptured spleen in Professor Ni's upcoming acute abdomen.

Are you brave or cowardly?
If you are brave, why are you in such a hurry?
Slowly put the endoscope in and stop the bleeding slowly, if you are timid.

What Fang Jingsheng thought was, can you stop asking me some words that even exceed my current understanding of the upper limit of healing?

Du Li's expression immediately became very exciting.

and also?

How fragile is the brain?

Zhou Cheng nodded and said, "Okay. What I'm going to do now is to embolize the brachial arteries of both upper limbs. The bleeding points in the brachial arteries are large and numerous, and the amount and speed of blood loss are the highest!"

If opening the abdomen could be so simple, just anyone, a knife can solve it, how do you get in, how do you get out, external oblique muscles, rectus abdominis, you have to go through all these anatomical levels one by one processed.

In addition to reaching the splenic hilum, the splenic artery!
There are subgastroepiploic arteries and short gastric arteries!
What Zhou Cheng wants to do now is to block the splenic artery first, and then block the splenic artery!

This young man's guts cannot be small.

Du Li's scalp has already been peeled off, but the time is too short, and he hasn't had time to open the window yet. When he heard this, he raised his eyes immediately: "You mean interventional embolization + conventional craniotomy to remove the hematoma?"

Deembolization of brachial artery bleeding from the femoral artery.

"This minimizes blood loss from ruptured arteries in both upper extremities."

What about Zhou Cheng?That is the miraculous person who can perform thrombectomy across the arteries of the lower extremities that are thinner than the femoral artery. Can you still believe what he said?
"After the rupture of the spleen in acute abdomen, there will be a large amount of abdominal bleeding, which is very fatal."

"I can try." Zhou Cheng narrowed his eyes.

Neurosurgery is a department very close to orthopedic spine surgery, so Zhou Cheng accidentally acquired some corresponding skills and understanding during the simulation.

Especially for important structural injuries in the brain, the final manifestations are all classified as orthopedic activities, and Zhou Cheng's understanding is more in-depth.

　Chapter [-] has been unsealed.

　　
　
(End of this chapter)