medical simulator

Chapter 405 Killing without a knife!

Surgery is not a joke, each surgery has its corresponding indications.

It's not a surgery, as long as it sounds better, high-end, and capable enough, it can be performed directly.

Needle hematoma evacuation under CT monitoring.

Naturally, it is the least traumatic, but it is only suitable for a single hematoma, especially if the patient suffers from a single and relatively large hematoma.

The problem can be solved quickly.

However, there are many hematomas like Lu Ganzhou today, but not very large, it may be safer to remove the craniotomy, or to do it slowly under the endoscope!
This is Du Li's idea, and it is also a relatively conventional idea.

However, Lu Ganzhou's condition is different now. According to the conventional perspective and thinking, then just wait for death.

Therefore, from the very beginning, Zhou Cheng's thoughts did not take the usual path!

The reason why medicine needs to develop is that the current level of inheritance and knowledge will never be able to analyze all existing diseases, no matter which medicine is the same.

Can you stop talking so casually?
However, it seems that their reaction at this moment is not as big as before. After all, everything has a process of getting used to it.After getting used to it, it wasn't as shocking as before.Zhou Cheng even blindly drilled the femoral artery into the cerebral blood vessels. Isn't it easy to blindly perform a lower extremity arterial embolectomy?
Why should they be surprised?

"The high-voltage cliff fell to 50+, and it can be rescued. This really requires a very high level."

He didn't intend to keep his own strength anymore, he was always thinking about self-protection, he decided that since Zhou Cheng wanted to save people with all his strength, then he would take a risk to cooperate with him and save him time.

Surgery continues.

Zhou Cheng nodded at that time, and after a slight turn in his mind, he suddenly understood, and said to himself, Brother Zhou Cheng, you better not be too careless!
You are now in Huashan Hospital. This is not a place where you can be unscrupulous. There are more professors and experts here than you can see.

But ischemic necrosis should come, if not dealt with in time, if muscle necrosis occurs in the limbs, then the patient will die, unless it is amputation to solve all the troubles at once.

Dean Wang and others didn't care about Professor Chu interjecting and leaving it alone, but just to be on the safe side, Dean Wang still asked: "Professor Lu, Professor Nong, you must not refuse, today's TV station The operation is an extremely difficult emergency operation, and I sincerely request the two professors not to hold back anything because of scruples."

There are some dangers that should be taken when necessary. We can't let a young man fight alone here to be a hero.

"Bring two more dopamine, and adjust the speed of the intravenous medication."

It's just that the speed at which Zhou Cheng was doing the hemostasis of the splenic artery and the intracranial artery was a little too fast!

The first reaction of every doctor is that they must not leave any mistakes in the operation process to cause trouble for others, and choose the optimal solution under the most standard operation suitability for everything!

Zhou Cheng's hemostasis was also very fast. Basically, he treated several intracranial bleeding points within two to three minutes.

In fact, Zhou Cheng wanted to get started directly from the very beginning, but he couldn't.

After replying, Professor Chu immediately followed his students: "Continue pumping electrolytes, replenishing so much blood, we must pay attention to hyperkalemia and metabolic alkalosis."

Zhou Cheng himself is a little confident about his current technical level, but others don't know!
It is impossible for everyone to know, this is still a lack of experience and resume.

"The hematoma removal operation?" Zhou Cheng still asked one more question, mainly because the hematoma might be fatal, Zhou Cheng didn't want him to save his legs and hands and lose his body when he performed the thrombus removal operation on limbs.

An assistant next to Du Li seemed to be a little frightened by Du Li's action, and said, "Mr. Du, the diameter of this hematoma is not very easy to operate, isn't it? Actually."

Stretch the rectus abdominis to both sides, clamp the posterior sheath of the rectus abdominis and the peritoneum, and clamp the peritoneum with toothed forceps, and the assistant clamps another one centimeter away from the place where the surgeon clamped with the assistant. , and then the surgeon loosens the clamped peritoneum, and then clamps another place, repeats the same procedure, and cuts it open with a knife.

Du Li didn't say much, and immediately began to change the operation method, and then began to draw a positioning line comparing the position of the intracranial hematoma.

Do what can be done, what should be done, what should not be done, there is no need to take risks.

If this was at the Affiliated Hospital of Shonan University, Zhou Cheng would have the home field advantage. With people behind him, Zhou Cheng would not even have to create opportunities by himself, but would directly tell Ding Changle and Cai Dongfan.

Even everyone in Huashan Hospital knew Zhou Cheng.

However, seeing Zhou Cheng's strength, it was almost a case of humbly begging for their opinions and trying all kinds of extreme methods before.

In this way, even if there is a lawsuit, it is strictly within the guidelines, and operations outside the guidelines are illegal operations!

These steps are indispensable, plus the process of hemostasis, this speed is considered the limit speed, okay?

But Zhou Cheng's words immediately made Fang Jingsheng and several vascular surgery staff, and even the neurosurgery staff who knew what an introducer tube was, cursed in their hearts.

In this way, the most deadly places are all solved first.

If the intracranial hemorrhage does not continue to expand, there is no big problem.If the rupture of the spleen is serious, just cut it off. The contusion and laceration of the liver is not particularly serious. For the professor of general surgery, it is just a piece of cake.

There is a teacher named Zeng Diwei in the Ninth Academy.

You know, under normal circumstances, who would embolize the arteries of the limbs?
The idea of ​​this operation is already in progress, so what can't be done with the thinking of interventional hemostasis and clearing the intracranial hematoma with a puncture needle?It's just that the premise is that you can do it yourself.

However, Fu Youhan from the Orthopedics Department recognized the identities of these people, walked over silently, and said in a low voice, "Director Tong, Teacher Zhang, and Zhou Cheng, a student of Teacher Zeng Diwei, are on stage."

"At that time, there was a rupture of the splenic artery and an intracranial hematoma. It was already difficult to maintain the balance of blood flow by debridement and precise hemostasis, so Xiao Zhou and I chose violent devascularization!"

This speed is not slow anymore. After all, it has only been more than 6 minutes since Zhou Cheng made his decision.

Fuwai Hospital is the best hospital for vascular surgery, and the best hospital for neurosurgery is Tiantan Hospital in Kyoto.At least officially, that's how it's defined.

The leader was an old man with gray sideburns. After he entered the door, he shouted: "Professor Fang, how is the patient's condition now? I happened to invite an expert from Fuwai Hospital in Kyoto to Shanghai on a business trip. "

"What are you going to do next?" Fang Jingsheng felt a headache at the moment. Although the temporary life-threatening part was temporarily resolved, how should the embolism in both lower limbs and upper limbs be treated?Now even if the embolized thing is removed, the blood probably won't be able to flow, and the bleeding will not come out.

But Zhou Cheng is not!

However, this situation has already returned to the familiar scene of Zhou Cheng.

But the professor of vascular surgery frowned slightly, looked at Lu Ganzhou's limbs, and said in disbelief: "Professor Fang, the blood supply to these limbs is cut off so neatly, could this be caused by trauma?"

Of course, the procedure they have to follow is very simple.

Then, at this time, a lot of people suddenly gathered at the door of the operating room, but these people just surrounded the door of the operating room and looked inside curiously, but none of them really stepped on the door of the operating room. The door of the room is afraid of affecting the rescue operation!
One of the itinerant nurses saw this scene and thought there was something wrong, so he went to the door and opened the door to ask about the basic situation.

And this kind of wry smile is the kind of bitterness where the bile is flowing backwards.

This is Huashan Hospital. This operating room is only open to doctors in Huashan Hospital!
Even if Zeng Diwei came to have an operation, he still had to go through procedures.

……

You are paralyzed!
Insulting people should also pay attention to the lower limit?

"Shave your hair!" Du Li just replied.

Why bother?
Therefore, under such circumstances, Zhou Cheng was a little touched that Du Li was able to say such words.

I firmly frame my actions under the so-called expert consensus and so-called guidelines, because only in this way can I be exempted from responsibility and attribute all accidents to the limitations of medical technology.

Full responsibility, losing money, apologizing, demotion, affecting promotion, and even being a doctor may not be possible anymore.

Professor Lu frowned when he heard the words: "Saving a limb to save life is not a choice. Keeping the green hills alive will not worry about firewood."

"Then this is Professor Nong from Tiantan Hospital in Kyoto. Him."

"Professor Ni, can you help me make the port of the inferior arterial sheath? I haven't done it yet." Zhou Cheng answered very quickly, but he was also a little bit embarrassed.It seems a little shy.

But, he wasn't absolutely sure.

Because, if you don’t hide six points of your skills and ideas, one out of a hundred patients will have an accident and go to court. It’s nothing to say, you didn’t act according to medical principles, and you didn’t follow the guidelines for treatment!

Professor Chu said: "Thanks to the limited blood loss, otherwise, the patient's heart rate would definitely be in ventricular fibrillation now, and it jumped to 160 at the highest point, and he was cardioverted not long ago."

At this time, Zhou Chengcheng was no longer polite or modest. Now that time is urgent, if he is humble a few times, the people of Lu Ganzhou will disappear.

"That doesn't look like it?"

Dean Wang had just finished speaking, and the professor Nong introduced by him, an old man with clear eyes but senile plaques all over the bridge of the nose, spoke: "Dean Wang, I will not be on stage anymore, with Professor Du here. The current operation It's going well."

Zhang Xingze, who was next to Tong Dawei, also felt that the word Zhou Cheng was more familiar.

The injury caused by Fang Jingsheng's words made the vascular surgery doctors standing beside Fang Jingsheng start to be partial, and helplessly smiled wryly!

After doing this, Professor Fang Jingsheng embolized all the blood vessels in the limbs.Zhou Cheng breathed a sigh of relief.

After all, the flow of blood in the blood vessels is completely dependent on the pump circulation of the heart. After the flow stops, it will stagnate.The blood does not move in the body, but there are other traumas, which will stimulate the activation of the endogenous and exogenous coagulation system, and then cause blood coagulation.

At this time, the general surgery personnel opened the abdomen.

The meaning of this is very simple, take out the emboli, and use the unimportant bleeding points to continue to stop bleeding through the remaining emboli. The important bleeding points are precisely located at the bleeding point after the thrombus is removed. Embolization to stop bleeding.

The only bad news is that the lower extremities that were embolized before have already started to embolize.

Du Li is also a well-known neurosurgery professor at Huashan Hospital, and it's not like he doesn't know how to evacuate a hematoma guided by a puncture!

"The oxygen flow can be adjusted down..."

He can start the main operation immediately.Even in the Ninth Academy, Zhou Cheng can directly say that I want to go on stage, instead of asking a few professors for their opinions, and I can only go on stage after getting permission.

However, the comprehensive strength of neurosurgery in Huashan Hospital ranks second in the country, and Professor Du Li is a well-known top expert and professor.

While saying this, the door of the operating room was pushed open.

Very skillful, three points are enough to eat, six points are hidden for self-protection, and one point depends on God's will.Isn't this life delicious?

Then a large number of middle-aged and elderly people wearing green clothes, surgical masks and hats squeezed in.

"Thank you, Professor Du."

However, Fang Jingsheng could also understand that Zhou Cheng was doing this to give them a better sense of participation.Don't let everyone's appearance be so ugly.

Professor Lu glanced at the blood pressure display on the anesthesia machine.

For this operation, because the director personally spoke, there is no upper limit for the staff of itinerant nurses and handwashing nurses. If she needs ten, she will call ten people to the operating room!If there is a real shortage of people, she can fill in by herself.

Good news came from all sides.

Along the direction of the muscle fiber, the rectus abdominis bundle is first separated with a vascular forceps and then with a knife handle or fingers.

Zhou Cheng nodded and said, "I can do it!"

"How much is the rehydration?" He was already busy.

He could only shave his hair.

"What?" Tong Dawei immediately turned his head and looked at the operating table.

However, everyone who came in didn't respond to his words. People from other specialties went to the direction of the film reader and were carefully reading the condition.

And according to the most conventional way of thinking, Du Li and Professor Ni did not scold his mother or even kick him out when Zhou Cheng opened his mouth to disturb their own surgical design ideas.

The speaker was the director of Huashan Hospital. When he spoke, Du Li and Fang Jingsheng were still working.

And if Zhou Cheng was not a little-known doctor but a very well-known associate professor in the industry, Zhou Cheng wouldn't have to make all kinds of suggestions in such a humble way, and just get started, let's say, this It's my specialty, please feel free to leave it to me.

Zhou Cheng was being modest, but it was just a little too much.

At this time, Professor Yan from the Department of Thoracic Surgery also sent good news, saying: "There is not a lot of bleeding in this chest, and the drainage on my side is not too much."

"We're now planning to reopen it."

After all, there are not many people like Zhou Cheng who have professors to speak and support him.

Let's put it this way, in fact, the current professors in major teaching hospitals may be able to carry out surgeries that are much wider than the scope of real surgeries, and they also have a lot of thoughts in their hearts and minds.

This is a bit sweet, but also a bit awkward.

After 6 minutes, sterilize the towel, stick a sterile film on the incision site, and cut the skin and subcutaneous tissue.Cut a small opening in the anterior sheath of the rectus abdominis first, and then use scissors to cut the anterior sheath upwards and downwards.

When Zhou Cheng said this, Du Li immediately said: "Xuan Xun, quickly push the computer over and transfer the MRA video to him."

However, in most cases, because of the current medical environment, these professors are unwilling to touch or try many things.

Fang Jingsheng said politely: "Professor Lu has good eyesight. The patient's blood vessels in the extremities are cut off. We did it ourselves to stop the bleeding quickly and easily."

Immediately afterwards, Du Li also took charge of his own work: "Xiao Zhou, I will do the needle drilling, and you only need to be responsible for stopping the bleeding!"

Fang Jingsheng opened and closed his mouth slightly, nodded, and stepped aside: "Then you start first, starting from the upper arm I have embolized last, there may be fewer embolisms to encounter, and the operation will be more difficult. Lower."

"Vital signs have also stabilized."

The anesthesiologist, Professor Chu, also took a long breath and said: "CVP has finally stabilized. The blood transfusion is still taking place here, so it should be more stable. For the time being, we are out of the period of possible shock at any time."

Zhou Cheng's words were calm, but the professional difficulty was beyond the comprehension of others.

Zhou Cheng said: "Professor Fang, now we will make another small incision at the farther part of the entrance of the femoral artery sheath, and then take out the thrombus in the artery, and then pass through the bleeding point collected by the previous MRA. , Selective and precise hemostasis, and then take out the embolus. If the bleeding point is really difficult to deal with, it is enough to open the local hemostasis."

Obviously, he also knew Fang Jingsheng. There were many international conferences in Kyoto and Shanghai, and there were even more collisions and exchanges between top professors, so basically the big shots in the world knew each other.

Then Zhou Chengcheng said: "Teacher on tour, can you push the computer for reading the images over for me? I want to see the specific location of the bleeding point. I'm going to put gel to stop the bleeding in the skull now, thank you!"

"Don't worry, I'm sure I can do this!" Du Li replied very calmly.

"Zhou Cheng, he has already gone to the operating table for surgery, and he has embolized the arteries of his limbs first, saying that the treatment will be delayed." Fu Youhan continued to explain.

After Tong Dawei saw Zhou Cheng's figure, he lowered his head and explained to Zhang Xingze: "Mr. Zhang, this Zhou Cheng is..."

In this way, the two people in the orthopedics department will no longer participate, and the operation is still going on.

……

(End of this chapter)