This doctor has a system

Chapter 181 179. It seems that I dreamed of my grandma just now.
"Are you over so soon?" Director Pan walked in at this moment, "Gao Feng, I have a patient with a stent here, come and take a look."

"The patient is my relative, who came from Shai." Director Pan gave Gao Feng a detailed introduction of the situation.

A 72-year-old male patient was admitted to the hospital with the main complaint of "cough, sputum and chest tightness for 9 days after 16 months after operation for esophageal cancer".Chest CT showed: chronic bronchitis, emphysema, thickening of the middle and lower esophagus wall, enlarged mediastinal lymph nodes, stenosis of the left main bronchus, and esophageal cancer involving the left main bronchus.

"Generally speaking, the breathing sound of the right lung is rough, no dry and wet rales are heard, the breath sound of the left lung is low, and wheezing can be heard, but no wet rales are heard." Director Pan said.

"Electrocardiogram, blood routine, coagulation function, brain natriuretic peptide, troponin I, cardiac color Doppler ultrasound, and double lower extremity venous color Doppler ultrasound showed no obvious abnormalities."

"The rigid endoscopy was done at the hospital over there in Shai, but the stent was not put in." Director Pan picked up a report card and showed it to Gao Feng, "This is the bronchoscopy report over there."

According to the report above, the middle and lower 2/3 segments of the left main bronchus showed more than 90% endogenous and external pressure stenosis. The tumor was ablated under bronchoscope, but the reason why the stent could not be put in was not described.

"I called and asked, and it was said that after repeated trials, the left and right branches of the stent could not enter the corresponding lobe bronchus smoothly." Director Pan saw Gao Feng's question and said hastily.

The patient's hometown is Han Nan. The purpose of coming to Director Pan this time is to try again. If he really fails, he will go home directly. The 72-year-old man is thinking about returning to his roots.

"It's starting to go numb!" The anesthetist wearing a flamboyant flower hat shouted, and began to push the medicine, and the patient quickly lost consciousness.

The patient was in the supine position with the neck hyperextended. Director Pan held a rigid bronchoscope and received high-frequency jet ventilation through the side port. The endophytic and extrinsic stenosis of the /2 segment was more than 3%, and the bronchoscope could not pass through it. The stenotic segment was dilated by balloon pressure, and the bronchoscope could barely pass.

After passing through, I saw a large amount of yellow-white purulent secretion gushing out, which was similar to some indescribable things, and everyone understood it.The scene was very healing, a trainee doctor who had never seen the world ran out covering his mouth.

"Look, the child is so excited that he vomited." Director Pan made a small joke.

After suction and cleaning, the bronchial mucosa of the upper lobe of the left lung was smooth and the lumen was unobstructed. The distal end of the neoplasm invaded the opening of the left lower lobe, and the lumens of the dorsal and basal segments of the left lower lobe were unobstructed.

In order to ensure ventilation of the left lung, Director Pan performed tumor ablation treatment on the patient under the bronchoscope. Firstly, the new growth in the left main bronchus was electrocuted, and the smell of barbecue wafted out instantly, a bit like charcoal-grilled pork belly. .

The trainee doctor who had just vomited in smelled the smell, turned around and ran out immediately
After finishing the work, the silicone stent will be placed. Director Pan looked at Gao Feng, "How should I say it?"

“根据他这个气道直径，可以选择了Dumon支架（15-9-9）。”高风让潘主任测量了一下病变长度，对支架进行了现场改良（主干40 mm、左侧分支14 mm、右侧分支1 0mm）。

Push the rigid mirror to the opening of the patient's left main bronchus, and use the pusher to push the stent to the left main bronchus. Trouble arises: the left and right branches of the stent cannot enter the corresponding lobe bronchi.Director Pan successively tried the method of guiding the two branches of the stent with the balloon and pushing the main body of the stent forward with the grasping forceps, but all of them could not be successfully inserted.

"This is not easy!" He frowned.

Gao Feng also tried a few times, but failed, "No way, let's try again with the hole-opening technique." He thought for a while and said.

"What drilling technology?" Director Pan raised his head, "Why haven't I heard of it?"

"Oh, there are relatively few applications, but I have seen others do it before." Gao Feng said, "It's quite suitable for his situation. Next, I need an aortic punch."

There is no aortic punch in the bronchoscopic room, but this is not a problem for Director Pan. He made a phone call, and soon someone trotted over to deliver this thing.

The process of opening the hole is not complicated. Gao Feng first made a small hole with a scalpel in the direction of 1 o’clock in the upper quadrant of the left branch of the stent, about 4 mm away from the distal end of the stent, so as to facilitate the entry of the punch; A 4.5 mm aortic punch was passed through the small hole and a round hole was punched, and the stent improvement was completed.

Director Pan's eyes widened, that's all?Can it work?He was a little skeptical.

Gao Feng pushed the stent again to the left main bronchus, the balloon assisted to guide the right branch into the left lower lobe, and the biopsy forceps clamped the side hole of the left branch.

"Quick, use a bronchoscope to help me guide the angle and direction of the biopsy forceps." Gao Feng shouted at Director Pan, who was a little distracted at this moment.

Soon the biopsy forceps entered the upper lobe of the left lung. Gao Feng grasped the forceps at the same time and pushed the trunk of the stent downward. The stent was inserted smoothly.

"Damn it!" Director Pan's eyes widened, "Gao Feng, you're amazing!" He couldn't help boasting, "Where did I learn this technique? Why haven't I seen it before?"

Of course I learned it from the system, Gao Feng thought.

"Your skillful operation has greatly improved Pan Weiyun's hard mirror skills, and you have gained 10 skill points."

Hearing the prompt from the system, Gao Feng couldn't help giving Director Pan a high look. The other party's understanding was the best he had ever seen so far.

Pang Tianming woke up now, and his wife quickly stood up and asked him if he felt uncomfortable.

"No, it was quite comfortable. I had a good night's sleep." Pang Tianming was telling the truth. He was under a lot of psychological pressure these days, and he prayed all day long that he would never get a tumor.

"I just don't know what's going on, I seem to have dreamed about my grandma just now." He felt a little weird.

Seeing that he was awake, Qin Hao came over and explained.

"It means that this might not be a tumor, but a mutated blood vessel?" Pang Tianming was so excited, "Are you sure?!"

"I'm not sure, I need to do an enhanced CT next." Qin Hao didn't dare to promise, "Let's go back to the ward first, I'll make a checklist, and the family members hurry up to make an appointment."

In the afternoon, the results of enhanced CT came out.

When Qin Hao saw the result, cold sweat broke out on his head, and he opened the biopsy forceps at that time.

How exciting!

"Enhanced CT must be done before biopsy!" He remembered what a teacher repeatedly emphasized when he first learned bronchoscopy. At that time, he didn't take it seriously. Increase the patient burden?

Think now
Fortunately, Gao Feng was there at the time, and Qin Hao's heart was very complicated. He originally thought that the other party was just writing articles and doing scientific research, but who knew that his clinical skills were so strong!
He is on the first floor, thinking that the other party is at most the third floor, who knows that he is in the atmosphere.

Li Youliang has not been so busy recently. He led Zhao Xingye to visit Secretary Zhou, Xue Donglai and others. These can be used at critical times.

There is still no progress in the matter of the airport laboratory, and there is no hope of resuming work in the short term. The construction party is in a hurry, and the delays every day are all money.

"Youliang, what is your dream?" Zhao Xingye started talking more after drinking two glasses of beer.

"I really can't say that." Li Youliang pondered for a while, "When I was young, I saw my dad working very hard, and I made up my mind at that time that I would never work when I grew up."

"Then your dream is to make money." Zhao Xingye said with a smile, "I dreamed of being a pianist when I was a child, but I didn't want to go after studying for a month. My mother almost broke my leg with a stick."

The two chatted a few more words, and felt that the relationship between them had increased a lot.

"Youliang, do you think our company is different from others?" Zhao Xingye said.

"What's different?" Li Youliang was a little curious, "I haven't stayed in other places, so I don't know what's going on in other companies."

"The things our company is doing now seem to be made by the boss alone, and I, the general manager, have too little participation." Zhao Xingye said: "There is no need to worry about the direction of development, no operation, no need to find target customers. .”

"I don't even have to worry about finances, just wait for someone to send money every day." He poured himself another glass of beer, "I can't get involved with the generic drug developed by the company now, and I'm quite confused now. "

"You think too much." Li Youliang said with a smile, "This is not very good, less work and more money."

"And I've contacted Jiaran. The progress of the experiment over there is gratifying. When the results come out, it will be hard to count the money."

Mentioning Hu Jiaran, Zhao Xingye was a little displeased, "The people under him spend too much money. I have no objection to paying overtime pay, but it can't be paid at the highest rate."

"They are the ones who spend the most in the company now. If there is no result, the loss will be quite big."

"It's not too big." Li Youliang said indifferently, "I think it's more than 700 million including equipment and equipment expenses, and the company's book is several hundred million."

Zhao Xingye almost choked to death on beer, did you speak human language?

Well, you don't care, do you?Then I don't care!Zhao Xingye thought to himself.

Li Youliang saw Zhao Xingye's displeasure, and quickly said a few words of comfort, "Old Zhao, don't worry, our generic drug is absolutely fine, you have to trust the boss, he will not be wrong."

"Okay." Zhao Xingye forced a smile, but his heart was still heavy.

He has not been idle in the past few months. Although he doesn't know much about the medical and pharmaceutical industries, he has consulted many professionals, many of whom are well-known figures in this industry.

Most people are not optimistic about the company's imitation of this bevacizumab injection, "This is not what your small company should do." Someone told him bluntly.

I think of the team in the company, the highest education in it seems to be a master's degree, the leader is still a child, every time I call back, he is urging for money
It didn't seem to be the last time. The last time I called, it seemed that I gave way to an Audi A6, saying that there was no one driving in Z state anyway.
Can this work?General manager Zhao was very confused.

　ask for votes

　　
　
(End of this chapter)