This doctor has a system

Chapter 566 629. Saw
Taking a detour is obviously useless. Inhaling gases containing psittacosis can also cause the onset of the disease. What's more, as he said before, bird droppings often fall on the quilt.

"Change the antibiotic to doxycycline." Gao Feng pulled out the patient's medical records again.

He had diagnosed psittacosis once before, but the patient's imaging features were very typical that time, but not this time, so he couldn't figure it out at first.

But now, working backwards from the results to the causes, Gao Feng actually discovered some problems.

"When the patient's temperature was 38 degrees Celsius, his heart rate was 120. When it rose to 39 degrees Celsius, his heart rate became 104. Don't you think it's strange?"

"Relatively slow pulse?" Mao Wen is a doctor after all, and he has the basic skills. As soon as Gao Feng reminded him, he also felt something was wrong.

"Yes, it is a relatively slow pulse."

"The patient has symptoms of pneumonia, but his white blood cell count is within the normal range, his PCT is elevated, he has headaches, muscle aches, and a relatively slow pulse. Basically, we can consider the possibility of atypical pneumonia."

"At this time, we should first consider Legionella or psittacosis."

When you find yourself overcomplicating things, you tend to fall into the other extreme.

Gao Feng felt a little ashamed when he said this. He couldn't remember how long it had been since he had felt this way.

"Mao Wen, you are fully responsible!"

Mao Wen
The NGS sequencing results came out the next day, and Chlamydia psittaci was clearly written on the report.

This means that even if they found nothing yesterday, they can still get a clear diagnosis today. But Gao Feng thought of more. In fact, compared with these tests, the diagnosis and treatment ideas are the most important.

There weren’t so many testing methods in the past. Is it possible to see a doctor without the advanced NGS?

"When we encounter such difficult patients, we must first think about whether each step of treatment is in line with our diagnosis and treatment standards?"

“Is there any room for optimization in the inspection steps?”

Experience can be accumulated slowly, but learning clinical thinking must be the most important, otherwise you will encounter the situation today.

"Director Gao, are you in the hospital?!" Director Dong Zhida from the emergency department called.

"I'm at home." Gao Feng replied, "What's wrong, Director Dong?"

"If it's not urgent, come to the hospital and help." Director Dong's tone was very anxious, "There is a special patient here!"

"I'll be there right away!" Gao Feng hung up the phone and left home.

The lobby of the emergency department was in chaos at the moment. Ma Liang was also there. When he saw him coming, he hurried over to greet him.

"Let's go to the emergency operating room. Everyone is there."

"What's going on?" Gao Feng asked.

"Oh, one is stupid and the other is a mentally unstable college student." Ma Liang said with a complicated tone, "I don't know what stimulated them."

The patient, Bi Shaokang, is a young male, 21 years old, who has not yet graduated from college. Let’s call him Xiao B.

The cause of the incident was actually very simple. Little B had a girlfriend during college. They loved each other and agreed to grow old together.

But as graduation approached, the girl suddenly changed her mind.

Don’t ask why, just know that I have loved you!
Xiao B was very sad and couldn't accept it, so he made a serious negotiation with the woman on the spot. But the other party was perfunctory and ignored his questioning.

"Then the kid took a chainsaw and ran to the other person's dormitory, saying that if they didn't get back together, he would die in front of them."

"And then what?" Gao Feng asked.

The result was that the patient used an electric saw to cut off both of his legs and five fingers on his right hand.
"So fierce?" Gao Feng was shocked. This guy is definitely a ruthless person!

"The patient drank a little at the time," Ma Liang replied. "I don't know if it was because he was drunk."

"His girlfriend must be very beautiful, right?" Gao Feng guessed.

Speaking of this, Ma Liang's expression was very complicated. "Maybe it's because beauty is in the eyes of the beholder," he said.

After arriving at the operating room door, Gao Feng understood why he said this.

A girl with an ordinary appearance, with a score of 4 at most, was sobbing there.

"That's the patient's ex-girlfriend." Ma Liang said to Gao Feng, "I'm wondering, has this kid never eaten pork or seen a pig run?"

Is it necessary to win back an ex-girlfriend who looks like this?

It would be fine if they just wanted to save the relationship, but they actually used such a tragic method.
"Either he got kicked in the head by a donkey, or the woman cast a spell on him," Gao Feng thought.

"You can't say that. I don't think the girl is particularly ugly." He said to Ma Liang against his will.

The patient's parents have not arrived yet, but they asked over the phone that everything possible be done to save the limb.

There were quite a few people standing in the operating room at this time. Director Li of the Hand and Foot Microsurgery Department and several doctors were discussing the surgical method. When they saw him coming, they showed overjoyed expressions on their faces.

"Director Gao is here too! That's great!"

Gao Feng quickly washed his hands and put on his surgical gown. The first time he saw the patient, he felt his anus tighten.

As mentioned before, the patient sawed off both of his legs and five of his fingers. This may not sound like a big deal, but when you actually see the five neatly arranged fingers in the tray, few people can hold back.

The patient had multiple wounds on his body, probably caused by being scratched by an electric saw. The medical staff had done a simple cleanup, but it still looked like a bloody mess.

"The blood pressure has dropped to 80/40 mmHg." The anesthesiologist said as if facing a great enemy, "Where is the blood? Send it here quickly!"

"The results of the infectious disease have not come out yet." The instrument nurse who set up the stage said, "What should we do? Should we wait or not?"

"Don't wait any longer." Director Li hesitated and said, "It took at least two hours to cut off these two calves and five fingers."

Moreover, they were in a severely contaminated state when they were delivered and had not been properly preserved. The longer they wait, the lower their survival rate will be.

"Is there any infectious disease?" The nurse was worried. "College students nowadays really like to have fun!"

"Probably not." Director Li said, "This guy is a licker. He is very loyal to his patients. Otherwise, he wouldn't have hurt himself."

Gao Feng also agreed to start now. His blood pressure had dropped and if he waited any longer his life might be in danger at any time.

"Okay, let's get started now." Director Li made a decision immediately, "I'll assign the areas that each of us will be responsible for."

At this time, Director Ma on the side was already eager to try.

Director Ma has only been working at the Provincial Hospital for 3 months, but he has already become a professor leading a team, thanks to his superb skills in limb replantation.

He had been working in the Orthopedics Department of Shanghai Sixth Hospital, mainly doing wound repair and limb reconstruction. The Orthopedics Department of Shanghai Sixth Hospital has a glorious history. In 1963, the world's first limb replantation surgery was performed here.

The golden signboard has lasted for more than half a century. To this day, the young and middle-aged doctors here are still doing the "most extreme repairs" under the shadowless lamp. The rapid iteration of artificial intelligence, robotics and other technologies still cannot replace the "skills" of these doctors.

Although Director Ma, who came from the Orthopedics Department of the Sixth Hospital, is not a top celebrity there, he is obviously not an unknown person, otherwise he would not have been introduced to the Provincial Hospital as a special talent.

During the three months here, he gained a general understanding of the limb replantation technology at the Provincial Hospital. To put it simply, it's okay.

It is very much in line with the standards of the local leading hospital. It can do the basics and is also able to try the complex ones, but the results are hard to say.

After Director Ma came, he participated in several complex operations, and his abilities were unanimously recognized by everyone in the department.

So in his eyes, these five fingers belong to him.

The reason is simple. These five fingers belong to the right hand. The right hand is used to perform various delicate operations. If it is not done well and most of the functions are lost, it will have a huge impact on the patient's life.

"I'll take care of the left leg, Director Ma will take care of the right leg, and Director Gao will be responsible for the fingers." Director Li's distribution method was obviously a little beyond Director Ma's expectations. He looked at Gao Feng with surprise.

'Who is this Director Gao? Is his skill better than mine?'

is it possible?

Seeing the other person's childish face, Director Ma immediately denied this possibility in his mind.

"Director Li, how about letting me use these five fingers?" he said.

Director Li looked up at the other person, looking a little embarrassed. Director Ma's level is indeed very high, and he has also proved himself during his time at the provincial hospital.

But it depends on who you compare yourself with.

Thinking of Gao Feng's previous miraculous operation, Director Li hesitated for a moment and then rejected the other party's proposal.

"Director Ma, you'll know soon." His confident tone made Director Ma doubtful.

Is there a doctor in the Provincial Hospital who is more proficient in limb replantation technology than me?

Director Gao is so young, could he be a returnee from overseas?
No, that's not right, Director Ma quickly rejected his idea. The reason is very simple. China is unique in the world in the field of limb replantation. Many foreign doctors come here specifically to learn.

Forget it, I'll fix my right leg first, and then the remaining fingers will still be mine, he thought.

If the other party is too slow, it can't be blamed on him.

Little B's lower limbs were not completely severed.
Gao Feng is carefully examining the five fingers of the patient Xiao B. You know what, they are cut quite neatly, as if they were sawed off in one go.

Most of the patients who commit self-harm lose fingers on their left side. The reason is simple. Most people have a more flexible right hand, which can be used to operate a heavier electric saw. Little B is most likely a left-handed person.

This kind of completely severed finger cannot completely restore its original function after being transplanted. The reason is very simple. Not to mention the recovery of blood vessels and nerves, just the four words "post-operative functional training" are a big hurdle. It is easier said than done.

But if the surgeon is very skilled, the prognosis will definitely be better.

Gao Feng plans to work on the thumb first. The thumb is the most important part for ordinary people because the function of the thumb accounts for more than 50% of the function of the whole hand.

If the thumb is missing, the hand function will be seriously affected, and the hand will not be able to perform actions such as pinching, grasping, grabbing, and holding. However, as long as the thumb retains a certain length, even if only one of the other four fingers remains, some of the hand functions can be restored through appropriate functional exercises, and actions such as grasping and pinching can be performed.

Therefore, in the case of a thumb injury, such as finger amputation, if the conditions for replantation exist, the priority is to replant the amputated finger.

Even if there are no conditions for replantation, we should actively adopt treatments such as flap transplantation, try to preserve the length of the thumb to realize the function of the thumb, improve the patient's quality of life as much as possible, and enable the patient to do simple work and self-care activities through practice.

"Use 12-0 sutures." Gao Feng said to the nurse. The latter was stunned for a moment, and then quickly moved. However, Director Ma on the side could not help but look up at Gao Feng.

Is this young man trying to show off?

12-0 suture is the thinnest thread used in surgical sutures, with a diameter of only 0.06mm, thinner than a hair. It is easy to imagine how difficult it is to operate with such a thin suture.

Director Ma had used this kind of suture before, but the patient was a 5-year-old girl with very thin blood vessels, so it was a helpless choice.

But this is obviously not the case for patient B. There is no need for him to use such thin sutures. The reason is very simple. Although in theory the thinner the suture, the less damage to blood vessels and nerves during suturing, the difficulty of the operation will increase exponentially.

Limb replantation also has certain requirements for the duration of the operation. Excessive pursuit of thin sutures will most likely greatly prolong the operation time, which will not be worth the cost.

"By the time I finish this leg, Director Gao won't even be able to reattach his thumb." Director Ma thought to himself, and when the time comes, he will have no choice but to step forward and help the other party clean up the mess.

By the way, brush up your reputation, so beautiful!
Gao Feng didn't know that Director Ma had such rich inner thoughts, so he had already taken action.

At present, technology is becoming more and more advanced, and vascular anastomosis devices have also been widely used in clinical practice. However, for the suturing of microvessels and nerves, manual suturing is still the first choice.

There are several ways to sew manually, but most doctors are more accustomed to simple suturing. Gao Feng chose the mattress suturing method: suturing and tying knots on two pairs of horizontal mattress eversion sutures, and then suturing continuously through the midpoints. After the anterior wall suturing and knotting are completed, the blood vessels are turned 180 degrees.
Gao Feng quickly found the rhythm, and Director Ma at the side also felt that he was in very good condition today. Although the patient's legs looked bloody and messy, the damage was not as serious as imagined.

The electric saw used by Xiao B might not have been very powerful, or he might not have had much strength as he was drunk. Although his tibia and fibula were damaged to varying degrees, they were not completely severed.

In fact, if the lower limbs are completely cut off, it will be a big trouble. Even if they are reconnected, the function will be greatly affected.

Director Ma successfully removed the great saphenous vein from the calf to repair the popliteal artery on the affected side. His assistant continued to remove free skin flaps from the calf to cover the exposed area of ​​deep tissue in the affected area. The two worked in perfect harmony.

According to the situation, they should be able to finish successfully in another hour. In a good mood, he glanced at Gao Feng in front of him.

"Fuck!" Director Ma couldn't help but shout out.

The movement of his hands completely stopped, and his lips trembled: "You"

The assistant was startled and quickly looked up at him, then followed Director Ma's gaze.

"Fuck!" he also shouted.

Gao Feng had just finished fitting his ring finger together when only his little finger was left.

"You... you've already sewed it?!" Director Ma asked in disbelief, "How is this possible!"

Although a finger looks small, it contains many blood vessels, nerves, tendons and flesh tissues. It is a huge project to completely sew it together.

Even though Gao Feng only matched one thumb successfully, Director Ma felt that he was fast enough!

But the current situation is that the other party has already anastomosed the thumb, index finger, middle finger and ring finger, leaving only the little finger.

This caused a great shock, or rather, a fright, to Director Ma.

"I was in a hurry, so I did it a little faster." Gao Feng explained that it was mainly because it took a lot of energy to operate under a microscope, and he would feel a little dizzy after a long time.

"How can you rush this?!" Director Ma shouted, "Did you come according to the standards?"

"Of course." Gao Feng replied as he picked up the last little finger.

Director Ma asked his assistant to continue the operation, and he stared at Gao Feng's operation with wide eyes. He wanted to see what tricks the other party had played!
(End of this chapter)