Gou is practicing medicine in the clinic

Chapter 232 Basic Treatment of Snakebite, Not Changing Both
Anastomosis is closely related to two surgical techniques of suturing and knotting, and now anastomosis is only at the proficient level.

And his continuous sutures, square knots, and surgical knots are all at the minor level, which means there is an upside down.

The level of basic skills is one level higher than that of advanced skills, which naturally allows the level of advanced skills to be improved quickly.

Practice a few more times, and after mastering the basic steps of advanced skills, the speed of progress is as fast as flying.

Successful anastomosis of a blood vessel increases proficiency by 10 points. It seems exaggerated, but it is actually normal.

When his anastomosis is at the same level as suturing and knotting, the improvement will become slow.Even affected by suturing and knotting, only when they are improved can anastomosis be advanced.

Li Jingsheng had more confidence this time and chose the anterior tibial artery for anastomosis.

"Director Hua, arteries have higher requirements for anastomotic techniques, so it's a bit worrying to let him do it!"

Director Bi was still a little worried.

"The great saphenous vein isn't broken either. Aren't there only a few blood vessels that need to be anastomosed? Let him try. If it doesn't work, let Director Chen take over."

Director Hua acts as Li Jingsheng's strong backing.

With his words in mind, Director Bi has nothing to say.

Li Jingsheng has become more and more courageous at this moment, and his anastomosis technology has continuously broken through and become more proficient.Some inappropriate operations were quickly corrected, as if a surgeon with many years of experience in vascular anastomosis.

Compared with the performance of the first time, it is a world of difference.

Director Hua's smile became wider and wider, and his eyes narrowed.

Chen Anchen looked at Li Jingsheng's operation with a look of monsters.This kid is indeed a genius, and the difficulty of anastomosis of blood vessels is quite high, but you can't do it well if you master the suture technique.

Because when blood vessels are anastomosed, at least three or four centimeters of sutures need to be left for each suture, and keeping them from knotting is enough to cause headaches for many doctors.

Next, make sure that every stitch is aligned correctly.

Because it is not possible to sew one stitch and lock one stitch, but to reserve enough space first to ensure that the subsequent anastomosis can be smooth.

Therefore, when inserting the needle, insert the needle from the broken end A of the blood vessel, and then insert the needle from the broken end B to pass out. It is difficult to grasp the needle position without practicing thousands of times or tens of thousands of times.

Li Jingsheng made many novice mistakes in the first blood vessel anastomosis.

But looking at the current operation, every movement is so sophisticated, it really makes people envy his talent.

At the beginning, Ou Qinglan was also sweating for her boyfriend, but now her bright eyes were full of smiles, admiration and pride.

This time, Li Jingsheng anastomosed this important artery in less than 5 minutes.

Only the last one left.

He did his part and rushed to do it. In the eyes of Director Hua, Director Hua naturally smiled knowingly.

Which general doesn't want his soldiers to fight bravely to be the first?
Li Jingsheng scrambled to anastomose the last blood vessel, and his aggressiveness naturally made Director Hua happy.

In the operating room, one has to rely on snatching opportunities to exercise.

This time, it took four minutes and 50 seconds, and the time was shortened by another ten seconds.And it's getting better and better.

The sutures are tight and fine, and the blood vessels fit tightly.

What is even more rare is that the size of the vascular anastomosis is also very good, and there is no obvious anastomotic stenosis.

Regardless of intestinal anastomosis or vascular anastomosis, it is easy to cause narrowing of the internal space of the anastomotic site.

This affects blood flow.

There are many consequences, such as insufficient blood supply to the extremities, weakness in walking, edema, and inexplicable pain.It may also cause the intravascular pressure to rise, and after a long time, the blood vessels will harden.

"Loosen the tie and do the blood test!"

Director Hua said directly to Li Jingsheng.

When the limbs are bound to stop bleeding, the time should not be too long.

Usually it needs to be loosened every half an hour or so to allow the extremities to get blood supply.

Except for broken injuries.

The most common is that after someone is bitten by a snake or spider, they are worried that the venom will invade the heart, so they are tied tightly.

However, he lacked the necessary medical knowledge, and by the time he was sent to the hospital, the ends of his bound limbs were already black and purple and cold.When the doctor asked, he learned that the binding time was far more than half an hour.

The result can be imagined, it might not be a big deal, but with such a bundle, the extremities lost blood for a long time, and irreversible necrosis occurred directly.

Then amputation is required.

This is really wronged.

Patients who make the above mistakes are relatively rare, because now the national education level has improved, and junior high school students will learn some first aid knowledge.

There is another kind of mistake that most patients are most likely to make.

After being bitten by a venomous snake, tie the upper end of the wound near the heart to prevent the snake venom from invading the heart.

In fact, doing so would most likely lead to amputation.

Of course, it depends on where you are. If you are in a mountain where the transportation is inconvenient and the time to go to the hospital is too long, it is a very good way to save your life.

It is better to lose a leg than to have the venom invade the whole body and cause death.

But if you are in the city, the best way is to go to the hospital for an emergency injection of the corresponding type of antivenom.

Because after being bound, the venom of the venomous snake is very deep and highly toxic.

It is concentrated in a narrow area at the extremities and can cause necrosis of the extremities.

When sent to the hospital at this time, it is often difficult to keep the leg.

In addition, many people watch TV and movies, and after being bitten by a poisonous snake, they cut a hole to squeeze out the poisonous blood, and even suck it out with their mouths.

This is unacceptable behavior.

Some snake venoms cause protracted bleeding.

If the wound is cut, bleeding will be difficult to stop.And where the snake bites, after the wound is scratched, its wound is extremely difficult to heal.

Your best bet is to avoid being bitten by a venomous snake.

After Li Jingsheng untied the bandages on the patient's legs, blood flowed immediately.

It can be seen that the blood vessels are becoming more and more full.

Leakage from the first anastomosed venous vessel.

The second anastomosis is still normal, but the anastomosis of the blood vessel seems to be relatively narrow, and the venous blood return is extremely slow.

"Director Hua, can I anastomose this vein again?"

"Hurry up and do it! Don't ask about this kind of thing."

Director Hua might feel that he was losing face, so he signaled Li Jingsheng to be smarter.

There are doctors from other departments present.

Li Jingsheng asked the nurse to bring a needle holder and sutures to ligate the vein first.This is where slip knots come in handy.

He didn't dare to embarrass the department anymore.

Quietly spent 43 health points to upgrade Slippery Knot from proficient to proficient.

It has the level of knotting at the attending level, which is barely enough in this place where there are all masters.

Seeing that Li Jingsheng ligated the blood vessels skillfully and made a firm and beautiful slippery knot, the whole process was very skillful.This made Director Hua nod again.

Director Bi glanced at it and didn't care about it any more.

In any case, the two arteries that Li Jingsheng anastomosed were unobstructed, which satisfied Director Bi.

The performance is not particularly outstanding, but among doctors of the same age, it is already a unicorn-like existence.

This young doctor in orthopedic surgery is really good.

After Li Jingsheng removed the stitches, he trimmed the two ends of the blood vessel again, and then re-anastomized.

The length of the blood vessels is fixed and has a certain degree of elasticity, but at most it can only be trimmed once or so.

If the blood vessel loses too much length, it will not be anastomosed properly.

At this time, either an artificial blood vessel is used, or the great saphenous vein is used for blood vessel grafting.

Senior doctors are generally reluctant to allow young doctors to anastomose important blood vessels, and they also have these concerns.

Because the stakes are really high.

Soon, the reworked venous vessel was anastomosed successfully.

Li Jingsheng breathed a sigh of relief.

After the slippery knot of the ligature was untied and the blood flowed, everything was normal.

He breathed a sigh of relief.

This operation tonight was an extremely important step for him.

After mastering the anastomosis, he is also qualified to participate in more difficult operations.

Today, only blood vessels are anastomosed, and next time you can find a chance to challenge nerve anastomosis.

However, neural anastomosis is much more difficult.

Even the chief physician often misses, so it is best to improve the anastomosis to a minimum level before doing nerve anastomosis.

With the blood circulating in the anastomotic blood vessels, after such a long time, the patient's severed limb has a tinge of blood.

Director Hua pressed the button, and then took a closer look.

"The blood vessel anastomosis was successful! Let's anastomose the tendon!"

It sounds like it means to let Li Jingsheng continue to learn!

In the future, we still need to do less bad things, otherwise, in the hands of a chief doctor with a sense of justice, there is a high probability that he will be rewarded to the novice doctor under him for practice.

Li Jingsheng quickly recalled the steps and technical points of tendon anastomosis.

Fortunately, I learned some basic skills during the operation with Professor Wu.

Although Professor Wu's surgery level is very average, but he is the chief physician at least, no matter how bad it is, it can't be much worse.

The knowledge of orthopedic surgery that should be mastered is even more profound.

With a proficient level of anastomosis, tendon anastomosis is actually a little easier than blood vessel anastomosis.

But the technical requirements are still high.

Li Jingsheng used the figure 8 stitching method.This is the most commonly used method of tendon anastomosis.

It took a lot of effort to anastomose the first ruptured tendon.

Not surprisingly, his life value has increased by more than 100.

The proficiency of anastomosis has increased even more.

Almost every blood vessel connected can increase proficiency by 10 points, and the same is true for connecting this tendon, which increases another 10 points of proficiency.

According to this trend, as long as he stays in the operating room and performs a few more such operations, his anastomosis can directly rise to a small success.

……

After nearly four and 10 minutes, the patient's tendons, blood vessels, nerves, tibia, and fibula were all effectively anastomosed or reset.Although still looking bloody, the limb-salvage surgery was nearing completion.

"Director Hua, can you ask Dr. Ou to sew the patient's skin?"

Li Jingsheng brought Ou Qinglan in, so he had to help his girlfriend get some exercise opportunities!

"Xiao Ou, are you confident?"

Director Hua looked at Dr. Ou.

"Yes, yes!"

Ou Qinglan was so excited, she was quite courageous.

In addition, after hearing about the crimes committed by this wounded man, there is nothing to be polite about.

Definitely try to grab the opportunity to exercise!
"Jingsheng, help her by the side! Make sure the wound heals without any problems, otherwise it will have to be reworked and stitched up again."

Director Hua made a confession.

It means that it doesn't matter if the stitches are ugly, as long as the healing is okay.

This is because she was in a big hospital, and with Li Jingsheng's help to fight for it, she was able to get a good opportunity for skin stitching so easily.

You know, Li Jingsheng has opened a clinic for several months, and he has only received three or four cases of wound sutures in total.

Master Liu gave him two suturing opportunities alone.

And the requirements are very low, as long as it can heal.

Li Jingsheng naturally taught Ou Qinglan to sew with all his heart, and if there was any problem, as long as it was serious, he would point it out to her in time.

Girls seem to be naturally more ingenious.

Her suturing skills are obviously poor, but under Li Jingsheng's guidance, her suturing skills are getting better and better.

At first, she seemed nervous.

Gradually, the whole person enters a good state.

When it came to the end, Li Jingsheng almost didn't need to give pointers anymore.

It can be seen that she has made great progress.

Basically, all surgeons are similar. As long as they practice a few times, they can make significant progress in mentality, technique, and skills.

Director Hua has already gone to see Director Bi and the others to repair the intestines and abdominal cavity.

The operation is drawing to a close.

Director Bi saw that the patient's vital signs were stable, and the operation was about to be completed, and he was in a good mood when it entered the final stage.

"Director Hua, I think you clearly took the opportunity to train today."

"Haha, nothing can be hidden from Director Bi's eyes! Although our orthopedic surgery department does not have a small amount of operations, but in terms of training opportunities for young doctors, your general department has enough volume!"

Director Hua laughed, and admitted it openly.

He looked at the young doctor who was suturing the patient's waist wound.

"This young doctor who sewed the waist wound is very smooth! Is it Ouyang Cheng from your general surgery department?"

"Thank you Director Hua for your compliment!"

The male doctor who was stitching up the waist wound raised his head and smiled politely at Director Hua.

"Why are you so familiar with our general surgery department? Let me tell you, don't try to poach someone from me, or I'll ask the dean for an evaluation." Director Bi looked nervous, guarding Director Hua like a thief.

Everyone knows that there is a shortage of doctors in orthopedic surgery, especially excellent young surgeons.

"Look at how stingy you are. If I really want to poach him, would I be stupid enough to do it in front of you? But then again, your general surgery department is really powerful, full of talents, excellent young Doctors emerge in endlessly, which is indeed enviable.”

Director Hua looked at Ouyang Cheng, clearly showing love for talent.

This made Director Bi even more nervous.

If it wasn't for limb salvage surgery that requires orthopedic surgery, I really don't want to invite Director Hua over.

Every time I come here, I always get the idea of ​​a young doctor in the general surgery department.

Bonus has always wanted to strive to become bigger and stronger, and it is also taking the elite route in terms of talent recruitment.

I heard that the Department of Orthopedics has at least five vacancies for residents, which are reserved for poaching at any time.

To be able to join Director Fayan of China, at least one must have a good character, excellent skills, and be young.

"Let's go, let's sit and chat over there, and just throw it here for them to clean up." Director Bi hurriedly brought Director Hua to the wall a certain distance from the operating table.

There are four round stools for the doctor to sit and rest.

"I see that the new Li Jingsheng recruited by your department is also very good! Our general surgery department really needs a doctor who can perform bone restoration. The speed of improvement he showed just now is even more amazing. I have been practicing medicine for almost 40 years. , I have never seen any doctor progress as fast as him."

Director Bi and Director Hua are actually the same.

All the way.

They all want to poach excellent young doctors when they see them.Only when the department is strong can it take on more hard work, benefit can increase, and everyone's income can increase.

And as the head of the department, he will become famous and receive high honors.

For example, if the Orthopedic Surgery Department under the leadership of Director Hua becomes the top orthopedic surgery department in China, everyone will praise Director Hua for his achievements.

"How should I put it, it feels like looking at other people's wives and always feel more beautiful and more exciting. Li Jingsheng is considered to be relatively good, but it is far less exaggerated than what you said. You also saw that he had a blood vessel anastomosis just now, and he leaked blood directly. How high do you think his level can go?"

Director Hua belittled Li Jingsheng calmly.

Not afraid of thieves stealing, but afraid of thieves thinking.

Li Jingsheng was missed by one of the most powerful surgical departments in the Second Hospital, which is by no means a good thing.

General surgery really attracts people, but orthopedic surgery can't stop it.

The weight and voice of both parties are not at the same level.

Cardiac surgery and neurosurgery combined cannot shake the status of general surgery, which shows how strong it is.

It can only be said that every hospital has its own powerful departments.

The general surgery department of the second hospital has given the general surgery department of all hospitals a bad face.

"I just like young doctors with great potential but low level for the time being. This kind of people don't have the stink of arrogance and are easy to cultivate. Don't you envy the many excellent young doctors in our general surgery department? How about I trade one with you? ?”

Director Bi should be about ten years older than Director Hua.

It is said that ginger is old and spicy.

It really is so.

Director Hua's little thoughts could not escape Director Bi's eyes.

"Give me Ouyang Cheng?"

Director Hua was calm on the surface, but in his heart he would definitely not agree.

Li Jingsheng is the second signboard of the orthopedic surgery manipulative reduction clinic, and he has shown extraordinary talent and ability in difficult case diagnosis and surgical operations.This kind of young doctor will definitely become the pillar of the department in the future, how can Director Hua be replaced?
"Ouyang Cheng, Director Hua wants you to develop in the orthopedic surgery department, and will focus on training you. Do you want to go?"

Director Bi was even more rude, and directly asked Ouyang Cheng who was stitching.

"This...is it true?"

Ouyang Cheng seemed a little moved.

There are many experts in general surgery, and there are not many outstanding young doctors like him.

It takes many years to get ahead.

Some people would rather make a phoenix tail than a chicken head.Ouyang Cheng felt that only by becoming a chicken head could he have a chance to become a phoenix.

"Ahem... I'm joking with you, Director Bi." Director Hua was embarrassed for a while.

He is the director of the department, and he can never agree to such a thing.

Not to mention taking one Ouyang Cheng, even if you give him ten, there is no way to exchange Li Jingsheng.

"I know that Director Hua has never done business at a loss. In addition to Ouyang Cheng, I will add another excellent young doctor for you, and exchange that little plum for our general surgery department."

Director Bi has already made up his mind, and now he is completely playing tricks on Director Hua.

"If you want to change to someone else, I can agree. Li Jingsheng is the doctor in our Orthopedic Surgery Manipulation Reduction Clinic. He can't be replaced, can't be changed, can't be changed!"

Director Hua repeatedly shook his head in denial.

The two sides are also like friends, joking around, and then setting the foundation of the other's department.

In this round of confrontation, Director Hua has already lost.

Even fools know that Li Jingsheng is the most important young orthopedic surgeon.

"By the way, after the wounded is cured, he should be arrested and sentenced, right?"

"I don't know for now. Seeing how badly he is injured, he might not be able to get out of bed in two or three months."

"It's true that good people don't live long, and the scourge will last for thousands of years! The injury was so serious and he was rescued. Who knows if he will hurt others again when he recovers next time?"

"We doctors can't control so much! This matter can only be handed over to the law. I heard that the city is going to hold a medical skills competition. The venue seems to be chosen at Qiaobang Hospital. The dean put the task on us These department directors are here, what are you going to do?"

Director Bi changed the topic, obviously unwilling to talk more about this patient.

Because he knows Director Hua's character and has a strong sense of justice.

The views of the two are completely different in this respect.

Director Bi believes that doctors only do what doctors do and don't care about other things.

When Director Hua faces some gangsters, he will carry personal feelings and even affect medical decisions.

For example, for this patient, if Director Bi hadn't pleaded for mercy, Director Hua would really talk to the family members. The patient's leg injury was too severe to save his limb, so he suggested amputation.

Of course, the final decision-making power in this matter rests with the family.

The family members insisted on limb salvage, and the doctor couldn't refuse.

It's just that family members will largely listen to the professional opinions of doctors before making judgments.So what the outcome will be, no one can say for sure.

"Skills competition is a good thing. It can let everyone know the strength and new technology of other hospitals. Our orthopedic surgeon has not yet decided on a candidate."

Director Hua said bluntly.

(End of this chapter)