Gou is practicing medicine in the clinic

Chapter 345 A diuretic shows one’s skill, the joy of success

This is no longer simply a matter of respect, but has elevated Li Jingsheng to a level where he can truly have an equal dialogue with him.

If Deputy Director He is Director Zhang's right arm, then Li Jingsheng is now Director Zhang's right arm.

Even more advanced.

"My medication recommendations are digitalis and hydrochlorothiazide as diuretics. As for antibiotics to treat respiratory infections, amoxicillin should be enough."

When the infection is not serious, the simpler the medication, the better.

Only in serious and difficult infections will a combination of antibiotics be considered.

Diuretics work by lowering blood pressure.

There are three major types of diuretic drugs. Li Jingsheng did not choose the high-efficiency diuretic furosemide. This drug is very effective, but has relatively large side effects.Can easily cause hypokalemia.

The patient is about to undergo major surgery, and the most common hydrochlorothiazide is the first choice.

Furosemide is used to treat heart failure and tissue edema.

It can be used now, but Li Jingsheng thinks it is not the first choice.It is the drug of choice when heart failure is complicated by pulmonary edema, because it can quickly reduce the water content in the blood and promote the reabsorption of pulmonary edema.

Doctors with a higher level of medication will only consider using this drug when the edema is severe and other diuretics are ineffective.

Spironolactone is also a commonly used diuretic drug.

It is an aldosterone antagonist and is mainly used to treat refractory hypertension.

The side effects of using this drug are opposite to those of furosemide. It can easily lead to an increase in blood potassium and induce hyperkalemia.

It seems to be just a very simple medication, but it tests the doctor's knowledge and level of medication in all aspects.As for the dosage, administration method, and timing of medication, these require strong pharmacological medicine skills to support.

Li Jingsheng just provided a medication plan.

If adopted, he will naturally strictly calculate the dose, administration method, timing, etc.

"Well, it's very good. Dr. Li's medication regimen is basically the same as mine. If there are no other questions, let's get started!"

Director Zhang praised him with satisfaction.

With Director Zhang's level, it is natural to see Li Jingsheng's progress in medication.

Preparations for the operation are being completed one by one.

General anesthesia, endotracheal intubation to maintain breathing, establishment of extracorporeal circulation, myocardial protection...

Make a midline incision in the patient's chest.

Because traditional intracardiac repair surgery has many shortcomings, such as poor long-term effects, time-consuming and labor-intensive surgery, and high risks.

So this time they used the advanced RASTELLI technique.

To put it simply, it is to double-switch the atrium and aorta.

Establishing extracorporeal circulation and stopping the heart is a very critical step.

Fortunately, the entire team has rich experience in this area.

Even Li Jingsheng can already direct and complete it independently.

After infusing cold-blood cardioplegia into the coronary arteries, nurses and medical assistants applied ice slush around the heart to protect the myocardium.

Then the ascending aorta was cannulated, and the superior and inferior vena cava right-angle drainage tubes were directly inserted.

This step was completed by Li Jingsheng.

There are more than three options for this intubation, and different intubation methods can be selected according to the specific conditions of the patient.

For example, through the right superior pulmonary vein, which is the most commonly used.

A left ventricular decompression tube can also be inserted through the patent foramen ovale after cardiac arrest.

Li Jingsheng's proficiency in implantation surgery has been improved to a very high level. In terms of intubation, he should be the strongest member of the team.

The operation is in progress.

Li Jingsheng closely cooperated with Director Zhang's work. When it was time to stop the bleeding and when it was time to assist in the exploration, he did not need Director Zhang to do anything, and he could always do the assisting work accurately and timely.

This is one of the reasons why Director Zhang likes to have him as his assistant.

Save trouble and relax.

In addition, Li Jingsheng has strong skills in all aspects and can be of great help at critical moments. Director Zhang naturally prefers to ask him to be his assistant.

"Xiao Li, are you confident in operating this incision?"

Director Zhang seems to have encountered a small problem.

At this moment, he actually needed to ask Li Jingsheng for support.

"Is it a longitudinal incision in the right ventricle?"

On the way to the hospital, Li Jingsheng had already reviewed the specific plan of the operation in his mind, and even reviewed every step many times.

Because this is the first time for the team to perform this operation, although everyone has sufficient experience in all aspects, many problems may still arise.

The better prepared you are, the higher your success rate will be.

"Correct!"

When Director Zhang heard him ask this, he immediately gave up his position.

He motioned for him to go over and stand in the main position to make the cut.

Li Jingsheng did not hesitate, stood at the surgeon's position, and took the lancet handed over by Chang Yueyue.

She has worked with Li Jingsheng many times and is very familiar with his surgical habits.

Knowing that he loves to use the lancet, the use of the electric knife should be minimized as much as possible.

This is especially true for some difficult cuts and separations.

He held the scalpel and made an incision from the upper end of the arterial trunk and then through the right ventricle.

There are many dangers in this process, and the requirements for incision are extremely high.

Director Zhang's incision skills are not low, but he has a bad character flaw. Whenever he is nervous, his hands tend to sweat or even shake.

Hands sweat too much, even if they are wearing gloves, it will still cause some interference to the hand feel.

Not to mention cutting through the right ventricle, even when cutting through the epidermal layer of the body, the feel is very important.

Because it is directly related to the feedback of the knife feel.

If your hand feels dull, it is easy to be unaware of the incision process.

For example, a large blood vessel has been cut, and then it is discovered that it has been cut.Also, it will affect the stability of the incision to a certain extent.

The wound cannot be cut in a straight line or flat, which will affect subsequent suturing and healing.

In addition, this time it is necessary to fully remove the hypertrophied septal and wall bundles to fully expose the aortic orifice and expose the entire ventricular septal defect to the surgeon.The technical difficulty is also extremely high.After Li Jingsheng took over, he was very calm.

He seems to have been very courageous since he was a child, and he doesn't have the problem of nervous hands shaking.

When applying for a job, surgeons with shaky hands are often eliminated directly.

But there are no absolutes in everything.

Top talents like Director Zhang don't have shaky hands at other times, and their mental quality is not bad either.Hand tremors may occur only when encountering uncertain situations and too much psychological pressure.

Especially when the operation does not go smoothly or if mistakes are made during the incision, hand tremors are most likely to occur.

Because this operation was extremely important to him and the entire team, and it was also related to the patient's life, so when he encountered this extremely difficult longitudinal incision, he instinctively thought of letting Li Jingsheng take over.

This can also be understood as a kind of dependence psychology.

Inevitable for almost everyone.

Fortunately, Li Jingsheng fulfilled his mission and successfully completed this difficult incision task.

"Director Zhang, it has been cut. Please check it."

Li Jingsheng stepped aside.

"Yeah, it's cut very well."

The operation continues.

Next, when cutting off the ascending aorta and pulmonary trunk, and suturing the proximal end of the pulmonary trunk, Li Jingsheng was put to use again.

Because of his suturing skills, he now seems to be the best and most comprehensive one in the team.

Many people, including Director Zhang, are only good at one or two suturing methods.

Li Jingsheng has a variety of suturing methods, and the lowest one has been upgraded to the Dacheng level, and the other four have all been upgraded to the proficiency level.

This allows him to choose the most appropriate suture method when facing various types of wound suturing.

……

After nearly six hours, the operation was finally completed.

It was already late at night, and the medical staff on the team were almost paralyzed from exhaustion.

Everyone was sleepy, tired and hungry.

The four lesbians, including the anesthetist nurse, were all unable to hold back.

For such a long operation, one of the first problems female nurses and doctors have to face is holding in urine.

Because the physiological structure is different from that of men, it is much harder for women to hold in their urine.

In order to avoid the embarrassing scene of wet pants, sometimes a diaper will be wet before attending an important operation.Even male doctors may do this.

This is also impossible.

Sometimes it is really difficult for medical staff to save a patient's life.

The hard work and sweat put in are unimaginable to outsiders.

When the patient's heart starts to beat again, everyone's heart is hanging.

"Successful, successful!"

The anesthesiologist is the first to give feedback.

"The physical signs are recovering, the heart rate is slightly unstable, the blood pressure is acceptable, and the pulse strength is not bad..."

Heartbeat and breathing are the two most important indicators.

They are the most fundamental part of life.

"good, very good!"

Director Zhang was not sleepy at all and looked excited.

When the patient's vital signs stabilized, everyone in the operating room showed a knowing smile.It feels really great to see many people working hard for a common goal and ultimately helping patients to be successfully cured.

Those with ambitions do not take mountains and seas as far away.

Everyone is filled with a sense of accomplishment, pride, and relief at this moment.

It is also the happiest time for everyone.

"I'm treating you today, and you have the final say on what to eat as a late-night snack. Don't worry about my money. Anyway, my children are adults, and my parents are gone, so I have nowhere to spend the money I earn."

Director Zhang said happily to everyone.

"Oh! Oh!"

There was a cheer in the operating room.

The happiest ones are the four female nurses.

If there were no women in this world, there would definitely be less joy.

On many occasions, they can make the atmosphere relaxed and lively, making everyone feel happy and cheerful.

"Lao Yu, you and Teacher Ma should have no other tasks tonight. Let's go together! We must celebrate today."

Director Zhang extended invitations to anesthesiologists and nurses.

In some hospitals, anesthesiologists and surgical teams are bundled.

In the second hospital, whenever there is a need, they apply to the anesthesia department.Arrange according to the situation.

Not fixed.

For example, Lao Yu basically runs around.

Orthopedic surgery sometimes requires partial anesthesia or general anesthesia, and he will be called over.

Li Jingsheng and Lao Yu first met in the orthopedic surgery manual reduction clinic.

"No problem, as long as you don't feel sore from being eaten by the time!" Lao Yu readily agreed. "Although the operation is successful, postoperative management is also extremely important. Whether an operation is successful, the operation only accounts for 60%, and the postoperative management accounts for 40%. Routine anticoagulation, observation and drainage, etc. must be clearly explained."

He was still taking advantage of his position and didn't just think about going out to have fun.

I was also thinking about the patient’s postoperative management.

The anesthesiologist is responsible for the patient's entire perioperative period. Li Jingsheng admires this sense of responsibility.

"Xiao Li, you have worked hard today. I asked you to go out to eat and drink in the middle of the night. You have to report it to Dr. Ou. Don't cause trouble for me then."

Director Zhang was in a good mood and teased Li Jingsheng.

(End of this chapter)