Start From Emergency Doctor

Chapter 154

“Doctor, please, give me a cotton…”

Zhou Yuan took a look and took a piece of cotton, “Here you are, one.”

“…”

Zhou Yuan: “Are you going to plug your left ear or your right ear?”

Soon, another circumcision operation was completed.

Several doctors in the urology department saw itchy hands, and they all divided the next operation.

Zhou Yuan, who had no use value, was sent back to the emergency department and earned a wave of operating commissions by the way.

A circumcision operation is very short, about ten minutes, Zhou Yuan can get one or two hundred yuan.

However, this kind of money is an extra income for urologists.

After all, there are only so many birds. Every year during the winter and summer vacations, there are circumcision. Other times, who would come to the hospital to have a circumcision?

After returning to the emergency department, Zhou Yuan took a short rest, and the sound of the ambulance rang again.

Zhou Yuan hurriedly got up and was about to go out when he saw Zhang Ling, who was flustered, running over.

“Doctor Zhou, it’s not OK…” Zhang Ling leaned against the wall and panted.

I feel a little proud: It seems that Zhou Yuan has a close relationship with me! No need to call now!

Zhou Yuan ran over with Zhang Ling and asked, “What’s the situation?”

“An old man got in and out of the ambulance. The abdominal pain was so severe that he couldn’t walk anymore, so he was sent by an ambulance.”

Zhou Yuan nodded, “Where did it go?”

“Observation Room No. 1, is now observing the situation at 900!”

Zhou Yuan immediately went to Observation Room No. 1.

He Jianyi was also in the observation room at this time, with a serious expression.

“Teacher, what’s the matter?”

He Jianyi sighed: “The patient’s situation is a bit complicated…”

“complex?”

He Jian handed the medical record to Zhou Yuan, saying: “The family members who came with the car brought the old man’s medical record, look at it…”

Zhou Yuan opened immediately.

The old man’s name is He Jianguo, 72 years old, with primary IgA nephropathy.(Read more @ wuxiax.com)

The clinical symptoms of patients with primary IgA nephropathy include abdominal pain, low back pain, muscle pain or low-grade fever. A small number of patients have persistent gross hematuria and varying degrees of proteinuria, which may be accompanied by edema and hypertension.

This disease is not easy to distinguish. It is likely to be confused with lupus nephritis, purpuric nephritis, and occult nephritis. Severe primary IgA nephropathy has similar symptoms to chronic glomerulonephritis.

“Past medical history, high blood pressure, gout…”

Like most elderly people, He Jianguo has a variety of illnesses, which can almost be called a medicine jar.

“Have you had hemodialysis before?”

Zhou Yuan took a close look at the hemodialysis medical record.

On July 7, 2017, the right internal jugular vein with cuff dialysis catheter was implanted, and hemodialysis treatment was started at the same time.

2017-09-25, laparoscopic peritoneal dialysis catheter implantation was performed, and peritoneal dialysis was started at the same time, and the cuff catheter placed two months ago was removed.

On May 21st, 2018, an autogenous arteriovenous fistulaplasty was performed on the left forearm. However, during this examination, it was found that the patient had poor compliance with peritoneal dialysis and poor ultrafiltration during a sneak attack, so he planned to change to hemodialysis.

On September 8th, 2018, acute peritonitis suddenly occurred, and it was decided to perform internal fistula surgery, and the peritoneal dialysis catheter was removed at the same time, and outpatient dialysis was performed regularly.

2018-11-24, due to insufficient flow of the internal fistula, a narrowing of the venous outflow tract was found after color Doppler ultrasound, and balloon dilation of the internal fistula was performed.

After three years of dialysis, there were various complications and physical illnesses.

There is no doubt that this is a critically ill patient, and a little carelessness may cause accidents.

Zhou Yuan stepped forward and examined the forearm cephalic vein carefully. He found that the forearm cephalic vein pulsed strongly, but the vibrato became extremely weak.

“Teacher, do color Doppler ultrasound?”

He Jian nodded, “I have finished the color Doppler ultrasound, and the results will come out soon.”

Soon, the color Doppler ultrasound results came out.

Zhou Yuan glanced at it: “The cephalic venous tumor in the upper forearm has expanded, accompanied by thrombosis. The return blood flowed into the collaterals, forming a thrombus, and the venous return was blocked.”

“There are two venous thrombosis, cephalic vein thrombosis and perforating vein thrombosis.”

“Teacher, I suspect it is due to high venous pressure with painful fistula.”

He Jian nodded: “I also suspect that it is due to high venous pressure with internal fistula pain, severe thrombosis, it may be necessary to clear the thrombus, but I don’t know how the thrombus is.”

“The doctor of vascular surgery will be here soon.” Haidao said.

Soon, several doctors in white coats walked in.

After a careful inspection, he looked a little serious, and said: “The patient is very old, is a high-risk patient, and is accompanied by a variety of diseases, so the operation is very difficult.”

“Doctor, save my dad!” said a middle-aged man.

“Isn’t it said that hemodialysis can survive for a long time? Why is it not working now…” Another middle-aged woman is He Jianguo’s daughter.

The doctor of vascular surgery said solemnly: “The operation is too difficult, the thrombus is difficult to clear, and the patient’s body function may not be able to support the entire operation…”

“Why not perform a great saphenous vein graft bridging?”

Zhou Yuan, who had been checking the results, said suddenly.

He Jianyi and the others were all taken aback.

Zhou Yuan continued: “The patient had a thrombosis in the vein of the elbow, blocking the main blood vessel where the thrombosis occurred, and then returning through the collaterals to establish a path to the heart.”

“I have seen color Doppler ultrasound. Although the thrombus is blocked here, the bypass blood vessels are unblocked. My idea is to block the blood vessels first, cut the blood vessels to take out the emboli, and open the perforating veins.”

“Why not give up the internal fistula and bring a cuff catheter for dialysis?” a vascular surgeon asked.

This is also a solution, of course, there are also huge risks.

“This method is indeed possible, but considering the patient’s advanced age and the body is still sick, the success rate of giving up the internal fistula and then implanting the dialysis with a cuff catheter can be almost zero. Even if it is successful, it takes a lot of time for the patient to recover. For a long time.”

“But… it is also very difficult to perform blood vessel transplantation…”

Zhou Yuan didn’t speak, picked up the marker, and scratched the old man’s arm, marking the upper thrombosis in the superficial skin except for perforating vein thrombosis, anastomosis, upper arm vein and forearm cephalic vein.

Zhou Yuan pointed to the place where the perforating vein thrombosis occurred, and said: “A thrombus has occurred here. Then, we can do a blood vessel transplantation here…”

As he said, Zhou Yuan took a marker and connected the thrombosis site of the perforating vein to the upper arm of the upper arm: “In this way, the blood from the upper arm of the upper arm can also enter the perforating vein, and the blood flow will resume!”

Several doctors in vascular surgery were stunned. The idea…by connecting the expensive veins and perforating veins next to them, so as to restore blood circulation and solve the thrombosis problem, they had never thought about it.

“But… this operation is very difficult!” A vascular surgeon asked the biggest question.

Zhou Yuan smiled: “What can be solved with technology is not a problem.”.