My medical skills add experience

Chapter 462 Over time, Xueyan wants to feel proud

After Zhou Can cut the wall of the abscess cavity, he first used a curette to carefully scrape off the rotten tissue on the wall of the abscess cavity until fresh tissue was exposed.Earned another 11 debridement experience points.

For this kind of chest wall tuberculosis lesion resection, the most earned is probably the experience value of debridement.

After scraping the abscess cavity clean, he changed to a scalpel to remove the abscess cavity wall and necrotic muscle tissue bit by bit.

This process seems easy, but in fact it is a test of excision and separation techniques.

Because the abscess cavity is irregular in shape, and when resecting necrotic muscle tissue, it is necessary to carefully look for the sinus tract and possible deep abscess cavity.

The operation not only tests the skill of the chief surgeon, but also requires the chief surgeon to have rich surgical experience.

It also requires flexibility in the procedure.

Moreover, extra care must be taken when removing the lesion tissue, so as not to injure the surrounding important blood vessels, nerves, tissues and organs.

For an operation of this level, even an ordinary deputy chief physician would feel his feet go limp.

Director Xueyan, Director Le and others unanimously asked Zhou Can to be the surgeon because of the complexity of the operation process and the technical requirements of the other party.

"Good fellow, it turns out that Dou Dao is here!"

Although modern high-tech examination equipment can bring a lot of convenience to doctors, the specific operation process is not something that you can easily complete by looking at the film.

When looking at the film, you can clearly know the size of the abscess cavity and the approximate location of the sinus tract.

If you do radiography, you can clearly know the direction and meridian of the sinus tract.

But when the abscess cavity is really cut, you will find that it is not the case.

There are too many variables and too many things to watch out for.

After discovering the sinus tract, Zhou Can cut open the sinus tract little by little and cleaned it up.

"This sinus path is really annoying, why does it penetrate behind the ribs?"

He dared to say that this is definitely one of the most complicated operations ever performed.

"Then how?"

Director Le must know some ways to deal with it, that is, to respect Zhou Can, so he used the tone of inquiry.

"I have no choice but to cut off this rib, expose the bottom of the sinus, and completely clean up the lesion. Otherwise, our operation is equivalent to a waste of time."

Zhou Can can also be regarded as a brave man with high skills and a veteran on the operating table.

See Tricks and Tricks.

Finding that the sinus tract penetrated behind the ribs, he was determined to gnaw hard bones.

This is also a major principle that Director Hu, Dr. Xu and others taught him when performing surgery.Physicians have the heart of their parents, when treating patients, they should not fool around a few times and get the job done.

The surgical plan must be considered from the perspective of the interests of the patient.

Some doctors with poor medical ethics usually consider their own interests first when encountering such major troubles during the operation.

Cutting the ribs will not only increase the difficulty and time of the operation, but also greatly increase the unknown risks.

When the time comes to explain to the family members, there may be disputes and even complaints.

Instead of doing good and getting in trouble.

It is better to sew up the wound against conscience and tell the patient that the operation has been completed.As for the recurrence of the patient after the operation, it was because the patient was unlucky and had to enter the uterus for the second time for another operation.

In the operating rooms of major hospitals, there are not a few patients who enter the palace twice.

Not to mention that every patient who enters the palace for the second time is because the doctor is unethical and did not perform the operation thoroughly, at least [-]% of them have such a result.

Sometimes it may not be that doctors are unethical, but that the level of doctors is only so high.

You ask him to do this kind of operation ten times, and he can guarantee that the patient needs a second operation ten times.

In general, the current tense doctor-patient relationship is also a major reason for forcing doctors to choose defensive medical measures.

He generally seldom saws bones, especially the patient's ribs and skull.

This time I just took the opportunity to practice my hands.

Surgical skills are prone to rust if not used for a long time, and even the skills are rusty and degenerate.

It is also not conducive to the upgrading of medical skills.

After careful sawing of the ribs, the sinus tract was exposed.It is dissected down to the bottom of the sinus tract.Then scrape it clean with a spatula.

"Sister Yan, can you help me see if this rib is broken?"

For patients with sinus invasion to the back of the ribs, if the treatment is not timely, the ribs are prone to necrosis.

"The situation is pretty good, I didn't find necrosis."

Director Xueyan gave her opinion after reading it.

Women are careful, and it is often a good choice for a female doctor to check some detailed lesions.

Fortunately, this patient met Zhou Can. In order to cure this person's disease, he almost spared no expense.

He proceeded to resect the sinuses.

Separation and resection are constantly increasing.

The difficulty of surgery itself is not low, and it is normal to get some experience rewards.

"Hey, there seems to be a pus cavity here! Give me an empty needle with a tube." Zhou Can felt that there might be a lot of pus in the newly discovered deep pus cavity.

The difficulty of piercing is almost zero.

I tried to pump out the pus inside, but I actually pumped out about [-] to [-] milliliters.

This deep abscess cavity is much larger than imagined.

"No wonder when I look at the CT film, I always feel that there is something wrong with this part! It seems that if you encounter this kind of patient in the future, you should not be superstitious about the CT results, and be careful of overlapping pus cavities, which will lead to missed diagnosis in the scan results."

At this moment, director Xueyan suddenly realized.

Not to mention her, even Zhou Can has gained a lot.

This is what studying medicine is like, accumulating over time and making progress in practice.

After Zhou Can's hard work, the deep abscess cavity was cleaned up again, then separated little by little, and completely removed.

"It's really dangerous. There is still a small sinus path here. Fortunately, it was discovered, otherwise this patient may be in danger."

When removing the deep abscess cavity, Zhou Can discovered another sinus tract.

It's small, but the depth is already quite deep.

During surgery, when encountering an abscess, as long as conditions permit, the surgeon will generally try to extract the pus, and wait for the right opportunity to operate again.

This is because the abscess has a strong ability to invade the surgical wound and various tissues in the body.

If the abscess is not completely removed, secondary infection and recurrence are very likely to occur.

There are even some unexpected postoperative complications.

……

After nearly an hour, the operation was over.

Zhou Can was very satisfied looking at the multiple medical experience points he had gained.What's more meaningful is that the patient's illness has been successfully cured. As long as the patient is sent back to the ward for proper maintenance, the patient will recover soon if nothing happens.

Many of these patients had relapses of tuberculosis, and it was assumed that this was due to refractory tuberculosis.

In fact, it is more likely that the lesion was not completely cleared, or a residual cavity was left when the incision was closed, or insufficient preoperative anti-tuberculosis, leading to active tuberculosis lesions in other parts and original drug-resistant tuberculosis infection, which eventually caused tuberculosis recurrence .

Mutual trust between doctors and patients is very important in the treatment of such diseases.

Then there must be confidence, the surgeon must have confidence, and the patients and their families must also have confidence.As long as you believe that the disease can be eradicated, you will most likely be cured in the end.

If there is a recurrence of tuberculosis, all kinds of doubts about the doctor will form a confrontational mood.

In this case, it is recommended to change to another hospital and find another doctor for treatment.

Find the original doctor again, because the trust is gone, and the doctor will be extremely conservative in treatment.This is commonly known as defensive medical strategy.

"Thank you for your hard work, the old rules, I have ordered a supper, everyone eats before leaving. Or take it home to eat!"

Director Xueyan was very happy to see the successful completion of the operation.

Under her leadership, cardiothoracic surgery has gradually improved.

In the eyes of many people, this is a miracle.

When director Hu Kan passed away suddenly, the cardiothoracic surgery department was in the middle of a crisis.Coupled with Director Xueyan's lack of experience in leading a large department, under the joint siege of several outer hospitals, he messed up and forcibly performed a difficult cardiothoracic surgery, resulting in the death of the patient on the operating table.

In cardiothoracic surgery at that time, everyone frankly believed that it would collapse.

Including the top management of Tuya Hospital, they are all ready for an emergency coaching change.

At the critical moment, Zhou Can spared no effort to help Director Xueyan and the Department of Cardiothoracic Surgery. In addition, she regained her confidence and continued to work hard, which led to the current situation little by little.

Vice President Zhang of the Third Hospital would put down his identity and go to the emergency department of Tuya Hospital to interview Zhou Can in person, trying his best to poach Zhou Can.

It is also enough to show that the Cardiothoracic Surgery Department of Tuya Hospital has regained its foothold.

Although not as good as it was at its peak, the Third Hospital, Provincial People's Hospital, and Xinxiang Hospital should all feel tremendous pressure.

Just like a country, when a neighboring country keeps getting stronger, its neighbors will definitely feel great pressure.

If you are really powerful, you don't need any publicity.

No matter how low-key he is, the opponents can still feel your strength.

There are only so many cardiothoracic surgery patients in this province. Excluding some cases that can be digested by small and medium-sized hospitals, the rest is the cake of several large hospitals.

When the situation of Tuya Hospital was not good last year, a large number of patients in the cardiothoracic surgery department lost, and other hospitals must have tasted the benefits.

Today, the Cardiothoracic Surgery Department of Tuya Hospital is on the rise again, attracting more and more patients, and those large hospitals can naturally notice that the number of outpatient and emergency departments has decreased a little bit.

The cure rate and the number of outpatient and emergency departments in each hospital are not secrets.

If you want to check, you can check it.

"Zhou Can, how about going to my office for a chat?"

After Director Xueyan took off her gloves and mask, she extended an invitation to Zhou Can.

She knew that Zhou Can was very busy during the day, and only after the operation had a chance to chat with him.

Instead of chatting here, invite him to the office and explain that the things you want to talk about don't want others to know.

"no problem!"

Zhou Can readily agreed.

The two came to Director Xueyan's office one after the other. She was going to make tea for Zhou Can, but Zhou Can stopped her.

"It's not an outsider, you're welcome, Sister Yan. If you have anything to say, just say it."

"Then I really didn't treat you as a guest! I think the current strength of the cardiothoracic surgery department is not bad, the number of outpatient and emergency departments is increasing every month, and the cure rate is also getting higher and higher. So I want to do a wave Propaganda, to increase the popularity even further, do you think it's okay?"

Director Xueyan suffered a big loss last year, and now she will discuss with Zhou Can about any major issues.

At the beginning, Zhou Can offered her three good strategies, one of which was to keep on developing, do practical things well, and not care about fame and the number of outpatient and emergency visits.

It is also this low-key strategy of "accumulating food widely and building walls high" that helped the cardiothoracic surgery department of Tuya Hospital get rid of many burdens and gain energy and determination to develop.

"It's been silent for too long, is Sister Yan trying to rush to the branch?"

Zhou Can asked with a smile.

"That's it!"

Director Xueyan nodded slightly.

"Your ambition is really not big! I thought that even if you don't spread your wings like a Kunpeng and soar up to [-] miles, at least you can go up to the sky like an eagle. Just soaring to the branches, the layout is so small!"

Zhou Can feels that cardiothoracic surgery can fly higher.

At the beginning, he promised Director Hu Kan to help the cardiothoracic surgeon and Director Xueyan. He had this ambition, thinking that at least Tuya's cardiothoracic surgery could be built into the top ten cardiothoracic departments in China.

"Oh, you're trying to trick me! It's too bad!"

Director Xueyan scolded.

"Speaking seriously, there is no big problem with Sister Yan's publicity this time. Maybe she can take the opportunity to get back some key patients from other hospitals. But I suggest that you must make preparations. After the publicity, it will definitely attract people. More patients will come to the clinic, there will be some difficult cases. Whether you can eat it or not, this must be taken into consideration. If you can’t eat it, you must think of a way out, and you must not swell your face Pretending to be a fat person, knowing that it can’t be cured, even admitted the patient.”

Zhou Can didn't say anything later.

I believe Director Xueyan will be able to understand.

If the admitted difficult case knows that it does not have the ability to treat others, but still has to perform surgery on others, and then another patient will die on the operating table, or a second-class medical accident will occur, and the consequences will be extremely serious.

It's basically like shooting yourself in the foot with a rock.

"I'll be ready to go and promote it. Any other suggestions?"

Xueyan attaches great importance to his opinion.

In terms of strategy, women are naturally inferior to men.

Because men have stronger logical thinking, more courage, and a broader mind than women, they will look at problems more comprehensively.

Since ancient times, those who have achieved great things have basically been men, and it really wasn't caused by the feudal society where men were superior to women.

It was difficult for women to stand out in ancient times, and they were affected by the feudal system, not all of them.

It's not that there were no female emperors in ancient times, it's just that they were rare.

"I hope to be targeted when making publicity, and it is best to maximize strengths and avoid weaknesses. Taking my personal experience as an example, I treated a child with dislocated joints when I was in the Xinxiang Hospital. It happened to be this case when I was doing publicity. So , Those who came to see me during that time were basically children with various fractures. Even some children with related bone deformities.”

Zhou Can's meaning is very clear, that is, when she selects publicity cases, she must choose the treatment field that the department is good at.

For example, tricuspid valve surgery is currently done in general, not particularly well.

It is necessary to reduce the publicity of such cases as much as possible.

In this way, patients who match the treatment ability can be attracted to the greatest extent.

"I've written it all down, do you have any other suggestions?"

Director Xueyan carefully recorded it in the notebook.

"Not for the time being, if I think of it, I will call you or let you know on WeChat."

Zhou Can personally thinks it's good to not rush to publicize for the time being.

However, he could understand Director Xueyan's repression for too long, and now that she has finally gained some strength, she wants to feel proud once again.And other people in the department also need to boost morale through such a publicity event.

"Among the publicity cases I'm going to select, the baby with heart failure who was transferred from the Third Hospital is among them. Do you think it's feasible? After the publicity, the Third Hospital will definitely feel that they are stepping on them."

She raised a highly sensitive issue.

(End of this chapter)