The genius doctor starts from the game
Chapter 148 Little Lu, you did a little good today!
Chapter 148 Little Lu, you did a little good today!
When the woman left with the child, neither Lu Cheng nor the doctor who was attending the clinic stopped her, nor were they qualified to stop her.
This guy obviously wants to renege on his debts.
Lu Cheng has seen a lot of this kind of situation. In the past five years, Lu Cheng has seen too many people who defaulted on their debts, moved out of the hospital overnight, and even went to the doctor to file a lawsuit for not paying the money. He would not treat those who didn't believe it.
I didn't want to pay attention to it anymore, but I was healed a little by that kid's thank you brother, so I wanted to go out and explain something.
But just as Lu Cheng was about to leave, Liu Cheng held Lu Cheng back and asked, "Hey, what are you going to do?"
"New here?"
Lu Cheng nodded, and looked at the other party's badge: "Ms. Liu, I am indeed the general inpatient who just took over the orthopedics department today."
Liu Chengqian said: "It's up to you to tell. It can be seen at a glance. I have clinical experience and solid basic skills. I haven't seen many radial head subluxations that are reset so quickly. "
"This proves that your theoretical foundation and professional ability are sufficient, but, clinical practice is more than theory and professional. Clinical practice is a process of communication."
"Are you dumbfounded?"
"Do you think everyone is like you, who can ignore the contract and do things in advance, and others have to fulfill the agreement? She doesn't pay the fee now, saying that she has never seen it, what can you do? Isn't it just Can you be shriveled?"
Lu Cheng thought about it carefully, it seems that this is really the case, and he didn't say that he has seen more things than this, but the results of those things may not all be good.
Some people have fractures or even infections after moving overnight after surgery, and lose a lawsuit with the doctor, and then privately go to the doctor to say that he has no medical ethics, and finally insist on suing them...
There are all kinds of life, and doctors can save people who can be saved.
"Thank you, Mr. Liu, for your reminder. I have indeed been taught today." Lu Cheng reluctantly picked up the signed consent form and walked to the operating room.
The patients and family members sitting there were stunned for a while, as if they still hesitated.
Lu Cheng had something on his hands and didn't have much time to talk to them: "Mr. Liu, there's nothing going on here for now. I'm going to go to the operating room first to see the patient who needs debridement and exploration."
Liu Chengqian said: "Don't leave in a hurry, this matter is not over yet. You follow me."
While talking, he was scribbling and writing something in the medical record. After finishing speaking, he just finished writing, and pulled Lu Chengcheng to go out.
In the emergency room, the woman seemed to be still talking to her husband. Liu Chengqian walked up and said, "Are you the child's parents? Come and sign the medical record, refusing to undergo surgical reduction and refusing to perform X." Check online at your own risk!"
The man almost understood what his wife meant. He just wanted to save some money. At the same time, he was a little confused that his child was cured so quickly.
Then I heard this again rashly, and couldn't help saying a little angrily: "What kind of doctors are you? He obviously touched my child just now. When did I say that I refused to reset the manipulation? I refused and you just tried to touch my child. try?"
"Let me tell you, if anything goes wrong with my child, both of you must be responsible to the end."
"I never said no!"
Although he also felt that it was a bit bad for his wife to run away like this, it was related to his child. These two doctors obviously touched his child, but they said that they refused treatment. What if they did something?Or if the treatment is wrong or there is a problem with the diagnosis and treatment, then?
At your own peril?How could he agree to such a thing?
It seems that this is not the first time Liu Chengqian encountered such a situation, so he said, "Do you have a registration?"
"Yes! I have registration!"
"Look, here, I just hung up your number, and you treated me. You still want to run away? Everyone comes to judge, these two doctors are not responsible! It was our child they treated just now, Now we have to bear the consequences!" The man's shout naturally attracted a lot of people to watch, and they were still pointing.
Seeing the crowd, the woman chimed in and said, "Yes, they want us to sign at our own peril. What kind of medical ethics? What kind of doctor? Let's take a picture of him and post it on the Internet."
When Lu Cheng heard this, he frowned slightly.
The kid was a little scared when he saw so many people and hid, but no matter how he hid, there were many eyes watching him, so he could only bury it in his mother's hair.
Liu Chengqian didn't seem to have any fear, and he didn't have any timidity: "Yes, you registered, and we also diagnosed you and wrote you an opinion."
"And I told your wife that your child needs manipulation reset and photo review. She refused?"
"Otherwise, why did you come out as soon as you went in?" Liu Chengqian said slowly.
"If you don't believe me, you can ask your wife."
When the man heard this, he was speechless. He turned to look at his wife and found that she was a little at a loss. In the end, he could only say: "I don't care. If you want us to sign, you have no medical ethics. My child has nothing wrong with you. Just They want us to pay!”
"You have all fallen into the eyes of money. They are the ones who have poor medical skills, indiscriminate diagnosis, and indiscriminate fees. Everyone will take pictures and expose them." At this point, she can no longer back down, otherwise she will be in front of everyone. It's not good to throw a deadbeat image in front of you.
The man also said that he didn't say anything.
Liu Chengqian quickly picked up the conversation and said, "Then let's not get married? We think your child needs treatment and examination. Your wife thinks your child is completely fine, and we are overcharging for examination and treatment. No medical ethics!"
"Isn't that just refusing our doctor's order? Moreover, you didn't pay for the relevant doctor's order we issued. How can you say that we have treated the child?"
"Then you don't check, don't treat, and violate our doctor's orders. This is your right to choose freely. We tell you that you need to be checked and treated, and their necessity. This is your right to know. Where is my treatment process? You can find out the problem, and I’m not afraid to spread it on the Internet.”
"If you don't cooperate with our examination and treatment, then you have to sign! It's not that I'm unreasonable."
"Come, here, sign, refuse!"
Lu Cheng watched from the side and nodded secretly.
I sighed secretly in my heart, sure enough, although I have accumulated some experience in the outside world for five years, there are no ordinary people in the Second Hunan University Hospital. Compared with these seniors, I still have a lot to learn.
Hearing these words, the people around started pointing:
"You die and don't listen to the doctor. What do you think? That's your freedom. You must say that people have no medical ethics. What's the reason for that?"
"That's right, they made it very clear that your child needs treatment and examination, they are professionals, can't you think it yourself?"
"The doctor gave you a suggestion, but you are unwilling to follow it, and you are still unwilling to sign it. What about the other doctor? You still want him to be responsible? You just don't care."
Hearing this, the men and women were a little panicked, and the women were also a little anxious.
Immediately said: "Then you are also doctors without medical ethics, as long as we spend money. You only think about our money."
"I have no money, and I didn't agree to your treatment. What are you treating my child? I don't have any money in my pocket now."
"Let me tell you, you moved my child without my consent. If there is any problem, I will never end with you. You have to be responsible to the end."
Liu Chengqian just laughed: "You said we treated it, but what about your evidence?"
"Payment certificate?"
"Plain film or report of X-ray?"
"You don't have any, and you just say we treated you. Can I sue you for defamation?"
"Do you mean that we doctors are ashamed of our own bones, sticking to our faces, and treating your child first?"
As soon as these words came out, the whole scene changed immediately.
Everyone also understood what was going on.
The men and women were suddenly very embarrassed, under the watchful eyes of the people around them.
In the end, after the man paid the fee, listened carefully to Lu Cheng's doctor's orders, fixed the forearm sling for a week, etc., and left the emergency department in a hurry under the strange gazes from all around.
Although in the end he made jokes and resolutely refused to pay the fee, it is possible not to pay the fee.
But you have to sign at your own risk, and after hearing the precautions that Lu Cheng said, it is very likely that you will not pay attention to it after you go back, which will affect the child's life.
Forget it, and get a reputation and notoriety for being arrogant and unreasonable,
This wave of blood loss!
After the two left, Lu Chengcai said: "Teacher Liu, I really learned a lesson this time. Thank you."
Liu Chengqian waved his hand and said, "It's okay. This is the trouble I caused for you. Of course I can't let you go in vain."
"You've just come in, you need to hone a lot, you can learn a little bit. Anyway, as long as we doctors remember, don't mess around, and follow the normal medical procedures prescribed by the state. Then it doesn't matter."
Hearing Liu Chengqian's words, the face of the patient who was undergoing emergency hip reduction and his family members were much more comfortable. Although it was still painful, at least there were no strange eyes from the people around him.
I don't want to pay for the treatment, and the doctor has to be responsible to the end.
But some people really regard themselves as the emperor of the celestial dynasty.
After hearing Liu Chengqian's words, Lu Cheng couldn't help being eager to learn again, and asked one more question: "Then if the patient and his family are unwilling to pay the fee or sign the contract, what should we do in the end?"
Liu Chengqian said: "Then write the truth."
"Patients and family members refuse treatment, refuse to sign and bear the consequences. Refuse doctors to carry out medical orders."
"If something goes wrong, there is this sentence in the medical record, and they don't have payment receipts or other circumstantial evidence. If something goes wrong with the child, they can't find you."
"If they didn't bring the medical records, it means they haven't seen the doctor,"
"Of course, there is still a high possibility that the child will not have any follow-up problems, so we will admit that we are in the wrong and take a blind trip."
"My seven yuan registration fee is worth one to two hundred yuan in treatment fees."
"Then what can we do?"
"For the time being, there is no such thing as a blacklist or a credit reporting system for medical treatment."
Lu Cheng nodded.
After the operation, some patients moved out of the ward overnight because they had not paid the money before, and they could no longer be contacted.
In the end, the department can only make up for the shortfall in surgical expenses.
Anesthesiologists, operating rooms, and material costs are indispensable, and they only find trouble with the department in the end.
In the end, it was deducted from the doctor's head. No matter how hard-headed a doctor is, he can't do such a good deed. How can there be so much salary compensation?
The cost of a patient is worth one or two months or even half a year to one year's salary.
After doing this, Lu Cheng really took his leave and left.
Benefited a lot from this.
In addition to professional knowledge and professional skills, there are more accumulations in clinical practice, as well as the style and skills of doing things, which clinicians need to learn.
If you don't pass the exam, you may have to pay tuition. Fortunately, Liu Cheng is here today.
Lu Cheng returned to the operating room, and then told Zheng Liu that there was a follow-up emergency operation to be done.
This kind of emergency surgery, however, does not mean that the general hospital attendant can carry out it completely independently. He must be accompanied by Zheng Liu or the doctor of this hospital to have this right.
Zheng Liu hurried off the stage after listening.
Zheng Liu naturally brought Lu Cheng with him immediately. Professor Huang already meant to regard Lu Cheng as the next chief hospital trainer, and he would be able to make it to the end soon.
Moreover, he not only wanted to take Lu Cheng for emergency type I surgery, but as long as Lu Cheng came in, he would leave all the outpatient and emergency surgeries to Lu Cheng to practice.
Lu Cheng followed behind Zheng Liu, his expression flickering.
This was not Lu Cheng's first emergency surgery, he had even done it before.
But this time he followed Zheng Liu to do it, and Lu Cheng didn't know if he could get the main knife, but since Zheng Liu shouted, he just followed behind, and if he had a chance to get started, forget it.It is also good to have a look at accumulating experience.
There are many clinical skills that must be accumulated bit by bit and integrated with theory.
The patient who started the debridement and exploration first, when Zheng Liu walked in, the thoracic surgery department and the staff from Shenwai had already arrived.
When the anesthetist saw Zheng Liu, he quickly said, "Now the patient's blood pressure is very unstable, already below the shock blood pressure. Even after blood transfusion, it still can't stabilize. It may be considered that there is still active bleeding."
"Orthopedics department, you have to stop the bleeding quickly, otherwise it doesn't matter how many bags of blood you transfuse, maybe the patient will die if he says no."
Zheng Liu is a very playful person. Even at this time, he didn't look nervous, so he said: "Mr. Anesthesiologist, this patient's blood pressure is not stable, but it has little to do with our orthopedics department. If the patient is fractured In the pelvis, that can still find us."
"However, just a trauma near the knee joint, even if the tibial artery or popliteal artery is injured, at most, a tourniquet will do."
Zheng Liu took a quick look and said, "Whether this patient's leg can be kept, and whether it will still function after it is kept is another matter. My inspection is very fast here. As long as there is a problem with the blood vessel, it will be sewn up. If there is no blood vessel problem, just stick a VAC and it will be done."
"I'll go out to talk first, you should call the brothers outside the gods and outside the chest to do it first."
"Lu Cheng, you first apply pressure to the popliteal artery to stop the bleeding. If you press for 5 minutes and the blood pressure stabilizes, it basically proves that there is a problem with the blood vessel. The unstable blood pressure is caused by bleeding. If there is still a problem with the blood pressure, you have to find another problem."
Hearing Zheng Liu's words, Lu Cheng suddenly became enlightened. He changed hands and pressed the patient's popliteal artery. After pressing for a while, he checked the signs of the blood vessels at the far end and found that there was a problem with the filling of the blood vessels. of,
This just represented Lu Cheng's pressing position to stop the bleeding, which was extremely precise.
Zheng Liu: "..."
General Shenwai was hospitalized: "..."
Thoracic general hospitalization: "..."
The anesthesiologist was speechless. Seeing this, he could only press the button to measure the patient's blood pressure again, and at the same time start checking blood gas and electrolytes.
Patients who have lost a lot of blood cannot be rescued by a large number of blood transfusions.
It is also necessary to check whether the blood oxygen saturation and electrolytes are disordered, especially hyperkalemia, which can lead to abnormal heart rhythm, and then cardiac arrest, and the person is gone.
This situation can come and go without a trace, so blood gas and electrolytes must be checked every once in a while.
Even so, the anesthesiologist still thought that the patient had active bleeding. Although he heard what Zheng Liu said was easy, just anastomose the blood vessels and it was over.
But the nature of the treatment of all diseases in this world is actually very simple to say.
It's just harder to do.
In the popliteal fossa, there are extremely important structures such as the popliteal artery, anterior tibial artery, and posterior tibial artery, as well as the medial great saphenous vein and popliteal nerve.
How can it be so easy to detect the specific bleeding location, find the bleeding point, and perform electrocoagulation or suturing to stop the bleeding?
It is not easy to stop bleeding under open and direct vision, let alone stop bleeding with finger pressure.
Pressing to stop bleeding is easy to say, as long as you have hands, but you also need to press accurately.
The general direction of the arteries of the lower extremities is that the femoral artery continues to the popliteal artery, and the rest of the arteries are branches of the popliteal artery. Because the femoral artery is large in size, it is not easy to press to stop bleeding. Therefore, it is generally preferred to press the popliteal artery for hemostasis, which is more reliable.
But reliability is reliability, and it doesn’t mean that you can find the position as soon as you get started, and then basically solve the following problems?
Can you still be an individual?
In this way, Lu Cheng basically exempted 90.00% of the orthopedic department's responsibility for traumatic blood loss. With this hand pressing to stop the bleeding, the patient's blood pressure is unstable, and the orthopedics department will never be able to find trouble. ,
Just call someone to ask the neurosurgery, thoracic surgery, and anesthesiologists.
Although there is another possibility that after trauma, the blood is in a hypercoagulable state, which leads to thrombus in the artery or vein, and then the thrombus falls off, causing fatal risks such as pulmonary embolism and cerebral infarction, but such risk is extremely small, and even if it happens , In the operating room, it can also be processed in the first time.
Moreover, Lu Cheng was pressing the popliteal artery at this moment. The detachment of the arterial thrombus would only lead to distal arterial embolism at most, but would not lead to pulmonary infarction or cardiac embolism.
So even if there are related risks, it's not Lu Cheng's problem.
The anesthetist could only say with a smirk; "Well, pretend I didn't say anything."
"The patient's current blood pressure is still extremely unstable, and it is only 75/65mmHg. Although he has been using norepinephrine, it can't rise back. He needs immediate craniotomy for decompression and thoracotomy."
Whether it is supernatural high intracranial pressure or hemopneumothorax, it can cause the patient's shock.
Hearing this, the general inpatients of neurosurgery and thoracic surgery even accelerated the disinfection speed by a full three points.
Emergency consultation is actually a game and competition between various departments. As long as someone can prove that there is no problem with other departments, you have to deal with the problems of your own department as soon as possible.
The psychological pressure suddenly increased. Both of them looked at Zheng Liu and said, "If I had known that orthopedics was so simple, I would have gone to orthopedics before."
"At first, I thought that there were limbs in orthopedics, and I had to remember too many dissections, which were far less typical than the anatomy of the external body and the external body of the chest."
"I found out that I was wrong, Brother Dariu."
Lu Cheng was able to press to stop the bleeding so quickly, which was beyond Zheng Liu's expectations, but now that Lu Cheng has done this, his responsibility has been reduced by 90.00%, and he is in a good mood immediately.
Because of this move, even if he did it himself, he would definitely not be able to do it.
Whether Professor Huang can do it, Zheng Liu doesn't know, but in exchange for any of the two associate professors in the department, it can only be said that it is very difficult.
If pressing to stop bleeding is so simple, why in the world should invent the surgical method of incision to stop bleeding?
Zheng Liu said: "It's already too late, the road to moving bricks is already on the way, and the cost of changing another construction site is too high."
"Once our orthopedics department is simple and rude, we will solve the problem in the simplest way."
"I feel that after I sign, I can just apply a VAC and it can be withdrawn. You continue slowly."
After Zheng Liu finished speaking, he hurried out of the operating room to talk.
There must be a limit to pretending to be aggressive. If Lu Cheng showed his face in the orthopedics department, if he didn't say anything, wouldn't it be a waste of such a good opportunity?But if you always say it, it will be annoying and affect other people's operations.
After pressing to stop the bleeding, the blood pressure fluctuation still exists, which proves that it has nothing to do with the active bleeding of the lower limbs or has little relationship. Then Zheng Liuda can think that there is no active bleeding in the lower limbs, or that the active bleeding will not affect the patient's vital signs.
That is equivalent to just oozing blood. From a basic point of view, he has already dealt with it, and only needs to deal with this open wound.
Lu Cheng pressed for a while, then let go, and then called the anesthesiologist to continue to measure the blood pressure, and the final result was not much different from before the pressure.
Lu Chengcheng smiled. It seemed that the patient was lucky this time. There was no active bleeding, only bleeding.
From a medical point of view.
Active bleeding and oozing are not the same.
Active bleeding is when blood flows directly from the opening in the blood vessel, which is called hemorrhage.
Bleeding is just a slight oozing of capillaries on the surface of the wound. After suturing and bandaging under pressure, the capillaries can generally be compressed to achieve the purpose of hemostasis.
The anesthesiologist asked, "Did you study under Zheng Liu?"
"Were there some ways before coming here?"
Pressing to stop bleeding is just the simplest way to stop bleeding. In fact, it is not very practical. Except for some lower-level hospitals, they are willing to take a slanted approach to practice. In fact, in teaching hospitals, few people are willing to practice this kind of hemostasis. method.
First, it is not easy to find, nor is it easy to press.
Second, even after successful hemostasis by pressing, hemostasis needs to be opened, which is not very practical.
It's better to open the investigation directly.
So he subconsciously regarded Lu Cheng as someone sent up from below to study.
Everyone was wearing surgical masks and caps, and the anesthesiologist didn't know who Lu Cheng was.
However, the chief resident of the Thoracic Surgery Department took over the conversation at this time and said, "Mr. Qin, this is not for advanced studies, it is almost for this hospital."
"The Lu Cheng who is known as the boss of the orthopedic infection department who doesn't want to be an infection doctor, is him. He used to have a bad reputation. You have definitely heard of it."
The anesthetist looked at Lu Cheng in surprise, and almost subconsciously said, "Didn't you say that Lu Cheng is an academic bigwig?"
"You just finished your doctorate in six years, so you haven't been to clinical practice?"
Han Xiaolu said: "Hearing is believing, seeing is believing."
"Before I saw Brother Lu Cheng, you and I had the same idea. How could a person reach the level of a Ph.D. in such a short period of time?"
"It was only today that I realized that I was short-sighted. If anyone tells me that there is no such thing as a genius in this world, I will never believe it anyway."
The chief resident of the Department of Neurosurgery has never seen Lu Cheng, but he has heard of it. After listening to Han Xiaolu's words, he naturally accepted the words. At the same time, his eyes were still staring at his surgical field, and he quickly opened the scalp; "Brother Lu, I think this is true."
"It may definitely not be as simple as an academic boss."
"He's a cross-border boss."
After speaking, he happened to cut the scalp, and before he could put on a scalp wallet to stop the bleeding, he asked the handwashing nurse for an electric drill.While looking at Lu Cheng, he said, "This will soon be a brother of our hospital."
"I, Huang Youzhi, move bricks outside the gods."
Although it was said that Lu Cheng threw all the risks to neurosurgery and thoracic surgery, this method made him sure that Lu Cheng was a good friend.
Professional, if an acquaintance watches a movie in the future, he won't panic if he finds Lu Cheng, and Lu Cheng's current level is low, so it's easy to find.
Lu Cheng also quickly introduced himself; "Brother Zhi, you can call me Lu Cheng or Xiao Lu."
"I've heard your name a long time ago." After Huang Youzhi finished speaking, he shouted to the anesthesiologist, "I'm going to incision and decompression. I'm going to prepare the suction tube and drainage tube."
The anesthesiologist replied: "Understood, there is no problem here anytime."
Immediately after he finished speaking, he said to Lu Cheng again; "Xiao Lu, it shouldn't be a problem for me to yell at you, Xiao Lu. What I said before was indeed a bit thoughtless. Don't take it to heart. I How old are you, I will invite you to Brother Tianbao tonight."
"Even if I make friends, I won't mention the polite words of apology."
When Han Xiaolu heard Brother Tianbao, he couldn't help looking up at the anesthesiologist, and said to Lu Cheng, "Lu Cheng, you've made a lot of money this time. This is Professor Jiang Yuan from the Department of Anesthesiology."
"Neural block No. 1 is recognized by the anesthesiology department. It is said that if you mainly give it a part, he will dare to perform it, and he can also help you with a nerve block."
"In the future, your orthopedic surgery will be combined with analgesia. If you find Professor Jiang Yuan, you will definitely find the right person."
Tianbao Brothers is the place where Internet celebrities in Shashi eat shrimp, and it is near the Second Xiangda Hospital.
The location is difficult to determine, the price is also high, and the taste is naturally quite acceptable. If you can deal with it there, it will be great.
In fact, Professor Jiang Yuan doesn't easily invite people to eat. After all, it is extremely difficult to get a recognition in such a large department as the Department of Anesthesiology.
In the entire Hua Kingdom, not to mention the pivotal position, but at least the popularity is definitely not bad.
Live broadcast of nerve block anesthesia at national large-scale academic exchange conferences in the Department of Anesthesiology more than once,
The surgeons who have been with Jiangyuantai are very relieved. If he didn't happen to be in the emergency class today, he would not care about this kind of emergency surgery. He only anesthetized the IV surgery, and left everything else to his students come to fight.
Lu Cheng was immediately flattered.
Hunan University Second Hospital is a well-known hospital in the country, and Crouching Tiger, Hidden Dragon is a must. You may meet an old man in ordinary clothes, and he may be a well-known master in a certain aspect of the country. Such a person, even if Lu Cheng wants to If you want to make friends, there is nowhere to find them.
Lu Cheng: "Mr. Jiang, you are too polite. I should treat the supper tonight."
"Calling the teacher is a little strange, do I look that old?"
Jiang Yuan continued jokingly: "Besides, you residents are competing with me, an associate professor, to pay the bills. I don't know where you get the confidence from."
"Every family has a mine? Then pretend I didn't say it, otherwise, don't mention it. In case it gets out, some people will say that I, Jiang Yuan, don't understand the rules and use it to bully the small."
"That's it, I'll call and book a table right away."
As soon as Jiang Yuan finished speaking, his student said: "Teacher, the patient's blood pressure is dying. Now the high pressure is only 70. The heart rate is only [-]+."
Jiang Yuan just threw away the phone he was about to pick up:
"1 mg of epinephrine, intravenously!"
"Speed up the demethylation pump to 40, and adjust the oxygen flow to 430."
"Shout two more bags of blood!"
Looking at Jiang Yuan's calm and busy figure, Lu Cheng became stable and revered in his heart.
In the operating room, many people actually misunderstand that the surgeon is the soul stone.
But not really,
When fighting against the sky, seven points of anesthesia and three points of surgery, although it is a bit exaggerated, but the level of anesthesiologists definitely occupies an active position of 80.00% in terms of patient safety.
With a good anesthesiologist, the surgeon will feel extra calm and at ease.
Because in addition to the responsibility of anesthesia, the anesthesiologist also has the responsibility of correcting the changes in the patient's vital signs during the operation, and the responsibility of monitoring the changes of the patient's condition during the operation.
Anyone who understands knows that the chance of a patient dying directly due to surgery is almost zero.
Complications are more likely to cause death.
Including myocardial infarction, pulmonary infarction and cerebral infarction caused by embolism;
Respiratory depression secondary to cerebral infarction;
Shock caused by hemorrhage, cerebral infarction caused by insufficient circulating blood volume;
Arrhythmias caused by electrolyte disturbances;
Even for aortic dissection with a mortality rate of nearly 50.00%, most of the causes of death are due to insufficient blood perfusion secondary to dissection bleeding, which then leads to brain death and myocardial infarction.
Surgeons are not afraid of the complexity and difficulty of the operation, but only of these complications.
The person who prevents and monitors these complications is the anesthetist.
This is why many people basically call anesthesiologists anesthesia teachers. Having a good anesthesiologist to protect them is a guarantee for surgeons to improve their operations, and it is also a guarantee for new doctors to have enough time to accumulate their clinical experience.
In his whole life, Professor Jiang Yuan did not know how many patients he had anesthetized and how many operations he participated in.
Compared with his ability and decisiveness in rescuing patients during surgery, Lu Cheng felt that even if he had external help, he would have to have at least five years of experience in anesthesia.
So now, he just needs to wait quietly for the handwashing nurse to prepare the surgical instruments. After he debrides the wound and explores it and covers it with VAC, the orthopedic surgery can be declared over.
Under Jiang Yuan's calm command, the patient's vital signs stabilized at a high pressure of 70, a low pressure of 40, and a heart rate of 65.
Although the blood oxygen saturation is not high, it is still 88.
Although long-term low oxygen saturation can lead to irreversible complications, at such a critical moment, a short-term drop in blood oxygen saturation will at least not cause cerebral ischemia, and there is a full guarantee.
While Lu Cheng was rapidly debridement, Han Xiaolu's thoracotomy had already found the bleeding point, and after performing a lobectomy on a part of the completely necrotic lung tissue, a closed chest drainage tube was placed. At the same time, Huang Youzhi also completed the drainage of subdural hematoma through fenestration.
Although debridement and suture is only a type of operation at the surgical level, the complexity varies depending on the injury. Its operation time will not be shorter than that of craniotomy for decompression and thoracotomy.
And because decompressive craniotomy and thoracotomy are life-saving operations, and there are extremely standardized operating procedures and experience to learn from.
The time of debridement and suture is longer than both.
The craniotomy, craniectomy, and decompression, which seemed to be the most dangerous, were the first to be completed. After reading the film again and seeing that the snow swelling in the brain was completely removed,
Huang Youzhi said: "Brother Han, I'm done here, and only need to clean up the hematoma. I just saw that the hematoma here is in good condition."
"So Brother Han, you may have to find the reason from the chest injury."
The two processes of craniotomy are decompressive craniectomy and hematoma evacuation, which are life-saving operations. Generally, as long as the decompression is completed, the remaining hematoma evacuation does not have much risk.
Unless there is concurrent cerebral hemorrhage or subarachnoid hemorrhage, it is extremely life-threatening and affects vital signs.
After completing this step, Huang Youzhi breathed a sigh of relief. After the subsequent hematoma was cleared, he could take his time without rushing.
He did not see obvious cerebral hemorrhage or subarachnoid hemorrhage in the patient's preoperative CT scan.
As a result, the pressure on Han Xiaolu, who least ruled out the risk of his own department's life, suddenly became very high.
Although he had opened his chest cavity and saw a hemopneumothorax, the situation was still not optimistic for the time being. Some lungs were contused, and some lung lobes were completely shattered.
At this time, surgery to remove part of the lung lobe must be performed.
Han Xiaolu didn't say a word, and after seeing the bleeding clearly through the open chest again, he immediately started to stop the bleeding.
It doesn't matter whether the operation is faster or slower, the most important thing is the effect of the operation.
On this basis, the pursuit of surgical speed is the right thing to do.
However, just when Han Xiaolu began to evaluate the damage to the lung lobes and lung segments.
Zheng Liu happened to wash his hands and walked in, and when he walked up to Lu Cheng and was about to put on his clothes, he found that Lu Cheng had bluntly separated the popliteal artery, anterior tibial artery, posterior tibial artery, and their accompanying arteries and nerves. open.
At the same time, he also discovered that Lu Cheng had already started to connect the broken medial collateral ligament at this moment.
Except for the completely necrotic medial head of the gastrocnemius muscle and the necrotic muscle tissue at the insertion points of the three muscles in the goose group, there is nothing wrong with it.
Zheng Liu immediately said: "Damn it, you're done? Then I'll fuck up."
After speaking, he held his mobile phone with a hand that had been washed and could be regarded as relatively sterile, which directly polluted it.
Turned on the time, less than 13 minutes passed impressively.
Did Lu Cheng tear the nerves and muscles directly with his hands to pull them out instead of using instruments?
Hearing Zheng Liu's words, Han Xiaolu and Huang Youzhi looked at Lu Cheng again.
With a confused look on his face, is this a debridement and exploration that started surgery later than us?
How did it finish so quickly?
Could it be that the trauma is such a coincidence that part of the dead muscle is pulled away, and there are blood vessels and nerves lying underneath?And it happened to be undamaged?
You must know that debridement and exploration must expose the anatomical deformation very clearly before proceeding to the next separation operation.
Otherwise, if there is partial damage to the blood vessel, in the case of blunt dissection, it will cause the corresponding structure to break.
Lu Cheng simply doesn't know how to be a human being, he shouldn't be a human being!
How can people be so fast and play like this.
Seeing Zheng Liu's arrival, Lu Cheng immediately reported: "Brother Zheng Liu, according to your request, the corresponding blood vessels and nerves have been separated. It should be fine if you evaluate it?"
Zheng Liu grimaced, although he also knew that Lu Cheng was trying to save face for him and at the same time excuse himself,
But he still cursed and said, "Lu Cheng, when did you become so hypocritical?"
"It takes a little sincerity to be a human being."
"Even a layman can clearly see that it is a normal blood vessel and nerve, so you can make an assessment."
"I really saw your ghost."
After scolding, Zheng Liu immediately said: "That's good. My emergency surgery will start soon. After you finish it here, come over and reset it with me."
Lu Cheng hurriedly said, "Okay, Brother Zheng Liu."
After speaking, continue to rinse, and then hook up the joint capsule without completely sealing it, cover it with VAC dressing, suture and fix it with the skin again, and seal it with the film.
Connected to the negative pressure suction, he got off the stage, and then said to the nurse who washed his hands: "The patient's bones are not fractured and X-rays are not visible, but the ligaments are damaged. When the time comes, tell the ward in charge and remember to contact the knee joint when you go back. The brace is fixed."
"Okay." Lu Cheng completed the debridement and suture in such a short period of time. He was almost the relatives of all the surgical nurses and anesthesiologists on duty in the emergency department. Not to mention spreading rumors, he would do it even if he invited him to eat.
After all, they may encounter some troubles in the future and have to set up a stage with Lu Cheng. Such speed and proficiency will allow them to take an extra day off.
After the operation here, Lu Chengcheng stepped down and walked to another operating room. Of course, he greeted Han Xiaolu and the others before leaving.
Lu Cheng still has emergency surgery, so they didn't say a word of nonsense, just see you at night when the opinions are very unified.Then get on with your work.
In fact, when the anesthesiologist Jiang Yuan made the appointment for dinner, he evaluated it based on his own experience. The operation time of the three people should be close to each other, so that he could make a better appointment for dinner, otherwise others would mention it for hours.
Do you still have to wait for a meal?
Isn't it delicious to eat and rest?
If Jiang Yuan knew that Lu Cheng would make a quick decision so quickly, he would be too embarrassed to call Lu Cheng to eat.
Who would have thought that Lu Cheng would be so fast?
Looking at the patient's current basic condition, which is relatively stable, Jiang Yuan looked at Han Xiaolu and Huang Youzhi again: "You two need to speed up the progress, the sooner you finish it, the sooner you can eat."
Han Xiaolu and Huang Youzhi smiled wryly
You want us to be fine soon, but then the patients will trouble the three of us.
……
When Lu Cheng rushed to another operating room, the patient with hip dislocation had already received anesthesia. Zheng Liu called two operating teams to help him fix the patient's pelvis, and he began to stretch and reset.
At this time, seeing Lu Cheng coming, he sighed profusely with sweat on his face: "Lu Cheng, come here quickly, this hip joint is a bit difficult to recover, you and I should work hard together."
Lu Cheng looked at Zheng Liu's method, and it was Allis method.Quite a bit of wanting to use violence to control violence.
Lu Cheng didn't think too much, and hurried up to help, but before Zheng Liu's external rotation, he first pretended to be impacted and used the force to adduct and internally rotate the hip joint, and then followed Zheng Liu's abduction and external rotation to pull.
Just like that, the patient's hip joint heard a click.
This is the triumphant sound of a successful reset.
Brother Zheng Liu immediately checked the patient's range of motion, straightening, adduction, internal rotation, abduction and external rotation.
Then he said in a good mood: "Call Brother Lei, let's take a picture."
"Finally it was reset, and it was still because of not enough strength."
The other two regulars nodded their heads in agreement.
And the anesthetist also started to wake up the patient from anesthesia,
Lu Cheng didn't say anything, and went directly to the operating room for elective orthopedic surgery to observe the operation.
On the back foot, Zheng Liu explained some precautions to the surgery class, and then followed him, saying, "Xiao Lu, I did a little better today. Then I might be able to be lazy in the future."
"Now that the joint replacement has been completed, the arthroscopic table has been divided. You go to Associate Professor Qin Qiguo, and I will help Associate Professor Zhou Ren, so that the brother in charge of the bed will not be scolded."
(End of this chapter)
When the woman left with the child, neither Lu Cheng nor the doctor who was attending the clinic stopped her, nor were they qualified to stop her.
This guy obviously wants to renege on his debts.
Lu Cheng has seen a lot of this kind of situation. In the past five years, Lu Cheng has seen too many people who defaulted on their debts, moved out of the hospital overnight, and even went to the doctor to file a lawsuit for not paying the money. He would not treat those who didn't believe it.
I didn't want to pay attention to it anymore, but I was healed a little by that kid's thank you brother, so I wanted to go out and explain something.
But just as Lu Cheng was about to leave, Liu Cheng held Lu Cheng back and asked, "Hey, what are you going to do?"
"New here?"
Lu Cheng nodded, and looked at the other party's badge: "Ms. Liu, I am indeed the general inpatient who just took over the orthopedics department today."
Liu Chengqian said: "It's up to you to tell. It can be seen at a glance. I have clinical experience and solid basic skills. I haven't seen many radial head subluxations that are reset so quickly. "
"This proves that your theoretical foundation and professional ability are sufficient, but, clinical practice is more than theory and professional. Clinical practice is a process of communication."
"Are you dumbfounded?"
"Do you think everyone is like you, who can ignore the contract and do things in advance, and others have to fulfill the agreement? She doesn't pay the fee now, saying that she has never seen it, what can you do? Isn't it just Can you be shriveled?"
Lu Cheng thought about it carefully, it seems that this is really the case, and he didn't say that he has seen more things than this, but the results of those things may not all be good.
Some people have fractures or even infections after moving overnight after surgery, and lose a lawsuit with the doctor, and then privately go to the doctor to say that he has no medical ethics, and finally insist on suing them...
There are all kinds of life, and doctors can save people who can be saved.
"Thank you, Mr. Liu, for your reminder. I have indeed been taught today." Lu Cheng reluctantly picked up the signed consent form and walked to the operating room.
The patients and family members sitting there were stunned for a while, as if they still hesitated.
Lu Cheng had something on his hands and didn't have much time to talk to them: "Mr. Liu, there's nothing going on here for now. I'm going to go to the operating room first to see the patient who needs debridement and exploration."
Liu Chengqian said: "Don't leave in a hurry, this matter is not over yet. You follow me."
While talking, he was scribbling and writing something in the medical record. After finishing speaking, he just finished writing, and pulled Lu Chengcheng to go out.
In the emergency room, the woman seemed to be still talking to her husband. Liu Chengqian walked up and said, "Are you the child's parents? Come and sign the medical record, refusing to undergo surgical reduction and refusing to perform X." Check online at your own risk!"
The man almost understood what his wife meant. He just wanted to save some money. At the same time, he was a little confused that his child was cured so quickly.
Then I heard this again rashly, and couldn't help saying a little angrily: "What kind of doctors are you? He obviously touched my child just now. When did I say that I refused to reset the manipulation? I refused and you just tried to touch my child. try?"
"Let me tell you, if anything goes wrong with my child, both of you must be responsible to the end."
"I never said no!"
Although he also felt that it was a bit bad for his wife to run away like this, it was related to his child. These two doctors obviously touched his child, but they said that they refused treatment. What if they did something?Or if the treatment is wrong or there is a problem with the diagnosis and treatment, then?
At your own peril?How could he agree to such a thing?
It seems that this is not the first time Liu Chengqian encountered such a situation, so he said, "Do you have a registration?"
"Yes! I have registration!"
"Look, here, I just hung up your number, and you treated me. You still want to run away? Everyone comes to judge, these two doctors are not responsible! It was our child they treated just now, Now we have to bear the consequences!" The man's shout naturally attracted a lot of people to watch, and they were still pointing.
Seeing the crowd, the woman chimed in and said, "Yes, they want us to sign at our own peril. What kind of medical ethics? What kind of doctor? Let's take a picture of him and post it on the Internet."
When Lu Cheng heard this, he frowned slightly.
The kid was a little scared when he saw so many people and hid, but no matter how he hid, there were many eyes watching him, so he could only bury it in his mother's hair.
Liu Chengqian didn't seem to have any fear, and he didn't have any timidity: "Yes, you registered, and we also diagnosed you and wrote you an opinion."
"And I told your wife that your child needs manipulation reset and photo review. She refused?"
"Otherwise, why did you come out as soon as you went in?" Liu Chengqian said slowly.
"If you don't believe me, you can ask your wife."
When the man heard this, he was speechless. He turned to look at his wife and found that she was a little at a loss. In the end, he could only say: "I don't care. If you want us to sign, you have no medical ethics. My child has nothing wrong with you. Just They want us to pay!”
"You have all fallen into the eyes of money. They are the ones who have poor medical skills, indiscriminate diagnosis, and indiscriminate fees. Everyone will take pictures and expose them." At this point, she can no longer back down, otherwise she will be in front of everyone. It's not good to throw a deadbeat image in front of you.
The man also said that he didn't say anything.
Liu Chengqian quickly picked up the conversation and said, "Then let's not get married? We think your child needs treatment and examination. Your wife thinks your child is completely fine, and we are overcharging for examination and treatment. No medical ethics!"
"Isn't that just refusing our doctor's order? Moreover, you didn't pay for the relevant doctor's order we issued. How can you say that we have treated the child?"
"Then you don't check, don't treat, and violate our doctor's orders. This is your right to choose freely. We tell you that you need to be checked and treated, and their necessity. This is your right to know. Where is my treatment process? You can find out the problem, and I’m not afraid to spread it on the Internet.”
"If you don't cooperate with our examination and treatment, then you have to sign! It's not that I'm unreasonable."
"Come, here, sign, refuse!"
Lu Cheng watched from the side and nodded secretly.
I sighed secretly in my heart, sure enough, although I have accumulated some experience in the outside world for five years, there are no ordinary people in the Second Hunan University Hospital. Compared with these seniors, I still have a lot to learn.
Hearing these words, the people around started pointing:
"You die and don't listen to the doctor. What do you think? That's your freedom. You must say that people have no medical ethics. What's the reason for that?"
"That's right, they made it very clear that your child needs treatment and examination, they are professionals, can't you think it yourself?"
"The doctor gave you a suggestion, but you are unwilling to follow it, and you are still unwilling to sign it. What about the other doctor? You still want him to be responsible? You just don't care."
Hearing this, the men and women were a little panicked, and the women were also a little anxious.
Immediately said: "Then you are also doctors without medical ethics, as long as we spend money. You only think about our money."
"I have no money, and I didn't agree to your treatment. What are you treating my child? I don't have any money in my pocket now."
"Let me tell you, you moved my child without my consent. If there is any problem, I will never end with you. You have to be responsible to the end."
Liu Chengqian just laughed: "You said we treated it, but what about your evidence?"
"Payment certificate?"
"Plain film or report of X-ray?"
"You don't have any, and you just say we treated you. Can I sue you for defamation?"
"Do you mean that we doctors are ashamed of our own bones, sticking to our faces, and treating your child first?"
As soon as these words came out, the whole scene changed immediately.
Everyone also understood what was going on.
The men and women were suddenly very embarrassed, under the watchful eyes of the people around them.
In the end, after the man paid the fee, listened carefully to Lu Cheng's doctor's orders, fixed the forearm sling for a week, etc., and left the emergency department in a hurry under the strange gazes from all around.
Although in the end he made jokes and resolutely refused to pay the fee, it is possible not to pay the fee.
But you have to sign at your own risk, and after hearing the precautions that Lu Cheng said, it is very likely that you will not pay attention to it after you go back, which will affect the child's life.
Forget it, and get a reputation and notoriety for being arrogant and unreasonable,
This wave of blood loss!
After the two left, Lu Chengcai said: "Teacher Liu, I really learned a lesson this time. Thank you."
Liu Chengqian waved his hand and said, "It's okay. This is the trouble I caused for you. Of course I can't let you go in vain."
"You've just come in, you need to hone a lot, you can learn a little bit. Anyway, as long as we doctors remember, don't mess around, and follow the normal medical procedures prescribed by the state. Then it doesn't matter."
Hearing Liu Chengqian's words, the face of the patient who was undergoing emergency hip reduction and his family members were much more comfortable. Although it was still painful, at least there were no strange eyes from the people around him.
I don't want to pay for the treatment, and the doctor has to be responsible to the end.
But some people really regard themselves as the emperor of the celestial dynasty.
After hearing Liu Chengqian's words, Lu Cheng couldn't help being eager to learn again, and asked one more question: "Then if the patient and his family are unwilling to pay the fee or sign the contract, what should we do in the end?"
Liu Chengqian said: "Then write the truth."
"Patients and family members refuse treatment, refuse to sign and bear the consequences. Refuse doctors to carry out medical orders."
"If something goes wrong, there is this sentence in the medical record, and they don't have payment receipts or other circumstantial evidence. If something goes wrong with the child, they can't find you."
"If they didn't bring the medical records, it means they haven't seen the doctor,"
"Of course, there is still a high possibility that the child will not have any follow-up problems, so we will admit that we are in the wrong and take a blind trip."
"My seven yuan registration fee is worth one to two hundred yuan in treatment fees."
"Then what can we do?"
"For the time being, there is no such thing as a blacklist or a credit reporting system for medical treatment."
Lu Cheng nodded.
After the operation, some patients moved out of the ward overnight because they had not paid the money before, and they could no longer be contacted.
In the end, the department can only make up for the shortfall in surgical expenses.
Anesthesiologists, operating rooms, and material costs are indispensable, and they only find trouble with the department in the end.
In the end, it was deducted from the doctor's head. No matter how hard-headed a doctor is, he can't do such a good deed. How can there be so much salary compensation?
The cost of a patient is worth one or two months or even half a year to one year's salary.
After doing this, Lu Cheng really took his leave and left.
Benefited a lot from this.
In addition to professional knowledge and professional skills, there are more accumulations in clinical practice, as well as the style and skills of doing things, which clinicians need to learn.
If you don't pass the exam, you may have to pay tuition. Fortunately, Liu Cheng is here today.
Lu Cheng returned to the operating room, and then told Zheng Liu that there was a follow-up emergency operation to be done.
This kind of emergency surgery, however, does not mean that the general hospital attendant can carry out it completely independently. He must be accompanied by Zheng Liu or the doctor of this hospital to have this right.
Zheng Liu hurried off the stage after listening.
Zheng Liu naturally brought Lu Cheng with him immediately. Professor Huang already meant to regard Lu Cheng as the next chief hospital trainer, and he would be able to make it to the end soon.
Moreover, he not only wanted to take Lu Cheng for emergency type I surgery, but as long as Lu Cheng came in, he would leave all the outpatient and emergency surgeries to Lu Cheng to practice.
Lu Cheng followed behind Zheng Liu, his expression flickering.
This was not Lu Cheng's first emergency surgery, he had even done it before.
But this time he followed Zheng Liu to do it, and Lu Cheng didn't know if he could get the main knife, but since Zheng Liu shouted, he just followed behind, and if he had a chance to get started, forget it.It is also good to have a look at accumulating experience.
There are many clinical skills that must be accumulated bit by bit and integrated with theory.
The patient who started the debridement and exploration first, when Zheng Liu walked in, the thoracic surgery department and the staff from Shenwai had already arrived.
When the anesthetist saw Zheng Liu, he quickly said, "Now the patient's blood pressure is very unstable, already below the shock blood pressure. Even after blood transfusion, it still can't stabilize. It may be considered that there is still active bleeding."
"Orthopedics department, you have to stop the bleeding quickly, otherwise it doesn't matter how many bags of blood you transfuse, maybe the patient will die if he says no."
Zheng Liu is a very playful person. Even at this time, he didn't look nervous, so he said: "Mr. Anesthesiologist, this patient's blood pressure is not stable, but it has little to do with our orthopedics department. If the patient is fractured In the pelvis, that can still find us."
"However, just a trauma near the knee joint, even if the tibial artery or popliteal artery is injured, at most, a tourniquet will do."
Zheng Liu took a quick look and said, "Whether this patient's leg can be kept, and whether it will still function after it is kept is another matter. My inspection is very fast here. As long as there is a problem with the blood vessel, it will be sewn up. If there is no blood vessel problem, just stick a VAC and it will be done."
"I'll go out to talk first, you should call the brothers outside the gods and outside the chest to do it first."
"Lu Cheng, you first apply pressure to the popliteal artery to stop the bleeding. If you press for 5 minutes and the blood pressure stabilizes, it basically proves that there is a problem with the blood vessel. The unstable blood pressure is caused by bleeding. If there is still a problem with the blood pressure, you have to find another problem."
Hearing Zheng Liu's words, Lu Cheng suddenly became enlightened. He changed hands and pressed the patient's popliteal artery. After pressing for a while, he checked the signs of the blood vessels at the far end and found that there was a problem with the filling of the blood vessels. of,
This just represented Lu Cheng's pressing position to stop the bleeding, which was extremely precise.
Zheng Liu: "..."
General Shenwai was hospitalized: "..."
Thoracic general hospitalization: "..."
The anesthesiologist was speechless. Seeing this, he could only press the button to measure the patient's blood pressure again, and at the same time start checking blood gas and electrolytes.
Patients who have lost a lot of blood cannot be rescued by a large number of blood transfusions.
It is also necessary to check whether the blood oxygen saturation and electrolytes are disordered, especially hyperkalemia, which can lead to abnormal heart rhythm, and then cardiac arrest, and the person is gone.
This situation can come and go without a trace, so blood gas and electrolytes must be checked every once in a while.
Even so, the anesthesiologist still thought that the patient had active bleeding. Although he heard what Zheng Liu said was easy, just anastomose the blood vessels and it was over.
But the nature of the treatment of all diseases in this world is actually very simple to say.
It's just harder to do.
In the popliteal fossa, there are extremely important structures such as the popliteal artery, anterior tibial artery, and posterior tibial artery, as well as the medial great saphenous vein and popliteal nerve.
How can it be so easy to detect the specific bleeding location, find the bleeding point, and perform electrocoagulation or suturing to stop the bleeding?
It is not easy to stop bleeding under open and direct vision, let alone stop bleeding with finger pressure.
Pressing to stop bleeding is easy to say, as long as you have hands, but you also need to press accurately.
The general direction of the arteries of the lower extremities is that the femoral artery continues to the popliteal artery, and the rest of the arteries are branches of the popliteal artery. Because the femoral artery is large in size, it is not easy to press to stop bleeding. Therefore, it is generally preferred to press the popliteal artery for hemostasis, which is more reliable.
But reliability is reliability, and it doesn’t mean that you can find the position as soon as you get started, and then basically solve the following problems?
Can you still be an individual?
In this way, Lu Cheng basically exempted 90.00% of the orthopedic department's responsibility for traumatic blood loss. With this hand pressing to stop the bleeding, the patient's blood pressure is unstable, and the orthopedics department will never be able to find trouble. ,
Just call someone to ask the neurosurgery, thoracic surgery, and anesthesiologists.
Although there is another possibility that after trauma, the blood is in a hypercoagulable state, which leads to thrombus in the artery or vein, and then the thrombus falls off, causing fatal risks such as pulmonary embolism and cerebral infarction, but such risk is extremely small, and even if it happens , In the operating room, it can also be processed in the first time.
Moreover, Lu Cheng was pressing the popliteal artery at this moment. The detachment of the arterial thrombus would only lead to distal arterial embolism at most, but would not lead to pulmonary infarction or cardiac embolism.
So even if there are related risks, it's not Lu Cheng's problem.
The anesthetist could only say with a smirk; "Well, pretend I didn't say anything."
"The patient's current blood pressure is still extremely unstable, and it is only 75/65mmHg. Although he has been using norepinephrine, it can't rise back. He needs immediate craniotomy for decompression and thoracotomy."
Whether it is supernatural high intracranial pressure or hemopneumothorax, it can cause the patient's shock.
Hearing this, the general inpatients of neurosurgery and thoracic surgery even accelerated the disinfection speed by a full three points.
Emergency consultation is actually a game and competition between various departments. As long as someone can prove that there is no problem with other departments, you have to deal with the problems of your own department as soon as possible.
The psychological pressure suddenly increased. Both of them looked at Zheng Liu and said, "If I had known that orthopedics was so simple, I would have gone to orthopedics before."
"At first, I thought that there were limbs in orthopedics, and I had to remember too many dissections, which were far less typical than the anatomy of the external body and the external body of the chest."
"I found out that I was wrong, Brother Dariu."
Lu Cheng was able to press to stop the bleeding so quickly, which was beyond Zheng Liu's expectations, but now that Lu Cheng has done this, his responsibility has been reduced by 90.00%, and he is in a good mood immediately.
Because of this move, even if he did it himself, he would definitely not be able to do it.
Whether Professor Huang can do it, Zheng Liu doesn't know, but in exchange for any of the two associate professors in the department, it can only be said that it is very difficult.
If pressing to stop bleeding is so simple, why in the world should invent the surgical method of incision to stop bleeding?
Zheng Liu said: "It's already too late, the road to moving bricks is already on the way, and the cost of changing another construction site is too high."
"Once our orthopedics department is simple and rude, we will solve the problem in the simplest way."
"I feel that after I sign, I can just apply a VAC and it can be withdrawn. You continue slowly."
After Zheng Liu finished speaking, he hurried out of the operating room to talk.
There must be a limit to pretending to be aggressive. If Lu Cheng showed his face in the orthopedics department, if he didn't say anything, wouldn't it be a waste of such a good opportunity?But if you always say it, it will be annoying and affect other people's operations.
After pressing to stop the bleeding, the blood pressure fluctuation still exists, which proves that it has nothing to do with the active bleeding of the lower limbs or has little relationship. Then Zheng Liuda can think that there is no active bleeding in the lower limbs, or that the active bleeding will not affect the patient's vital signs.
That is equivalent to just oozing blood. From a basic point of view, he has already dealt with it, and only needs to deal with this open wound.
Lu Cheng pressed for a while, then let go, and then called the anesthesiologist to continue to measure the blood pressure, and the final result was not much different from before the pressure.
Lu Chengcheng smiled. It seemed that the patient was lucky this time. There was no active bleeding, only bleeding.
From a medical point of view.
Active bleeding and oozing are not the same.
Active bleeding is when blood flows directly from the opening in the blood vessel, which is called hemorrhage.
Bleeding is just a slight oozing of capillaries on the surface of the wound. After suturing and bandaging under pressure, the capillaries can generally be compressed to achieve the purpose of hemostasis.
The anesthesiologist asked, "Did you study under Zheng Liu?"
"Were there some ways before coming here?"
Pressing to stop bleeding is just the simplest way to stop bleeding. In fact, it is not very practical. Except for some lower-level hospitals, they are willing to take a slanted approach to practice. In fact, in teaching hospitals, few people are willing to practice this kind of hemostasis. method.
First, it is not easy to find, nor is it easy to press.
Second, even after successful hemostasis by pressing, hemostasis needs to be opened, which is not very practical.
It's better to open the investigation directly.
So he subconsciously regarded Lu Cheng as someone sent up from below to study.
Everyone was wearing surgical masks and caps, and the anesthesiologist didn't know who Lu Cheng was.
However, the chief resident of the Thoracic Surgery Department took over the conversation at this time and said, "Mr. Qin, this is not for advanced studies, it is almost for this hospital."
"The Lu Cheng who is known as the boss of the orthopedic infection department who doesn't want to be an infection doctor, is him. He used to have a bad reputation. You have definitely heard of it."
The anesthetist looked at Lu Cheng in surprise, and almost subconsciously said, "Didn't you say that Lu Cheng is an academic bigwig?"
"You just finished your doctorate in six years, so you haven't been to clinical practice?"
Han Xiaolu said: "Hearing is believing, seeing is believing."
"Before I saw Brother Lu Cheng, you and I had the same idea. How could a person reach the level of a Ph.D. in such a short period of time?"
"It was only today that I realized that I was short-sighted. If anyone tells me that there is no such thing as a genius in this world, I will never believe it anyway."
The chief resident of the Department of Neurosurgery has never seen Lu Cheng, but he has heard of it. After listening to Han Xiaolu's words, he naturally accepted the words. At the same time, his eyes were still staring at his surgical field, and he quickly opened the scalp; "Brother Lu, I think this is true."
"It may definitely not be as simple as an academic boss."
"He's a cross-border boss."
After speaking, he happened to cut the scalp, and before he could put on a scalp wallet to stop the bleeding, he asked the handwashing nurse for an electric drill.While looking at Lu Cheng, he said, "This will soon be a brother of our hospital."
"I, Huang Youzhi, move bricks outside the gods."
Although it was said that Lu Cheng threw all the risks to neurosurgery and thoracic surgery, this method made him sure that Lu Cheng was a good friend.
Professional, if an acquaintance watches a movie in the future, he won't panic if he finds Lu Cheng, and Lu Cheng's current level is low, so it's easy to find.
Lu Cheng also quickly introduced himself; "Brother Zhi, you can call me Lu Cheng or Xiao Lu."
"I've heard your name a long time ago." After Huang Youzhi finished speaking, he shouted to the anesthesiologist, "I'm going to incision and decompression. I'm going to prepare the suction tube and drainage tube."
The anesthesiologist replied: "Understood, there is no problem here anytime."
Immediately after he finished speaking, he said to Lu Cheng again; "Xiao Lu, it shouldn't be a problem for me to yell at you, Xiao Lu. What I said before was indeed a bit thoughtless. Don't take it to heart. I How old are you, I will invite you to Brother Tianbao tonight."
"Even if I make friends, I won't mention the polite words of apology."
When Han Xiaolu heard Brother Tianbao, he couldn't help looking up at the anesthesiologist, and said to Lu Cheng, "Lu Cheng, you've made a lot of money this time. This is Professor Jiang Yuan from the Department of Anesthesiology."
"Neural block No. 1 is recognized by the anesthesiology department. It is said that if you mainly give it a part, he will dare to perform it, and he can also help you with a nerve block."
"In the future, your orthopedic surgery will be combined with analgesia. If you find Professor Jiang Yuan, you will definitely find the right person."
Tianbao Brothers is the place where Internet celebrities in Shashi eat shrimp, and it is near the Second Xiangda Hospital.
The location is difficult to determine, the price is also high, and the taste is naturally quite acceptable. If you can deal with it there, it will be great.
In fact, Professor Jiang Yuan doesn't easily invite people to eat. After all, it is extremely difficult to get a recognition in such a large department as the Department of Anesthesiology.
In the entire Hua Kingdom, not to mention the pivotal position, but at least the popularity is definitely not bad.
Live broadcast of nerve block anesthesia at national large-scale academic exchange conferences in the Department of Anesthesiology more than once,
The surgeons who have been with Jiangyuantai are very relieved. If he didn't happen to be in the emergency class today, he would not care about this kind of emergency surgery. He only anesthetized the IV surgery, and left everything else to his students come to fight.
Lu Cheng was immediately flattered.
Hunan University Second Hospital is a well-known hospital in the country, and Crouching Tiger, Hidden Dragon is a must. You may meet an old man in ordinary clothes, and he may be a well-known master in a certain aspect of the country. Such a person, even if Lu Cheng wants to If you want to make friends, there is nowhere to find them.
Lu Cheng: "Mr. Jiang, you are too polite. I should treat the supper tonight."
"Calling the teacher is a little strange, do I look that old?"
Jiang Yuan continued jokingly: "Besides, you residents are competing with me, an associate professor, to pay the bills. I don't know where you get the confidence from."
"Every family has a mine? Then pretend I didn't say it, otherwise, don't mention it. In case it gets out, some people will say that I, Jiang Yuan, don't understand the rules and use it to bully the small."
"That's it, I'll call and book a table right away."
As soon as Jiang Yuan finished speaking, his student said: "Teacher, the patient's blood pressure is dying. Now the high pressure is only 70. The heart rate is only [-]+."
Jiang Yuan just threw away the phone he was about to pick up:
"1 mg of epinephrine, intravenously!"
"Speed up the demethylation pump to 40, and adjust the oxygen flow to 430."
"Shout two more bags of blood!"
Looking at Jiang Yuan's calm and busy figure, Lu Cheng became stable and revered in his heart.
In the operating room, many people actually misunderstand that the surgeon is the soul stone.
But not really,
When fighting against the sky, seven points of anesthesia and three points of surgery, although it is a bit exaggerated, but the level of anesthesiologists definitely occupies an active position of 80.00% in terms of patient safety.
With a good anesthesiologist, the surgeon will feel extra calm and at ease.
Because in addition to the responsibility of anesthesia, the anesthesiologist also has the responsibility of correcting the changes in the patient's vital signs during the operation, and the responsibility of monitoring the changes of the patient's condition during the operation.
Anyone who understands knows that the chance of a patient dying directly due to surgery is almost zero.
Complications are more likely to cause death.
Including myocardial infarction, pulmonary infarction and cerebral infarction caused by embolism;
Respiratory depression secondary to cerebral infarction;
Shock caused by hemorrhage, cerebral infarction caused by insufficient circulating blood volume;
Arrhythmias caused by electrolyte disturbances;
Even for aortic dissection with a mortality rate of nearly 50.00%, most of the causes of death are due to insufficient blood perfusion secondary to dissection bleeding, which then leads to brain death and myocardial infarction.
Surgeons are not afraid of the complexity and difficulty of the operation, but only of these complications.
The person who prevents and monitors these complications is the anesthetist.
This is why many people basically call anesthesiologists anesthesia teachers. Having a good anesthesiologist to protect them is a guarantee for surgeons to improve their operations, and it is also a guarantee for new doctors to have enough time to accumulate their clinical experience.
In his whole life, Professor Jiang Yuan did not know how many patients he had anesthetized and how many operations he participated in.
Compared with his ability and decisiveness in rescuing patients during surgery, Lu Cheng felt that even if he had external help, he would have to have at least five years of experience in anesthesia.
So now, he just needs to wait quietly for the handwashing nurse to prepare the surgical instruments. After he debrides the wound and explores it and covers it with VAC, the orthopedic surgery can be declared over.
Under Jiang Yuan's calm command, the patient's vital signs stabilized at a high pressure of 70, a low pressure of 40, and a heart rate of 65.
Although the blood oxygen saturation is not high, it is still 88.
Although long-term low oxygen saturation can lead to irreversible complications, at such a critical moment, a short-term drop in blood oxygen saturation will at least not cause cerebral ischemia, and there is a full guarantee.
While Lu Cheng was rapidly debridement, Han Xiaolu's thoracotomy had already found the bleeding point, and after performing a lobectomy on a part of the completely necrotic lung tissue, a closed chest drainage tube was placed. At the same time, Huang Youzhi also completed the drainage of subdural hematoma through fenestration.
Although debridement and suture is only a type of operation at the surgical level, the complexity varies depending on the injury. Its operation time will not be shorter than that of craniotomy for decompression and thoracotomy.
And because decompressive craniotomy and thoracotomy are life-saving operations, and there are extremely standardized operating procedures and experience to learn from.
The time of debridement and suture is longer than both.
The craniotomy, craniectomy, and decompression, which seemed to be the most dangerous, were the first to be completed. After reading the film again and seeing that the snow swelling in the brain was completely removed,
Huang Youzhi said: "Brother Han, I'm done here, and only need to clean up the hematoma. I just saw that the hematoma here is in good condition."
"So Brother Han, you may have to find the reason from the chest injury."
The two processes of craniotomy are decompressive craniectomy and hematoma evacuation, which are life-saving operations. Generally, as long as the decompression is completed, the remaining hematoma evacuation does not have much risk.
Unless there is concurrent cerebral hemorrhage or subarachnoid hemorrhage, it is extremely life-threatening and affects vital signs.
After completing this step, Huang Youzhi breathed a sigh of relief. After the subsequent hematoma was cleared, he could take his time without rushing.
He did not see obvious cerebral hemorrhage or subarachnoid hemorrhage in the patient's preoperative CT scan.
As a result, the pressure on Han Xiaolu, who least ruled out the risk of his own department's life, suddenly became very high.
Although he had opened his chest cavity and saw a hemopneumothorax, the situation was still not optimistic for the time being. Some lungs were contused, and some lung lobes were completely shattered.
At this time, surgery to remove part of the lung lobe must be performed.
Han Xiaolu didn't say a word, and after seeing the bleeding clearly through the open chest again, he immediately started to stop the bleeding.
It doesn't matter whether the operation is faster or slower, the most important thing is the effect of the operation.
On this basis, the pursuit of surgical speed is the right thing to do.
However, just when Han Xiaolu began to evaluate the damage to the lung lobes and lung segments.
Zheng Liu happened to wash his hands and walked in, and when he walked up to Lu Cheng and was about to put on his clothes, he found that Lu Cheng had bluntly separated the popliteal artery, anterior tibial artery, posterior tibial artery, and their accompanying arteries and nerves. open.
At the same time, he also discovered that Lu Cheng had already started to connect the broken medial collateral ligament at this moment.
Except for the completely necrotic medial head of the gastrocnemius muscle and the necrotic muscle tissue at the insertion points of the three muscles in the goose group, there is nothing wrong with it.
Zheng Liu immediately said: "Damn it, you're done? Then I'll fuck up."
After speaking, he held his mobile phone with a hand that had been washed and could be regarded as relatively sterile, which directly polluted it.
Turned on the time, less than 13 minutes passed impressively.
Did Lu Cheng tear the nerves and muscles directly with his hands to pull them out instead of using instruments?
Hearing Zheng Liu's words, Han Xiaolu and Huang Youzhi looked at Lu Cheng again.
With a confused look on his face, is this a debridement and exploration that started surgery later than us?
How did it finish so quickly?
Could it be that the trauma is such a coincidence that part of the dead muscle is pulled away, and there are blood vessels and nerves lying underneath?And it happened to be undamaged?
You must know that debridement and exploration must expose the anatomical deformation very clearly before proceeding to the next separation operation.
Otherwise, if there is partial damage to the blood vessel, in the case of blunt dissection, it will cause the corresponding structure to break.
Lu Cheng simply doesn't know how to be a human being, he shouldn't be a human being!
How can people be so fast and play like this.
Seeing Zheng Liu's arrival, Lu Cheng immediately reported: "Brother Zheng Liu, according to your request, the corresponding blood vessels and nerves have been separated. It should be fine if you evaluate it?"
Zheng Liu grimaced, although he also knew that Lu Cheng was trying to save face for him and at the same time excuse himself,
But he still cursed and said, "Lu Cheng, when did you become so hypocritical?"
"It takes a little sincerity to be a human being."
"Even a layman can clearly see that it is a normal blood vessel and nerve, so you can make an assessment."
"I really saw your ghost."
After scolding, Zheng Liu immediately said: "That's good. My emergency surgery will start soon. After you finish it here, come over and reset it with me."
Lu Cheng hurriedly said, "Okay, Brother Zheng Liu."
After speaking, continue to rinse, and then hook up the joint capsule without completely sealing it, cover it with VAC dressing, suture and fix it with the skin again, and seal it with the film.
Connected to the negative pressure suction, he got off the stage, and then said to the nurse who washed his hands: "The patient's bones are not fractured and X-rays are not visible, but the ligaments are damaged. When the time comes, tell the ward in charge and remember to contact the knee joint when you go back. The brace is fixed."
"Okay." Lu Cheng completed the debridement and suture in such a short period of time. He was almost the relatives of all the surgical nurses and anesthesiologists on duty in the emergency department. Not to mention spreading rumors, he would do it even if he invited him to eat.
After all, they may encounter some troubles in the future and have to set up a stage with Lu Cheng. Such speed and proficiency will allow them to take an extra day off.
After the operation here, Lu Chengcheng stepped down and walked to another operating room. Of course, he greeted Han Xiaolu and the others before leaving.
Lu Cheng still has emergency surgery, so they didn't say a word of nonsense, just see you at night when the opinions are very unified.Then get on with your work.
In fact, when the anesthesiologist Jiang Yuan made the appointment for dinner, he evaluated it based on his own experience. The operation time of the three people should be close to each other, so that he could make a better appointment for dinner, otherwise others would mention it for hours.
Do you still have to wait for a meal?
Isn't it delicious to eat and rest?
If Jiang Yuan knew that Lu Cheng would make a quick decision so quickly, he would be too embarrassed to call Lu Cheng to eat.
Who would have thought that Lu Cheng would be so fast?
Looking at the patient's current basic condition, which is relatively stable, Jiang Yuan looked at Han Xiaolu and Huang Youzhi again: "You two need to speed up the progress, the sooner you finish it, the sooner you can eat."
Han Xiaolu and Huang Youzhi smiled wryly
You want us to be fine soon, but then the patients will trouble the three of us.
……
When Lu Cheng rushed to another operating room, the patient with hip dislocation had already received anesthesia. Zheng Liu called two operating teams to help him fix the patient's pelvis, and he began to stretch and reset.
At this time, seeing Lu Cheng coming, he sighed profusely with sweat on his face: "Lu Cheng, come here quickly, this hip joint is a bit difficult to recover, you and I should work hard together."
Lu Cheng looked at Zheng Liu's method, and it was Allis method.Quite a bit of wanting to use violence to control violence.
Lu Cheng didn't think too much, and hurried up to help, but before Zheng Liu's external rotation, he first pretended to be impacted and used the force to adduct and internally rotate the hip joint, and then followed Zheng Liu's abduction and external rotation to pull.
Just like that, the patient's hip joint heard a click.
This is the triumphant sound of a successful reset.
Brother Zheng Liu immediately checked the patient's range of motion, straightening, adduction, internal rotation, abduction and external rotation.
Then he said in a good mood: "Call Brother Lei, let's take a picture."
"Finally it was reset, and it was still because of not enough strength."
The other two regulars nodded their heads in agreement.
And the anesthetist also started to wake up the patient from anesthesia,
Lu Cheng didn't say anything, and went directly to the operating room for elective orthopedic surgery to observe the operation.
On the back foot, Zheng Liu explained some precautions to the surgery class, and then followed him, saying, "Xiao Lu, I did a little better today. Then I might be able to be lazy in the future."
"Now that the joint replacement has been completed, the arthroscopic table has been divided. You go to Associate Professor Qin Qiguo, and I will help Associate Professor Zhou Ren, so that the brother in charge of the bed will not be scolded."
(End of this chapter)
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