Auto chess in the operating room

Chapter 270 Delayed Diagnosis, Regretful Shen Bingbing
After Tang Lou made the preoperative preparations, he entered the operating room. As soon as he saw Tang Lou, Dr. Fei immediately gave up the position of the chief surgeon, and asked for help very respectfully: "Doctor Tang, you are here."

Tanglou nodded slightly and walked to the surgeon's position to observe the patient's condition.

Physician Fei at the side immediately cooperated and explained: "The patient is a typical saphenous varicose vein. The main cause is his venous valve insufficiency, weak vein wall and venous return disorder caused by increased superficial venous pressure. In severe cases, he developed reflux. flow."

"Moreover, the patient's occupation is a chef, which caused him to need to stand for a long time, and his obesity led to an increase in intra-abdominal pressure, which directly led to an increase in venous blood pressure in the lower extremities."

Hearing Dr. Fei's explanation of the patient's condition, Tang Lou looked at the surface of the patient's lower limbs at the same time, it was really horrible.

The superficial veins of the patient's legs were tortuous and dilated in the shape of earthworms, and some venous stasis malnutrition, skin pigmentation, eczema, and venous ulcers even appeared locally.

Especially on the right leg, due to the slow blood flow in the lower extremities, the skin surface eventually bulges, the skin surface dander falls off, and the pigment slowly deposits, causing itching of the lower extremity skin, further causing edema of the lower extremity, and the skin has already ulcerated.

"So you had a very routine high ligation and stripping of the great saphenous vein."

Tang Lou looked at the affected area and said.

"Yes."

Dr. Fei was a little ashamed and puzzled. He clearly remembered that Director Wu used to operate like this before, and he himself did several of them. Why did he encounter a femoral artery injury today.

"Actually, you are not to blame for this surgery." Tang Lou looked at the wound and continued, "The first is that your surgical incision was not chosen properly, the surgical field was not exposed enough, and the operating space was limited."

Hearing this, Physician Fei was startled and took a look at Tang Lou. This time, he really thought he was more familiar with the surgical technique, so he reduced the incision without authorization and increased the difficulty a little.

"Originally, this incision is not impossible, but you pursued too much to separate and dissect the five subordinate branches, and you happened to meet the patient's vein wall was weak, and the patient was too obese, so after the vein ruptured during the operation, you blindly forceps The clamp stopped the bleeding, which caused the artery to be damaged."

Tang Lou raised his head and glanced at Dr. Fei, the latter's pupils dilated, as if Tang Lou had seen through him.

He really wanted to show it in front of the interns. It was a rare time to be the main surgeon, so he pursued the ultimate separation and anatomy.

Unexpectedly, it was so unlucky that the patient's vein wall was weak and his body was obese, so he overturned directly.

"Oh, you can't live without doing your own crimes."

Physician Fei was filled with remorse.

It has only been a few minutes since he came in. Tang Lou deduces his entire operation process just by observing the wound and the affected area, and the analysis of the patient's condition is even better than that of the chief surgeon who has studied for a long time before the operation. deep.

"Doctor Tang, you are amazing."

Dr. Fei was amazed, surprised and admiring, and of course his heart was completely relieved.

"Then how to fix it next?"

Physician Fei completely treated Tang Lou as a superior physician, and sincerely asked for advice.

"If the defect is small, it can be repaired with in-situ sutures. The femoral artery is unobstructed and the dorsalis pedis artery can be pulsated. After 10 days of hospitalization, it can be improved and discharged. But you made it a little big this time. Look at the patient here, the patient The femoral artery injury was severe, and the defect area was also large. Only artificial blood vessel patch repair can be performed."

Tang Lou analyzed it very professionally.

Hearing Tang Lou's explanation, Dr. Fei's forehead was covered with cold sweat. Although he had never done it before, he knew how difficult it is to repair artificial blood vessels.

"Doctor Tang, if we still perform artificial blood vessel replacement, the difficulty is too high."

Doctor Fei was ashamed and heartbroken. If Director Wu was here, he would definitely not be able to forgive himself. This would be considered a medical accident. Fortunately, Doctor Tang came to the rescue, otherwise the patient would have amputated or even died.
Doctor Fei was afraid for a while.

"It's okay, just patch it up, I can do it."

Tang Lou did not perform artificial blood vessel replacement, which is simpler but several times more expensive.

"Dr. Tang, thank you."

Dr. Fei, of course, knows that Dr. Tang is trying to minimize the consequences for himself. The difficulty of patch repair is several times that of artificial blood vessel replacement, but its advantages are also obvious. Happened.

In Director Shen Bingbing's office.

Mr. Mu wore a pair of presbyopic glasses and read the information carefully, but there seemed to be a flash of light in his mind, but he couldn't catch it.

"What kind of disease is it?"

Thinking about it, Mr. Mu suddenly felt weak.

"Teacher, here is your favorite flavor."

Shen Bingbing peeled off a piece of candy and handed it to Mr. Mu. The teacher had hypoglycemia, so whenever he went out with the teacher for meetings, consultations, ward rounds, etc., Shen Bingbing would always stuff a few candies in his pocket.

This habit, starting from the intern stage, gradually became a habit of hers.

"Bing Bing." Mr. Mu touched his hand with sweet eyes, "In a blink of an eye, the little girl who used to follow behind me is now the deputy director."

"Yeah, I was scolded by the teacher a lot at that time."

Shen Bingbing also peeled off a piece of candy and put it in his mouth. Looking at Mr. Mu's gray hair and dull eyesight, he couldn't help but feel emotional.

"Yeah, how many times have we been in the duty room together like this, studying medical records night after night."

Mr. Mu also leaned on the back of the chair, sighed with emotion, and then continued to browse.

"Hey! This page of information seems to be a bit different, these sets of data."

Mr. Mu looked at this piece of paper, and suddenly, the aura in his mind became concrete.

"Bingbing, I think I have found the cause of the patient, no wonder, no wonder!"

Mr. Mu bit the candy into pieces excitedly.

"real!"

Shen Bingbing also looked at the teacher excitedly.

"Kawasaki syndrome!"

Mr. Mu flattened the paper in his hand and patted the table heavily.

"Kawasaki syndrome?"

Shen Bingbing, as the deputy chief specialist of Pediatric Surgery, of course had heard of this extremely rare disease, but she had only heard of it, and had never encountered this disease herself.

Kawasaki syndrome is the first cause of acquired heart disease in children. It may cause myocardial infarction or even sudden death in children. It is a very cunning and camouflaged disease.

In the history of world medicine, Kawasaki disease is also an opponent that is not easily defeated. Since Dr. Tomisaku Kawasaki of Japan discovered this disease more than 5 years ago, there has been no specific examination that can help doctors diagnose Kawasaki disease. Symptoms must be relied upon to see if at least [-] diagnostic criteria are met. In addition, patients may not have every symptom, so misjudgment or delayed diagnosis will inevitably occur.

And Xiao Yunyun is really this kind of atypical Kawasaki syndrome with less than five diagnostic conditions.

The symptoms of Kawasaki disease in the first few days are not very different from the common cold. At the beginning, there is a high fever of 39 or 40 degrees, and then the eyes are red. After a few days, the skin develops a rash, the mouth is red, dry and cracked, and the tongue is swollen. Symptoms such as bulging taste buds and small particles similar to the surface of strawberries appear one after another. Most doctors can diagnose that it may be Kawasaki disease.

However, about [-]% of children with Kawasaki disease have a cold-like cough and runny nose at the beginning of the onset, and about [-]% of children have mild diarrhea, and their symptoms are like viral infection.In particular, Kawasaki disease can cause an inflammatory reaction throughout the body. It is inevitable that anxious parents will rush to the doctor, and even the doctor will get the wrong direction or delay the diagnosis.

For example, some young patients were taken to the dermatology department by their family members because of a rash on their body (this is also a reaction of inflammation of the blood vessels in the skin), or to the ENT department because of a fever. It is found that the number of white blood cells is high, there is proteinuria, it is regarded as a urinary tract infection, or someone has stomach pain, gallbladder edema, abnormal liver function, and it is regarded as gastroenteritis caused by a cold.

There are also some children who are not told that it may be Kawasaki until one or two weeks after the fever has subsided, and they are about to leave the hospital or go home and seem to be in good health, but small pieces of skin peel off the tips of their fingers and toes, and they seek medical attention again. disease.

The most feared coronary artery lesion in Kawasaki disease is not the most obvious change during fever, but after the fever subsides, about 7 to 10 days after the fever, it slowly invades the heart, and the coronary artery lesion reaches its peak about two weeks after the fever.

Obviously Xiao Yunyun now belongs to this kind of coronary artery disease about two weeks after the fever reached its peak!

While Mr. Mu and Shen Bingbing were confirming their condition, Tang Lou also came out of the orthopedic surgery room and came to Shen Bingbing's office.

As soon as he entered the door, Tang Lou asked urgently: "Director Shen, has Xiao Yunyun started treatment? Have you given gamma globulin and aspirin treatment in time?"

Hearing Tang Lou's words, both Shen Bingbing and Mr. Mu were taken aback for a moment, and then Mr. Mu reacted immediately: "You recorded this paper with different handwriting? So, you already knew that the patient had Kawasaki disease." ?”

"What paper? I knew it was Kawasaki disease."

Shen Bingbing looked suspiciously at Mr. Mu, and at the piece of paper in her hand that recorded special data, and suddenly looked at the notebook that she had forgotten in a corner.

At this moment, outside Director Shen's office, there was a sound of running. It was Shen Bingbing's resident doctor who said out of breath as soon as he entered the door: "Director Shen, it's not good. Xiao Yunyun's situation suddenly took a turn for the worse. gone."

"what?"

Shen Bingbing got up immediately.

After all, Mr. Mu has a lot of experience, so he directly thought of a possibility: "Oops, the diagnosis is still an hour late. If it is treated in time, it may be possible to save it, but if it exceeds the critical point, traditional treatment methods will no longer be effective. It worked."

Shen Bingbing happened to turn to the last page of Tang Lou's record book, looking at the symptoms and the perfect treatment plan that had been established earlier, her face turned ashen.

(End of this chapter)