Auto chess in the operating room
Chapter 368 Doctor Tang's Classroom
Chapter 368 Doctor Tang's Classroom
Seeing Tanglou speechless for a moment, Doctor Tian suddenly lost his temper: "Doctor Tang, you don't know how to do it, right?"
Faced with Dr. Tian's questioning, Tang Lou was a little embarrassed. He was just a doctor from the city's first hospital who came to study, wouldn't it be natural? Besides, wouldn't it be reasonable for him to be in the prime of his life? .
Dr. Tian seemed to understand what Tang Lou saw as a matter of course, swallowed his saliva, and looked at Dr. Wang who was on the side. Dr. Wang moved to the side, bowed his head, and acted as his own puller.
Doctor Tian coughed lightly: "Doctor Tang, should I go find Director Huang to save the situation now?"
[Ding, new mission: Temporary rescue, help colleagues fight thunder.Task reward: 5 gold coins, the card library is refreshed once. 】
Tang Lou directly redeemed and upgraded the three-star valve replacement (three-star, 27), countless information and cases entered Tang Lou's mind.
Seeing that Tang Lou was still silent, Dr. Tian also made a decisive decision: "Doctor Wang, you should immediately contact Director Huang to save the scene."
"No, I'll take over."
Tang Lou retreated from the system space, looked at Dr. Tian and said.
"Doctor Tang, you!"
"Oh, I recalled it again just now, and deduced it in my mind, it's almost ready."
Tang Lou said something casually.
"Doctor Tang, this is not a joke. If the separation of mediastinal and pericardial adhesions is not done properly, it may cause medical accidents."
"Get out of the way! Instrument nurse, scalpel scissors"
Tang Lou stood at the position of the chief surgeon forcefully. Under the aura of the chief surgeon, Dr. Tian stepped aside and swallowed the words he wanted to persuade.
Dr. Wang was a little at a loss: "Go, or not!"
"Look first."
Dr. Tian, after thinking about it, after all, Dr. Tang's reputation is still there. If it were a young doctor, he would have been sprayed to death by him.
"The extent of separation of pericardial adhesions in re-valve replacement surgery should vary according to the number of reoperations, the severity of pericardial adhesions, and the type of surgery."
Tang Lou explained while starting to operate.
"Huh?" Dr. Tian was fascinated on the spot. He was still not familiar with it just now, but now he suddenly started teaching. Although he was a little suspicious, he still nodded instinctively.
It is indeed the inner taste!
"Remember that when performing pericardial separation in the future, it must not be completely separated. Although extensive separation can overcome surgical difficulties, it increases the chance of damage to the myocardium. Moreover, it often leads to extensive bleeding that is difficult to control after the operation. The increase in operation time also increases the risk of operation."
Tang Lou was under the three-star technique at the moment, and what he said was really good words, which were the experience summed up from countless cases.
Dr. Tian, who was on the side, was still a little nervous. Hearing this, he seemed to have returned to yesterday's demo operation, chewing and savoring Tang Lou's explanation carefully, and then, it was like a treasure!
"Then Doctor Tang, how should we separate better?"
Doctor Tian asked for advice seriously.
"The so-called limited separation is to separate the operation area and meet the operation requirements of the main surgeon. Of course, you cannot imitate my current separation degree. After all, the operation area I need is relatively limited. "
Tang Lou was naturally afraid that these two melon skins would be like cats and tigers. After all, not everyone has his solid basic skills and super wild talent.
"Understand."
Dr. Tian and Dr. Wang nodded. They still have some self-knowledge, but they are a little angry.
"Electric knife"
Tang Lou issued an order, and the equipment nurse immediately cooperated.
With the electric knife in hand, Tang Lou quickly operated, and at the same time taught: "The principle of separating adhesions is to use the electric knife or scissors to do sharp separation as much as possible, without damaging the epicardium. Generally, the pericardium is cut longitudinally at the interventricular sulcus. , to the right atrium and both sides of the right ventricle to gradually expand to expose the right atrium and part of the right ventricle."
Tang Lou quickly completed the operation while explaining the tricks.
"In addition, in the separation of pericardial adhesions, it can be cut with electric knife or sharply with scissors, so as to be close to the parietal pericardium, so as not to damage the myocardium and coronary vessels. The operation should be gentle to prevent the heart from being compressed and causing arrhythmia or cardiac arrest. For patients with poor myocardial function, the vena cava and aorta must be intubated first, connected to an extracorporeal circulation machine, and separated after preparation for diversion. If the separation of the ventricle and diaphragm is difficult, it can be performed after diversion to avoid separation during pulsation Causes a heart muscle to tear."
"Doctor Tang, that's amazing!"
After Dr. Tian listened to Tang Lou's explanation, he seemed to understand half of it, but he suddenly became enlightened.
Dr. Wang listened in a ignorant manner, and looked at Tang Lou with admiration in his eyes. Speaking of which, he was a few years older than Tang Lou.
"Oh, this is talent."
After separating the mediastinal pericardial adhesions, it is time to establish extracorporeal circulation.
"Because the patient has heart failure and pulmonary edema, an ultrafiltration device should be used to expose and separate the common femoral artery and femoral vein, and intubation should be done if necessary to prepare for femoral-femoral bypass to prevent bleeding when separating pericardial adhesions; Prepare enough blood and prepare 3 aspirators connected to the extracorporeal circulation. Once bleeding occurs, ensure that it is returned to the circulation blood circuit device in time.”
Tang Lou continued to operate, and at the same time introduced the solutions for various situations in detail.
"Doctor Tang, your knowledge is too extensive. If you didn't know that you can learn the operation at a glance, I really thought you had performed hundreds of valve replacement operations."
Dr. Tian looked at Tang Lou, deeply moved.
Under Tang Lou's stable operation, the establishment of extracorporeal circulation was quickly completed.
"The next step is to protect the myocardium. Because the patient's preoperative heart function was poor, and it was an emergency operation, there was insufficient blood supply to the myocardium. Moreover, the entire operation was complicated, and the aorta was blocked for too long. Moreover, the patient's left ventricle was adhered. There are ice chips on the surface of the heart to cool down, so before another valve replacement, we must pay attention to the strict protection of the myocardium. This is also an important part of the success of the operation."
Tang Lou’s very serious education, Dr. Tian and Wang, naturally nodded obediently. They did not feel disgusted at all because of Tang Lou’s age. Instead, they were filled with gratitude. Following Tang Lou’s surgery, they really learned a lot. a lot of things.
Especially for Dr. Tian, who is half-understood, he is only short of this finishing touch. With Tang Lou's strategic position, next time, he is confident that he can independently perform the surgery.
"Whole body cooling to 26°C. Cold-blooded cardioplegia."
Tang Lou continued to give instructions, because the next operation was more complicated, so Tang Lou reduced the explanation and focused more on the operation.
Dr. Tian looked at Tang Lou's operation with full attention: "Mitral valve and tricuspid valve surgery use antegrade perfusion; aortic valve and double valve surgery, first use antegrade perfusion, and then switch to retrograde coronary sinus perfusion Very precise operation, amazing!"
"Ice chips are used to cool the surface of the heart, and 4°C ice saline is perfused into the heart cavity to cool down."
Dr. Wang also memorized seriously. After 10 minutes, the first stage was completed.
The next step is the extremely difficult valve replacement operation!
(End of this chapter)
Seeing Tanglou speechless for a moment, Doctor Tian suddenly lost his temper: "Doctor Tang, you don't know how to do it, right?"
Faced with Dr. Tian's questioning, Tang Lou was a little embarrassed. He was just a doctor from the city's first hospital who came to study, wouldn't it be natural? Besides, wouldn't it be reasonable for him to be in the prime of his life? .
Dr. Tian seemed to understand what Tang Lou saw as a matter of course, swallowed his saliva, and looked at Dr. Wang who was on the side. Dr. Wang moved to the side, bowed his head, and acted as his own puller.
Doctor Tian coughed lightly: "Doctor Tang, should I go find Director Huang to save the situation now?"
[Ding, new mission: Temporary rescue, help colleagues fight thunder.Task reward: 5 gold coins, the card library is refreshed once. 】
Tang Lou directly redeemed and upgraded the three-star valve replacement (three-star, 27), countless information and cases entered Tang Lou's mind.
Seeing that Tang Lou was still silent, Dr. Tian also made a decisive decision: "Doctor Wang, you should immediately contact Director Huang to save the scene."
"No, I'll take over."
Tang Lou retreated from the system space, looked at Dr. Tian and said.
"Doctor Tang, you!"
"Oh, I recalled it again just now, and deduced it in my mind, it's almost ready."
Tang Lou said something casually.
"Doctor Tang, this is not a joke. If the separation of mediastinal and pericardial adhesions is not done properly, it may cause medical accidents."
"Get out of the way! Instrument nurse, scalpel scissors"
Tang Lou stood at the position of the chief surgeon forcefully. Under the aura of the chief surgeon, Dr. Tian stepped aside and swallowed the words he wanted to persuade.
Dr. Wang was a little at a loss: "Go, or not!"
"Look first."
Dr. Tian, after thinking about it, after all, Dr. Tang's reputation is still there. If it were a young doctor, he would have been sprayed to death by him.
"The extent of separation of pericardial adhesions in re-valve replacement surgery should vary according to the number of reoperations, the severity of pericardial adhesions, and the type of surgery."
Tang Lou explained while starting to operate.
"Huh?" Dr. Tian was fascinated on the spot. He was still not familiar with it just now, but now he suddenly started teaching. Although he was a little suspicious, he still nodded instinctively.
It is indeed the inner taste!
"Remember that when performing pericardial separation in the future, it must not be completely separated. Although extensive separation can overcome surgical difficulties, it increases the chance of damage to the myocardium. Moreover, it often leads to extensive bleeding that is difficult to control after the operation. The increase in operation time also increases the risk of operation."
Tang Lou was under the three-star technique at the moment, and what he said was really good words, which were the experience summed up from countless cases.
Dr. Tian, who was on the side, was still a little nervous. Hearing this, he seemed to have returned to yesterday's demo operation, chewing and savoring Tang Lou's explanation carefully, and then, it was like a treasure!
"Then Doctor Tang, how should we separate better?"
Doctor Tian asked for advice seriously.
"The so-called limited separation is to separate the operation area and meet the operation requirements of the main surgeon. Of course, you cannot imitate my current separation degree. After all, the operation area I need is relatively limited. "
Tang Lou was naturally afraid that these two melon skins would be like cats and tigers. After all, not everyone has his solid basic skills and super wild talent.
"Understand."
Dr. Tian and Dr. Wang nodded. They still have some self-knowledge, but they are a little angry.
"Electric knife"
Tang Lou issued an order, and the equipment nurse immediately cooperated.
With the electric knife in hand, Tang Lou quickly operated, and at the same time taught: "The principle of separating adhesions is to use the electric knife or scissors to do sharp separation as much as possible, without damaging the epicardium. Generally, the pericardium is cut longitudinally at the interventricular sulcus. , to the right atrium and both sides of the right ventricle to gradually expand to expose the right atrium and part of the right ventricle."
Tang Lou quickly completed the operation while explaining the tricks.
"In addition, in the separation of pericardial adhesions, it can be cut with electric knife or sharply with scissors, so as to be close to the parietal pericardium, so as not to damage the myocardium and coronary vessels. The operation should be gentle to prevent the heart from being compressed and causing arrhythmia or cardiac arrest. For patients with poor myocardial function, the vena cava and aorta must be intubated first, connected to an extracorporeal circulation machine, and separated after preparation for diversion. If the separation of the ventricle and diaphragm is difficult, it can be performed after diversion to avoid separation during pulsation Causes a heart muscle to tear."
"Doctor Tang, that's amazing!"
After Dr. Tian listened to Tang Lou's explanation, he seemed to understand half of it, but he suddenly became enlightened.
Dr. Wang listened in a ignorant manner, and looked at Tang Lou with admiration in his eyes. Speaking of which, he was a few years older than Tang Lou.
"Oh, this is talent."
After separating the mediastinal pericardial adhesions, it is time to establish extracorporeal circulation.
"Because the patient has heart failure and pulmonary edema, an ultrafiltration device should be used to expose and separate the common femoral artery and femoral vein, and intubation should be done if necessary to prepare for femoral-femoral bypass to prevent bleeding when separating pericardial adhesions; Prepare enough blood and prepare 3 aspirators connected to the extracorporeal circulation. Once bleeding occurs, ensure that it is returned to the circulation blood circuit device in time.”
Tang Lou continued to operate, and at the same time introduced the solutions for various situations in detail.
"Doctor Tang, your knowledge is too extensive. If you didn't know that you can learn the operation at a glance, I really thought you had performed hundreds of valve replacement operations."
Dr. Tian looked at Tang Lou, deeply moved.
Under Tang Lou's stable operation, the establishment of extracorporeal circulation was quickly completed.
"The next step is to protect the myocardium. Because the patient's preoperative heart function was poor, and it was an emergency operation, there was insufficient blood supply to the myocardium. Moreover, the entire operation was complicated, and the aorta was blocked for too long. Moreover, the patient's left ventricle was adhered. There are ice chips on the surface of the heart to cool down, so before another valve replacement, we must pay attention to the strict protection of the myocardium. This is also an important part of the success of the operation."
Tang Lou’s very serious education, Dr. Tian and Wang, naturally nodded obediently. They did not feel disgusted at all because of Tang Lou’s age. Instead, they were filled with gratitude. Following Tang Lou’s surgery, they really learned a lot. a lot of things.
Especially for Dr. Tian, who is half-understood, he is only short of this finishing touch. With Tang Lou's strategic position, next time, he is confident that he can independently perform the surgery.
"Whole body cooling to 26°C. Cold-blooded cardioplegia."
Tang Lou continued to give instructions, because the next operation was more complicated, so Tang Lou reduced the explanation and focused more on the operation.
Dr. Tian looked at Tang Lou's operation with full attention: "Mitral valve and tricuspid valve surgery use antegrade perfusion; aortic valve and double valve surgery, first use antegrade perfusion, and then switch to retrograde coronary sinus perfusion Very precise operation, amazing!"
"Ice chips are used to cool the surface of the heart, and 4°C ice saline is perfused into the heart cavity to cool down."
Dr. Wang also memorized seriously. After 10 minutes, the first stage was completed.
The next step is the extremely difficult valve replacement operation!
(End of this chapter)
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