Back in 2002 as a doctor

Although it was just a plain film, Zhou Congwen stopped complaining in an instant, and focused all his attention on the film.

This patient is very dangerous and must be on stage!

The patient suffered a severe fracture, but the problem was still in the heart.

Although the chest was not opened, Zhou Congwen already had his own guess. The patient's heart contusion must be very serious, and there was a large amount of fluid in the pericardial cavity.

The supraventricular tachycardia and bundle branch block mentioned by Liu Di just now are a manifestation of the heart being overwhelmed.

"How did enzymology pay back?" Zhou Congwen asked in a low voice holding the film up to the lamp.

"Zhou, what did you say?" Liu Di didn't understand, and asked in a low voice.

"..." Zhou Congwen choked speechlessly, with sadness in his heart.

After myocardial cell injury, the integrity and permeability of the membrane change, causing the escape of macromolecular enzymes in the cells, causing the increase of serum myocardial enzymes. These macromolecular substances are called myocardial injury markers.

It's useless to say these things. In 2002, I didn't know how to apply the knowledge in books to clinical practice.Including Liu Di, who was born in internal medicine, even Wang Chengfa couldn't think of the application of myocardial enzymes in trauma.

However, it’s useless even if you think about it yourself, and many inspection departments can’t check it.

Laboratory items such as CK-MB, CK-BB, and CK-MM are gradually perfected after the development of circulatory medicine.

"Nothing." Zhou Congwen said.

"Prepare for surgery." Wang Chengfa waved his hand.

Indwelling gastric tube and urinary catheter, skin preparation in the surgical area, and preoperative preparations. After 10 minutes of busy work, Zhou Congwen helped Liu Di send the patient to the operating room.

Liu Di is still very unfamiliar with this surgical technique, and Zhou Congwen is also very clear about the purpose of his calling himself before.

So Zhou Congwen didn't wait outside to wait for Liu Di to get ready before pulling the hook, but instead helped with various preoperative preparations.

How to put the armrest, how to put the headrest, which side of the patient's chest to open, and how to position the patient are all explained clearly.

Liu Di is also eager to learn, nodding silently and writing down Zhou Congwen's words in detail.

Zhou Congwen also did the disinfection and laying of the sterile sheets by himself, explaining every detail clearly.The anesthesiologist looked at Zhou Congwen's careful teaching and thought it was a little funny, but he didn't say anything.

After laying out the form, Zhou Congwen said to the anesthesiologist, "Brother Guan, call Director Wang to come on stage."

"You old Wang is big enough." The anesthesiologist said with a smile.

"Hehe, it's okay. If you want to talk about big airs, who can have big airs in orthopedics." Zhou Congwen said casually.

"The director of the orthopedic department is too much. Every time the emergency surgery is on stage, it's so fast at 11 o'clock." The equipment nurse answered absent-mindedly while counting.

But she said something casually, she forgot where to count, innocently raised her head and looked at Xun Xun, and started again.

Don't be distracted while counting, or it will be miserable.

"Xiao Zhou, can the operation be completed in 2 hours?"

"How is it possible." Zhou Congwen shook his head, "I want to get into my chest."

"Chest entry? I saw that the operation notice said internal fixation of rib fractures, and there was no pneumothorax on the radiograph, only a small amount of pleural effusion. What is the purpose of thoracic entry?" the anesthesiologist asked.

Zhou Congwen didn't speak, he was a little sad.

The choice of the patient's surgical method is decided by the director. I am just a small doctor and I don't have this right.

If Wang Chengfa did not go into the chest, and simply performed internal fixation of rib fractures, the patient's heart contusion and cardiac tamponade would become more and more serious, and it is estimated that there would be major problems within a few hours.

Plus anesthesia...

Zhou Congwen felt very helpless.

Although I can understand and treat it now, I don't have the right to speak.

The three words of the right to speak are very important. If you don't have it, you can't do anything if you want to do something.

"Xiao Zhou, what are you thinking?" the anesthesiologist asked.

"I didn't think about it. I just watched the World Cup match between South Korea and Italy. It disgusted me."

Having said that, the anesthesiologist's eyes lit up.

"Why don't you say that your emergency caller has good eyesight." The anesthesiologist smiled, "It's good to start the game after the game. But the referee in that game was too much. No sentence! If this is changed to Colombia, you will have to be shot in the face when you return to your country.”

Zhou Congwen squinted his head and stared at the monitor. The patient's heart rhythm changed, and Zhou Congwen seemed to hear low, distant heart sounds from the stethoscope.

Wang Chengfa came up, brushed his hands and put on his clothes, and stood next to Zhou Congwen in the position of the practitioner.

"Director Wang, open your chest?"

"Open the chest." Wang Chengfa's mask moved, and the movement of curling his mouth was so obvious that a layer of mask couldn't cover it at all. "Normal breathing, rib fractures and fixation are enough. Avoid opening the chest as much as possible. This is the principle."

The anesthetist glanced at Zhou Congwen triumphantly, but he didn't make trouble.

No one wants the operation to be long. Although the night is very long, wouldn’t it be nice to lie down to sleep or watch TV?But it is unnecessary to ridicule Zhou Congwen for this.

It is best not to open the chest, and everyone is happy and at ease.

After brushing his hands and getting dressed, Wang Chengfa reached out his hand directly after coming on stage, and the nurse handed over the sterile gauze and knife.

Along the 5-6 ribs, Wang Chengfa cut it with a single knife.

No matter how many times he watched it, Zhou Congwen was still not used to the technical level of the big knife in 2002.When the knife was cut down, blood flowed horizontally, couldn't he be gentle?

But as far as the matter is concerned, this matter has nothing to do with Wang Chengfa.

Zhou Congwen remembers that in 2004, Professor Didu was invited to perform the operation. Although the incision was a little smaller and electric cauterization was used, the operation was still rough.

This is the so-called historical limitation. Zhou Congwen didn't care about it. What he cared about was how to persuade Wang Chengfa to enter his chest and take a look at the patient's heart.

Persuasion should be impossible, the biggest possibility is that the more I talk about Wang Chengfa, the more he refuses to enter his chest.

It was a little tricky, Zhou Congwen frowned.

After incision, the bleeding was stopped, and the muscles were separated layer by layer. After about 40 minutes, the fractured ribs could be seen.

The snow-white bone stubbles were as sharp as nails, and appeared in the surgical field in a staggered and uneven manner.

"Hand drill."

After Zhou Congwen heard Wang Chengfa's words, he almost threw himself on the operating table.

The self in the previous life didn't understand, but after being reborn, when he heard the hand drill, a strange emotion rose.

The rib fracture was fixed, and memory metal clips were used clinically 5 years later.

This kind of high-value consumable is more interesting, heat shrinks and expands with cold.When performing surgery, first soak it in ice-cold salt water, wait for the clip to swell and unfasten it on the rib fracture, and then heat it with warm salt water gauze.

However, there is no such high-value consumables yet, and the most common disposal method is the same as that of orthopedics, using a board to fix it.

But Wang Chengfa doesn't use metal plates at all, and his thinking is still stuck in the era of hand drills 10-20 years ago.

There was a smell of decay.

Chapter 0107

"Director Wang, you still have a high level and good character, so you don't need those high-value consumables at all." The anesthesiologist said with a smile.

"Of course, any high-value consumables are crooked." Wang Chengfa's mask moved again, "The hand drill is so good, the steel wire is fixed, and there is no need to take it out."

Zhou Congwen didn't know how to vomit his old cliches.

The hand drill that Wang Chengfa is proud of is to drill holes on both sides of the broken ribs, pass them with steel wires, and then screw them on with pliers to fix the ribs.

Technological progress is indeed achieved little by little, there is no way.

Fortunately, Wang Qiang wasn't here. If he was, all kinds of rainbow farts would be shot at this time.Liu Di is still very unfamiliar with thoracic surgery, and he can't find the most critical point if he wants to flatter him.

Moreover, Liu Di is much more honest and simple than Wang Qiang, so he can't say such nasty words.

Zhou Congwen asked for an intestinal compression board, and placed it under the position where the hand drill at the broken ribs was to be drilled, so as not to break the pleura with a hand drill, or even make a hole in the lung with a "bang".

He didn't deliberately "slip his hand" and deliberately caused an accident that had to open his chest.

It's not impossible to do this, but Zhou Congwen was afraid that Wang Chengfa might really hit the patient's lungs and poke a big hole.

The person who knows Wang Chengfa best is Zhou Congwen, definitely not Wang Chengfa himself.Zhou Congwen knew his level very well, so the intestinal compression board was very stable, and it was protected under the hand drill without moving.

Wang Chengfa held a hand drill in his hand, fixed it, and shook it. White bone foam mixed with red blood streaks appeared around the drill bit.

It takes three to five minutes to play a hole, and then move on to the next one.Wang Chengfa was not in a hurry, but Zhou Congwen was in a hurry to fix all the broken ends of the ribs with holes.

He was not aiming at the ECG monitoring, the patient's blood pressure was still stable, and the blood oxygen saturation also improved after the anesthetist gave pure oxygen, but the heart rate changed.

Previously, because of supraventricular tachycardia, the patient's heart rate was as high as 150-160 beats/min.

Over time, the patient's heart rate gradually decreased.

For the anesthetist and Wang Chengfa, this is a normal phenomenon, but for Zhou Congwen, it is definitely not a good thing.

"The abnormal breathing caused by rib fractures seems to be nothing. Some young doctors don't understand it at all. When Zhu Jun of the People's Hospital first arrived in the clinic, he accepted a patient and didn't find anyone for surgery. It was so delayed all night."

Wang Chengfa punched holes in the patient's ribs with a hand drill while gossiping about the past.

Zhu Jun is the director of the Department of Cardiothoracic Surgery at the People's Hospital. Wang Chengfa always talks about Zhu Jun's youth, letting people know from the side that Director Zhu Jun taught the first surgery by himself, and he can be regarded as his "apprentice". ".

If Wang Qiang was here, he would definitely be a perfect supporter at this time.First of all, he pretended to ask that he didn't know, and finally he had to confirm that Director Wang was Director Zhu's master. By the way, he and Zhu Jun were doctors of the same generation.

But Wang Qiang killed himself, and Wang Chengfa lost the doctor who made him feel refreshed during the operation.

"Director Wang, at that time you were a master in the Department of Surgery of the People's Hospital. I heard that Zhu Jun was brought by you?" Seeing that no one spoke, the anesthesiologist could only bite the bullet and say a few words to make Wang Chengfa happy.

He is happy that the operation can end sooner, and everyone is well.

"Hahaha, that's it." Wang Chengfa said with a smile, "At that time, Zhu Jun didn't understand anything. He accepted a patient with abnormal breathing and didn't know how to perform an operation. The next day I went to see the patient early in the morning and called him Go to the office and scold."

"what happened?"

"Abnormal breathing affects cardiopulmonary function, which he doesn't understand. If surgery is not done in time, the mediastinal vibration caused by abnormal breathing can seriously affect the return of blood to the heart, especially increase pulmonary venous pressure and induce pulmonary edema."

"so serious."

"He doesn't know how to see a doctor at all." Wang Chengfa said contemptuously, "After being trained by me, I took him to the stage to perform the operation. It was delayed all night, and the patient almost went on a ventilator after the operation."

"If it weren't for my bright eyes, the patient would probably have to tell Corey."

Speaking of director Zhu Junzhu's previous embarrassment, Wang Chengfa was in a good mood, and the operation was a little faster.

But the anesthetist was not Wang Qiang, and there was no continuous flattery to pat, so the operating room soon became quiet.

Zhou Congwen suddenly asked, "Di Zi, I just saw the patient's heart rate was very fast, and I couldn't read the electrocardiogram. Tell me about it."

Wang Chengfa suddenly heard Zhou Congwen's confession, the mask moved a little, and a "chi" sound came out from the corner of his mouth.

"Liu Di, do you know why I want you?" Wang Chengfa asked.

Liu Dilue was a little flustered, not knowing what Director Wang meant, so he could only smile embarrassingly.

"Because we are cardiothoracic surgery, we will have heart bypass surgery sooner or later. But the quality of the department staff is not enough. You are from circulatory medicine and have a good foundation. You are here for the better development of the department in the future."

Zhou Congwen lowered his head, almost laughing out loud.

Heart bypass surgery?

In another year, the People's Hospital will come to the People's Hospital to lead an interventional cardiac surgery led by a doctor who has returned from China.Since then, the cardiac surgery departments of all hospitals in Jianghai City have shrunk day by day.

The provincial capital can be better, and the patients who can't do the intervention are sent to the heart surgery department, but they can barely survive.However, the grand occasion of specialized hospitals like the Mudanjiang International Cardiovascular Hospital a few years ago has disappeared in China.

Zhou Congwen was thinking about interventional heart surgery. Hearing what Wang Chengfa said, Liu Di coughed and cleared his throat, "Master, let me tell you, if there is anything missing, you..."

"It's okay, let's talk."

"Supraventricular tachycardia refers to a group of tachyarrhythmias in which the site of ectopic excitation or the reentry circuit is above the bifurcation of the His bundle."

"Patients with supraventricular tachycardia are common in the circulatory department. Generally speaking..."

Liu Di's endless endorsement, his foundation is very solid, and a common indoor speed will not trouble him.

Listening to Liu Di's smooth explanation of the principle of intraventricular speed, Wang Chengfa's eyes became crescents with laughter, and the operation became faster and faster.

"Master, it's probably like this." Liu Di said for a full 2 ​​minutes before stopping the endorsement.

"Well, it's good. You see, this is the person I want to come, work hard, and the heart of our hospital will be pointed at you in the future."

Liu Di was a little restrained, he still didn't know what to say next, but it seemed wrong not to say anything.

"Master, I still have to practice. Don't worry, I will work hard."

"The foundation is solid, and the rest will continue to practice. It's okay." Wang Chengfa said with certainty that the big cakes are big enough and enough.

"But supraventricular tachycardia is common in people over 50 years old. Why does this 22-year-old patient have supraventricular tachycardia?"