My medical skills are a billion points

And some trainee doctors are almost 40 years old, older than their teachers.

Learning things, but not keeping up with the thinking of young people.

Therefore, it is also difficult to learn high-level knowledge and technology.

Seeing everyone's expectant eyes, Xiao Chu said: "I will teach you the closed chest drainage technique today, and Wang Panpan will go get things ready."

Wang Panpan ran to the disposal room and prepared all the necessary things.

Xiao Chu saw that there were seven or eight fellow trainee doctors and interns in total.

This kind of scene is just like the director's rounds.

Zhao Fangshu, who was busy at the side, smiled at Xiao Chu:

"Director Xiao, you see, these trainee doctors and interns give you more face, making you look like you are doing ward rounds with the director. There is a huge queue."

"The platoon is huge, and it puts a lot of pressure on me!"

Xiao Chu smiled.

"cut!"

Zhao Fangshu rolled her eyes at Xiao Chu.

"You are the leader of our emergency department, stop 'Versailles'!"

Among the many doctors who studied, some of them heard that Xiao Chu was very good.

Some have witnessed Xiao Chu's operation.

Listening to what Zhao Fangshu said now, Xiao Chu is also at the top level.

Immediately, he was full of anticipation for Xiao Chu's teaching task.

The patient was already lying on the hospital bed, waiting for Xiao Chu's treatment.

At first, when he heard that a trainee doctor was going to operate on him, he was very worried.

As a result, now that I heard that there was a doctor with a very good surgery, I immediately felt relieved.

Chapter 226 Teach me that I am a professional

Xiao Chu glanced at the patient.

His entire body has been clearly shown in front of Xiao Chu's eyes.

It is a very clear pneumothorax.

Like this spontaneous pneumothorax, it is accompanied by pleural effusion.

This kind of effusion is usually blood, that is, when the lung ruptures, a certain amount of blood comes out.

Doing a simple closed chest drainage can expel the blood and air, thereby promoting the recovery of the disease.

While disinfecting, Xiao Chu explained to the surrounding doctors and interns.

"We do closed drainage for patients, where are the puncture points chosen?"

“穿刺点一般选在胸部叩诊实音最明显部位。一般常取肩胛线或腋后线第7-8肋间；有时也选腋中线第6~7肋间，或腋前线第5肋间为穿刺点。

Encapsulated effusion can be confirmed by X-ray or ultrasonography. "

Wang Panpan hurriedly stood up and answered.

Her hands-on ability is not good, but her theoretical knowledge is not bad.

Xiao Chu glanced at her.

This Wang Panpan quite likes to express himself.

Xiao Chu disinfected the poison, put on sterile gloves, and spread a towel on the patient.

"Dr. Wang's answer is good, but there is still a kind of pneumothorax, if you want to put closed drainage to exhaust,

The puncture point is the second intercostal space on the midclavicular line.This puncture method is only suitable for simple pneumothorax, and you must remember that there is no pleural effusion. "

Standing in front of everyone, Wang Panpan couldn't help but blushed.

Secretly stuck out his tongue.

She thought she had given a comprehensive answer.

In the end, he still missed one item, embarrassing himself in front of everyone.

Xiao Chu didn't think there was anything wrong with it. As a doctor in training, it's normal for Wang Panpan not to have a comprehensive understanding of the knowledge points.

In comparison, she is better than other trainee doctors.

While operating, Xiao Chu continued to explain to the students.

"This closed chest drainage, although we all know where the puncture point is, color ultrasound positioning is still required before the operation, which is an essential step."

Everyone nodded to express their memory.

The patient in front of him has already been positioned by color ultrasound in advance, and the position of the puncture point has also been indicated.

"Today's patient is a spontaneous hydropneumothorax, but he has been in the hospital for more than half an hour now. His chest tightness and shortness of breath are not very serious. Does anyone know the reason?"

Xiao Chu started to prepare for the puncture work, but asked another question.

This time Wang Panpan did not answer in time.

She didn't answer satisfactorily just now, this time she didn't dare to show off again.

Everyone looked at each other, and a male trainee doctor replied: "The reason why this patient has difficulty breathing is not very serious, I think it is the ruptured opening on the lung, which was squeezed after being compressed by air.

There was no air leakage into the chest cavity, and no tension pneumothorax was formed, so his dyspnea symptoms were not too severe and could be tolerated! "

Xiao Chu nodded.

"Well, to put it more comprehensively, the reason why this patient is not very dyspneic is because there is no tension pneumothorax. If it is a tension pneumothorax, closed thoracic drainage must be performed immediately, and it is impossible to wait for such a long time. This You must remember!"

"Now the puncture point we choose is at the midaxillary line of the sixth intercostal space. First, we should perform local infiltration anesthesia, but we must pay attention to it when administering anesthesia.

In the direction of your needle insertion, you must insert the needle along the upper edge of the next rib to gradually anesthetize, and you must not insert the needle along the lower edge of the rib.

Because the intercostal nerves and intercostal blood vessels run on the lower edge of the ribs, if the puncture point is too close to the ribs, it is easy to damage the blood vessels and nerves. This is also a point that needs attention. "

After Xiao Chu explained, his anesthesia work was also completed.

Several students around secretly nodded and wrote down Xiao Chu's words.

Xiao Chu picked up the scalpel and cut a small incision about one centimeter long along the upper edge of the rib.

"If you do this closed chest drainage in the future, remember that the opening should not be too long, otherwise it is easy to leak air. About one centimeter is enough!"

After Xiao Chu cut through the skin, he used vascular forceps to bluntly separate the subcutaneous tissue.

"The incision we made only needs to cut to the dermis, that is, to cut through the skin.

The tissue behind needs to be bluntly separated with vascular forceps, and must not be separated with a scalpel, otherwise, it is easy to damage the blood vessels and cause massive bleeding. "

Xiao Chu took the vascular forceps, and just gently pierced the subcutaneous tissue before entering the chest cavity.

After complete separation, withdraw the vascular clamp.

He hurriedly took a piece of sterile gauze and covered the incision.

"Did you see it? Because the patient is not wearing a ventilator, so after we have penetrated the skin, we must cover the incision with a piece of sterile gauze in time.

Otherwise, air will easily enter the chest cavity.If the patient is on a ventilator, this item can be ignored, you have to remember it. "

While operating, Xiao Chu explained to the students in detail, meticulously.

Anyway, his operation is very standardized, and the explanation is very detailed.

As for the students and trainee doctors, it is their own problem to understand how well they understand.

Xiao Chu has fulfilled the responsibility of a teacher.

The skin has been expanded, Xiao Chu clamped one end of the chest tube with a vascular clamp, and slowly inserted it into the chest cavity.

"The distance for the chest tube to be inserted into the chest cavity is 11 cm. Remember not to go too deep. If the chest tube is placed too deep, it is easy to insert into the interlobar fissure and cause poor ventilation."

Closed thoracic drainage, for Xiao Chu, is simply an extremely small operation.

Asking him to explain to these trainee doctors and students is like shooting mosquitoes with anti-aircraft guns.

But Xiao Chu didn't feel that he was overqualified.

The explanation is still very detailed and in place, try to let the students understand clearly.

As long as the chest tube is placed in the chest cavity, chest drainage is basically completed.

All that's left is a couple of stitches to secure the exposed chest tube, connect the drainage bottle, and you're done.

Xiao Chu was explaining to the students while operating, and it took about 10 minutes to complete the patient's drainage.

Xiao Chu pointed to the bubbling bubbles in the drainage bottle and said:

"Did you see it? The air bubbles coming out of this drainage bottle are the gas expelled from the patient's chest cavity.

After the air in the chest cavity is completely exhausted, the patient is asked to inflate the balloon for lung recruitment.

A week later, a chest CT scan was performed, and the chest tube could be removed only if there was no problem. "

Because Xiao Chu's narration was very careful and in place, and he didn't have any bad temper.

His operation drew applause from the doctors.

Chapter 227 There are many benefits to studying with Teacher Xiao

"Ms. Xiao's explanation is really too detailed, Mr. Xiao's explanation is too good!"

"I should have known, I also practiced with Mr. Xiao! Good temper, handsome, and good skills! How rare!"

"But we already have a teacher, what should we do?"

"That's right, we already have a substitute teacher now, if we continue to follow Teacher Xiao, it won't be so good!"

"Wait a while and ask!"

Several trainee doctors whispered.

Closed chest drainage has been completely completed.

A large amount of gas and a small amount of blood were drained from the patient's chest cavity.

After about 10 minutes, the patient's dyspnea was significantly relieved.

He thanked Xiao Chu even more.

This made a group of trainee doctors and interns admire Xiao Chu even more.

Xiao Chu looked at the crowd who still didn't want to leave, and asked: "What else do you want me to teach you, feel free to ask it out boldly."

A trainee doctor stood up and said, "Mr. Xiao, I want you to explain to us in detail the key points and techniques of subclavian vein puncture."

"I have been in our emergency department for a while, and the puncture of the subclavian vein is always unsuccessful. Can you give us some guidance?"

When someone suggested subclavian vein puncture, other trainee doctors nodded in agreement.

Subclavian vein puncture is currently not used as an intern.

But for trainee doctors, it is more important.

In fact, Xiao Chu also performed several cases of subclavian vein puncture before.

However, at that time, not so many people followed suit.

Xiao Chu looked at the expectant eyes of several trainee doctors, and said: "It's nothing to teach you the technique of subclavian vein puncture, but now there is no patient who needs to do this puncture. Just explaining it to you in writing is meaningless." so big."

This is a male doctor who is a trainee and immediately said: "Mr. Xiao, a patient in our group is in the ICU and needs to have a deep vein replaced today. This patient just happens to be your teaching material."

"Okay, you go to prepare the equipment now, and let's teach on the spot."

The male trainee doctor quickly prepared the equipment needed for subclavian vein puncture.

Then he led everyone to the patient's bed in their group.

The patient was a post-traumatic cerebral hemorrhage.

Been in the emergency department for over a week.