My medical skills are a billion points

It’s almost impossible to cry without seeing the coffin, hum, I’ll let you know in a moment that medicine is not for you to brag and pretend. "

"If the patient dies during your endoscopic operation, I'll see how you explain to the family and wait for a lawsuit."

Tang Ming stood aside with his arms folded, sneering in his heart, watching Xiao Chu start to stop the bleeding on the old lady under the endoscope.

Tang Ming stood aside, although he didn't say anything on the surface, but Xiao Chu also read a trace of disdain from his eyes.

There is even a little, the mentality of watching a joke.

Xiao Chu didn't care either.

Anyway, if he didn't say it out loud, it's hard for him to say anything, so let's slap him in the face with strength.

Before Tang Ming came, he had spent [-] points to upgrade his endoscopy technique to an advanced level.

World class is not necessary, advanced technical level is sufficient.

Xiao Chu turned on the monitor of the gastroscope and checked the instruments again.

Only then did he begin to prepare for the operation of endoscopic hemostasis on the old lady.

Endoscopic hemostasis is a general term for endoscopic treatment of gastrointestinal bleeding, and is widely used clinically.

Common methods of hemostasis under endoscopy, including local spraying of hemostatic agent, local injection (absolute alcohol, sclerosing agent/tissue adhesive, etc.), high-frequency electrocoagulation to stop bleeding, microwave, laser, hemostatic clip, ammonia ion coagulation, and vascular ligation wait.

Among these methods of hemostasis under the microscope, hemostatic clips are more commonly used, that is, titanium clips are used to clamp the bleeding blood vessels.

There are also high-frequency electrocoagulation to stop bleeding, and blood vessel ligation to stop bleeding.

In addition to contraindications, gastrointestinal bleeding caused by various reasons can use these methods of hemostasis under the microscope.

Of course, there are still contraindications for this kind of endoscopic hemostasis.

The so-called contraindications, that is, the following diseases, are absolutely not suitable for endoscopic hemostasis.

First, acute upper respiratory tract infection and severe pharyngitis.

Second, uncontrolled high blood pressure and heart failure.

Third, severe respiratory insufficiency.

Fourth, extreme exhaustion or uncorrected shock, hemodynamic instability.

Fifth, severe spinal deformity, descending aortic aneurysm, suspected gastrointestinal perforation.

Article [-]. Bleeding combined with perforation.

Article [-]. The patient cannot cooperate if he is uncooperative or unconscious.

The above seven contraindications are written in textbooks.

Since the textbook is written like this, of course most doctors need to follow it.

If there are contraindications here, endoscopic hemostasis is prohibited.

The reason why Tang Ming insisted on not performing endoscopic hemostasis on the old lady was because of the seventh contraindication, the patient was uncooperative or unconscious, and could not cooperate.

Now the old lady is in a coma, so of course she can't cooperate.

Therefore, it became Tang Ming's reason for not being able to perform endoscopic hemostasis.

Of course, there is also a reason that bleeding can occur at any time, which will aggravate the condition.

But for the above contraindications, for Xiao Chu, except for the fourth and fifth, he really can't perform endoscopic hemostasis on this kind of patients.

The other contraindications are nothing to Xiao Chu at all.

For endoscopic hemostasis, in principle, choose the appropriate hemostasis method according to the cause and location of bleeding.

The first is local spraying of drugs to stop bleeding.

After routine endoscopic examination, determine the bleeding focus (gastric lavage should be given to those with a lot of blood in the stomach and poor vision).

Through the biopsy channel, it is sent into a plastic catheter, and the hemostatic drug is sprayed on the bleeding lesion.

5%~10% Montessori solution (basic ferric sulfate solution) can be used.

Or 1 unit of thrombin for injection or 2000 units of thrombin.

Or 4~8mg/dl norepinephrine solution.

Others use medical adhesives.

Observe for several minutes after spraying, and back off the mirror when the bleeding stops.

The first local drug hemostasis method can only be used if the gastric bleeding is not serious.

The second is local injection of drugs to stop bleeding.

The operation steps are similar.

First, endoscopic examination is performed to determine the bleeding focus, and the injection needle is sent from the biopsy channel.

Inject sclerosant, tissue adhesive or adrenaline into the bleeding lesion, and inject 4-6 points under the mucosa around each lesion, and inject 1.0-2.0ml of medicine at each point.

Depending on the size of the lesion, the total volume is 6~20ml.

If injected into the blood vessel, 5~10ml each time.Observe for a few minutes after the injection, and withdraw the endoscope when the bleeding stops.

This hemostatic method is used for relatively large ulcer bleeding.

The third is high-frequency electrocoagulation to stop bleeding.

At the beginning, the bleeding lesion was determined by endoscopy, the blood clot was removed first, and the electric coagulation current intensity of the high-frequency electric generator was adjusted.

Generally, it is adjusted at 3~4 files.

The spherical electrode is sent into the biopsy hole, and when the electrode touches lightly with the lesion, the electricity is turned on immediately.

Every few seconds, use the foot switch to control. Under direct vision, if the mucosal surface turns white, smokes, and bleeding stops, remove the electrodes.

Observe for 2 to [-] minutes. After the bleeding stops, withdraw the endoscope.

For general gastric bleeding, high-frequency electrocoagulation can be used to stop bleeding.

The fourth is laser (ammonia ion beam coagulation) to stop bleeding.

Endoscopic examination confirms the bleeding focus, introduces the optical fiber through the biopsy channel of the endoscope, adjusts the angle button, aims at the bleeding focus, and sets the output power of the optical fiber.

The ammonia laser needs 6~9W, while the Nd:YAG (doped aluminum garnet crystal) laser needs 40W.

When irradiating, the output end of the optical fiber should be 0.5~1.0cm away from the lesion.

The laser emission angle should be controlled at 70°~80°.

Each pulse time is 3-5 seconds. After irradiation treatment, the surface of the lesion solidifies into a layer of off-white carbonized layer to stop bleeding.

The fifth is microwave coagulation to stop bleeding.

Initially, endoscopy was performed to identify the bleeding lesion.

Send the coaxial cable connected to the microwave generator into the biopsy hole, and insert the electrode into the submucosal membrane at the edge of the bleeding focus.

The power is adjusted at about 40~50W, and the coagulation time is 10~20 seconds, and it can be coagulated in points until the mucous membrane turns white and the bleeding stops.

Of course, these five methods of endoscopic hemostasis require attention.

When local spraying of drugs to stop bleeding, flushing should be given to those with a lot of blood in the stomach and poor vision.

During microwave coagulation to stop bleeding, if there is clot or necrotic tissue attached to the probe, it should be removed in time, otherwise the curative effect will be affected.

Moreover, the wall thickness of the digestive tract is different in each part, so be wary of perforation.

High-frequency electrocoagulation, microwave coagulation hemostasis, laser hemostasis, etc. may accidentally injure the digestive tract.

In order to reduce gastrointestinal motility, pain relievers and sedatives can be given, such as intramuscular injection of sanjokine, diazepam (stable), etc.

There are also hemostatic clips to stop bleeding, and vascular ligation.

Hemostatic clip hemostasis is to determine the bleeding lesion by endoscopic examination, reveal the blood vessel, insert the device through the titanium clip, and use the titanium clip to clamp the bleeding site, which should be clamped together with the tissue.

Blood vessel ligation is similar to the procedure of hemostatic clip.

Of course, in addition to precautions, these endoscopic hemostasis methods also need to pay attention to the occurrence of complications.

Chapter 99

The most common complications of endoscopic hemostasis may cause bleeding, perforation, etc., and should be strictly monitored.

Of course, complications like bleeding and perforation did not exist for Xiao Chu.

There is also the Montessori solution used in the operation, which can cause severe spasms of smooth muscles, causing nausea, vomiting, and diarrhea, but they are all transient.

And this is because of the complications caused by drugs, which can only depend on the luck of the patient.

Xiao Chu couldn't avoid it either.

However, under normal circumstances, there is no problem. Even if symptoms such as nausea and vomiting occur, they will improve quickly and will not cause any serious problems.

Endoscopic hemostasis not only requires the doctor to have superb operating skills, but also requires the cooperation of nursing care after the operation.

In principle, fast for 24 hours, and it can be adjusted appropriately according to the cause of bleeding and the method of hemostasis.

And give intravenous rehydration according to the situation, and gradually return to normal diet according to the doctor's advice.

The second one is given antibiotics for 2-3 days according to the doctor's advice, and takes mucosal protective agent for 3 days continuously, if necessary, intravenous infusion, proton pump inhibitor or histamine H2 receptor antagonist.

The purpose of this medication is mainly to prevent further bleeding in the stomach and to heal the ulcer better.

It is also necessary to closely observe the condition and measure blood pressure and pulse regularly.

Observe whether there is hematemesis and blood in the stool, and pay attention to whether there are complications. If there are complications such as delayed bleeding, ulcer, perforation, etc., the doctor should be notified in time and actively deal with it.

Therefore, endoscopic hemostasis not only requires doctors to have superb operating skills, but also requires strict cooperation in nursing.

Even after the operation, the nurse needs to closely observe the changes in the patient's condition to see if the patient's blood pressure has dropped and the body temperature has risen.

Vital signs are stable and unstable, etc., all require nurses to pay attention to the patient's condition at all times.

If the patient's blood pressure continues to drop, but the nurse does not notice the situation, then this patient may have continued bleeding or perforation in the stomach.

If not detected in time, this situation will bring immeasurable harm to the patient.

Therefore, medicine not only requires doctors to have very high skills, but also requires nursing to strictly cooperate with the doctor's doctor's orders, so that patients can achieve the most ideal results.

Of course, except for the side effects of the medicine, Xiao Chu can't control it.

But for the operation, he has full confidence that there will be no complications in any aspect.

In terms of postoperative care, there is no need for nurses to closely observe the patient's condition changes.

At this time, Xiao Chu had already prepared all the instruments, and began to perform microscopic hemostasis on the old lady.

Although the old lady had already entered a coma state, Xiao Chu still gave her some sedative drugs appropriately to prevent agitation during the intubation process.

Seeing Xiao Chu's skillful movements of inserting the gastroscope into the patient's esophagus, Tang Ming, who had been waiting to see the joke, couldn't help but slowly began to pay attention.

Because Xiao Chu's operation method is not like a novice at all, but like a master who has gone through a lot of tempering.

Just from the operation method of entering the mirror, Tang Ming felt that he was definitely not as proficient as Xiao Chu.

Xiao Chu operated the gastroscope, and when it entered the patient's esophagus, he inserted it directly without twisting the direction at all.

What does this mean?

This shows that Xiao Chu has absolute confidence in his own skills, that's why he did this.

In less than 10 seconds, Xiao Chu operated the gastroscope and entered the patient's stomach.

At this time, on the gastroscope monitor, the condition of the patient's stomach has already appeared.

When several doctors saw the condition of the patient's stomach on the monitor, they were all taken aback.

I saw the old lady's stomach was full of blood.

The lens of the gastroscope has been flooded with blood, and the entire monitor only shows a bright red color, and only occasionally can you see the gas bubbles in the stomach.

From these alone, the blood vessels in the old lady's stomach are still bleeding.

Sure enough, just as Xiao Chu expected before, if the operation under the microscope was not performed on her in time, the old lady would vomit blood again.

Because a lot of blood covered the lens and blocked the operator's sight, Zhou Ziqiang couldn't help but sweat for Xiao Chu.

This time hemostasis under endoscopy was very difficult.

Looking at this situation, the old lady's stomach is obviously bleeding, even though Xiao Chu can use the suction device carried by the gastroscope to suck out the blood inside.