My Medical Skills Give Me Experiences
Chapter 145: 1 Soaring into the sky, epilepsy case consultation
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Dr. Zou was the only one who was embarrassed to greet Zhou Can proactively.
When operating on a patient, he stabbed a basket, and Zhou Can wiped his butt. The key point is that he also scolded Zhou Can a few words.
Now Zhou Can successfully placed all the yellow circles, and the patient's threat of cerebral aneurysm was relieved. Comparing him with Zhou Can, everyone can tell whether his level is high or low.
"Who is Xiao Zhou currently training under?"
Director Wen's question, it is estimated that he has already started to think about this talent.
It is not just the patent of top doctors to like excellent medical juniors. Senior doctors with weaker medical or surgical abilities have even stronger desire for these talents.
Because as long as you recruit people, you can help a lot.
It has high utilization value.
"I followed Dr. Cheng Gang in the inpatient department to do some ward rounds and follow up on patients' surgeries."
Zhou Can told the truth.
"Cheng Gang? Are you the resident doctor in charge of the bed?"
It is estimated that if Cheng Gang heard this, he would be so angry that he vomited blood.
Anyway, he is a resident doctor with the ability to manage the bed independently, but the chief physician in the same department doesn't even remember his name.
There are not many doctors in the neurosurgery department.
Cheng Gang has been in this department for several years, but such a result is absolutely sad.
Unlike regular trainees and interns, residents are serious department employees. Participate in various performance and bonus sharing. It should be a bit of an impression anyway.
Besides, not long ago, a 22-bed patient had a postoperative complication—epilepsy.
Cheng Gang also called Director Wen to report the situation.
Compared with other departments, the doctors in the neurosurgery department are particularly indifferent.
There are layers of invisible and intangible barriers.
"That's right, Cheng Gang is in charge of the bed in the ward."
Dr. Ou answered the question instead of Zhou Can.
It can be seen that in Dr. Ou's small eyes, there is a desire to curry favor with Director Wen.
"Cheng Gang's academic and surgical abilities are very average. If you follow him, you can only learn some basic methods of patient management. I will transfer you to my group, and follow me in surgery, consultation, management bed or something."
As expected, Director Wen was playing Zhou Can's idea.
Not to mention anything else, Zhou Can's implantation skills alone are enough to help him in many interventional surgeries.
The key is that such talents are completely free.
Gui Peisheng does not participate in the operation commission, and does not participate in the distribution of various bonuses in the department.
You can't even write your own name on doctor's orders and medical records.
It is equivalent to recruiting a free helper.
To be able to take such a big advantage, it's no wonder Director Wen didn't rush to do it.
"Thank you Director Wen for cultivating!"
Zhou Can thanked with a 'happy' smile.
In fact, he hopes to have the opportunity to be appreciated by Wu Baihe, and hang out with Wu Baihe for two months.
Because Director Wen's surgery level is very average, there are really limited things he can learn.
Right now, he has no choice but to agree to be 'happy'.
Director Wen didn't ask him if he agreed.
A decision was made directly.
If he said he disagreed at this time, Director Wen's face would be longer than that of a donkey.
A little Gui Peisheng doesn't know how to praise, and the consequences are very serious.
Zhou Can can only lower his expectations, first gain a firm foothold, and then seek development and greater progress.
Now that I follow Director Wen, I still have a chance to be appreciated by Wu Baihe later.
If you can't wait for that opportunity, it's fate.
I can only find opportunities to study outside the gods in the future.
"Doctor Ou, that Cheng Gang is your resident doctor, right?"
"Yes! Usually I am responsible for him."
Dr. Ou looked at such an excellent Gui Peisheng under his command, who was poached away on the first day of his training outside of Shenwai, and he was envious, but envious.
He also very much hoped that Director Wen would dig him out.
Not every attending doctor is covered by a superior doctor.
Dr. Ou is a "wild child".
If there is a problem with the patient under his care, he can report it to the department director and deputy chief physicians. Anyone can.
But no one took him as an apprentice.
Basically, I will have a third-level operation with this one today, and another one with another director tomorrow.
The only way to make progress is with difficulty.
"I'll explain this to Cheng Gang later."
Dr. Ou took the initiative to show his kindness again.
"Well! Thank you for your hard work!" Director Wen nodded in satisfaction.
It can be seen that he is very happy to find a good talent.
At this time, the patient had already woken up under the call of the anesthesiologist.
Generally speaking, after stopping the anesthesia, about ten minutes later, patting the patient's shoulder and calling the patient's name can wake the person up.
General anesthesia is also considered deep sleep.
After examination, the patient still had vomiting and headache after waking up from anesthesia, and the neck stiffness still existed.
It does not appear that the condition has improved in any way after the operation.
In fact, this is not the case.
After the bleeding stops, the aneurysm will no longer receive new blood influx, and its volume will shrink appropriately.
This process does not take too long, maybe not even 24 hours.
At that time, the patient's intracranial pressure will be reduced.
In addition, the accumulation of blood in the brain will be slowly absorbed by the brain tissue, and the intracranial pressure will be further reduced.
If nothing else, the patient's condition will be relieved quickly.
Various symptoms gradually disappeared.
It is by no means that the family members think that the operation is unsuccessful or that the operation is useless.
Many family members and patients do not understand medical expertise, and interventional operations are almost non-invasive.
They will think that after spending more than 100,000 yuan, have they been fooled by the doctor?
Maybe it will get better on its own in a day or two without surgery.
Not really.
The explanation work will be done by doctors and nurses.
Although most family members hold a skeptical attitude, they will eventually accept the explanation given by the doctor when they see their relatives recover and leave the hospital.
From this point of view, the credibility of a hospital is really important.
For a well-known top provincial hospital like Tuya, patients don't need to explain too much, patients will trust them naturally.
…
After the operation was completed, Zhou Can followed Director Wen straight back to the doctor's office.
What are you doing?
The 22-bed patient was operated by Director Wen, and now there are complications, so he must find a way to solve it.
Call the doctors in the group to consult together, this is the most basic.
As soon as he arrived at the corridor of the inpatient department, Cheng Gang, who came out of the ward, saw Director Wen coming with a large number of doctors from a distance.
Immediately stood there respectfully, smiling all over his face, ready to take the initiative to say hello.
"Hello, Director Wen! I heard that the operation on the 31-bed patient was very successful. After the patient was transferred back to the ward, the family members are very grateful to you!"
"Haha, that's right! It's our doctor's job to relieve patients' sufferings. Tell the family members and patients to cooperate with the doctor's requirements and take care of the postoperative care."
Thousands of wears and thousands of wears, only flattery does not wear.
Cheng Gang's flattery made Director Wen smile all over his face.
At this time, Cheng Gang's gaze caught a glimpse of Zhou Can actually mingling with Director Wen's team.
His eyes fixed on Zhou Can.
"Xiao Zhou, go to work in the ward as soon as possible after the operation. The wound of the patient in bed 27 shows signs of infection. You should take care of it."
Cheng Gang flattered Director Wen like a pug.
But when speaking to Zhou Can, it was in a commanding tone.
Crushing people to death at the first level is not only applicable to officialdom.
The same applies to work units and hospitals.
Zhou Can looked at him with rebellious eyes.
If I don't listen to you, I won't listen to you, what can I do?
"Xiao Cheng, Zhou Can has been transferred to my group to participate in the regular training work."
Director Wen's words were like a bolt from the blue, blasting Cheng Gang into a mess.
He asked in disbelief, "He, was he directly transferred to your group?"
"What, do you have an opinion?"
Director Wen's tone turned cold.
When talking to Cheng Gang, a non-existent resident doctor, Director Wen didn't have any kind or even humorous ideas.
"No problem, no problem, don't get me wrong. I'm happy for him!"
Cheng Gang found that Director Wen's tone and expression were not right, so he was so frightened that he hurriedly explained.
"Xiao Zhou, it's a great opportunity to join Director Wen's group, you know? The attending physicians and residents under Director Wen are all elites among the elite. In the future, you must be diligent with the new residents. ,do you know?"
According to Cheng Gang's idea, Zhou Can was lucky to be appreciated by Director Wen.
At best, Director Wen asked one of his resident doctors to take Zhou Can.
After all, this is the routine operation of chief doctors.
"Dr. Zhou's surgical ability is extremely strong, we are not qualified to take him. Instead, Director Wen will take him in person."
The three resident doctors hurriedly clarified.
This Cheng Gang is simply a chatterbox.
Ba la ba la talked a lot, and the key point almost caused three residents to lie down with their guns.
"What? Director Wen will take him personally?"
Cheng Gang's eyeballs almost fell out of shock.
It is only now that he understands that Zhou Can has not hit the big luck, but has risen to the top based on his strength and soared into the sky.
It directly won the high appreciation of Director Wen.
Otherwise, with Director Wen's status, not to mention a regular trainee, even the attending doctor might not be able to teach in person.
Director Wen ignored Cheng Gang's shocked + jealous expression at all, and directly led the doctors in the group into the office. In his heart, Cheng Gang is no different from the weeds on the roadside.
Zhou Can just glanced at Cheng Gang indifferently.
Not surprisingly, the days of Cheng Gang giving orders to him are completely over. In the future, when Cheng Gang meets him, he should find ways to lick him.
After entering the office, Zhou Can was regarded as a new member of the group.
He consciously took the last seat.
Even further back than the seats of the three graduate students.
Low-key is an attitude, but also a kind of self-cultivation. It can make people feel like a spring breeze, can greatly increase the favorability of others, and greatly reduce the chance of making enemies.
The only thing that needs to be overcome is the inner vanity and showing off psychology.
"Tang Li, first put the patient information and the latest EEG on the 22nd bed on the screen for everyone to see."
Director Wen ordered the female attending doctor under his hand.
"OK!"
She projected the patient's latest EEG on the screen.
"This patient's cerebrovascular malformation operation yesterday, everyone must still have an impression. It is very common to have postoperative complications. Now the patient has postoperative epilepsy and has been in a coma twice. The family members' emotions are very intense. It’s fierce. Let’s take a look at the EEG and enhanced CT of the head.”
Director Wen was actually very annoyed when he encountered this situation.
Postoperative complications are, to put it mildly, common.
But to put it bluntly, it can also be understood as the level of the doctor's operation, the operation is not thorough, or it is not done well. caused other symptoms.
In terms of responsibility, Director Wen certainly cannot escape.
If it is defined as a medical malpractice and punished, it does not exist.
After all, the operation is only performed after signing the consent form for the operation.
And no doctor can guarantee that the operation will be successful.
Not to mention craniotomy.
Even if it is only a minor operation, there is a possibility of failure.
For example, suturing traumatic wounds, is this a simple first-level minor operation? Even a barefoot doctor in a small clinic can do it.
But after a few days of suturing, the wound became infected and suppurated.
Who is responsible for this?
Doctors certainly don't want to take on this responsibility.
In the end, the patient can only pay the bill.
Then again, if there is a problem with the operation, should the family members make trouble?
In fact, there is no harm in making a fuss.
On the one hand, there is indeed a need to vent emotions. On the other hand, the hospital will pay more attention to it if it is more violent. For follow-up treatment, even if the patient pays for it himself, the treatment will be more guaranteed.
Even the hospital will make some compromises and reduce some of the costs.
Therefore, it is more in line with the interests of family members and patients to make trouble when it is time to make trouble.
Talking too easily will only make people feel easy to bully, like a lamb waiting to be slaughtered, it is easy to suffer greater losses and suffer more crimes.
Most of the doctors have seen the patient data of the 22 beds.
And overripe as a chest.
Before the operation, when formulating the operation plan, everyone will know the patient's medical history, condition, examination report and other information.
Therefore, when passing on the information at this moment, many doctors just flipped through it and passed it on to the next person.
Zhou Can was the only doctor who hadn't seen the data of the 22-bed patient.
When it was passed to him, he was already the last one.
I also looked at it intently.
At present, his pathological diagnosis and medical skills are inferior to those of residents.
Compared with the doctors present here, it may only be better than the three graduate students.
The strength of the three resident doctors is not clear for the time being.
The diagnosis level of the attending doctor is beyond doubt.
Not to mention Director Wen's level.
As long as they can get a high professional title in Tuya Ping, no one is easy to be with. Director Wen's proficiency in interventional surgery does not mean that other abilities are also bad.
After everyone has seen the latest EEG and head CT scans, extensive discussions have begun.
Zhou Can was not disturbed by external sounds, and concentrated on looking at the patient's information.
"Gao Zongyi, male, 46 years old, has symptoms of mental retardation, had a history of epilepsy before admission, and the frequency of the onset is getting faster..."
After a long time of trouble, it turned out that the patient had a history of epilepsy before admission!
Those family members are still making such a fuss, which shows that the family members are not fuel-efficient lamps.
It belongs to the category that is difficult to deal with and difficult to deal with.
Zhou Can defined the patient's family.
After investigation, the patient had a venous vascular malformation in his brain. But this part is very close to the internal capsule.
Many may not know where the inner capsule is.
The internal capsule is the name of a part through which the nerve fibers connecting the cerebral cortex with the brainstem and spinal cord pass, and is located between the basal ganglia and the thalamus.
The motor nerve fibers and sensory nerve fibers leading to the cerebral cortex are fan-shaped and radially distributed upward through the internal capsule.
It is not difficult to see from here that the internal capsule is equivalent to a contact point between the cerebral cortex, the brainstem, and the spinal cord.
Its risk is second only to the brainstem in intracranial surgery.
Generally, a knife needs to be performed near the inner capsule~www.readwn.com~ Even in the top tertiary hospitals with considerable strength in the local area, most of them will politely tell the family members that they cannot perform this operation.
Because the risk is too great.
At present, Tuya Hospital is basically able to achieve no restricted area for intracranial surgery.
Of course, this is for external publicity, and there is a certain amount of moisture.
If you really want to use a knife in the brain stem area, even Wu Baihe will feel terrified.
The hypertensive pregnant woman who was in the emergency department last time was fortunately a pseudoaneurysm. Because Wu Baihe made it clear that he was not even 50% sure of the operation.
As far as Tuya's supernatural power is concerned, it is not particularly powerful in itself.
Not even necessarily the strongest in the province.
The provincial people's hospital and a certain digital hospital are all very powerful.
Not to mention Renhe Hospital in the imperial capital.
In addition, the Shenwai of the two large hospitals in Shanghai are also powerful. It even surpassed Tuya, and was comparable to the benevolence and spirit of the imperial capital.
Director Wen dared to perform this operation, which is enough to see that his level of traditional surgery is quite high.
May not have much talent in interventional surgery.
Zhou Can made a new evaluation and understanding of Director Wen.
On the operation record sheet, it clearly stated that the diseased vein segment was removed.
Now that the resection has been successful, why does the patient's epilepsy worsen after surgery?
Zhou Can looked up at the latest inspection report.
Electroencephalogram, obviously abnormal discharge.
In fact, epilepsy patients are basically caused by abnormal brain discharge.
As for the cause of the abnormal discharge, it must be thoroughly investigated. Brain arteriovenous tumors are not the only ones that can cause them.
Varicose veins, telangiectasia, and cavernomas can all cause abnormal electrical discharges in the brain.
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