MTL - Doctor’s Life Simulator-Chapter 241 Go to Modu Changhai Hospital to teach

While listening to Dr. Tian's words, Qin Lang began to make a diagnosis based on the experience accumulated over several generations.

After countless experiences, Qin Lang quickly thought of many similar cases. In comparison, he had a complete plan.

Qin Lang is also increasingly feeling the advantages accumulated over a lot of time. He has experienced many patients' symptoms, and of course he can safely formulate the best plan.

No wonder the sharpshooter is fed by bullets one by one, and the great doctor is also piled up by the patient!

Qin Lang looked at Dr. Tian and nodded slightly:

"What Dr. Tian said is right, the patient does need to undergo valve replacement again within a day, but the most important thing at present is to first intubate the patient's organs to assist breathing, and then choose the thoracic approach, synchronously separate the mediastinal pericardial adhesions, and establish an extracorporeal Circulation to complete the protection of the myocardium."

Hearing that Qin Lang clearly finished the preliminary operation, Dr. Tian kept nodding: "Yes, yes, Director Qin, what he said is not bad at all. Then we will start preoperative preparations according to Director Qin's vision."

The patient's family members were also watching. Dr. Tian's fear of hands and feet made them very scared. After all, in the city's first hospital, the director also talked like this, said a lot, it's difficult, It's difficult and complicated, but when it comes to specific treatment options, I can't hold back for a long time. The final solution is to transfer them to another hospital.

After seeing Qin Lang coming here, they made a surgical plan in three or two times, and their hearts were relieved a lot.

It's just that I'm a little puzzled by Dr. Tian, ​​an older-looking doctor, who obeys this young doctor so much.

Soon, after communicating with the family members and signing, the patient was sent to the operating room for the first stage of surgery.

For tracheal intubation to assist breathing, Dr. Tian is still very skilled.

"Intravenous infusion of positive systolic drugs, combined with dopamine and dobutamine..."

"Increase cardiac output, maintain blood perfusion of major organs, and intravenously inject cedilan and furosemide, rapid diuresis and dehydration..."

The first step was completed quickly, and then the second step was started, the separation of the mediastinal pericardial adhesions.

Qin Lang watched from the sidelines, while Physician Tian and Physician Wang were operating, and while they were doing, Physician Tian stopped.

"Why don't you do it?"

Qin Lang watched with relish, and blurted out when he saw Physician Tian's movements stopped abruptly.

"That... I'm not very skilled in the next operations, Director Qin, why don't you give me some guidance."

Physician Tian looked at Qin Lang as a matter of course, and seriously asked for advice.

Qin Lang was immediately stunned: "Don't you know that you still dare to do this first-stage technique?"

Physician Tian looked at Qin Lang blankly, a little aggrieved: "Director Qin, isn't this the plan you made?"

[Ding, new task: temporarily rescue the field, and at the same time teach the corresponding surgical skills to cooperate with the doctor. Mission reward: 1 life simulation point]

Qin Lang looked at the Hanhan Doctor Tian, ​​and couldn't help laughing and crying: "Okay, okay, I'll take the lead."

Qin Lang took over the position of the main knife and began to control the entire operation: "Nurse instrument, scalpel...scissors..."

"The extent of pericardial adhesion separation in revalve replacement surgery should vary according to the number of reoperations, the severity of pericardial adhesions, and the type of surgery."

Qin Lang explained while starting the operation.

"Okay." Dr. Tian nodded and took it down seriously. After all, this was Director Qin, who made the entire Zijingang First Hospital proud, personally instructing the operation.

"Remember that in the future, when the pericardium is separated, it must not be completely separated. Although extensive separation can overcome the difficulty of surgery, it increases the chance of damage to the myocardium. Moreover, it often leads to extensive bleeding that is difficult to control after surgery, and can also lead to The increase in operation time also increases the risk of surgery."

Having gone through so many surgeries, what Qin Lang said was really good advice, and it was the experience summed up from countless cases.

Before hearing this, Dr. Tian, ​​who was on the side, seemed to return to yesterday's demonstration operation, chewing and savoring Qin Lang's explanation, and then, like a treasure!

"Then Director Qin, how should we separate better?"

Dr. Tian asked for advice seriously.

"The so-called limited separation is to separate the operating area and meet the surgical operation requirements of the main surgeon. Of course, you cannot imitate the current degree of separation. After all, the operating area I need will be relatively limited. "

Qin Lang is naturally afraid that these two melon skins will look like cats and tigers. After all, not everyone has his solid basic skills and super talent.

"Understand."

Dr. Tian and Dr. Wang nodded, they still have this self-knowledge, but they are a little angry.

"Electric knife..."

Qin Lang issued an order, and the equipment nurse immediately cooperated.

With the electric knife in hand, Qin Lang quickly operated and taught at the same time:

"The principle of separation of adhesions is to use electrocautery or scissors for sharp separation as much as possible without damaging the epicardium. Generally, the pericardium is longitudinally incised at the interventricular sulcus, and the right atrium and both sides of the right ventricle are gradually enlarged to expose the right atrium. with part of the right ventricle."

Qin Lang explained the tricks and quickly completed the operation.

"Also, in the separation of pericardial adhesions, electric knife cutting or sharp scissors can be used to separate the pericardium, which is close to the parietal pericardium to avoid damage to the myocardium and coronary vessels. For patients with poor myocardial function, the vena cava and aorta must be cannulated first, connected to the cardiopulmonary bypass machine, and the separation is performed after the bypass is prepared. When the separation of the ventricular diaphragm surface is difficult, it can be performed after the bypass to avoid separation during pulsation Myocardial tear."

"Director Qin, it's amazing!"

After Dr. Tian listened to Qin Lang's explanation, he seemed to understand but suddenly became enlightened.

Dr. Wang listened without realizing it, and looked at Qin Lang with adoration in his eyes. Speaking of which, he was a few years older than Qin Lang.

"Oh, that's talent."

After the separation of mediastinal pericardial adhesions is completed, the establishment of cardiopulmonary bypass is started.

"Because the patient has heart failure and pulmonary edema, an ultrafiltration device should be used... Expose and separate the common femoral artery and femoral vein, and intubate if necessary to prepare for femoral-femoral shunting to prevent separation of pericardial adhesions. Bleeding occurs; prepare enough blood, prepare 3 suction devices connected to the extracorporeal circulation, once bleeding, ensure that it is promptly returned to the circulatory blood circuit device..."

Qin Lang continued to operate, and at the same time introduced the treatment options under various circumstances in detail.

"Director Qin, your knowledge is too broad. If you didn't know that you can learn the surgery at a glance, I really thought you had done hundreds of valve replacement surgeries."

Dr. Tian looked at Qin Lang with great emotion.

Under Qin Lang's steady operation, the establishment of extracorporeal circulation was quickly completed.

"The next step is myocardial protection. Because the patient's preoperative cardiac function is poor, and it is an emergency operation, there is insufficient myocardial blood supply. Moreover, the entire operation is complicated, the aorta is blocked for too long, and the patient's left ventricular adhesion, 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.”

Qin Lang's education was very serious. Dr. Tian and Dr. Wang naturally nodded their heads obediently. They didn't feel any resentment because of Qin Lang's age. Instead, they were full of gratitude. Following Qin Lang's operation, they really learned it. a lot of things.

Especially in a situation like Physician Tian who seems to understand but does not understand, he is just a step away. With Qin Lang's high-rise building, next time, he is confident that he will be able to lead the knife independently.

"The whole body is cooled by 26°C...Cold blood cardioplegia..."

Qin Lang continued to give instructions. Since the next operation was more complicated, Qin Lang reduced the explanation and more of the operation.

Dr. Tian watched Qin Lang's operation with full attention: "Anterior perfusion is used for mitral and tricuspid valve operations; antegrade perfusion is used for aortic valve and double valve operations for the first time, and retrograde coronary sinus perfusion is used later. ...so accurate operation, amazing!"

"The surface of the heart is cooled with ice chips, and the intracardiac cavity is cooled with 4°C iced saline."

Dr. Wang also seriously memorized it. Ten minutes later, the first stage was completed.

Next is the extremely difficult valve replacement surgery!

At this point, the two doctors were completely relieved.

In order to prevent the embarrassment from happening again, this time Dr. Tian behaved well: "Doctor Wang, the first stage is over, and the patient is temporarily out of the dangerous period. You can invite Director Huang over to perform another valve replacement surgery."

Dr. Wang nodded: "Okay."

Just as Dr. Tian was about to start the repair, he heard the voice of doubt from the side of Qin Lang: "Dr. Tian, ​​why did you ask Director Huang to do it? Could it be that you still can't do this valve replacement surgery again?"

Looking at Qin Lang who asked such an obvious question in a serious manner, Physician Tian was stunned for a while, and his face flushed, he said:

"No. Of course I can't do such a difficult operation. What, you can?"

Physician Tian looked at Qin Lang, who nodded lightly: "Yes!"

Doctor Tian: "..."

Finally, Dr. Wang, who was about to walk out of the operating room, also stopped. In this second stage, both in terms of operation and difficulty, it was a few levels higher. Generally, only senior directors dare to operate.

Director Qin actually knew it again, **** it, he pretended to be there!

"Director Qin, this is not a joke. Are you really sure that surgery is possible? The patient is out of the dangerous period now, and we have enough time to wait for Director Huang to come back."

Physician Tian confirmed it again, and was a little reluctant to admit that Qin Lang crushed him again!

Qin Lang waved his hand and shouted directly at the equipment nurse, "Scalpel..."

He took the scalpel and said to Dr. Tian: "Next, cooperate with me to perform another mitral valve replacement. I will use a right atrial-atrial septal incision. You are all optimistic. You can't do anything, just dare Entering the operating room, the heart is also really big."

Listening to Qin Lang's complaints, Physician Tian and Physician Wang were suffocating, they really wanted to hit someone.

Dr. Tian glanced at Dr. Wang helplessly, and shrugged: "Since Director Qin has spoken, then we will cooperate."

"Oh."

Dr. Wang is like a duckweed in the water, drifting with the waves. He can only float wherever the wind from the superior doctor blows.

At this time, Qin Lang's scalpel was already on the lateral wall of the right atrium, about 2cm away from the interatrial sulcus, and a longitudinal incision was made.

"This patient's right atrium is small. If you encounter this situation in the future, the incision will be extended to the inferior vena cava cannulation site to expand the surgical field. However, be careful not to injure the border ridge, because it contains nodes. It is also unlikely that the conduction tract will damage the atrioventricular groove, which contains the right coronary artery."

After hearing Qin Lang's instructions, Dr. Tian and Dr. Wang wanted to refute, but after thinking about it, they really didn't dare to operate with such a small surgical field as Qin Lang.

"What kind of eyes are these, it's too powerful."

Physician Tian sighed in his heart, and his confidence was hit again.

"Suture thread..."

Qin Lang went on to the next step. Seeing that Qin Lang was using sutures, Dr. Tian didn't quite understand it.

"Director Qin, who are you?"

"The atrial incision edge can be pulled with sutures to expose the atrial septum. After that, the incision is made in the center of the fossa ovalis, and then extended up and down. The ascending incision can reach part of the superior muscle bundle, and the descending incision must end at The medial coronary sinus is more than 1.5 cm."

When Qin Lang's voice fell, he had already completed this step.

"It turns out that, Director Qin, your excision is too powerful."

Qin Lang continued the operation and fixed the incision edge of the right atrial septum to the parietal pericardium with sutures, and sutured the left edge together with the right atrial wall with two stitches of traction thread.

Doctor Wang, after Qin Lang's operation, suddenly found that his hook became very easy.

"Social experience has improved again!"

Dr. Wang's eyes lit up and looked at Qin Lang's operation. It turned out that it was still possible. The mitral valve was exposed by gently pulling on the hook, which was a bit laborious.

Oh ho!

The mitral valve and prosthetic valve are very clearly in view.

"The next step is to first remove the possible thrombus and check for valve failure."

Qin Lang passed on his experience to Dr. Tian and Dr. Wang while operating.

"Okay, Director Qin."

Physician Tian began to check according to Qin Lang's instructions. After a while, the whole person was not well.

"Director Qin, this situation is a little dangerous. The sewing ring has been covered by the new endocardium growth. What should I do?"

If it wasn't for Qin Lang, Physician Tian would have panicked in the face of this extreme situation.

"Round head blade..."

Qin Lang glanced at it, and took a scalpel directly from the instrument nurse, and began to cut it with a round blade at the part of the seam ring close to the host seam ring.

"So direct?"

Dr. Tian's heart skipped a beat: "Director Qin, slow down, slow down."

Qin Lang ignored it and extended it to both sides. After a while, he incised a full 3cm in the seam ring.

"Director Qin, just dig it! How can you determine the depth and length of the incision?"

Qin Lang's mind was full of various cases, and after accumulating for several generations, he said casually: "Without him, I only know you by hand."

Physician Tian murmured in his heart, "I believe in you!"

Then, watching Qin Lang very easily peeled off the tissue embedded in the sewing ring to the ventricular wall, is it so barbaric?

"pliers..."

After a while, a whole seam ring was caught by Qin Lang and thrown on the iron plate. It was very clean and there was no trace of adhesion.

Looking at the seam loop processed by Qin Lang, Dr. Tian is both envious and puzzled. How did this technique come about?

"Scalpel..."

Qin Lang didn't give Dr. Tian any time to repair, and went directly to the next step, which was the most critical removal of the artificial valve.

"Two, remember, next time you remove the artificial valve, you must find the sewing ring from the valve annulus and remove it at this part, otherwise it may damage the mitral valve annulus and the important tissues around it, and even cause the atrioventricular annulus. ventricular perforation."

"It's good, but Director Qin, can you slow down the operation a little bit, I can't keep up."

Doctor Tian's old face flushed.

"Oh."

Qin Lang responded casually, and then there was still no change in the operation: "I help flush the ventricular cavity with a large amount of saline..."

Doctor Tian: "..."

Dr. Wang laughed aside, as if he saw himself when he was helping Dr. Tian again.

It turned out that in front of Qin Lang, Physician Tian looked like a not-so-smart Yazi.

The next step is to replace the artificial valve. Since the previous steps are very clean and perfect, Qin Lang's next method of suturing the valve is exactly the same as the first operation.

The only difference is that Qin Lang inserts the needle on the atrial surface and exits the atrial surface from the endocardium on the ventricular surface, so as to avoid leaving a rough surface and affecting the movement of the disc.

Ten minutes later, Qin Lang completed the entire operation.

"The treatment after the second valve replacement surgery is basically the same as the first surgery, but there are a few things to pay attention to:

The first point is hemodynamic monitoring. The swan-ganz catheter can be used to measure the pulmonary incarceration pressure and cardiac output, and at the same time monitor the central venous pressure and arterial pressure to accurately judge the important functions of the heart, such as blood volume and vascular resistance. Exceptions to indicators are dealt with in a timely manner. "

After listening, Dr. Tian's brain processor was not enough, so he looked at Dr. Wang on the opposite side.

Dr. Wang said softly, "Don't panic, Dr. Tian, ​​we still have a video, isn't he good at eight times the speed?"

Physician Tian, ​​this is how you feel at ease.

Qin Lang continued: "The second point is cardiac function support, the third respiratory support, and finally the close observation and treatment of bleeding. If a clot in the mediastinum blocks the drainage tube and causes cardiac tamponade, pancreatic peptidase can reduce non-surgical blood pressure. Sexual bleeding."

After Qin Lang finished his instructions, he walked out of the operating room.

The two doctors were left shocked.

The ultra-difficult secondary valve replacement surgery was a complete success!

[Congratulations to the host for completing the task: temporarily rescue the field, and at the same time teach the corresponding surgical skills to cooperate with the doctor. Get the task reward: 1 life simulation point]

...

...

A few days later, Qin Lang was resting in the dormitory, and he was awakened by a phone call when he was half asleep.

Qin Lang half-squinted and looked at the screen of the mobile phone. It was a landline number of a magic capital. He just hung up without thinking.

After all, nowadays such unfamiliar landline numbers are either advertisements or various certificates.

Press it down, and it didn't take long before it rang again, still the same number.

Qin Lang was annoyed, but generally speaking, when the number advertised in an advertisement is pressed, it is rare to call a second time. After connecting the phone, he heard the voice of a middle-aged man on the opposite side. in Mandarin: "Hello, Director Qin, I'm Zhao Ran..."

"No need to install etc, no need to send a mobile phone, no need for a certificate, no need for a loan, no need for anything. Thank you."

Qin Lang was sleeping soundly. When he heard an unfamiliar name, he tacitly assumed it was an advertising promotion, and pressed it ruthlessly.

On the other end of the phone, Zhao Ran, the chief physician of Changhai Hospital in Modu City, was immediately fascinated: "Are young people now so temperamental? Besides, why is it like a salesman when he is a dignified department director?"

Zhao Ran hit it again, not discouraged, but Qin Lang, who had no accident, was blocked directly, and he was not given any chance to connect.

"These **** advertising sales!"

Zhao Ran looked at the landline in his hand, put it down depressed, then took out his mobile phone and sent a text message directly to Qin Lang:

"Director Qin, I'm Zhao Ran, not a liar. The chief physician of the Cardiovascular Department of Changhai Hospital, you forgot that I was invited to attend the academic conference on ventricular correction in the Asia-Pacific region. Not many, the stocky men sitting in the row behind your Director Huang."

After a while, Qin Lang's text message came back: "Oh, I don't remember."

After Zhao Ran watched it, his whole person was not feeling well. Are young people so crazy now? After all, he is also the director of the Cardiovascular Department of Changhai Hospital in Modu City.

Zhao Ran took a deep breath, and then edited another text message aggrieved:

"Director Qin, it's normal not to remember. After all, those directors are either bald or have big stomachs. However, I really insisted on watching your operation that day, and I didn't even chew a mouthful of beef jerky. UU reading www.uukanshu.com I personally I appreciate you very much, how about, are you interested in coming to our hospital to give a lecture, our hospital is also in the top ten in the domestic cardiovascular field, and many doctors can’t ask for it to come to our hospital to teach.”

After a while, Qin Lang's text message came back quietly: "Busy."

"???"

Zhao Ran almost smashed the phone, but when he thought that his wife would give 100 yuan in pocket money every month, if he smashed it, he could only use the old phone, so he held back.

"Director Qin, I have already explained to Director Wen and Director Huang, and they will arrange a spare time for you. Moreover, after coming to our hospital for this lecture and exchange, our hospital will pay you 50,000 yuan. piece."

Zhao Ran decided to be a little more humble, after all, he had already blown away, and said in the department that he would invite a mysterious celebrity to give them a lecture.

This time, Qin Lang's information meeting was very fast: "It doesn't matter whether you have money or not, the important thing is that I think of your temperament, Director Zhao, and I appreciate it. Time? Location?"

After all, who can't live with money!

Then, the second text message followed: "Username: Qin Lang, account number: xxxxxxxxxxxx, make money!"

Seeing Qin Lang's reply so directly, Zhao Ran was dumbfounded.

Three days later, Qin Lang came to Changhai Hospital in the capital city according to the time and address set by Director Zhao.