MTL - My Medical Skills Give Me Experiences-Chapter 413 The relationship between thrombectomy and debridement, hypochondria is the most terrifying

【My medical skills can add experience points】【】

"Teacher, I went to the ward for rounds just now."

"Oh, that's alright."

"The gangrene patient who just finished the debridement operation reported a symptom to me. He said that his right leg would have free pain from time to time after the injury. According to his description and when he was debridement today, Regarding the blood supply of the right leg, I suspect that arterial embolism may have occurred. And it is likely that local arterial embolism caused gangrene in the leg wound."

Zhou Can revealed all his inferences and basis.

After listening to his report, Dr. Xu was silent for nearly half a minute, and then said, "If it is true that there is a local arterial thrombus in the right leg, then the thrombus must be removed overnight. First, take a color Doppler ultrasound. If necessary, I will contact the intervention room for assistance." Patient undergoes angiography."

As an old doctor with extremely rich surgical experience, he naturally understands the danger.

The biggest danger of arterial thrombosis is that the thrombus dissociates and enters the heart and brain, which will directly cause life-threatening.

I believe that many people have been frightened by their parents since they were young, saying that embroidery needles should not be thrown around. If they are accidentally inserted into a blood vessel, they will enter the heart or head along the blood vessel and kill people.

This risk does exist, but the probability of it actually happening is extremely small.

Adults are mainly afraid of children throwing embroidery needles around, especially on the bed or fabric sofa. When people sit down, they are particularly easy to be stabbed.

After getting Dr. Xu's permission, Zhou Can immediately went to the emergency duty room, borrowed the doctor's computer, logged in to his account, and ordered a color ultrasound examination for the patient who was added to the 22nd bed.

Many checks cannot be done at night.

The emergency department has an advantage. Even at one o'clock in the morning, some emergency inspection items can be done.

The medical technical departments of specialized outpatient clinics usually only work during the day. Some special inspection rooms are even only open one day a week.

The test results came out soon.

The patient did have a suspected vascular embolism in his leg.

Zhou Can was about to call Dr. Xu, but Dr. Xu rushed back by taxi.

"It would be better to use interventional surgery to remove the thrombus. You are very good at interventional surgery and endoscopic surgery. Are you sure about letting you remove the thrombus?"

He asked Zhou Can.

"Seventy to eighty percent sure!"

Zhou Can didn't dare to speak too much.

"I called a doctor in the intervention room to open the door, and the thrombus had to be removed overnight. There was a thrombus in this part, no wonder the patient's wound was difficult to heal! Fortunately, the hidden cause was found in time, otherwise his leg would have been lost."

Dr. Xu was also filled with emotion.

Any kind of illness is possible. Even he, an old doctor with decades of experience in surgery, did not find the real cause of the patient's wound gangrene. At that time, everyone's first reaction was that the debridement and suturing skills in the small clinic were poor, and the patients were not sutured properly. In addition, in order to save money, patients recuperate at home, which leads to infection.

Who would have thought that the culprit would be arterial thrombosis.

If the artery is completely blocked, it will definitely be discovered in time. Because limb ischemia will directly necrosis.

It just so happened that the thrombus did not completely block the blood vessel, but blocked more than 90%.

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【My medical skills can add experience points】【】

As a result, the artery can still supply blood, but the blood supply is very poor, with only 10% of its blood supply capacity remaining. With such a poor blood supply, it would be a miracle that the wound could heal.

It has a blood supply and can maintain the basic survival of the lower limbs, which also makes it difficult for doctors to find the existence of this thrombus.

Don't even think about it at all.

Intervening in the room, Zhou Can successfully took out the real culprit who had mutilated the patient for many days for the patient by virtue of his superb operating skills. This is a blood clot about one centimeter long.

Visually, it should be caused by blood clotting.

Not like a fat embolus.

There are various reasons for the formation of this thrombus, mainly caused by trauma. Even when some nurses make indwelling needles for patients, if they use them for the second time, improper operation may cause blood clots.

Experienced nurses usually draw back with a syringe of about 10ml before using the indwelling needle for infusion for the second time, and will not start the infusion until redness is seen.

A common mistake made by reckless novice nurses is direct infusion.

Then I found that the indwelling needle that was just inserted yesterday seemed to be blocked.

Then, the lazy nurse flushed the tube directly with liquid water.

They didn't know that the indwelling needle tube just inserted yesterday was blocked, probably because blood flowed back into the needle when the needle was sealed. Over night, a blood clot forms.

In this case, forcibly flushing the tube with saline is very easy to forcibly flush the blood clot into the patient's vein.

The indwelling needle tube is blocked. In addition to the possibility of thrombus, it is also possible that the residual infusion fluid has formed crystals in the needle tube. This is more dangerous.

No matter which one, as long as it is forcibly sent into the patient's vein, it may cause serious consequences of death.

When the indwelling needle tube is blocked, there are three correct operation methods.

After identifying the cause, use a 10ml empty syringe to gently withdraw to extract the clot from the tube.

Or if the patient's condition permits, the pinch tube can also be diluted with 10ml of 0.9% sodium chloride injection containing heparin sodium or urokinase for 5 minutes, and then withdraw with an empty syringe. If there is no return of blood, repeat it again. If there is still no blood return after two operations, the needle should be pulled out immediately.

In this case, replace the indwelling needle with a new one and pierce it again.

After Zhou Can successfully removed the thrombus for the patient, he was afraid for a while. If this thrombus is not found in time, the wound on the patient's leg will definitely continue to deteriorate. It is estimated that until tomorrow, nine out of ten can only make a cruel decision to amputate to save their lives.

It could be devastating to the family.

After the amputation, the patient will lose the ability to work. His wife may be in financial difficulties because of the family, and the husband will become disabled. Such a result cannot be accepted. Intense family conflicts occurred, and finally they chose to divorce.

Her husband is equally likely to give up on himself.

In the end it was the little boy who was poor.

Only that little bit big.

And I heard from them that there is an eldest daughter in the family who is in junior high school.

Who will take care of the two underage children?

[Pathological diagnosis experience value +1, reward experience value +100.]

[Debridement experience +1, bonus experience +1000.]

[Special medical skills, heart of benevolence experience +1, reward experience +100.]

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【My medical skills can add experience points】【】

Zhou Can didn't expect that he would be able to gain so many medical skill experience rewards just by taking a thrombus from a patient.

In particular, it is extremely difficult to obtain the experience points of benevolence and medical skills.

Once he was rewarded with 100 experience points, he was as happy as winning the lottery. This special medical skill has not yet been upgraded.

Its role has also remained a mystery.

According to Zhou Can's experience, the more difficult a medical skill is to improve, the more effective it will be.

For example, if pathological diagnosis and pharmacological syndrome differentiation are upgraded to the fourth level, then he is at the level of serious internal medicine. When he reaches the fifth level, he is at the level of the deputy director.

At present, his two medical skills are both level five, which is a proper deputy director level.

This is also the reason why he was often better than the deputy director of the department in the later period of regular training. Especially after the regular training in gastroenterology, this advantage becomes particularly dazzling.

He is often invited by the attending physician of the department, or even the chief physician, for consultation.

To put it nicely, it was a joint consultation. To put it bluntly, didn't you just ask him to help?

After reaching the fifth level of pharmacological syndrome differentiation, it is directly reflected in the ability to prescribe medical orders.

Whether it is a temporary doctor's order, a rescue doctor's order, or a hospital admission doctor's order, postoperative doctor's order, etc., Zhou Can can always gain the trust of the superior doctor, and has the right to act first and act later.

What do you mean?

That is, when encountering a situation where a doctor's order is required, he can first write the doctor's order to save lives, and then ask the superior doctor to sign it afterwards.

"It's obviously just a thrombus, but how can the experience value of debridement increase? And it's an unprecedented reward of 1,000."

He was rewarded with one hundred pathological diagnosis experience points, which is understandable.

After all, he was the one who discovered the extremely concealed arterial thrombosis based on some clues. No matter whether it was the clinic where the patient was first seen, or the doctors of the Provincial People's Hospital, or the doctors of Tuyap Surgery and Emergency Department, they failed to discover the existence of this hidden lesion.

Zhou Can was able to discover it, which is a major breakthrough in diagnosis and an accumulation of diagnostic experience.

Debridement and thrombus removal seem to be out of reach!

After a moment of contemplation, Zhou Can had a glimmer of understanding. It seems that thrombectomy has nothing to do with debridement, but if the arterial thrombus is not removed, no matter how well he does the patient's wound debridement work, it will be useless.

This is a bit similar to the metaphor often used by entrepreneurs, the health is 1, and the money earned is the zero after the 1.

If there is no health, it is useless to earn more zeros.

This arterial thrombus is directly critical to the healing of the wound.

It seems to have nothing to do with debridement, but it determines the prognosis of debridement.

After the medical skill is upgraded to the fifth level, it is no longer a simple improvement of skill operation, but begins to involve deeper pathology and body mechanism.

He has a feeling that maybe when he reaches the sixth level, a small illness may require him to take the lesion as the focus and consider all aspects of the three major circulations and the nine major systems.

The human body is originally a whole.

What seems to be a small lesion often involves the whole body.

This change in cognition is more like forcing him to take a longer-term view and look at the overall situation. It is no longer limited to a narrow lesion, or a certain body system that is endangered by this lesion.

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【My medical skills can add experience points】【】

Taking off the heavy lead clothes, Zhou Can walked out of the intervention room with a smile from the heart on his face.

Nothing makes him happier than successfully treating a patient.

…

During the rounds the next morning, he went to see the patient specifically.

According to the patient's own feedback, there is no such faint pain in the legs anymore. Moreover, the patient's wound showed obvious signs of improvement. This is a very good trend.

After checking the ward, he made a special trip to the cardiothoracic surgery room.

"Doctor Zhou is here!"

"Good morning, Doctor Zhou!"

Although the medical staff here still greeted him warmly as usual, he could clearly feel the dull and depressing atmosphere in the air.

Patients also seem to be much less than before.

There are various indications that this former ace department is declining at an alarming rate.

It is in sharp contrast with the thriving and rapid rise of the emergency department.

Seeing this situation, Zhou Can felt a dull pain in his heart.

The teacher, Director Hu Kan, exhausted his life's painstaking efforts to create a cardiothoracic surgery department across the country. As a result, the department quickly declined because there was no follow-up.

"Is Director Xue here?"

"She didn't seem to go back yesterday, and she seemed very depressed. Go and have a look! It's in the office!"

After Zhou Can heard this, he felt a burst of self-blame in his heart.

After learning the news that her operation failed yesterday, he should have called her immediately.

She locked herself in the office, and it was conceivable that she must be very sad inside.

"Hey, Xiao Zhou hasn't been here for some time!" Deputy Director He led two doctors under him. When walking, there was wind under his feet and his face was shining.

The smile almost burst out.

'Xiao Zhou', this is a kind of contempt for Zhou Can. There is also the suspicion of showing off his identity in front of him and pretending to be a senior.

"Our side" means to remind Zhou Can that this is cardiothoracic surgery, and Zhou Can is just an outsider.

This old guy, who failed to compete for the head of the department last time, I'm afraid he has always hated him.

Seeing Director Xueyan having an accident now, not only did she not help them overcome the difficulties, but she was so happy that she almost didn't hum a little song, it was so annoying. But that's just how human nature is.

He was naturally happy to see his competitors in bad luck.

If Director Xueyan loses the position of department chief this time, wouldn't it be his turn to take this seat again?

"It's been a while since I've been here! Director He looks good!"

Zhou Can talks nonsense when he sees people, and talks nonsense when he sees ghosts.

To deal with this kind of person, there are still superficial things to do.

"Haha, thank you, thank you!" Deputy Director He suddenly smiled happily.

"It's just..." Zhou Can dragged out his voice, with a tactful expression that hesitated to speak.

"Just what?"

Deputy Director He couldn't help asking.

"It's nothing, I suggest that Director He can go for an examination when he has time." Zhou Can said calmly.

"What do you mean?"

Deputy Director He was obviously a little nervous.

Zhou Can's ability, he is clear. Whether it is a consultation in the cardiothoracic surgery department or a round of the ward, patients who Zhou Can says have problems can basically be verified quickly.

Now the meaning of Zhou Can's words obviously means that his body is sick.

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【My medical skills can add experience points】【】

And judging by his tone and demeanor, he might be seriously ill.

How can this not make Deputy Director He nervous?

"Uh... I just casually gave a kind reminder. Director He doesn't need to take it too seriously. Just hurry up and go for a check-up when you have time. I have something to do with Director Xue, and I'm going back to work in the emergency department soon." , talk next time when you have time."

Zhou Can raised it high and put it down gently.

Just to whet the appetite of this old thing.

What he dislikes the most is this kind of villainous behavior.

There are no eggs under the nest.

Cardiothoracic surgery is really doomed, how can Deputy Director He be better?

Where is the country?

But there are some people who are very stupid. They only care about competing for the immediate interests, and they don't care about the overall situation at all. Director Hu Kan refused to hand over the heavy responsibility of department director to Deputy Director He until his death, probably because he saw through the nature of this old thing.

If a department is handed over to such a person, it will be finished sooner or later.

"Hey, hey... don't go, what's wrong with my body?"

Deputy Director He shouted anxiously from behind.

Zhou Can stopped and didn't turn around. He just turned around and smiled at Deputy Director He inscrutablely.

"The body is yours. If there is a problem, I believe you will know better than me."

The trick of pretending to be a ghost has been effective for thousands of years~www.novelbuddy.com~ As long as a person suspects that his body is sick, it will be troublesome. You can get sick without being sick.

When Zhou Can was in college, every time the teacher introduced a certain disease in class, he always felt that he also had this disease. I believe many medical students have experienced this feeling.

Once a person becomes suspicious, before he finds the correct answer, he is guaranteed to be trapped in paranoia.

For example, a man suspects that his wife is cheating. When he sees his wife getting close to a certain male colleague in the company, he will think, this old Li has never seen my wife go home. How could the two of them just get together today? There must be something wrong with the two of them.

Seeing that his wife got an extra thousand yuan in bonuses this month, he would think again, did Manager Wang take a fancy to my wife? If the two have no special relationship, why only give my wife an extra 1,000 yuan bonus

[To be honest, I have recently followed up, changed sources, and have many voices for reading aloud. Both Android and Apple are available for .huanyuanapp. 】

…

It is guaranteed that this man will eventually become more and more neurotic and nervous in countless doubts. Divorce is almost inevitable.

Zhou Can is now planting a seed in Deputy Director He's heart, telling Deputy Director He that there is something wrong with his body, but he doesn't point out where the problem is.

Deliberately let Deputy Director He guess by himself.

Deputy Director He is in his fifties, at this age, it is impossible for him to not have any pain in his body. I'm afraid he will live in fear and suspicion every day in the future, that **** Xiao Zhou is referring to what is wrong with me?

If he has a stomachache today, he will wonder if he has bowel cancer.

Then I will try my best to make an appointment for colonoscopy and do abdominal CT.