The 6th and 7th intercostal spaces on the left side, the midline of the clavicle, were marked and sterilized.

Chu Zhixi had already prepared the anesthetic, and Wu Mian used a 5ml syringe to draw the anesthetic, and the local infiltration anesthesia.

The peeling knife made an incision of about 1.5cm, and Wu Mian used a hemostat to perform blunt separation. The pliers were closed one by one, and Cheng Linhai's intercostal muscles were separated a few times.

"Dr. Wu, your hands are very light, and they don't hurt at all. Cheng Linhai wanted to comfort Wu Mian as much as possible, and he said lightly with a smile.

"Big man, why did you say this mountain fire started again?" Wu Mian asked.

Chu Zhixi prepared the chest tube, cut two side openings, clamped them with hemostats, and handed them to Wu Mian.

The county hospital also uses fewer chest tubes and chest bottles, and they will at most have a closed drainage. Thoracic surgery is a little more advanced than brain surgery to some extent, at least the county hospital can do neurosurgery drilling and drainage surgery.

The chest tube is still the oldest-fashioned, not the one with a steel core. But for Wu Mian, everything is pretty much the same. With pliers in one hand, he poked into the incision, chest tube in his palm, ready to go.

"Isn't this greenery, the old forest drops leaves year after year, and there are places in the mountains where the leaves are so thick that you can't walk. Cheng Linhai said, "Some times there is an open fire that lights the forest, which is okay to say." But thunder fire...... Our captain said that a piece of dew, which refracts the sun's rays, can be ...... by coincidence Ahh

As he was talking, Cheng Linhai suddenly shouted.

"Okay, it's okay. Wu Mian had already taken advantage of his full attention to talk about the mountain fire, and sent the chest tube in.

Cheng Linhai is in good health, coupled with the tension of the whole body, the pleura is hard, and it is almost impossible to complete the operation unconsciously. Wu Mian used a hemostat to penetrate the pleura, opening the jaws in an instant, and the other hemostat sent the chest tube straight in, clean and neat.

Chu Zhixi connected the chest bottle, and the dark brown pleural fluid gurgled out.

Sutured, fixed, the horn needle is seventh, Wu Mian's hand does not seem to move, and a beautiful knot appears, which firmly fixes the chest tube to the chest wall.

Wu Mian didn't let Cheng Linhai get up, he squatted in front of the disposal bed, carefully watching the fluctuations of the chest bottle.

There is a large amount of pleural fluid, with 500ml of saline underneath, and the saline is mixed with dark brown pleural fluid, and the water surface rushes up along the scale.

When it was 1000ml, Wu Mian stuck the chest tube with hemostats.

"Prepare methylene blue solution. ”

After saying that, Chu Zhixi handed the ajia blue to Cheng Linhai.

"Do you want to drink?" Cheng Linhai looked at the blue cup and frowned.

"Well, drink. Wu Mian said with certainty.

Cheng Linhai didn't chatter, he believed Wu Mian, even if Wu Mian "tricked" him once with a small trick just now.

Like drinking, Cheng Linhai is quite heroic, and he doesn't care whether the methylene blue is good or not, he simply pours the methylene blue down.

"When you drink slowly, take a sip ......" Before Chu Zhixi finished speaking, he saw that the cup in Cheng Linhai's hand was empty.

Wu Mian was ridiculous, sighed, and said, "It's okay, wait for me to see." ”

In general, the doctor will ask the patient to drink the methylene blue solution slowly, and if there is a rupture in the esophagus, the blue solution will enter the chest cavity along the esophageal fissure and then lead out along the chest tube.

This is a set of logical self-consistent diagnostic methods, which is commonly used in clinical practice. The only regret is that Chu Zhixi is a little slow to speak, and Cheng Linhai is a little strong in execution.

After about 10 seconds, Wu Mian opened the chest tube clamped.

The color of the liquid this time changed from dark brown to a strange color, and the dark brown pleural fluid was even more colorful, mixed with an extremely dark blue.

The diagnosis is clear, and it is indeed a ruptured esophagus.

Director Lu had been standing behind Wu Mian, engrossed in looking at the color of the liquid that came out of the chest bottle.

He sighed deeply at the sight of the strangely colored pleural fluid coming out, knowing that the young doctor's judgment was correct.

"Doctor Wu, how do you judge?" asked Director Lu.

"Boerhaave's syndrome......" Wu Mian said naturally in English, and then paused, "Spontaneous rupture of the esophagus is not very common, but there is no other reason for a large pleural effusion in a short period of time, and it can only be thought to be a spontaneous rupture of the esophagus." ”

"How do you know it's a short time?" Director Lu continued to ask.

"Because you've had a diagnosis. Wu Mian said.

"Me?" Director Lu was stunned, he looked at Wu Mian suspiciously, not understanding what Wu Mian meant at all.

"You are the old director of the respiratory department of the county hospital, and you have done all the simple tracheoscopy, how can you not listen to the auscultation? My judgment is that there is not so much fluid accumulation when you are examined, and the left breath sound is clear, slightly weak, and there is no wheezing, so you judge that there is no problem. ”

What Director Lu wanted to say was all said by Wu Mian, and he could only remain silent.

"And when I listened, the patient's left lower lung breath sound was very weak. At this time, the patient did not show signs of cyanosis of the lips, and I said before that you should not have failed to do auscultation, so I judged that it was a rupture of the esophagus. It is estimated that the pleural effusion is caused by a large person who drinks a lot of water after your examination. ”

It turned out that he had become a part of the patient's disease judgment, Director Lu carefully tasted it, and felt more and more that the young man in front of him was not simple.

"Dean Zhou, can you sign it. Wu Mian turned around and asked.

"Sign what?"

"The esophagus ruptures and requires a thoracotomy and surgical sutures. Wu Mian said.

"......" Dean Zhou was stunned for a moment, and said stubbornly, "Yes!"

If it weren't for the fact that he couldn't help it, he didn't want to make this trouble for himself. Esophageal rupture and sutures, that's the esophagus, not the prostate!

The prostate gland is picked casually, even if there is a secondary injury, how big can it be. The tension of the esophagus is very high, and the blood circulation after suturing is quite critical, and the possibility of esophageal fistula after surgery is quite high.

But this is a firefighter fighting a wildfire, who needs emergency surgery, and his family is not around. Moreover, the front line is urgent, and the people in the command and Captain Li are not there, so this word can only be signed by himself, the dean.

"Big man, gotta have surgery. Wu Mian said.

Cheng Linhai had been listening, and he asked suspiciously, "Doctor Wu, why do you think my esophagus is broken? ”

"I think you reflexively hold your breath when the flame rises, the abdominal muscles reflexively contract strongly, the abdominal pressure increases, and the cricopharyngeal muscles spasm, and the pressure in the esophageal lumen increases rapidly.

At the same time, you abruptly and abruptly stop inhaling during inhalation, and the negative pressure in the pleural space increases, resulting in esophageal rupture. ”

"......" Cheng Linhai asked a little regretfully what he said just now, Wu Mian's explanation, he didn't understand a word.

"Actually, it doesn't matter how it breaks, the important thing is that I have to sew the hole for you. The chest tube will be removed 2 days after surgery, you can go home in 1 week, and the stitches will be removed in 2 weeks, and you will be like a normal person. Wu Mian said with a smile.