Monday when I just wanted to have a thoracentesis.

He Congshuang on the side stopped: "Wait, what is an intern doing in such a hurry, let's talk about the taboos of thoracentesis surgery first." See how good your theory is. ”

Monday's face was helpless.

Brother is a man who scored 100 points in the practical exam, and he has to ask questions about thoracentesis.

Monday just wanted to complain.

Seeing that He Congshuang's thin cherry red lips were about to open again, I was afraid that she would deduct points again.

Hey, under the fence, let's answer honestly......

"First of all, the chest puncture should be anesthetized, and those with a history of anesthesia allergy should not be punctured. ”

"In patients with suspected thoracic echinococcosis, puncture can cause spread of infection and should not be punctured. ”

"No, if there is an infection at or near the puncture site. ”

"Coagulation dysfunction, severe bleeding tendency, not suitable for puncture. ”

“……”

Monday was gushing endlessly.

He Congshuang finally said: "Okay, okay, the answer is good, let's start operating." ”

Monday is ordered.

Surgery begins immediately.

Puncture is the same as all surgeries.

After the sterilization is completed, it is time to choose the location of the operation.

Pneumothorax puncture point, midclavicular line, second intercostal space, inferior superior rib border.

Determine the position and spread the hole towel, which is a piece of cotton cloth with a hole in the middle, which can facilitate the surgeon to determine the position of the operation.

This is followed by an injection anesthesia.

Minor surgeries can be performed without a professional anesthesiologist.

Monday has to be hands-on.

Local anesthesia is still infiltrating local anesthesia with 2% lidocaine along the upper border of the next rib at the puncture site.

Infiltrative local anesthesia is when anesthetic drugs are injected directly around the surgical site or surgical excision site.

But it's a local anesthetic.

It's still a little different from the debridement kind.

A dermal mound is inserted into the skin, and then the needle is inserted vertically to anesthetize the pleural layer in layers. One thing to note here is that when pushing the anesthetic, the needle should be withdrawn.

This kind of small operation was played in the emergency center on Monday.

After the anesthesia is finished, apply pressure for a while.

While waiting for the anesthesia to work, I chatted with the patient on Monday out of boredom.

"Where are you from?" asked Monday.

"Qin Zhong. ”

"Do you have a girlfriend?"

"Doctor, you still ask these questions. ”

"Didn't I let you relieve your stress?"

"Oh, no. ”

"Is the anesthesia uncomfortable?" Zhou Zhou finally got to the point.

"Nope. ”

Don't look at this as a virtual world, it's not the same level as the stupid NPCs in those virtual games in reality, and he has a decent answer to Monday's professional questions and small talk.

So that Zhou Yi didn't feel like he was in a virtual world at all.

At the end of the inquiry, it can be regarded as a small assessment of local anesthesia.

The anesthetic also began to work at this time.

The next step is the official operation.

Monday picked up the needle and checked that it was sharp.

Wait a minute, the puncture will all depend on this thing.

As the saying goes, if you want to do a good job, you must first sharpen your tools.

After confirming that the needle is correct, the next step is to check that the rubber tube to which the needle is connected is normally and airtight.

Everything is in perfect condition.

On Monday, the rubber tube on the puncture needle is clamped shut and the rubber tube is wrapped in sterile gauze.

Everything is in order, the index finger and middle finger of the left hand are fixed in the skin of the puncture point, and the puncture needle is slowly inserted along the anesthetic site in the right hand.

At this time, Zhou Ming clearly felt the resistance of the patient's body tissues to the needle, and Zhou Zhou felt a slight force on his hand.

This is where the need for inspection equipment comes in.

If you happen to come across a flawed needle, the patient has suffered in vain.

Little by little, the needle entered, and when Monday felt the resistance of the needle suddenly disappear in an instant.

It is proved that the puncture has been successful and the needle has entered the body.

The next step is to connect the other end of the rubber tube to the syringe, open the clamp, and start pumping the gas.

……

The piercing is complete.

Because the trauma is small, less than those minimally invasive.

Therefore, the iodophor wound can be disinfected and bandaged.

Monday is the end of the operation.

Waiting for He Congshuang to check.

There's nothing to check for this either.

Monday was a 100-point practical demonstration.

The screen turns.

Monday went straight back to the office.

Regarding Zhou Zhou's performance just now, He Congshuang didn't have any after-the-fact evaluation.

The quest is continuing.

Since it is a cardiothoracic surgical copy.

You can't just have thoracic surgery.

Cardiac surgery is also indispensable.

No, the second patient is the one who has heart problems.

The patient, male, presents with palpitations, chest pain, and malaise for 5 days.

He Congshuang is still the same, and after a physical examination, he asked Zhou Zhou to give the inspection items.

Such a patient with chest pain. An electrocardiogram (ECG) is indispensable.

Monday is of course the first to have the patient check the ECG.

The ECG came out, and the ECG showed sinus tachycardia of 119BPM, mild ST-segment elevation and T-wave inversion.

This chest pain has nothing to do with the outside of the chest. It must be a heart problem.

In order to confirm the diagnosis, heart-related tests are continued.

Without the help of the system, none of the inspections that can be done are missing.

Biochemical, photographic, and functional examinations were all given.

Open the door, close the door.

All kinds of inspection data came one after another.

Cardiac enzymes are negative, CT angiography shows a large pericardial effusion to rule out pulmonary embolism, echocardiography shows a large pericardial effusion, and right ventricular diastolic collapse with signs of cardiac tamponade.

Well, that's it.

Pericardial effusion is almost certain.

When pericardial effusion is severe, pericardiocentesis is required for drainage.

In principle, it is similar to thoracentesis.

However, it is much more difficult than thoracentesis.

Thoracentesis can be done casually in a county hospital, but pericardiocentesis may not be possible.

Is it wrong for this surgery to appear in the intern's copy all at once?

Actually, no.

Because this is an extracardiac first degree surgery.

It can be seen how terrifying it is outside the heart. Any first-level surgery is difficult.

Same process.

Before the start of surgery.

He Congshuang first tested Zhou Yisheng's theory.

But this time, He Congshuang no longer asked about the contraindications of pericardiocentesis on Monday. Instead, ask him about the indications.

Theory is not difficult at all for a good student like Zhou Sheng.

Monday tells the story.

"If a large pericardial effusion presents with cardiac tamponade symptoms, puncture and aspiration are used to relieve compression symptoms. ”

"Pericardial effusion is taken to assist in diagnosis and determine the cause. ”

"Pericardial intracavity therapy. ”

Although it is also a puncture, it also has two functions, treatment and diagnosis.

But pericardiocentesis is the father of thoracentesis.

If you can do pericardiocentesis, you must be a master of puncture.

In an urgent care center, the chances of having a pericardiocentesis done are almost non-existent.

If the pericardiocentesis is not done well, if the puncture penetrates the heart, then it will lead to massive bleeding, which is directly life-threatening.

Therefore, the emergency department is generally an electrocardiogram, and as soon as the CT film comes out, it will be directly consulted.

If further puncture diagnosis or treatment is required, it is also a matter of cardiac surgery.

After all, the degree of danger in the heart is not comparable to that of the chest.

Without two brushes, that's going to kill you.

Take Cao Xin, who is outside the heart, for example, he has been outside the heart for more than a year, and he has not done this pericardiocentesis.

……

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