"The patient, a 25-year-old man, was admitted to the hospital with bleeding from his head and vomiting for two hours after a car accident."

"Forehead scalp laceration with local skull depression, normal limb muscle strength and muscle tone, emergency scalp debridement and suturing. The patient is conscious, fluent in language, has two pupils equal to the size of the circle, diameter 3 mm, sensitive to light, automatically opens the eyes, answers questions correctly, can follow the instructions, GCS score 15. ”

Reading the results of his assessment, Zhang Lu handed the film in hand to Tian Lu: "According to the results of the CT examination, it is suggested that the forehead skull is depressed fracture. ”

Tian Lu took the film, and after watching it for a while, he nodded and said: "Acute open head injury, open skull depression fracture, and pneumocranium, I think it's better to prepare for surgery." ”

Nodding, Zhang Lu agreed with Tian Lu's judgment. In acute open head injury, the key to preventing complications is immediate and thorough debridement, although the patient's condition is good, but it is better to have surgery earlier.

Before the operation, there were a series of necessary examinations to be done, and the anesthesiology department had to be asked to do a risk assessment, which was a lot of things, so Zhang Lu sat down and got busy.

"Huh?"

Watching Zhang Lu open the list, Tian Lu was very sensitive to find that his movements often stopped suddenly, often halfway through a word, Zhang Lu's hand would stop for a while, and then he could continue to write.

What's going on?

Tian Lu's brows furrowed deeply.

As a neurosurgeon, the importance of hand stability naturally goes without saying, and looking at Zhang Lu's performance at this time, it seems that his body is in an abnormal state!

Because it was related to the next operation, since he found that something was wrong with Zhang Lu tonight, Tian Lu asked without hesitation: "Teacher Zhang, are you a little uncomfortable?" ”

"Huh?"

Zhang Lu was taken aback when he heard this, hurriedly raised his head, and said with a forced smile: "Oh, it's okay, it's just that I'm a little tired today, and my spirit may not be very good, hehe, I'm older, I can't compare to you young people." ”

"Then you still don't want to participate in the next operation, go back to the duty room and rest first." Tian Lu immediately said with concern.

Zhang Lu waved his hand again and again: "No need, wait for me to be your assistant, it should be fine!" ”

"That's not going to work!"

Tian Lu shook his head and persuaded: "Teacher Zhang, even if you can persevere, we are still responsible for the patient, I think you should go back and rest first." I asked Zhang Qianqian and the two of them to help, this operation is relatively simple and there is no problem. ”

After hesitating for a moment, seeing that Tian Lu's expression was very resolute, Zhang Lu finally nodded and agreed.

Lin Jun and Zhang Qianqian rushed over when they heard the news, and when they heard that there was an opportunity to do Tian Lu's assistant surgery, the two students were very excited, such an opportunity was relatively rare for them.

Everything went smoothly, and soon, the patient was wheeled into the operating room, and Tian Lu and the two students were also standing in front of the operating table.

"Activate the Clinical Operations Support System!"

Silently, Tian Lu gave a command in his heart.

An operation that is not complicated, there is no problem if the operation support system is not activated, but Tian Lu has long been accustomed to surgery with the help of the operation support system. Moreover, in the future medical practitioner law, it is also stipulated that the surgeon must turn on the system when performing surgery, even if he has performed thousands of surgeries!

Being able to give 100% certainty of surgery an additional layer of protection is something that every qualified physician should do.

The patient's hair had been shaved, Tian Lu drew a line on the patient's head, and after glancing at the two students, he found that Lin Jun and Zhang Qianqian were obviously a little nervous in addition to being excited, and the four eyes fell on Tian Lu's face, for fear of missing any instructions.

"Hehe, don't be so nervous about you two."

Tian Lu said with a smile: "This is not a complicated operation, and the patient's condition is not bad, so don't worry." Your job is to be an assistant, just do what I tell you to do. ”

Perhaps infected by Tian Lu's indifferent expression, after a few words, Lin Jun and Zhang Qianqian's expressions relaxed a little. Indeed, depressed skull fracture surgery is only a second-level operation in the surgical classification of the gods, which is not difficult and not very dangerous. However, the eyes of the two were still firmly fixed on Tian Lu's movements, as if they were afraid of missing a little.

While comforting the two students, Tian Lu's movements were not slow at all, drawing a marker line on the patient's head almost without thinking, and then directing the two to place the patient in a supine position.

After routine disinfection and towel laying, Tian Lu began to inject lidocaine subcutaneously into the patient.

"Can anyone tell me what is the purpose of injecting lidocaine?" Tian Lu asked softly while operating.

Zhang Qianqian wrinkled her nose and was still thinking, but Lin Jun replied on the side: "Avoid the stimulation of blood pressure during the skin cutting process, and it also has a certain hemostatic effect." ”

"Good!"

Tian Lu nodded with satisfaction. Since both of them call him Teacher Tian, naturally they can't do the operation by themselves, and the operation is not very complicated, so they just have the addiction of being a teacher.

Cutting open the skin and subcutaneously, directing the two students to stop bleeding with scalp clips and bipolar electrocoagulation, Tian Lu's hands are like mechanical arms, without a trace of trembling, and performing a series of operations: separating the scalp under the cap aponeurosis, turning the skin flap forward, exposing the partially sunken skull.

"So fast!"

While helping Tian Lu fix the flap, Lin Jun and Zhang Qianqian's eyes lit up, and they suddenly exclaimed in their hearts. Although they have never been assistants on the operating table, both of them have seen neurosurgical operations, and it seems that they have never seen any doctor whose movements can be as fast and stable as Tian Lu!

"I'm afraid that even Director Leng, he can't do Teacher Tian like this, right?"

After recalling and comparing the cold surgery, Zhang Qianqian mentally got an answer that surprised her.

Carrying out the next step, Tian Lu then asked: "Zhang Qianqian, what is the function of the gauze under the flap?" ”

Zhang Qianqian, who was named by Tian Lu, was stunned, and shook her head in a little panic, indicating that she didn't know, but after Lin Jun saw her shaking her head, he said softly: "Prevent scalp blood vessel occlusion." ”

Zhang Qianqian's little face turned red!

She didn't know the answer to the two questions in a row, but Lin Jun's stuffy gourd answered it as soon as possible, which made her suddenly feel extremely ashamed, if she hadn't stood on the operating table, she couldn't wait to find a crack to get in.

Ignoring the change in the assistant's expression, Tian Lu, who was very satisfied with Lin Jun's answer, continued the operation he was working on.

"Zhang Qianqian rinsed the field with hydrogen peroxide and normal saline, and Lin Jun operated the suction device!"

While instructing the two of them, Tian Lu cleaned up the foreign body in the surgical field, and then cut open the periosteum, and used a periosteal driver to separate the periosteum, exposing the patient's skull.

"Oh!"

It was the first time for the two students to see the real skull so closely, and they couldn't help but let out a low exclamation when they saw the sunken skull that had been partially shattered.

The next step is one of the difficult aspects of the operation: punching.

It looks very simple, but to master the strength of the hand, it is indeed necessary to have a certain amount of experience in judging the depth of the punch, Tian Lu did not hesitate without any hesitation under the prompting of the system, and soon made two holes at both ends of the depression.

Next, the dura mater is isolated under the inner skull plate with dural stripping, the bone flap is milled along the perimeter of the depressed fracture with a milling cutter, the subdural mater is separated with a gelatin sponge, and a hole is drilled at the edge of the bone plate to suspend the dura mater.

Doing the above series of operations, Tian Lu did not forget to give a lecture to the students: "Using a gelatin sponge under the bone flap for separation can avoid dural rupture and hemorrhage, and suspend the dura mater, which can reduce the dissection and hardness of the dura mater after surgery."

Occurrence of extrameningeal hematoma. You have to remember that a good surgeon has a lot to master, not only to do the surgery quickly and cleanly, but also to think about the postoperative treatment and try to prevent complications. ”

After separating the bone flap and revealing the dura mater with some tears, Tian Lu began to cut the titanium steel plate according to the size of the bone flap.

"Teacher Tian, can't the removed skull be reset?" Zhang Qianqian asked with some curiosity.

Tian Lu shook his head and said, "The fracture is obviously shattered, and it is difficult to reset." ”

Looking at Tian Lu's cutting titanium steel plate, Zhang Qianqian shuddered when she thought that there was no skull on the top of her head, but a titanium steel plate with many holes, and she couldn't help but shudder.

Because there was a break in the dura, after cutting the titanium steel plate, Tian instructed Zhang Qianqian to rinse it with normal saline, and then carefully cut the dura mater along the breach and began to clean up the bone pieces embedded in the brain. Because it is necessary to minimize the stimulation of the brain, this step requires special caution, and Tian Lu not only followed the prompts of the system, but also opened his eyes wide and operated carefully.

After the cleanup, there was no obvious hemorrhage and cerebral contusion under the dura, and Tian Lu covered the surface of the brain with hemostatic material and sutured the dura mater tightly. After doing this, Tian Lu's attention was focused again.

Next, there is another difficulty in the operation: covering and fixing the titanium steel plate.

Covering the outside of the dura mater with hemostatic material, Tian Lu carefully removed the titanium steel plate and fixed it to the outer plate of the skull with screws. While fixing, the titanium steel plate should be constantly molded to conform to the original skull shape as much as possible to avoid the surrounding area of the titanium steel plate from being warped. This work is quite tedious, and even with the help of the system, it still takes a lot of time.

However, after this step, the operation is basically half completed, and Tian Lu, who was slightly relieved, suddenly accelerated the following operations.

A drain is placed, the cap aponeurosis is sutured in layers, the subcutaneous skin is sutured, and the scalp is sutured. Tian Lu's hands were like two dexterous butterflies, flying up and down, extremely dexterous, and completed the rest of the operation at the speed at which Zhang Qianqian and Lin Jun were stunned!

"Wow, that's great!"

At the moment when she finished the last stitch, Zhang Qianqian finally couldn't suppress the excitement in her heart, and called out in a low voice: "Teacher Tian, how did you practice?" Have you done this a thousand times? ”

Lin Jun also had an incredible look on his face, and looked at Tian Lu in a daze. When he first met Tian Lu, this kid was still quite unconvinced, especially when he learned that he returned to China after completing his residency training, he felt that Tian Lu couldn't get along there before coming back.

Now, Lin Jun has finally completely put aside this idea in his heart!

"Alright, let's send it to the postoperative anesthesia recovery room!"

The operation didn't make Tian Lu use up much physical strength, ignoring the surprise of the two students, he changed the subject with a smile: "But before that, I want to ask one last question!" ”

Zhang Qianqian's spirit immediately became highly tense, and the first two questions were not answered, which made her feel extremely embarrassed, and the last question could not let Lin Jun be in the limelight anymore.

"What are the routine postoperative treatments?" Tian Lu asked with a smile.

It's a simple question!

Zhang Qianqian was overjoyed, and hurriedly replied: "Postoperative neurological signs examination, 24-hour CT skull examination, three-dimensional skull reconstruction before discharge, antibiotics for three days, regular dressing changes。。。。。。 ”

After answering, Zhang Qianqian couldn't help but glance at Lin Jun proudly. This time, she finally got ahead of the wood.

"Anything else?"

Regarding Zhang Qianqian's answer, Tian Lu was noncommittal, and looked at Lin Jun, who had been silent.

Lin Jun thought for a while, frowned a little hesitantly, and said, "Do you want to evaluate, is it necessary to use anti-epileptic drugs prophylactically?" ”

"Ahh

If it weren't for the blood stains on the gloves, Zhang Qianqian would probably have to slap herself in the mouth as soon as possible! The incidence of late epilepsy caused by head trauma is not low, how can I forget this?

"Very good!"

Tian Lu, who was very satisfied with Lin Jun, did not hesitate to praise himself, smiled and waved his hand: "Send it away, remember, when he wakes up, the head of the bed will be raised thirty degrees." ”

In Zhang Qianqian's frustration, the two and the nurse sent the patient away together, but Tian Lu's face immediately became serious after they went out, and after cleaning up, he walked briskly towards the ward building。。。。。。

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I was a little hesitant to write this chapter, mainly because the terms used in the article were all used, I was afraid that everyone wouldn't understand, and my personal meaning was relatively boring, what do you think?