For severed limbs, surgery within 6 hours will generally have a good survival rate. The preservation environment is OK, and if the temperature is low, there is still hope within eight hours.

There have even been cases that have been successfully received for more than 12 hours.

The man's four fingers were still pale and wrinkled for more than 24 hours after they were replanted, which is a very bad sign.

Only the fingers that have lost their life look like this.

Dr. Shan examined the patient carefully and then asked about some post-operative symptoms.

For example, do your fingers hurt?

Have you paid attention to keeping it warm?

Did you follow your doctor's instructions after surgery, etc.

Zhou Can just stood at the end of the bed and listened.

When the doctor rounds the ward, the order of admission and the position are all particular.

The right side of the patient is generally reserved for the director and attending physician, and the left side is reserved for the resident physician. When the director rounds the ward, there are usually multiple residents, and at this time, it is necessary to determine the priority according to the seniority.

The station with high seniority is in front of the station, and the station with low seniority is behind.

The head nurse usually stands in front of the bed, so that she can 'care for the patient' at any time.

The rest of the bedside position is reserved for inconsequential people to stand.

For example, trainees, interns, graduate students, advanced students, etc. These are all at the end of the bed.

After Dr. Shan examined the patient, his face was quite solemn.

Others also felt the oppressive atmosphere.

Failure of the operation is a bad outcome for the patient, his family, and all the doctors and nurses.

"Can you show me the medical records?"

Zhou Can didn't come up with this limelight, but remembered a situation that the teacher had said.

He wanted to confirm the basic condition of the patient before making further analysis.

The bedside doctor was a somewhat greasy young doctor, about thirty years old. It may be that there is too much puberty, and there are dark marks on the face that have been left after the acne has healed.

He just glanced at Zhou Can faintly, and did not respond.

I'm afraid I'm still thinking in my heart, this stupid B-regulation trainee, didn't you see that this is the attending round? Who do you think you are?

"Bring the medical records!"

Doctor Shan saw that the greasy man did not react, and her tone was extremely cold.

A lot of doctors actually hate bureaucracy and bureaucracy.

Because the patient can't afford to wait, can't delay, and the condition can't be perfunctory.

The normal way for doctors and nurses to curry favor with leaders at all levels and senior doctors is understandable. They all want to be on top, and they want to get more support and resource inclination.

But absolutely no doctor likes bureaucracy.

Because it means a high mortality rate, a high accident rate.

The greasy male doctor was frightened, he didn't understand why Dr. Shan was so angry?

He respectfully handed over the medical notebook.

"Check it out!"

After Dr. Shan took it, he handed it over directly to Zhou Can.

"If there is anything Dr. Zhou wants to know, if it is not recorded in the medical record book, you can ask questions at any time."

By doing so, she is almost tantamount to publicly supporting and cheering for Zhou Can.

"Thank you!"

Zhou Can took the medical record book and read it carefully.

The patient was operating a shovel with a co-worker when he cut off four of his fingers due to the co-worker's improper operation.

After the accident, he was immediately sent to the local social hospital.

The doctor simply bandaged the wound and provided the patient with an ice pack to refrigerate the severed finger. They are advised to go to a major hospital immediately for finger amputation and replantation.

So I drove to Tuya Hospital.

After receiving the consultation, Director Shen led a team to perform finger amputation and replantation surgery on the patient.

At that time, in order to shorten the operation time, Dr. Shan and Director Shen performed finger replantation for the patient at the same time. One person received two severed fingers. The bone grafting of the four fingers was all done by Director Shen.

She mainly performed tendon anastomosis, vascular anastomosis and nerve anastomosis on the patient's two fingers, and cortex suture of the severed fingers.

The whole operation went very smoothly.

At that time, the blood supply to the four fingers was also unobstructed.

After Zhou Can read the medical records, he walked to the bed and carefully checked the patient's palms and backs.

I saw that the back of his hand was close to his wrist, and near the tiger's mouth, there were many bruises and purple scars.

"When you talked to Dr. Shan, you mentioned that your thumb is numb, right?"

"That's right! When I first got hurt, I thought I was in pain. After the surgery, I thought I would be fine when I woke up from anesthesia. As a result, the thumb still feels numb until now. ”

The patient is honest about what he really feels.

Zhou Can nodded and took a straw from the tin cabinet at the head of the bed. Touched the patient's index finger near the palm end.

"Do you feel it?"

"It's a little bit, but it seems to be a layer of clothing."

The patient's literacy level is limited and the description is not so specific.

The analogy is quite vivid.

Zhou Can tried his other three fingers in turn, and they were almost the same.

It feels very wooden and extremely insensitive to the touch.

At this point, Zhou Can basically has the bottom in his heart.

He picked up the patient's film again and watched it carefully.

Doctor Shan waited patiently, and even though the other doctors were a little dissatisfied with Zhou Can in their hearts, they had to be patient.

"Doctor Shan, do you see the position where the back of the patient's hand is injured, is it the reflux branch of the median nerve?"

"That's right! The median nerve is at about this location. ”

She nodded.

Then, little by little, the eyes brightened.

There was also a hint of sudden realization on his face.

"You mean, the median nerve is damaged, so the blood vessels are affected?"

Doctor Shan's expression at the moment, how can he still have a cold and serious demeanor.

is clearly a happy child who has found the answer.

The previous solemn expression has long been swept away.

"I didn't say it, you said it." Zhou Can blinked.

"Hehe, you can find out the cause of the poor blood luck of the severed finger, you at least have a lot of credit."

Doctor Shan generally rarely laughs.

At this moment, Zhou Can's sensibility saved her enough face and gave her all the credit. It makes her very happy and useful.

"Mr. Gao, now we suspect that this part of yours is injured, and it is likely that it has injured nerves. Nerve cells are the only ones that are not renewable. So, if the nerve damage is severe, there is probably nothing we can do about it. Now I will prescribe two tests for you, focusing on whether the nerve pathway is interrupted and the hematoma in this area. ”

"After we find out, we will formulate a new treatment plan for you, and do our best to preserve the fingers of your hand, as well as the function of the hand."

She communicates with her patients and leaves room for her to be left at every turn.

And let the patient make their own choices.

Among them, Zhou Can secretly learned and absorbed the communication skills.

In addition to the efforts of doctors to improve the level of diagnosis and treatment, communication with patients is also a compulsory course.

"Doctor Shan, may I ask me, is there any relationship between nerve damage and poor blood flow of the replanted severed finger?"

The medical level of the greasy male doctor should not be very high.

I don't know the relationship between the two.

The relationship between the two is rarely recorded in books. These are all valuable experiences that doctors have summed up in practice.

Zhou Can just clicked, and Doctor Shan knew the reason.

She clearly knows the link between nerves and blood vessels.

This also shows that it is too important to have a director-level teacher.

There are a lot of detours that can be avoided.

"You can ask Dr. Zhou!"

She should have taken this opportunity to deliberately teach the greasy male doctor a lesson about his arrogance and official behavior towards Zhou Can before.

The greasy male doctor looked at Zhou Can with an embarrassed expression.

Let him, a senior resident doctor, ask a regular trainee for advice, which is somewhat faceless.

What's more, not long ago, he also pretended to be an uncle in front of Zhou Can.

How embarrassing it is to ask people for advice now!

If you don't ask, it's only more embarrassing.

Everyone knows what's going on, and they're sure to laugh at him secretly.

"Zhou ...... Doctor, can you give me some pointers? ”

The greasy man had no choice but to be cheeky and open this mouth to Zhou Can.

"The nerves are damaged, which may affect the poor blood flow, and your teacher didn't teach you?" Zhou Can asked rhetorically.

"Ahem...... Maybe I taught, maybe I forgot. ”

The teacher of the greasy male doctor, who died is the attending level.

If the instructor doesn't like his personality, it's probably a routine formality.

Therefore, the reason for the poor level is still to find the reason from yourself.

Arrogance, incompetence, bureaucracy, these personality flaws may not please the senior doctor.

"Doctor He, remember to follow up with the patients in this bed. After he finishes the examination, he can show me the results or ask Director Shen. It has been more than a day since his severed finger was replanted, and it must not be delayed. ”

Dr. Shan explained the matter to Dr. Ho for follow-up.

She took a few people to continue her rounds.

There are more than 100 beds to check, and even if each bed takes an average of one minute, it will take nearly two hours.

Therefore, ward rounds are basically to check key patients.

Patients who have just undergone surgery, may be life-threatening, and who are focused on by the director need to be carefully examined to understand the patient's condition. The remaining ordinary patients can only be left to resident doctors, trainees, and interns to check slowly.

After about half an hour, they checked all the open beds in the group.

Dr. Shan took them to the two wards of the group to continue their rounds.

Patients who need to be admitted to the ward generally require special care or have high environmental requirements.

Nurses and doctors are also very attentive to the patients in the ward.

Everyone was afraid of something.

Zhou Can saw the male patient who had been transferred from bed 120 at a glance.

"Hello Dr. Zhou!"

When the male patient saw Zhou Can, he immediately greeted him warmly.

If Zhou Can hadn't been scolded by the senior doctor two days ago, his problems would have been reflected.

It's hard to say whether he can keep this leg.

The male patient didn't say anything, but this gratitude has always been remembered in his heart.

Seeing Zhou Can at this moment, he was very excited and very happy.

"Hello! Coming here? ”

Zhou Can smiled and stepped forward to talk.

The male patient's wife also knew that the young doctor was a benefactor. He handed a bottle of eight-treasure porridge for the patient's breakfast to Zhou Can.

"I have to thank you last time, we countrymen, we don't have anything good. Please drink a bottle of porridge and don't dislike it. ”

"Thank you, but our hospital has a policy that we cannot accept any gifts from patients and their families. This bottle of porridge, let's keep it for my uncle! ”

Zhou Can felt very relieved and happy.

Every time a patient is cured of a disease or a patient's life is saved, they are grateful from the bottom of their hearts.

For example, Mr. Cui, and Mr. Wu's child, or the simple middle-aged couple in front of them. The gratitude of these people made Zhou Can feel very happy.

"Are your legs better now?"

"After a re-operation, it's much better. My leg doesn't swell anymore. ”

The middle-aged uncle said with a smile.

It seems that the middle-aged uncle's spirit is much better than that day.

Zhou Can took the opportunity to uncover the quilt and check the middle-aged uncle's feet.

The edema is gone, and the subcutaneous purpura is gone. The skin tone of the feet looks pretty good. However, the skin of the foot is still a little wrinkled. This is normal.

It is necessary to wait until the patient is able to walk on the ground and then do some rehabilitation exercises for this foot.

When the time comes, it will naturally return to normal.

"After his first operation, a blood clot formed in his blood vessels, which may have something to do with the damage to that blood vessel. Later, Director Shen intercepted a section of his vein and replaced it, which was completely resolved. ”

Dr. Shan explained later.

may also want to tell Zhou Can that the formation of blood clots is not that she did not sew them well. Rather, it is the patient's blood vessels that are damaged.

In fact, in the final analysis, it is still inexperienced and unskilled.

If it had been Dr. Xu who had done the vascular anastomosis in this operation, this would definitely not have happened.

Soon, they checked all the beds in the two wards.

The patients who live here all have problems of one kind or another, and they need to be carefully cared for or monitored. And a lot of them have had major surgeries.

For example, the sternalectomy patient that Director Shen presided over yesterday, Zhou Can was fortunate to see in the inpatient ward.

The ultimate goal of this surgery is usually to remove the glandular tumor.

It is a major thoracotomy surgery.

The minimum level is level 3, and the risk factor is extremely high.

Orthopedics sometimes cannot perform one such operation alone, and it needs to be performed together with a cardiothoracic surgeon.

If we have a subdivision of the glandular gland surgery department, we may also ask the doctor of this department to perform the surgery directly.

In today's more and more subdivided medicine, to achieve a certain subdivision to the extreme, that is the real cow B.

I can't help but mention the spirit of craftsmanship in Japan.

Their craftsman spirit of pursuing only one thing all their lives is actually worth learning from.

Even if you make a sushi serving, there are people who take it to the extreme.

Who would have thought that someone would be able to become a master with such a simple thing as making sushi. In addition, after continuous refinement of sushi making, several genres have been divided.

It belongs to the subdivision again.

With a small understanding.

It is not for nothing that Japan can imagine that Japan has been able to make achievements in many fields.

"Let's go to the operating room! The three of you newcomers, every day after work, need to understand all the surgical patients in this group clearly. The patient's information and surgical arrangements can be viewed through the intranet. In addition, you are also required to keep abreast of the newly admitted surgical patients in this group, as well as the patients who have not been discharged after surgery. ”

Doctor Shan taught the three of them how to log in to the intranet.

First of all, you need to verify the login identity, and the hospital information center will contact the department where the trainee is located after receiving the verification request. After obtaining the permission of the section director, the corresponding viewing permission will be released.

This one is actually quite convenient.

Zhou Can went up to check it, and the surgical patients in this group were classified into three categories according to unoperated, upcoming surgery, and postoperative.

The patient who is about to operate, when, in which operating room, and who will perform the surgery, are clearly written.

This is not the case in the emergency department.

Basically, we treat whatever patient comes. If surgery is not possible on the same day, the emergency department must be transferred to a specialist.

It's already past 8 a.m., and there will certainly be no more time left for them to review the information of their patients.

Dr. Shan took them straight into the operating room.

Today, I entered a 100-level operating room. It seems that this is preparing to participate in a major surgery.

After entering, an unfamiliar male doctor with two resident doctors had already arrived early.

The male doctor may be thirty-seven or eighteen years old, tall and burly, and the whole person exudes a lot of aura. He was studying a dozen pieces that appeared on the light curtain.

"Doctor Chi is early! is worthy of being the strongest attending doctor in our group, and he came to study the patient's film so early in advance. ”

Dr. Shan greeted each other with a smile.

"Don't compliment me! If you hadn't taken on the ward rounds, would I have been able to go into the operating room in advance so leisurely to read the information? ”

After Dr. Chi responded, he continued to concentrate on reviewing the patient's footage.

Being able to become the strongest attending doctor in the group really has his strengths.

If nothing else, this concentration alone is not something that ordinary people can have.

Dr. Shan also walked over to watch the film.

The film is not complicated, showing an X-ray of a patient's right hand.

The patient's thumb bone is clearly missing.

Qi root, the whole thumb is gone.

I don't know if it's a congenital malformation or an acquired accident that causes disability.

What kind of surgery is going to be done?

Zhou Can was secretly curious.

His status is extremely low, so he can only stand behind Dr. Tang and Dr. He, watching the film from afar.

Not long after, Director Shen walked into the operating room quickly.

One director, two very good attendors, plus several residents and trainees. There are also three surgical nurses.

Just by looking at this battle, you know that this is a major operation.

Finger replantation is only a second-level surgery.

There is no need for so many doctors to go out together.

"It's all here! Yes, the work attitude is very positive. ”

When Director Shen looked at Doctor Shan and Doctor Chi, he seemed to be looking at the two generals he relied on the most.

Zhou Can has just entered orthopedic surgery for a few days, and I don't know how many groups there are in orthopedic surgery?

I don't know who the doctors in this group are.

Director Shen is the team leader, and Dr. Shan and Dr. Chi are the two main directors. There are also four resident doctors, including Dr. Tang and Dr. He.

This is the person he knows at the moment.

The screen shows the patient's mutilated right hand. It is a natural malformation. The thumb holds more than 50% of the functions of the hand, and it is very important! The patient is now a twenty-one-year-old man who earns a little money from a part-time job, and he happened to hang up my number when I went to the clinic. He said that the lack of his right thumb has brought him a lot of troubles over the years. ”

"It's not easy to write, it's inconvenient to hold things, and you can only use your left hand to wipe your buttocks. Looking for a partner, the girl saw that his hand was disabled, and ran away. He wanted to ask our doctor to think of a way to help him get a thumb. ”

Director Shen gave a brief introduction to the patient's situation.

In addition to sympathy, the doctor was deeply moved by this kind of self-improvement disabled patient.

Be willing to help them in any way you can.

Another thumbs-up?

How is this made?

Nowadays, medical technology is becoming more and more developed, and I have never heard of artificial hip joints, artificial blood vessels, and never heard of artificial thumbs.

A low-level leg amputation can be fitted with a prosthesis to restore most of the patient's leg motor function.

But how do you get the thumb on your hand?

Director Shen smiled and scratched the display screen of the light curtain.

"Look, this is an X-ray of the patient's foot."

Zhou Can looked carefully, and the patient's right foot bone was clear and complete.

(End of chapter)