"It's not started yet!"

Dr. Zou and Tang Li replied in unison.

Attending physician rounds are usually conducted after 7:40. However, it is not fixed, and it can be flexibly arranged according to the attending physician's own schedule.

As a general rule, you need to make rounds every morning.

Because only the doctor on duty deals with it at night.

On the one hand, there is a shortage of manpower, and on the other hand, the doctors on duty are often of low rank, experience and level.

This can lead to some cases where the patient's sudden danger is not handled properly.

During the morning rounds, the attending physician can check and fill in the gaps to avoid the expansion of risks.

"Well, then you guys hurry up and do your rounds. The first operation started at half past eight in the morning. I may not take a break in the middle of the way, and I will finish all the two surgeries today in one go. At four o'clock in the afternoon, I will take three graduate students to do scientific research experiments, and then you can only keep an eye on it. ”

Many professors in various departments have teaching tasks.

Or just work part-time in a hospital.

In addition to their own projects and scientific research, they also have to go to school to attend classes.

It's going to be very busy.

……

The two attending physicians acted separately during ward rounds.

Zhou Can followed Tang Li, a resident doctor, and three graduate students to make rounds together.

Dr. Zou took two older residents to check the beds he was responsible for.

All beds outside the gods are in charge of doctors. Many interns only have two or three beds per person. Regular trainees generally focus on about five beds. Residents who specialize in bed management keep an eye on ten to fifteen beds.

The attending doctor will be staring at more beds, and one person may need to be responsible for about 25-30 beds.

It must be explained that the beds that these people are staring at coincide.

For example, Zhou Can stared at 21-25 beds, and Jiang Xiaohua stared at 26-31 beds.

Cheng Gang, the senior doctor of the two, is responsible for 21-31 beds.

Here you can find that the bed that the junior doctor is staring at, the senior doctor needs to stare at again.

It's just that as the level of doctors increases, the number of beds in charge also increases.

At the level of Director Derwin, he is often responsible for all the patients in the entire team.

Director level, room rounds once a week. Some patients who are discharged quickly may not be able to see the chief physician for ward rounds.

"Dr. Zhou, the number of beds in our group is not fixed. You're new and probably not clear. ”

Tang Li walked forward and pointed at Zhou Can.

It is said that a woman's sixth sense is very powerful.

That may be the case.

Tang Li must feel that Zhou Can has a bright future in the future, so she will not hesitate to lower her figure and befriend him.

"There are two attending physicians in our group, me and Dr. Zou. Normally, I check the general beds in the group, and Dr. Zou is older and more experienced than me, and he checks the ICU ward. ”

The attending physicians in the group have a clear division of labor during ward rounds, which is conducive to the responsibility of people.

And according to the doctor's personal ability and level, better service to patients.

Dr. Zou is about five years older than Tang Li.

The experience will definitely be richer as well.

The patients in the ICU ward are all critically ill.

It is safer for an older doctor to check the ICU ward.

"Doctor Tang, it's early!"

Cheng Gang waited early in the ward under his jurisdiction.

Seeing Tang Li leading someone closer, he immediately greeted him with a smile.

"Morning!"

Tang Li seemed quite cold to him, just responded casually, and began to check on the patient in charge.

Cheng Gang looked at Zhou Can who was following Tang Li, and couldn't help but have mixed feelings.

It can be seen that after Zhou Can was transferred to Director Wen's group, the treatment was quite generous.

This kid is really lucky, why don't I have such good luck?

Cheng Gang was really envious.

"Dr. Zhou, this patient had surgery this afternoon. Operated by Dr. Zou, her skull was fractured and sunk deep into it. But fortunately, it didn't hurt the brain. ”

Tang Li took the initiative to introduce to Zhou Can the patient who was about to operate today.

The purpose is to let Zhou Can know in advance.

Zhou Can found that the injured woman was in her thirties, with multiple bruises and bruises on her face and hands.

How did you get hurt?

It feels like being beaten up like this by domestic violence.

The wound on her head was already gauze. The nurse should come two hours before the procedure to shave her hair and clean the surgical site. and measure basic signs such as blood pressure.

"How did you get hurt?"

Zhou Can couldn't help but ask.

"I just accidentally fell and injured myself."

The woman's gaze was a little evasive.

"This fall is a blessing in misfortune, because according to the results of the examination, a little bit more may lead to serious brain injury. At the mildest level, they are paralyzed and intellectually disabled, and if they are more serious, they may die directly. ”

Zhou Can didn't break it, but just told her the possible consequences.

It's not always like that.

There are only zero and countless instances of domestic violence.

Generally speaking, it is impossible for parents and brothers to be so ruthless.

It is highly likely that the woman's husband did it.

However, when Zhou Can was interning, he was beaten by the woman because he was in charge of such a bad thing. So, he didn't ask too much.

It's just a point-and-click approach.

The woman was in her thirties and was already an adult. She had to make her own choice.

After examining the woman with a fractured skull, the other patients in charge of the group continued to be examined.

After a round of examination, the condition of some patients is alarming.

However, I didn't see the car accident patient who needed surgery today.

It is estimated that he will be in the ICU to save his life.

Some of the injured are so severe that they are not ready for surgery and may need to stay in the ICU for a while. Save your life first, then have surgery.

There is also a situation in which the patient's injuries are extremely severe and complex.

For the sake of safety, doctors need to go through a multi-department consultation. After discussion, the surgical plan is formulated.

After checking the room, Tang Li prescribed some new medical orders. Medication adjustments have also been made for some patients.

After processing, he took Zhou Can and others into the operating room.

At this moment, the patient has been lifted onto the operating table.

The anesthesiologist is carefully examining the patient.

Dr. Zou watched with two resident doctors.

"Your speed is very sluggish!"

Tang Li said with a smile.

"There are only a few patients in the ICU, and after the examination, the three of us directly pulled the patients to the operating room."

Dr. Zou shrugged.

There are only 20 beds in the ICU, and there are probably only a few critically ill patients in their group.

In addition, the ICU has always had a special attending physician on duty, and ward rounds are relatively a process.

Zhou Can looked at the patient on the operating table, and saw that there were tubes inserted everywhere on this person's body, and dried blood stains could be seen.

The most seriously injured part should be the head.

The patient is currently in a coma.

At this time, Director Wen finally arrived.

"Is the patient okay? It is estimated that this craniotomy will take at least four to eight hours, will he be able to withstand it? ”

Director Wen was obviously asking the anesthesiologist.

"The situation is quite ideal. His surgical tolerance, my rating is relatively low. However, if the intracranial hematoma is not cleared, his life may not be saved. Therefore, I personally think it makes sense to have surgery as soon as possible. ”

The patient was in a coma and has not been revived.

That in itself speaks volumes about the seriousness of the problem.

The ICU can only give some basic life support, which does not mean that it can always save life.

In the ICU ward of Tuya Hospital, patients often die.

And many times, it is normal to die three or four people a day.

Of course, some of the deaths were due to family members insisting on having the tube removed.

After all, the cost of a day in the ICU is simply too high.

If it is an elderly person or a patient with little hope, and spends too much money on rescue, the family may feel that it is not worth the loss of both people and money. The hospital will be asked to extubate.

"Let's get ready for a craniotomy and hematoma removal!"

Director Wen spoke.

The car accident patient's examination report indicated that the person had a severe intracranial hematoma. Indicates that the intracranial hemorrhage is quite severe.

Craniotomy to stop bleeding and remove hematoma is a very aggressive treatment.

The patient was very young, in his twenties.

I heard that it was a car race with someone in the middle of the night and had a tragic car accident, so I was reweighted.

Zhou Can has seen the patient's film, and the situation is not optimistic.

Because this person is experiencing infracurtainal hemorrhage.

Surgery is usually required for supratentorial bleeding of more than 30 ml. As long as the subtentorial hemorrhage exceeds 10ml, it meets the surgical index.

After the patient was under general anesthesia, Director Wen selected the craniotomy position, cut the patient's scalp layer, exposed the skull, and directly applied the chainsaw.

Not long after the skull was cut, the anesthesiologist hurriedly shouted to stop.

"Director Wen, the patient's vital signs are declining rapidly. If I insist on a craniotomy, I'm afraid he won't be able to get off the operating table. ”

The patient's blood pressure, respiration, body temperature, heart rate, and blood oxygen index are all declining rapidly.

This is a very terrible sign.

During craniotomy, there is a risk that the patient's condition will be further aggravated due to various reasons.

The patient at this time is like a candle in the wind.

The wind blew a little stronger, and the flame of life was extinguished.

Director Wen's face sank like water.

The critically ill patients in the Department of Surgery are really difficult to save, and there are not only cases, but also a lot of cases.

Doctors perform surgeries to minimize mortality as much as possible.

Because it is related to a number of assessments, as well as personal reputation.

Imagine that a chief doctor performs 100 surgeries and kills seven or eight people. Who would dare to let this doctor go under the knife?

This is despite the fact that the hospital knows that the patients who died were critically ill.

However, during the assessment, this high mortality rate will still be criticized by the vice president, or even the dean himself, at the conference. It is possible to give a warning, or to reduce the authority for surgery.

The high rescue mortality rate not only has a serious impact on the doctor and his team, but also has an impact on the overall evaluation of the hospital.

"It seems that the patient's condition is more serious than I thought! It's a bit harder! ”

Director Wen stared at the rapidly declining vital indications on the screen of the life monitor, and his heart was stunned.

Even if the operation is stopped now and the patient is transferred back to the ICU, it will be difficult to get through.

"The intracranial hematoma has to be removed, otherwise he won't survive. Traditional surgery does hurt patients a lot. Before the surgery, I was prepared for the worst and prepared a second set of surgical plans. ”

Director Wen was prepared with both hands.

It is no wonder that when a patient is in danger, he can still be so calm.

"Let's drill holes for endoscopic surgery! This should be the only way to save him! ”

Endoscopic surgery requires only a small hole to be drilled in the skull, which is small and causes little damage to the patient.

However, compared with traditional surgery, endoscopic surgery is extremely difficult to operate.

Tuya's neurosurgery department is actually very short of talent in this area.

Director Wen's talent for advanced surgery is average, which is the main reason why he prioritizes traditional craniotomy.

Traditional surgery pursues a large field of view.

The whole procedure is simple and straightforward.

Endoscopic surgery is a great test of a doctor's manipulation skills.

"Endoscopic Surgery...... It's not our forte, the patient is bleeding under the tentorial hemorrhage, and the operation is extremely difficult, will it ......?" Tang Li wanted to say and stopped.

Not to mention her, even Dr. Zou was worried, and his eyebrows were full of sadness.

"If you're not good at it, you can't help it! It's really not good, so I can only ask Director Zhang of the Department of Obstetrics and Gynecology for help. Among the chief physicians of our hospital, she has done a good job in minimally invasive. ”

Director Wen has already thought of the way back.

Seeking help from other departments is a common practice when encountering critical and difficult cases.

This time, the patient's skull was drilled directly, and the bone flap was broken and a 1cm wound was drilled. A cross incision is then made in the dura mater.

Throughout the process, Director Wen was cautious.

Even if the patient's vital signs drop again and again, they still dare not stop.

At this time, every second must be taken to save the patient's life.

Fortunately, he has a lot of experience in surgery, and according to the CT images, the location of the hematoma is quite accurate.

Now it's time for the most critical action.

A rigid endoscope with a diameter of 6~8 mm is required to be introduced into the cerebral hematoma center.

This is a great test of the operating skills of the main knife.

Because the brain is full of important tissues, the slightest mistake can lead to serious consequences.

Director Wen carefully operated the endoscope and explored inside.

It was only when entering the center of the hematoma that he had a hard time.

Nearby is the brainstem area, which brings him great psychological pressure.

Sweat continued to ooze from his forehead, and the nurse helped wipe the sweat.

Director Wen's hands trembled uncontrollably slightly.

At this critical juncture, every second of delay increases the risk of death for patients.

The more this is the case, the greater the pressure on Director Wen.

Not to mention that he is the chief surgeon, even Tang Li and Dr. Zou next to him, including several resident doctors, are all hanging with a heart. Holding his breath, he didn't even dare to get out of the air.

"Director Wen, let me try? I should be more than eighty percent sure. ”

At this time, Zhou Can did not choose to sit idly by.

Actively ask for battle.

Although such behavior may seem arrogant and rude to outsiders.

"Are you 80% sure?"

Director Wen stopped his operation and turned his head to look at him.

"Sure!"

Zhou Can's gaze was firm, full of confidence, and he looked extremely calm.

"Okay, you try!"

Director Wen also knew that Zhou Can's level of operation in minimally invasive operations was quite high. In this unavoidable situation, it was decided to take the risk and let him try.

He himself stood nervously and watched, ready to stop at any moment.

Zhou Can took the lever of the endoscope, adjusted the angle slightly, and then manipulated the endoscope to probe deeper.

The whole operation process is very stable.

And it's precise.

The long practice of implantation has helped him a lot.

"That's it! Successfully reached the hematoma area, is the blood now withdrawn? ”

Zhou Can asked.

As soon as his words fell, the doctors and nurses in the operating room all breathed a sigh of relief. A smile of joy appeared on everyone's faces.

The hardest part of the game was finally over.

"Smoke it!"

Director Wen should be the most excited person.

Looking at Zhou Can's gaze, it was like looking at a treasure.

Zhou Can manipulated the catheter of the endoscope and performed aspiration. Blood in the cranial cavity is withdrawn.

After the intracranial pressure decreased, the patient's vital signs improved rapidly.

"Rise, rise! The patient's vital signs are on the rise. That's great! ”

The anesthesiologist was happier than anything else.

The good news is announced in a timely manner.

(End of chapter)