[Pathological diagnosis experience value +1.] 】

After Zhou Can gained 1 point of diagnostic experience points, he was even more sure that his judgment was correct.

Then you have to tell the two senior doctors in time.

[Congratulations on your pathological diagnosis being upgraded to level 4, current experience value: 1/10000, the main treatment is at the inferior level.] It can diagnose a variety of more complex diseases, with a certain probability of dialectically identifying hidden diseases and a small probability of dialectically identifying comorbidities. 】

Zhou Can didn't expect that at this moment, the pathological diagnosis would be upgraded.

Originally, his pathological diagnosis was only at the intermediate level of a resident doctor. It was because of eight months of hard work in the emergency department, bone surgery, and neurosurgery that it was raised from the inferior level of the resident doctor to the medium level.

He was able to move up to level 4 this time, thanks to the successful diagnosis of three cases of super difficulty in the intensive care department, plus several cases of normal difficulty. These include occult cases.

Comorbidities are those in which multiple lesions may be present at the same time under the same symptoms.

Multiple diseases are the most difficult to diagnose.

Even senior residents can easily miss the diagnosis when they encounter such cases.

"Pathological diagnosis has finally been elevated to the level of indication. Calculate the time, the one-year training period is about to expire, and you can apply for the medical practitioner certificate. ”

According to the requirements, one year of work experience is required after graduation to obtain a medical certificate.

Zhou Can has been training for 11 months, and it is estimated that during the cardiothoracic surgery, he will be able to get the medical certificate.

The pathological diagnosis was upgraded to level 4 at this time, which would be of great help to him in taking the medical practitioner's certificate.

Then the practical skills test, he is even more so.

The three-month training in the intensive care department, coupled with the surgical experience in multiple departments, was enough for him to pass the medical certification exam with ease.

Taking this certificate is simply a barrier for many trainees.

Many people fail the test, and in the end they are forced to change careers or take up administrative positions.

It is precisely that sentence, those who are difficult will not, and those who will will not be difficult.

Zhou Can forcibly suppressed the joy of the pathological diagnosis being upgraded to the fourth level, and looked at Dr. Zhao.

"Wait!"

It is a matter of patient safety, Zhou Can must be reminded.

"What's the matter with you?"

As soon as Dr. Zhao stood at the main surgical position, he was about to finish the finishing work when he was interrupted and looked very unhappy.

"Your electrocoagulation seems to have gone a little too far to stop the bleeding, and I'm worried that it will lead to tissue avascular necrosis."

Zhou Can stubbornly asked this question.

As soon as he heard this, Dr. Zhao's face changed suddenly.

It was only a little cold just now, but now it is overcast and frighteningly dark.

Even Doctor Duan didn't say anything, this Gui Peisheng actually found fault with him, it was too presumptuous, too arrogant.

"How do you know it's going to be avascular and necrotic? It's really just a mouthful. A novice like Ling just likes to be rare and strange, and people are worried. Dr. Zhao was quite annoyed.

almost didn't point at Zhou Can's nose and scold.

It is very dangerous to find fault with a senior doctor.

If Zhou Can really didn't have a choice, he really wouldn't care about this idle matter.

Dr. Duan did not rush to make a statement, but stared at the patient's wound.

"Although the electrocoagulation technique is a little rougher, there is no obvious problem. As for the damage to a little normal tissue, this is a normal phenomenon, and there is no need to make a fuss about it. The principle of electrocoagulation and hemostasis is to use the principle of high temperature to form scabs in the blood vessels, so that the bleeding stops. It is inevitable that there will be improper grasp during operation, which will cause damage to the surrounding tissues. Our body's recovery ability is very strong, and it can recover quickly, so you can rest assured. ”

Dr. Duan's tone was quite gentle.

even patiently explained to Zhou Can the principle of electrocoagulation and hemostasis.

He never imagined that this young man's level of hemostasis was still above him.

"But this patient has a lot of damaged tissue, so if you stitch it up like this, in case of ischemia and necrosis, the consequences will be very serious."

Zhou Can accentuated his tone.

"Okay, well, facts speak louder than words, and in two days, when this patient is successfully discharged, you will understand. As doctors, we must not only have a reverence for life, but also be bold and careful. If you're timid, you can't be a good doctor. ”

Dr. Duan stopped Zhou Can from dwelling on the topic again.

"Stitch it up!"

He directly asked Dr. Zhao to suture the wound.

It can also be seen from this incident that the level of each doctor is different. Perceptions will also be different.

Zhou Can clearly pointed out the problem, and Dr. Duan was like being blind, and he couldn't find it at all.

On the one hand, he thinks that Zhou Can is just a trainee with no experience in surgery, and his opinions are completely fussed. On the other hand, in Dr. Tuan's cognition, he has always done this. It was fine before, and it will be fine this time.

Dr. Zhao's level of sutures is okay, and the resident is at a medium level.

It's still a little short of the excellent level of residency.

After the wound was sutured, Dr. Duan examined it and nodded with satisfaction.

"Well, it's a good sewn. After waking up from anesthesia, you can send it back to the ward to recuperate. ”

The surgery has been done and can be withdrawn.

"Xiao Zhou, in order to prevent you from making a fuss next time, you will be punished to stay in the operating room today and help the nurses clean up together. It also allows you to have a little more insight and take a good look at how the surgery is done, so as not to laugh and be generous. ”

Dr. Zhao was annoyed that Zhou Can had found fault with him, and decided to give a slight punishment to Zhou Can to make him have a longer memory.

Punish him to stay in the operating room to clean up, killing two birds with one stone.

It can not only punish him, but also allow Zhou Can to observe the operations of other doctors.

Dr. Duan didn't care about this, didn't say anything, and left directly.

Zhou Can stayed in the operating room to clean up.

Because there is only one instrument nurse in this operation, there is no patrol nurse and handwashing nurse, and the cleaning task is all handed over to Zhou Can alone.

By the time Zhou Can finished cleaning, it didn't take long for doctors and nurses to push the patient and rush to the operating table.

"Yo, why is it a male nurse?"

The chief surgeon is a 38-9-year-old male doctor with gray hair, a temperament that looks quite elegant, and a very energetic person.

He was stunned when he saw a strange young man standing in the operating room.

"He's not a nurse, he seems to be a new trainee. Dr. Zhao asked him to stay in the operating room to clean up for the day, and by the way, he watched other doctors perform surgeries and gain more knowledge. ”

The surgical nurse came the same as last time.

She quickly explained.

The eyes of the other doctors and nurses who looked at Zhou Can immediately changed a little.

Everyone is a human spirit.

Gui Peisheng was arranged by the senior doctor to clean up in the operating room, and even fools understand that this is a punishment.

Only the anesthesiologist carrying the box looked at Zhou Can with a somewhat surprised expression.

He even nodded slightly at Zhou Can, which was regarded as a greeting.

"Quick, lift the patient to the operating table! Doctor Guan, immediately administer anesthesia to the patient. ”

Looking at the situation, the condition is critical.

Zhou Can also walked over to help. Anyway, it's just a rubbing operation, and if there is one more person to help, the chief surgeon will definitely not mind.

This anesthesiologist called Dr. Guan, Zhou Can knows.

Because Zhou Can has done many surgeries, and he has also done a lot of major surgeries above the third level.

For some major surgeries, this doctor is often seen.

Anesthesiologists are actually the same as ordinary doctors, and are divided into three levels: resident, attending and director. For different anesthesia procedures, the qualifications required are also different.

At the same time, anesthesiologists will also take apprentices like ordinary doctors.

All kinds of surgeries with more serious heart, brain, lung, endocrine and other systemic complications or surgical anesthesia with greater risk in preoperative evaluation need to be presided over by the director or deputy chief anesthesiologist.

They assess the risks throughout the perioperative period and consider that the safety factor is sufficient before the surgeon can perform the surgery.

Otherwise, even if the heavyweight department bosses like Wu Baihe and Hu Kan formulated a surgical plan for the patient, the anesthesiologist felt that the risk was too high after evaluation. Then it can only be put aside.

Or wait until the patient meets the criteria for surgery before elective surgery.

Therefore, the status of anesthesiologists is not low.

Moreover, they know the respiratory, nervous system, blood system, and the functioning of various organs of the human body as well as their hearts.

All of them are hidden masters.

The only thing that makes people criticize is that the anesthesiology department is a subdepartment, and the treatment cannot be compared with the doctors in the weight department.

They seem insulated from fame.

No matter how powerful the director-level anesthesiologist is, the most well-known is that people in the industry know it. As for the patients and their families, they only know the name of the surgeon.

Who the anesthesiologist is, they rarely care.

At least all of them should be senior attending anesthesiologists. The anesthesia operation that allowed him to go out in person shows that the difficulty is not low.

At least the stakes are high.

What is this patient's disease? It seems that the patient's face is pale, irritable, cold sweat is constantly breaking out of his forehead, and he has difficulty breathing, indicating that the patient is in great pain at this time.

When the cloth is removed from the patient's body, a visible external injury to the intercostal space can be seen.

Zhou Can immediately understood that the patient was likely to have a thoracic hemorrhage, accompanied by a large amount of pleural effusion.

This disease is very dangerous, and it is best to have emergency surgery to stop the bleeding before the patient is in shock.

Dr. Guan quickly connected the patient's vital monitoring probe.

Originally, it was even necessary to establish central venous pressure monitoring if possible. Now the situation is urgent, just monitor heart rate, blood pressure, breathing, body temperature, etc.

"Doctor Zhou, can you help insert the trachea and put on the ventilator?"

The official doctor is alone and lacks surgery, and the patient's condition is getting worse and worse.

In order to save anesthesia time, he had to ask Zhou Can for help.

Others don't know Zhou Can's ability, but Doctor Guan knows it very well.

In particular, Zhou Can's glorious deeds in the intensive care medicine department are known not only to the medical staff of the intensive care department. Most of the doctors in the anesthesiology department have also heard of it.

Because many doctors in the intensive care department are anesthesiologists.

For example, Dr. Shi used to be an anesthesiologist and later switched to life science. Thinking about how to provide better life support for patients, how to save people back at the moment of life and death of patients.

It is very easy for news to reach the ears of former colleagues in the anesthesiology department.

The other doctors and nurses were surprised to hear that Dr. Guan asked Zhou Can for help.

It seems that the official doctor is quite familiar with this punished trainee!

Endotracheal intubation is not too difficult, but it is still a little difficult to complete it quickly and accurately.

The operation of the ventilator is relatively easy to learn, but the adjustment of parameters is a great test of a doctor's level and experience.

In the disbelief of everyone, Zhou Can stepped forward quickly, and then intubated the patient.

At this moment, it would have been very difficult to intubate in a patient's restless state.

Endotracheal intubation Zhou Can was easily completed.

Endotracheal intubation is a special endotracheal tube inserted through the mouth and into the trachea through the glottis. It can also be inserted through the nasal cavity, depending on the situation.

The patient's current condition is more suitable for oral intubation.

At least a little more comfortable than nasal insertion.

The patient is already irritable, and it is not easy to get him to cooperate.

After the intubation was completed, Zhou Can began to skillfully adjust the parameters of the ventilator. Three months in the intensive care department have not been in vain, and now he is able to operate these instruments with ease.

The experience is also very experienced.

For the adjustment of various parameters, it can be done clearly.

There is no road in vain in life, and every step you take counts.

He trained in intensive care medicine for three months, and when he came out, he found that the benefits were huge.

It can be used in many situations.

Moreover, the mental tension when working in the intensive care unit is very tense, which is a very good sharpening of his mind.

"That's it!"

Zhou Can calmly retreated to the most inconspicuous bystander position under the operating table.

Just now he intubated the patient, and he earned 1 point of experience in implantation.

As long as you stay in the operating room, you can always get something.

"Good Cow B!"

"This regulation trainee's operation just now is too coquettish!"

"It turns out that endotracheal intubation can be so simple! I'll have to try again next time! ”

The other doctors were dumbfounded.

Zhou Can's performance was very eye-catching, and even gave people the illusion that tracheal intubation was particularly easy.

"The anesthesia was successfully administered, and the operation could be performed."

As Dr. Guan's words fell, the chief surgeon had already stood in the chief surgical position and made an incision between the patient's ribs. The pleural lining is then cut layer by layer until the pleural lining is visible.

There's a lot of blood in there.

"Let's suck some of the blood out first. The bleeding point should be between the costal spaces. ”

The chief surgeon said as he operated on the patient.

He was quickly searching for the bleeding spot.

However, the environment in the chest cavity is complex, and there is blood remaining, so it is not easy to find the bleeding point.

The incision site selected by the chief surgeon was examined before the operation, and the bleeding point was roughly locked in this position.

As a result, a window was opened in the chest cavity to realize that the bleeding point was much more difficult to find than expected.

The main knife was already so anxious that his forehead was sweating.

In the blink of an eye, the patient's bleeding soon caused a large amount of blood to accumulate in the chest.

"The patient's blood pressure is dropping rapidly! Breathing is also a warning, to speed up the operation! ”

The anesthesiologist looked anxious.

The type of thoracic hemorrhage in this patient should be a vascular injury to the chest wall.

Bleeding points in this type of injury are usually in the intercostal arteries, veins, and intrathoracic vessels.

Because it belongs to systemic circulation and high pressure, it is mostly continuous bleeding.

Without surgery to stop the bleeding, there is almost no possibility of automatic hemostasis.

Zhou Can picked up the patient's examination report and looked at it carefully. At this time, they were trying their best to save the patient, and no one cared about him.

The patient had a coronary angiography but no bleeding points were found.

Chest x-ray shows a pleural effusion opacity on the injured side, mediastinum moving to the unaffected side, fluid levels visible with pneumothorax, and even the lungs collapse.

The incision is on the injured side.

Where will the bleeding point be?

After reading the examination report, Zhou Can calmly inspected the patient's wound.

It has an indicor-level medium-level hemostasis, plus a 50% bonus of emergency health intelligence, and a new treatment-level pathological diagnosis. The combination of the three medical skills doubled Zhou Can's diagnostic ability and quick thinking.

No bleeding is visible, but the pleural effusion is rising.

Indicates that the bleeding point is relatively hidden.

The amount of bleeding is certainly not small.

"Dr. Long, the patient's blood type is special, and the plasma preparation is insufficient. At this amount of bleeding, the three bags of plasma prepared are simply not enough. ”

The assistant sends a reminder to the main knife.

This is tantamount to adding insult to injury.

The hemp rope is broken in detail, and the disaster is not a single line.

This operation, which was originally risk-controllable, faced a huge risk of death in an instant.

If there is such intrathoracic hemorrhage, and the bleeding is heavy, and the bleeding cannot be stopped in time, the patient will die quickly.

", I've done so many thoracotomy surgeries to stop bleeding, and I encountered a hard stubble today."

The chief sword dragon doctor cursed.

The person who is most stressed during surgery is the surgeon.

Sometimes, the chief surgeon is like eating gunpowder, with a dark face in the operating room, catching and scolding whom.

They can't be blamed either.

Because of the problems with the surgery, the pressure on them was just too great.

In this case, some minor mistakes by assistants and nurses will be infinitely magnified in the eyes of the chief surgeon, so the phenomenon of scolding and crying will occasionally occur.

Many doctors and nurses who have participated in major surgeries say that the surgeon is the barometer of the operating room.

This is not an exaggeration.

The main knife is in a bad mood, and other people usually lower their sense of presence, so as not to find scolding.

"It's possible that the bleeding point is under this rib! The amount of bleeding is so large that it is very rapid, and the possibility of artery rupture is the greatest. ”

Zhou Can risked being scolded and told his diagnosis.

"Don't make a mess here, you rules!"

The assistant doctor glanced at Zhou Can and asked him not to scold.

The instrument nurse looked at Zhou Can sympathetically.

This new doctor is really a head iron, he has been punished for the last operation, and now he is running out with a lot of mouths.

When a senior doctor performs surgery, which one of the regular trainees can give a finger?

"The patient has a lot of bleeding and insufficient plasma preparation, so autologous blood can be transfused!"

Zhou Can made another suggestion.

In some heavy bleeding surgeries, autologous blood can be retransfused if the bleeding is not contaminated.

Tuya Hospital definitely has this kind of equipment.

The blood salvage machine can collect, filter, separate, clean, and purify the blood lost by the patient during the operation before infusing it into the patient's body. The risk of self-transfusion is much lower than that of allogeneic blood transfusion.

Allogeneic blood transfusion, it is possible to be infected with hepatitis, HIV, etc.

In addition, allogeneic blood transfusion can suppress the patient's immune function, increase the risk of wound infection after surgery, and is also not conducive to the healing of wounds in the body.

"Get the blood recovery machine now!"

After hearing this, Dr. Daolong immediately made a decision.

The patient was bleeding profusely and was critically ill, which made him a little dizzy.

Zhou Can's words really woke up the dreamer.

"Are you really sure the bleeding is under this rib?" Dr. Long felt that this inconspicuous trainee was a bit unfathomable.

Helping the official doctor to intubate the patient's trachea and put him on a ventilator showed his extraordinary strength.

The autologous blood retransfusion proposed just now at the critical moment is also extremely clever.

(End of chapter)