This cardiopulmonary bypass is not an artificial membrane lung, which is called ECMO, and it is much more complicated to establish.

It should only be considered if the heartbeat and breathing have stopped.

The cardiopulmonary bypass that Zhou Can is now building for patients is a life support that maintains the blood supply to tissues and organs throughout the body during open-heart surgery.

It works by using a series of special artificial devices to drain venous blood out of the body, manually exchange gases, regulate the temperature and filter it, and then infuse it back into the arterial system in the body.

This cardiopulmonary bypass machine is mainly used for the arrest of the surgery center, or the heartbeat and breathing need to be suspended.

It is also that Director Xue thinks too much about the cost of surgery for patients, otherwise this cardiopulmonary bypass system should be established from the beginning to ensure the safety of patients' lives.

If it weren't for Zhou Can's operation speed being far faster than others this time, the consequences would be difficult to predict.

Zhou Can connected the instrument, waited until the patient's nasopharyngeal temperature dropped to about 28 °C, used a blocking forceps to block the ascending aorta below the innominate artery, and injected cold cardiac arrest fluid into the root of the ascending aorta to arrest the heart.

Dr. Guan was finally able to stop the pericardial compressions.

Next, if the operation is too long, about every 20 minutes or so, the coronary venous sinus is continuously retrograde perfused with cardiac arrest fluid to maintain the heart in a state of deep hypothermia.

Just clipping an aneurysm shouldn't take that long.

After Zhou Can successfully established cardiopulmonary bypass, he breathed a sigh of relief.

The patient's life is temporarily guaranteed.

"Director Xue, you can hurry up and get that vein tumor right now."

Zhou Can kindly reminded.

"Oh! Good! ”

She began to scramble the aneurysm.

The cardiopulmonary bypass machine only simulates part of the heart's functions, and it is no problem to supply oxygen and blood to tissues and organs in a short time, but it will definitely not work after a long time. It can cause damage to organs.

After the establishment of artificial membrane lungs, it can theoretically replace people's cardiopulmonary function for a long time.

Therefore, ECMO is more advanced than cardiopulmonary bypass machines, and the start-up fee is also more expensive.

It is more complex to set up a circulatory system and requires multiple medical caregivers to operate at the same time. It also has to be the kind that is skilled.

Novices get this, and the probability of accidents is extremely high.

After the patient's life was guaranteed, Director Xue was no longer so nervous during the operation. The state of mind has become calmer, and the clipping surgery has gone much more smoothly.

It didn't take long for her to successfully clamp the complex heart aneurysm.

It is equivalent to cutting off its blood supply, and it will naturally no longer cause harm to blood vessels.

Some people think that after clipping the aneurysm, it will cause narrowing of blood vessels, which is pure nonsense. As long as the operation is done well, it will not affect the patency of blood vessels at all.

After the hemangioma is clipped, it is generally necessary to repeat the blood flow test to confirm that the aneurysm is completely clamped and the arterial blood vessels are unobstructed, and the chest can be closed.

She double-checked it several times to make sure there was nothing wrong, and then she looked at Dr. Guan.

"Doctor Guan, the operation has been completed, but you need to pass blood to check the effect of the operation, do you think you can get your heart beating again?"

"Okay! I'll try! ”

Dr. Guan began to warm up the heart.

Gradually, the heart beats hard, and the blood circulation slowly recovers.

Fortunately, the patient's ventricular fibrillation has long since disappeared and the heart beats normally. The clipping of that aneurysm was also very successful.

After the blood, it can already be determined that it will be completely clamped.

And it was possible to determine that the blood flow of this arterial vessel was not significantly affected.

Everyone breathed a sigh of relief, and their hanging hearts fell to the ground.

Deputy Director Lu was like being reborn after a catastrophe, and his back was already soaked.

After all, the patient's heart problem was caused by blocking the blood passage of the stem of the head and brachiophora twice in a short period of time.

"It's finally no problem, close your ribcage!"

Director Xue was also quite frightened.

It is estimated that she will not take such a big risk after surgery.

All the doctors are similar, before the accident, they always feel that they can do it, and there will be no problems.

Then after one or two incidents, the courage became smaller.

They are also acting more and more cautiously.

Deputy Director Lu and the second assistant worked together to close the chest cavity for the patient.

The sawn sternum needs to be re-secured with steel nails.

Zhou Can watched them operate and was very greedy.

It's just that something happened just now, and now I open my mouth to ask Director Xue for the opportunity to close my chest cavity for exercise, I'm afraid it will be difficult to get.

He wasn't in a hurry.

This time, I left a good impression in the hearts of Director Xue, Deputy Director Lu and others, and my skills were also revealed. Are you afraid that you won't get the opportunity to exercise in the future?

After the patient's closed cavity is finished, the examination is correct, and the patient is intoxicated with anesthesia.

I guess I won't wake up for a while.

You can only push to the anesthesia recovery room and wait for the patient to wake up on his own.

Before Director Xue left, he turned to look at Zhou Can.

"Dr. Chow, thank you today! If you want, I'll transfer you to my team tomorrow, and I'll take you with the team's doctors. ”

Director Xue does things with the empathy of a woman.

She didn't take Zhou Can away directly, which was a kind of respect for Dr. Zhao.

Although she is the chief physician and Dr. Zhao is only a resident at the bottom, she still saves enough face for Dr. Zhao.

Leaders maintain the majesty of other leaders, not necessarily the protection of officials and officials, but a self-cultivation.

Dr. Zhao is now the equivalent of Zhou Can's leadership.

He punished Zhou Can, and Director Xue wanted to intervene, but with just one sentence, Dr. Zhao would obediently comply.

But what would Dr. Zhao think?

Discomfort is for sure.

may hate Director Xue and Zhou Can at the same time because of this incident.

Therefore, her way of doing things is like a spring breeze and very clever.

can follow a chief physician, Zhou Can is naturally willing.

No matter which department he enters, he can learn much more than other doctors by being able to be personally led by a director-level doctor.

This is also an important reason why he left other trainees far behind in a year.

"I do!"

Zhou Can decisively agreed.

"Okay, you report to my doctor's office tomorrow."

When she saw Zhou Can agree, she was quite happy.

Because Zhou Can's strength is there, taking him for surgery in the future is equivalent to having an extra senior anesthesiologist in the group who can provide life support for patients.

Dr. Zhao's order to punish Zhou Can was already uncontrollable, he glanced at Zhou Can with very complicated eyes, and finally did not withdraw the punishment order.

……

The next day, Zhou Can went to report to Director Xueyan without mentioning it.

In the big office, Director Xue had already helped Zhou Can make arrangements for the transfer.

"The patient who had yesterday's heart aneurysm clipping surgery has woken up. At present, all vital signs are stable, and the operation has been successful. "Director Xue should have deliberately told Zhou Can about the patient's postoperative situation.

The patient turned the corner, and when she mentioned it, she naturally had a happy smile on her face.

"This morning I need to go to the outpatient clinic to sit in the specialist clinic and in the afternoon to attend the study. I'm afraid I won't be able to take you. I have already explained to Deputy Director Lu and asked him to take you. ”

Director Xue has already arranged everything for Zhou Can.

It took a lot of thought.

"Thank you!"

Zhou Can was sincerely grateful to her.

Generally speaking, it is already good for the chief physician to agree to take him. How could it be so thoughtful and thoughtful?

She can be so sincere to Zhou Can, which really touches Zhou Can.

"When you first arrive in this group, you can first take a look at all the cases in this group. If you don't understand anything, you can ask me or Deputy Director Lu in time. If neither of us is there, you can also ask Dr. Long and others. ”

Doctor Long, who was not far away, hurriedly said, "It's almost the same thing I asked Dr. Zhou for advice, he is much better than me." ”

"You can skin it!"

Director Xue smiled and gave him a blank look.

Dr. Long really wanted to tell Director Xue that Zhou Can's skills in all aspects were really strong.

Even more than him, the attending physician.

His lips moved, but he didn't say anything.

Because Director Xue won't believe it if he says it.

"The time is almost up, I have to check the orders of a few important patients and then rush to the clinic. Dr. Long, let's teach him what the daily work of the department is! ”

After speaking, Director Xue began to hurriedly turn on the computer to check the medical orders of important patients.

The medical orders of ordinary patients are generally the responsibility of the doctor in charge of the bed and the attending doctor.

In practice, it is basically the regular trainee or resident doctor who is in charge of the bed to give medical orders, and then at the two points of commuting, the attending will take time to check it.

Modify unreasonable and problematic medical orders.

The only medical orders that can be handled by the chief physician are those key patients. For example, you are in a critical condition, or you have just undergone major surgery, or you have many underlying diseases.

Only such important patients need to be checked by a chief physician.

The difficulty of prescribing medical orders for other patients is much lower, and all aspects of prescribing medical orders for these key types of patients need to be taken into account, and there are very few opportunities for trial and error.

So you have to be cautious.

"Dr. Long, I'm sorry for your trouble!"

Zhou Can walked up to Dr. Long and humbly asked for advice.

Each department has a different day-to-day work and focus, so it's always a good idea to learn more.

"Don't be so polite! As a team, we should help each other. Let me give you a brief description of the daily life of our cardiothoracic surgeons! ”

Dr. Long was very polite to Zhou Can.

"In the morning, it is generally required to arrive at the hospital department at about 7.30 to check the medical records, examination reports, treatment methods, medications and so on of the patients in this group through the HIS system. The review of the review, the preparation of the preparation. You don't have a single surgical task right now, like me, and need to be in charge of some patient surgeries. If the condition is not complicated, I will make a surgical plan and take it directly to Director Xue or Deputy Director Lu for review. If the condition is complicated or difficult, I take the initiative to consult them and formulate a surgical plan together. ”

Basically, every department has more or less the same workflow.

Zhou Can's internship is like this outside the gods and bones.

"The anesthesia for the first operation will be done before 7:50, so the surgery that you follow up with will start at about 8 o'clock, and you have to send the patient to the operating room around 7:40."

The time of delivery is late, and the anesthesiologist rarely scolds, so it is difficult to say the chief surgeon.

If you're in a bad mood, you can be scolded and buried in your pants.

"Around 7:50 a.m. Director Xue will take the lead in ward rounds once a week, all of which are to check the cases in his own group. Sometimes the department may be led by Director Hu Kan himself, so basically he has to follow along. During the ward rounds, the attending and directors will listen carefully to the bed doctor to report the patient's situation, so you must know the bed you are in charge of. Before the senior doctor rounds the ward, it is best to prepare all the examination results and medical records. ”

One of the most important things for the doctor in charge of the bed every day is to introduce the patient's situation in a timely and accurate manner during the ward rounds of the senior doctor.

"At the end of the rounds, at about eight o'clock, the doctor was on duty. After the shift is completed, it is necessary to seize the time to give medical orders and discharge certificates to the patients in charge. Then, if you stay in the ward with the resident doctor, you will be responsible for the work of lifting surgeries, changing dressings, etc. If you follow into the operating room, then it goes without saying that you will cooperate with the chief surgeon to complete the operation. ”

Zhou Can basically understands these daily tasks.

"It is worth mentioning that one operation in our cardiothoracic surgery usually takes a long time. It is not uncommon for the knife to be operated around 9 a.m. and finished at 1 p.m. After the first operation, there will be a short meal break before operating on the next patient. There is also the handover of ICU patients, or sometimes there are emergency patients in a certain department who need to be equipped with ECMO, or CCU patients who give up treatment and ask to remove ECMO, they have to rush over to help. ”

ECMO is usually done by the surgeon and anesthesiologist together.

Zhou Can benefited from three months in the intensive care medicine department and has mastered the skills of installing ECMO. Fully capable of working with the anesthesiologist to complete it.

"Your ability is excellent in all aspects, and if the doctors in the group are too busy, they may send you to the internal medicine department or emergency department for a consultation."

It's a good greeting in advance.

Cardiothoracic surgery requires a lot of consultations, and manpower here is often tight.

The consultation needs to be attended by a good doctor.

Consultations that are not too difficult are often accompanied by an excellent resident doctor.

Although Zhou Can is only a regular trainee, his strength is there, and sending him over for consultation is no worse than an excellent resident doctor.

Of course, he had just entered cardiothoracic surgery and had not studied for two days, so he would definitely not be sent to a consultation now.

In case of a joke and a foreign appearance, it will be the face of the cardiothoracic surgeon who will be lost.

After introducing the day's daily work tasks, Dr. Long helped Zhou Can board the HIS system and taught him to view the cases in his group.

……

Zhou Can was thirsty for knowledge and carefully checked the cases of this group.

This is the fastest way to learn.

Because each patient's symptoms, etiological diagnosis, what tests have been done, what treatments have been used, and what the treatment effect is, there is the most realistic record.

Each time he reads a case, his experience in pathological diagnosis increases by 1.

Deputy Director Lu also had a consultation task in the morning, and Zhou Can stayed in the inpatient department to manage the patients in this group. The morning passed quickly.

After eating lunch, when he went to the ward to check on the situation of the patients in the group, he heard the family members of the 19-bed patients shouting there.

"Nurse, nurse, my son still feels a lot of pain in his chest after the operation, you can help prescribe some painkillers!"

"Didn't you just take painkillers in the morning? You can't use this all the time! Your son is a manly man, and he woke up with anesthesia after surgery, and it is normal for him to have some pain, let him bear with it! ”

Nurses do not have the authority to prescribe medicines, and prescriptions need to be prescribed by a licensed doctor.

And, as she said, painkillers can't be used all the time.

This one has a safe amount.

If you really want to use it, you have to wait until the body has passed a metabolic period before asking the doctor to prescribe painkillers.

She just didn't tell her family explicitly to tell your son not to be so squeamish.

After hearing this, Zhou Can glanced at the family members and patients with some sympathy.

It is indeed normal to wake up with anesthesia and experience pain after surgery. However, the patient's pain is not necessarily normal. It may be an abnormal pain due to tissue ischemia and necrosis.

This pain is like cutting meat with a slow knife, and it is very torturous.

The patient's beautiful wife kept operating with her mobile phone and checked the medical records from time to time.

Zhou Can almost fainted.

She is also in Baidu, and solves problems by herself.

Could it be that a woman with big breasts can really be brainless?

Her approach is ridiculous.

But it's good to teach her a lesson. Lest next time I would rather believe Baidu than believe the doctor's words.

When Zhou Can finished checking the patients in this group and came out, the patients in bed 19 couldn't stand the pain and lost their temper there.

He is the only child in the family, and the family conditions are also very good.

Since childhood, thousands of pets.

Now that I have suffered such a great sin, I am inevitably a little manic.

"Doctor, doctor, my son can't stand the pain, please help me take a look!"

The patient's mother saw Zhou Can passing by, as if grasping at a life-saving straw.

The patient's beautiful wife also seemed to realize at this time that Baidu on the Internet was unreliable and could not solve the problem at all.

She also stood up and was willing to cooperate with the doctor for the first time.

It's a pity that Zhou Can is no longer in charge of this patient.

And this woman complains and complains at every turn, and Zhou Can is even more reluctant to provoke.

"I'm sorry, I'm just a regular doctor, and I'm very unprofessional. I can't handle it, and I'm not responsible for the patients in this bed. I'll help you inform the nurse. ”

Zhou Can directly refused.

What are you kidding, you told me to get out last time, I got out. Now you're telling me to come back, sorry, I'm going to get away.

If you have something, you can find the doctor and nurse in charge of the bed to deal with it yourself!

"What kind of attitude do you have! My husband is in pain like this, but you shirk like this, believe it or not, I'll complain about you now? ”

The patient's beautiful wife blew up.

The words 'very unprofessional' are the comments she gave to Zhou Can when she complained to Dr. Zhao.

Now that Zhou Can is using these words as a shield, she is not stupid, so she naturally understands that Zhou Can is deliberately using words to pay tribute to her.

So she was very angry.

Maybe this woman usually relies on her husband's family to be a little powerful, and her economic conditions are good, so she acts a little arrogantly.

Almost the vast majority of people with some power have this problem.

When they encounter things that they think are 'unreasonable', they always like to blow up their hair.

Zhou Can stared at her beautiful face with a straight face, and then his gaze collided with her bright eyes.

"It's your right to complain. I have other patients to deal with, goodbye! ”

Things are different now.

Zhou Can is now appreciated by Director Xue and others, and this patient is indeed not his responsibility, he really did it according to the process, and no one can find fault.

(End of chapter)