"Thank you, thank you!"

Zhou Can had a flattered expression on his face, but he didn't really feel much in his heart.

Because the chief physician has served as an assistant to him, this is not the first time.

He's used to it.

I saw that he first disinfected the patient's abdomen, and then drew the knife position for opening the window.

Endoscopic surgery requires only two small incisions.

The entire abdominal fenestration process was completed by him alone.

Internal medicine doctors, especially chief physicians, actually have certain surgical abilities. But it certainly can't be compared to the chief physician of surgery.

Opening a small window in the abdominal cavity is already a high-risk and difficult operation in their opinion.

Zhou Can completed it easily.

The surgical strength displayed was enough to amaze Director Shang and Director Shi. The two of them were much more relieved in the face of Zhou Can's operation.

At least you don't have to worry about it like you used to.

After the window was opened, the endoscope operating arm was inserted, and with the help of the visual function of the endoscope, Zhou Can carefully began to perform the operation.

The fistula is first debrided and incised to some extent.

Because after the fistula is formed, it has already formed a healing layer, and it is useless to suture it directly.

This is one of the reasons why fistulas are difficult to repair.

For example, the ductal fistula of the breast, many surgeons do not do this surgery well. Recurrence is always caused.

Zhou Can's debridement is currently level 4, and there is still a certain distance from level 5.

The main thing is that most of the debridement is ordinary debridement, and you can only earn 1 experience point at a time.

Naturally, the pace of upgrades has become slow.

This is the first time that a fistula has been debrided with endoscopic surgery.

Based on his experience, he should be rewarded with a large amount of experience points.

As for whether to give 10 points or 100 points, it is difficult to say for the time being, only when you get it.

Under Zhou Can's careful operation, the fistula was finally successfully debrided.

[Debridement XP +1.]

[If you complete a difficult endoscopic surgery fistula debridement for the first time, you will be rewarded with +100 experience points.]

Successfully harvested 100 debridement experience points, Zhou Can was overjoyed.

The effort is completely proportional to the gain, and this is the best reward he expects.

After the debridement was completed and the fluid and tissue residue at the wound were sucked out, he carefully examined the fistula again to confirm that there was no problem, and then began to suture.

"Wow, what a strong level of stitching."

Director Shang's eyes widened instantly, this was the first time he had seen Zhou Can's suturing ability.

To be honest, with Zhou Can's deputy director suturing level, it is extremely amazing in any department of internal medicine.

In less than 20 minutes, Zhou Can had successfully completed the suturing of the fistula.

"Director Shang, can you think it's okay?"

"It was just perfect! Good boy, it turns out that your surgical ability is so strong, I was always worried when I first started. I'm wondering if I'm going to let you have a fistula repair surgery! ”

Director Shang was completely like he had picked up a super baby, and he smiled.

There are a lot of interventional surgeries that need to be done in internal medicine.

In particular, in gastroenterology, interventional surgery is required for the removal of various intestinal polyps and tumors.

However, there is a great shortage of skilled surgeons in the Department of Internal Medicine.

Including them, the chief physicians, the level of surgery is just like that, far from how powerful it is.

It is also possible to deal with some routine surgical problems.

However, in case of some emergencies or extremely difficult surgery, internal medicine often needs to ask a surgeon to help.

Director Shang now found that Zhou Can's surgical strength was so strong, and he was thinking in his heart that if he encountered some thorny surgical problems in the future, he might be able to solve them without inviting someone.

Asking for someone is like swallowing a three-foot sword, and inviting doctors from other departments to perform joint surgery often has to suffer from some idleness.

The trainees in their own departments are naturally called casually.

The more he looked at Zhou Can, the more pleasing he felt to the eye, and he was extremely happy in his heart.

Zhou Can lived up to his high expectations, cleaned the fistula by the way, and then adjusted the drainage tube to a certain extent, and then removed the endoscope and closed the two small wounds in the patient's abdomen.

As for the drain, it can only be removed when the patient has recovered after surgery and there is no more ascites or pleural effusion.

"Doctor Zhou, I just adjusted the original drainage tube, is there any meaning?"

Luo Jingyi watched Zhou Can's operation and was shocked.

Only now did she know that Dr. Zhou, who had stronger diagnostic skills, still had the ability to operate extremely evilly.

Such a genius is truly amazing.

When she looked at Zhou Can, countless little stars were already shining in her eyes.

The other two graduate students, Xie Lin and Qiu Chengyu, also admired Zhou Can's skills.

They haven't even learned the four major punctures yet, and if you look at Zhou Can, you can already open your abdomen alone and complete difficult endoscopic surgery tasks independently. People are more angry than people.

Why is the gap so big?

"The position of the drain that was set before should be problematic. I even suspect that the formation of an esophageal anastomotic leak after the patient's first surgery to remove the entire stomach is related to the fact that the drainage tube is not properly repaired. ”

Zhou Can has rich experience in surgery and has a good understanding of thoracic, abdominal and cranial cavity drainage.

During the operation, he found that the drainage tube was not in order.

"When I was doing endoscopic surgery just now, I deliberately checked the preset position of the drain. When the previous doctor set it, the drainage point was set too high. If the person is able to stand for a long time, it may not affect much. However, the patient has been bedridden after surgery, which makes it impossible to drain part of the pleural effusion. The effusion soaks at the anastomosis of the esophagus and jejunum, eventually causing the wound to become infected and suppurated, and cannot heal well. Eventually, an esophageal anastomotic fistula is formed. ”

Zhou Can said his point of view.

When dealing with the drainage tube, Director Shang did not say anything, but showed a look of approval.

It shows that his operation is completely fine.

"I see, I see!"

Luo Jingyi nodded teachably.

Zhou Can just explained that this problem is in place, and it is also a mistake that many novice surgeons are prone to make. I guess this drain should not have been made by the chief surgeon, but probably the chief surgeon who threw the rest of the work to his doctor after the operation. It happened to be a novice with little practical experience who buried this drainage tube. The result was a tragedy. ”

Director Shang seized the opportunity to educate his three graduate students.

The three of them nodded their heads again and again, indicating that they would remember it.

The surgical part of the chief surgeon is very well done, and there are not a few medical cases where there is a problem with the tail sweeping work.

Some surgeons are very busy, and after completing the key parts of the operation, they will throw them to their doctors. He left the operating room or went to the next operation or did something else.

When the final finishing touches are completed, there is a lack of oversight and it is easy for some problems to arise.

"Well, the operation was truly complete. If the anastomotic leak no longer exists, the patient will become normal again. The problems that have plagued us for most of the year will be gone forever. Send it to the recovery room, and if there is no problem, you can send it back to the ward for nursing. However, it is important to ask the family to follow the doctor's instructions. Salmonella infection must not happen again in 73 patients. ”

Director Shang advised.

The patient with 73 beds is considered lucky, otherwise he has just undergone major surgery, his vitality is greatly damaged, and there are wounds in his body, and he is very likely to die.

"I'll be extra careful."

Zhou Can said on the spot.

This patient is in his charge, and he will definitely do a good job of post-operative management.

"Director Shang, the wife of the patient with a brain infection with Schizocephalus was asking me when I could have surgery not long ago, how do you think you can give them an answer?"

"I'll go back to the office and call the doctor outside the gods to discuss, and on the family's side, you say that it will be arranged as soon as possible."

Director Shang wanted to ask someone else for something, and he didn't dare to say the exact time.

"There are also 77 stomach cancer patients, and their families have rushed to the hospital. In the morning, I talked to the family and the patient, and they agreed to the surgery. The patient's mother said that she would save her daughter by smashing the pot and selling iron. ”

These patients in his charge must be reported to Director Shang in a timely manner.

Treatment of patients should not be delayed.

"That stomach cancer patient is a miserable woman! Okay, I'll arrange it for her later, and if she can get it, I'll have surgery tomorrow morning at the earliest. If her illness drags on for a day, it will be dangerous for a day, so it is better to treat her as soon as possible. ”

Director Shang has a lot of patients.

Zhou Canguan's few alone were enough to make him a little anxious.

In addition, there are also consultation, teaching, and scientific research tasks, so you can imagine how busy he is.

In addition, he also holds the position of head of the department, and he also has to take care of the affairs of the department.

Fortunately, there are two deputy directors of the department to help share the worries, otherwise he would definitely not be busy.

……

Zhou Can returned to the office, wrote the medical records, and then studied the postoperative medical instructions given by Director Shang to the 71-bed patient.

He found that the medicine prescribed by internal medicine was obviously more precise than that of surgery.

I also learned a lot about medication.

When he finished reading the post-operative instructions.

[Pharmacological Pattern Differentiation Experience Value+1.]

This is not the first time that a doctor's order has been learned to increase the experience value of pharmacological syndrome differentiation.

His pharmacological differentiation is currently level 3, that is, at the level of a resident. Ordinary small medical orders can already be prescribed on his own, but he can't prescribe postoperative medical orders like this kind of complex surgery.

With such an important medical skill, we must find a way to elevate it.

Zhou Can set a small goal for himself, and the remaining more than a year will be spent in internal medicine anyway. It is hoped that the pharmacological differentiation can be successfully promoted to level 5.

When the time comes, with the pharmacological syndrome differentiation at the deputy director level, he will have no problem going back to the emergency department to set up his own team.

Although this ideal is a bit ambitious, he has faith in himself.

"Doctor Zhou, Doctor Zhou, the vomiting patient you were in charge of just fainted. Go over and take a look! ”

The nurse ran into the doctor's office in a panic and beckoned to Zhou Can.

"Isn't it okay in the morning? Why did you faint all of a sudden? ”

Zhou Can hurriedly kept the unfinished medical records, got up and walked out.

"How do I know! As soon as he was placed in bed 11, and he was about to take his blood pressure, when his eyes suddenly rolled up, and he was unconscious. ”

The nurse's working hours should be very short.

When she recounted the incident, her hands were still shaking, and she was probably frightened.

"Have the patient's temporary beds been removed?" Zhou Can secretly pondered in his heart, changing from a temporary bed to a formal inpatient bed, this is a good thing!

Is the patient fainting because he is too excited?

"Didn't Director Shang say hello on purpose! After the 11-bed patient was discharged from the hospital today, the head nurse personally gave the patient priority to bed 11 for him. ”

Director Shang's personal greeting was quite effective.

Even the head nurse has to sell this face.

It's just that the patient is not blessed!

"Did the patient's head hit somewhere during the bed change?"

Zhou Can thought about it, and he could only think of this reason.

"No, absolutely not. It was always his wife's back, and Sister Wang and I supported the patient to bed 11. During this time, it is certain that the patient has not bumped into anything. ”

The nurse girl just didn't pat the immature body to pack the ticket.

Since it didn't hit its head, it is unlikely that it will disturb the schizocephalic larvae.

As long as it is not a parasite that burrows deep into the patient's brain cavity and destroys the patient's brain stem in a frenzy.

However, this accident also sounded the alarm for Zhou Can.

The patient's condition is very dangerous and cannot be delayed any longer.

You have to find a way to operate on the patient as soon as possible to get the parasites out.

If this patient's illness is cured, it will also be a great achievement for Zhou Can.

When I came to the ward, I immediately saw the male patient who had become a skeleton with his eyes rolled up, lying motionless on the bed. The patient's wife cried as if the sky had fallen.

"Big sister, don't cry, don't cry! His signs were stable in the morning, and now even if he is unconscious, there will be no major problems. ”

Zhou Can comforted the patient's wife while quickly examining the patient.

At this moment, the elderly nurse named Sister Wang is measuring the patient's heart rate, breathing and other key signs.

"What is the patient's blood pressure?"

Zhou Can probed the patient's pulse and felt weak and extremely weak.

It's like you're about to run out of oil.

It can be predicted that the patient's blood pressure must be very low at the moment.

"Systolic blood pressure 95 mmHg, diastolic blood pressure 65 mmHg. Low blood pressure. ”

The blood pressure reported by the nurse was really not ordinarily low.

According to international standards, a systolic blood pressure of less than 100 is considered a serious problem.

"How did your blood pressure drop so badly? Did he eat anything in the morning? ”

"I drank a little water, and I vomited. I haven't eaten anything until now. ”

The patient's wife replied with teary eyes.

Zhou Can checked the patient's symptoms again, and saw that sweat was oozing from the patient's forehead and other places, and his body trembled slightly. Seeing this, he had a bottom in his heart.

"It doesn't seem to be a big deal, it should just be low blood sugar caused by starvation. Immediately give him an intravenous injection of 50% glucose solution 50ml. ”

Zhou Can gave a verbal medical order.

It's not the same when you have a medical certificate.

In the past, this situation had to be dealt with by a senior doctor.

[Pharmacological Pattern Differentiation Experience Value+1.]

[The first time you make a doctor's order to save someone, you will be rewarded with pharmacological pattern differentiation experience points +100.]

Zhou Can only felt as if he had been hit by a huge happiness cannonball.

Happiness came so suddenly.

That's not all, he got so many pharmacological pattern differentiation experience points at once, and he noticed that his ability to distinguish and understand pharmacology seemed to have improved significantly.

Looking at the attributes, it turned out that the pharmacological syndrome differentiation medical skills were upgraded from the inferior level of resident doctors to the intermediate level of resident doctors.

Although it has only improved a small level, the benefits are real.

The use and understanding of drugs seems to have reached a new level.

"Great, a few more rewards like this can directly raise the pharmacological differentiation to the fourth-level level."

He was so eager that pharmacological differentiation could be upgraded to the level of level four.

As long as you are promoted to the main level, it is no problem to prescribe a doctor's order of general difficulty alone.

The nurse took glucose solution and injected 50ml into the patient.

All were nervous looking at the unconscious patients.

Giving medicine to such a patient who is already extremely weak, whether it is a nurse or a doctor, they are all worried and nervous.

The family members also watched nervously.

Hands unconsciously clenched together.

"Hmm......"

The patient hummed lowly, and listening to the ears of the doctors and nurses was tantamount to great news.

It indicates that the patient has improved after using glucose solution.

The man also woke up.

"GIVE HIM ANOTHER 50ML OF GLUCOSE SOLUTION."

Zhou Can calmly pointed at the nurse to save people.

[Pharmacological Pattern Differentiation Experience Value+1.]

This time he didn't award another 100 XP.

However, Zhou Can is very content, and it is already very good to take it once.

His eyes are fixed on the patient's every move.

Hopefully, the patient will be able to fully recover.

(End of chapter)