Several directors and deputy chief physicians are quite calm, at least able to calm down and stay calm. Everyone is trying to find the cause of ventricular tachycardia.

The risk of death from thoracotomy is already extremely high.

This type of surgery, which involves atrial resection, ventricular folding, and tricuspid valve replacement, has a higher mortality rate.

A casual accident can easily cause irreversible consequences.

"Could it be tricuspid stenosis?"

Director Xueyan was so anxious that she was about to smoke.

Finally, he was in charge of a difficult fourth-level major surgery, and the whole operation process has been smooth, who would have thought that such an accident would occur during the intraoperative test.

First, it is clear that the presence of ventricular tachycardia is not directly related to the opening and closing of the tricuspid valve on the perfusion test.

Even if you don't do this test, as soon as the heart returns to beating, the problem of ventricular tachycardia will be revealed.

"It shouldn't be a tricuspid valve problem. That's a terrible thing, what's the problem? ”

Director Hu Kan was in a hurry, and the load on his heart increased, and he couldn't help but cover his heart.

Breathing became heavier and shorter.

People with heart disease and high blood pressure are afraid of being stimulated.

In particular, patients like Director Hu Kan, who have repeatedly had heart diseases, should pay more attention.

"Why don't we hurry up and ask for help from the Department of Cardiovascular Medicine! We are strong in surgery. Diagnosing the cause of ventricular tachycardia, they are better at it. ”

Deputy Director Lu always speaks so straightforwardly.

But he is not right, the difference between surgery and internal medicine is quite big.

Regardless of the Department of Cardiovascular Medicine and Cardiothoracic Surgery, both are good at treating diseases in the thoracic cavity and heart area, but the two departments have their own strengths. Cardiothoracic surgery is more adept at surgery, removing lung tumors, heart bypasses, myocardial infarction, ......

The Department of Cardiovascular Medicine is more adept at treating some heart and blood vessel diseases that do not require surgery.

For example, abnormal cardiac arrest, ventricular tachycardia, arrhythmia, insufficient blood supply to the heart, cardiovascular embolism and so on. The etiological diagnosis and drug treatment of these diseases are the 'disease spectrum' of cardiovascular medicine.

"Teacher, ...... you look" Director Xueyan looked at Hu Kan worriedly, not that she wanted to stimulate Director Hu, but that she really couldn't help it.

"Immediately contact the Department of Cardiovascular Medicine and ask them to send a chief physician to come over for a joint consultation and rescue the patient."

Director Hu Kan made a quick decision.

The loss of face is a small matter, and the patient's life is more important than anything else.

"Director Dongfang, can you contact the other chief physicians of the anesthesiology department and ask them to think of a way together!"

Director Hu Kan looked at the snow falling in the east.

As an anesthesiologist, you have an obligation to protect the patient's life during surgery.

The heart cannot be exposed to air for a long time, otherwise there will be a lot of serious complications. When the time comes, things will be more troublesome.

Even at this time, the snow fell in the east, and it was still calm.

His eyes were cold and he looked very calm.

She didn't speak, but she had already taken out her mobile phone and dialed someone directly.

Zhou Can almost didn't have to guess to know that this call for help was probably to Dr. Xu.

"Director Xu, there's something going on here. ...... patient undergoing atrial plication"

She gave a general overview of the patient's situation.

As for what the doctor on the other end of the phone said, everyone doesn't know.

Dongfang Luoxue quickly hung up the phone.

looked at Zhou Can with an emotionless gaze.

"Director Yu rushed over from home, and it took more than half an hour. He told me to look for ...... first You discuss it. ”

She seems to have a natural dislike of dealing with anyone.

So much so that in her forties, whether she was dealing with Zhou Can or other doctors, she had this unpleasant attitude and tone.

The first half of her sentence was addressed to everyone, and the second half of her sentence was to look at Zhou Can and say it specifically to him.

Many people in the Department of Cardiothoracic Surgery know that Zhou Can has a close relationship with the director of the Department of Anesthesiology, and has received a lot of guidance from Director Xu. Now that there was an accident, Director Yu asked her to discuss with Zhou Can first, and they were not surprised.

Zhou Can didn't react, his eyes were fixed on the patient's bloody pericardium, and a puzzled expression appeared on his face.

"Hey, did you hear me?"

Dongfang Luoxue thought that he was deliberately paying tribute to her previous ignorance, she felt that Zhou Can was too small-bellied.

Zhou Can still didn't react.

This time, there was a clear hint of anger in her eyes.

"Dr. Zhou is thinking about something, don't interrupt him."

Director Xueyan has cooperated with Zhou Can the most times and has been together for a long time, so she knows Zhou Can quite well.

Dongfang Luoxue listened to Director Xue's explanation and didn't say anything more.

She herself is actively looking for the cause of ventricular tachycardia.

While everyone was looking for the cause, the patient's pericardium vibrated. It's like a thinly dressed person, shivering in the ice and snow. "No, it's ventricular fibrillation! Prepare for the rescue! ”

Everyone's hearts are tight, and their nerves are like taut strings.

If ventricular fibrillation is left untreated, it can quickly progress to cardiac arrest.

The dangers of surgery are always unexpected, which is why it is important to find a family member to sign before surgery. If something really goes wrong, it is impossible for doctors and nurses to sweat and cry.

I can only regret to tell the family that we have done our best.

"Take the test stick and the test ring!"

Zhou Can seemed to finally figure out what the problem was at this time.

He has the special medical skill of first aid and wisdom, which can achieve twice the result with half the effort in the process of rescuing patients. This medical skill has now been promoted to the intermediate level, and the results are even better.

When rescuing patients, not only can they increase their wisdom and calm mind, but they can also improve their diagnostic thinking by 100%.

"What rods and rings?"

The three surgical nurses were all confused, not knowing what Dr. Zhou was suddenly pumping.

"Xiao Zhou, are you going to do epicardial mapping?"

Director Hu Kan is worthy of being the boss of cardiothoracic surgery, and he instantly understood Zhou Can's intentions.

"Exactly!"

Zhou Can nodded vigorously.

"What do you do with epicardial mapping at this time?"

The snow in the east is full of doubts, the patient is in ventricular fibrillation, and the situation is getting worse and worse, defibrillation is the only way to save people.

Director Xueyan seemed to have comprehended what Zhou Can meant, frowning and pondering.

Because the others are not at the level, they can't speculate about Zhou Can's intentions in doing this.

"If I'm not mistakenly diagnosed, the patient should be pre-excitation syndrome. In this case, if the abnormal conduction signal is not cut off, all rescue measures are palliative rather than curative. After defibrillation, ventricular tachycardia persists, and ventricular fibrillation can still recur. Before the operation, I felt that the ECG was a little abnormal, but I couldn't understand the crux of the problem due to lack of clinical experience. ”

Zhou Can explained to everyone very calmly.

"When the operation was in the final stage just now, it was just a water injection test, and it was impossible to cause such serious problems as ventricular tachycardia and ventricular fibrillation. There was no mistake in the whole operation of Director Xue, which means that there was no problem with the operation itself. Then there is only one explanation, and it is likely that the problem existed before the surgery. It's just that it's very hidden, or it comes and goes, so it hasn't been discovered by us. ”

After listening to Zhou Can's explanation, Director Xue Yan and Director Le nodded again and again, both showing expressions of sudden realization.

Deputy Director Lu was bright-eyed, full of appreciation and admiration when he looked at Zhou Can.

"It's really careless! It's not too late to make amends, and treat them immediately according to pre-excitation syndrome. ”

Director Hu Kan had already guessed a few points when Zhou Can proposed to map the rod and the mapping ring.

Now that he has listened to Zhou Can's explanation, he feels that it makes perfect sense, and he immediately agreed to take rescue measures in this regard.

Originally, this should have been done immediately after the open chest.

Because pre-excitation syndrome is obvious in some patients, and it is subtle in others.

Normally, the patient's ECG will show a significant shortening of the PR interval and the presence of a pre-excitation wave. However, this disease itself is an atrioventricular conduction abnormality, and it may not appear when the electrocardiogram is checked, which forms a missed diagnosis.

Zhou Can felt that the electrocardiogram was abnormal at that time, and he didn't think about it at all.

And it was only a slight abnormality, there was no pre-shock wave on that ECG at all.

So even Director Hu Kan, Director Xueyan, Dongfang Luoxue and others were not diagnosed. It can only be said that doctors are also human beings, not gods.

It's normal for things to slip through.

If the patient has supraventricular tachycardia, he or she may feel significant chest tightness and palpitation.

Unfortunately, this patient has a serious heart condition, let alone palpitation, and even if he is in cardiac arrest, doctors will never suspect pre-excitation syndrome.

The biggest danger of pre-excitation syndrome is a series of complications.

Generally, there are syncope, shock, heart failure, sudden death, etc.

In addition to discomfort such as palpitations, the patient's body may also experience shock, heart failure, and even sudden death.

Whether this patient can be saved or not is still to be said.

Director Hu Kan, as the 'commander of the three armed forces', only pretends to be calm and speaks very easily in order to stabilize the morale of the army.

"Mapping rods, mapping rings are here!"

The patrol nurse was quite good, and found the things that Zhou Can needed from the first-aid supply cabinet in the shortest possible time, and took them.

"Give it to Director Xue, my experience is still ......"

"Can you talk less nonsense, boy? Hurry up and get it! It's all this time, and I'm still there to be humble! Director Hu Kan glared angrily and cursed.

He thinks that Zhou Can is good at everything, but sometimes he is too modest, and he is not good at all when he makes a move.

It's really worrying to watch.

"Okay, okay! You can't blame me for messing up! ”

Zhou Can was helplessly driven to the shelves. Mapping the epicardium, he has studied, but to say proficient is.

Originally, this kind of thing should be done by Director Xue and Director Le, and they must be more familiar with it.

There are several ways to map the epicardium, the most common of which is to divide the ventricular surface into 53 cells, each of which is a mapping point.

The goal of this is to identify the area of the conduction abnormality.

The potential of each mapping point is recorded synchronously with a mapping rod and a mapping ring, and the potential time difference recorded by each mapping point and the reference electrode is calculated with the reference electrode.

As you can tell from its mapping principle, this is an extremely complex process that requires the entire team to work together in a very short period of time.

"I'll draw!"

Director Xueyan volunteered.

"I'll be Dr. Zhou's deputy!"

Director Le also put down his body and went all out.

"During this time, I will do my best to protect the lives of patients." Dongfang Luoxue's tone was still cold, but she could take the initiative to say this, which also meant that she was convinced by Zhou Can.

It's like being defeated by an opponent in the ring, and I'm very convinced.

Director Hu Kan also came over and personally guided Zhou Can.

With the full cooperation of everyone, Director Xueyan drew the epicardial mapping map.

Epicardial mapping requires fast and accurate speed, and Zhou Can is definitely not the wrong person to complete the core operation.

Otherwise, with the slow habits of these doctors in cardiothoracic surgery, it is estimated that the diagram has not yet been drawn, and the patient has already ascended to heaven.

Director Xue's knowledge, calculation ability, and knowledge are very strong, and she is definitely the best candidate to draw the drawing.

This cooperation inadvertently allowed the Department of Cardiothoracic Surgery to gather a strong team, with Zhou Can as the core.

"Xiao Zhou, when doing epicardial mapping, we must remember that because the accessory conduction is faster than that of the atrioventricular node, the earliest excitatory point of the ventricular muscle is the anatomical positioning point of the accessory pathway."

Director Hu Kan taught him everything he could, and tried his best to pass on what he had learned to him.

"Now that the anomalous conduction zone has been found, can I cut it off?"

"Hurry up!"

Director Hu Kan is about to start cursing again.

Director Xue smiled at Zhou Can and made a gesture to ask Zhou Can to stand in the main knife position.

In terms of the speed of surgery, apart from Dr. Xu, it is difficult to find a second person who is faster than Zhou Can.

After Zhou Can decisively cut off the abnormal conduction tract of the atrioventricle, the patient's ventricular tachycardia was able to return to normal.

[Incision XP +1, because you accurately cut the AV bundle for the first time, you will be rewarded with XP +100.] Successful use of the Quick Knife Technique, experience +1. Due to the perfect integration with the knife stabilization method, the experience point reward of the fast knife method is +100, and the experience point reward of the knife stabilization method is +10. 】

Receiving so many experience points at the same time made Zhou Can extremely surprised.

Just surprised, he wondered why the Slow Knife Method only rewarded 10 experience points?

Is it because in the process of applying the knife just now, the fast knife method is the main method, and the stable knife method is supplemented?

That's how it should be.

The system rewards experience points when he has made a major breakthrough or made a great improvement. When calculating, it is very fair and impartial.

Playing support is definitely not as good as the main attack.

It's like when you go to war, a soldier gets more merit than a general, and that's certainly not fair.

"The problem has been solved, Xiao Zhou, you will complete the finishing work later, and after checking that it is correct, seize the time to close the chest cavity. The heart should not be left exposed for long periods of time. ”

Director Hu Kan did not relax because of this, but urged Zhou Can to hurry up and complete the operation.

lest happiness and sorrow and serious complications occur.

……

Half an hour later, the ribcage was successfully closed.

The patient's vital signs were kept in a safe state after Dr. Xuan arrived. However, anesthesiologists should not be too deified, they are the ones who know the most about the three major cycles of the body, and the people who are the most powerful in maintaining vital signs. If the patient's pre-excitation syndrome is not resolved, no matter how good the anesthesiologist is, it will be useless.

After the operation was completed, Director Hu did not announce the end of the operation.

Because this kind of twists and turns of heart surgery itself is high-risk, it is necessary to observe for a period of time to ensure that the patient does not have postoperative complications or other abnormalities before being transferred to the intensive care unit for care.

After leaving the operating room, if there is an abnormality, it is often too late to push back to the operating room, and the patient will not be able to do it.

The heart and brain are two forbidden areas for surgery, and many hospitals often invite experts to sit in the operation when it comes to surgery in these two forbidden areas because of their lack of capacity. Sometimes, even the whole hospital transfers elites from various departments just for one operation.

"Today, this patient almost couldn't get off the operating table, the lesson is extremely profound, everyone must seriously summarize after going back, keep in mind the lesson this time."

Director Hu Kan began to take advantage of the gap between the observation of patients to make a postoperative summary.

"Xiao Zhou, although you have made a lot of contributions to the operation today, I have to criticize you!"

Zhou Can didn't expect that after the operation was completed, the patient turned around, and the teacher would scold him.

There are no mistakes or mistakes!

He was very puzzled, but he didn't confront Director Hu Kan in person.

A teacher is a teacher, and respecting teachers is the minimum criterion.

(End of chapter)