"Teacher, I went to the ward to do my rounds just now."

"Well, that's good."

"The gangrene patient who had just undergone debridement had a symptom to me, saying that he had a free form of swelling pain from time to time since the injury to his right leg. Based on his description, and the vascularization of his right leg when he was debrided today, I suspect that an arterial embolism may have occurred. It is also likely that local arterial embolization caused gangrene in the leg wound. ”

Zhou Can told all his inferences and bases.

After listening to his report, Dr. Xu was silent for nearly half a minute, and then said, "If it is really a local arterial thrombosis in the right leg, then it must be removed overnight." Take a color ultrasound first, and if necessary, I will contact the interventional room to do an angiogram on the patient. ”

As an experienced veteran, I naturally understand the danger.

The biggest danger of arterial thrombosis is that the thrombus enters the heart and brain after free, which will directly cause life-threatening injuries.

I believe that many people have been scared by their parents since they were children, saying that embroidery needles cannot be thrown around, and if they are accidentally pierced into the blood vessels, they will enter the heart or head along the blood vessels and kill people.

This risk does exist, but the probability of it happening is extremely small.

Adults are mainly afraid that children will throw embroidery needles indiscriminately, especially on the bed and fabric sofa, and when people sit down, they are particularly easy to be punctured.

After getting Dr. Xu's permission, Zhou Can immediately came to the emergency duty room, borrowed the computer of the attending doctor, logged in to his account, and opened a color ultrasound examination for the patient with bed No. 22.

Many tests cannot be done at night.

The emergency department has the advantage of being able to do some urgent tests even at 1 a.m.

The medical and technical departments of the specialist outpatient clinics usually only work during the day. Some special examination rooms are even only open one day a week.

The results of the examination came back quickly.

The patient does have a suspicious vascular embolism in the leg.

Zhou Can was about to call Dr. Xu, but Dr. Xu took a taxi and rushed back.

"Thrombectomy will be better in the way of interventional surgery, you are very good at interventional surgery and endoscopic surgery, so you can be sure that you will have to remove the thrombe?"

He asked Zhou Can.

"Seventy or eighty percent sure!"

Zhou Can didn't dare to say too much.

"I called a doctor in the intervention room to open the door and had to remove the clot overnight. Blood clots occur in this area, no wonder the patient's wound is difficult to heal! Fortunately, the hidden cause was found in time, otherwise his leg would not have been saved. ”

Dr. Xu was also emotional.

Any kind of condition can be encountered. Even he, a veteran doctor with decades of surgical experience, did not find the true cause of the patient's wound gangrene. At that time, everyone's first reaction was that the debridement and suturing techniques of the small clinic were poor, and the patients were not sewn well. Coupled with the fact that patients recuperate at home in order to save money, this is what causes the infection.

Who would have thought that the culprit would be arterial thrombosis.

If the artery is completely blocked, it will definitely be detected in time. Because limb ischemia will lead to direct necrosis.

It just so happened that this blood clot did not completely block the blood vessel, but blocked more than 90%.

As a result, the artery can still supply blood, but the blood circulation is very poor, and only 10% of the blood circulation capacity is left. With such a poor blood supply, it is a miracle that the wound can heal.

There is a blood supply, which can maintain the basic survival of the lower limbs, which also makes it difficult for doctors to detect the presence of this blood clot.

I don't even think about it at all.

In the intervention room, Zhou Can successfully took out the real murderer who had been mutilating the patient for many days with his superb operation skills. This is a blood clot about a centimeter long.

Visually, it should be caused by blood clotting.

It's not like a fat plug.

There are a variety of causes of this type of clotting, mainly due to trauma. Even some nurses may cause blood clotting if they use the indwelling needle for the patient a second time and operate it improperly.

Experienced nurses, before using the indwelling needle for the second time, will generally use a syringe of about 10ml to withdraw and withdraw until they see red, and will not start the infusion.

A common mistake made by reckless novice nurses is to give direct infusions.

Then I found that the indwelling needle that I had just pierced yesterday seemed to be blocked.

Then, the lazy nurse flushed the tube directly with liquid.

They didn't know that the indwelling needle that had just been punctured yesterday was blocked, and it was likely that blood was backing up into the needle when the needle was sealed. After a night, a blood clot formed.

In this case, the blood clot is forced to flush the blood into the patient's veins.

If the indwelling needle is blocked, in addition to the possibility of a blood clot, it is also possible that the residual infusion has formed crystals in the needle. This one is more dangerous.

In either case, if it is forcibly inserted into the patient's veins, it may cause serious consequences of death.

When the indwelling needle is blocked, there are three correct ways to operate.

After identifying the cause, a 10ml empty syringe can be used to gently withdraw the clot from the tube.

Alternatively, if the patient's condition allows, 10 ml of 0.9% sodium chloride injection containing heparin sodium (25 U/ml) or urokinase (100,000 U/ml) can be diluted and clamped for 5 minutes, and then withdrawn with an empty syringe. If there is no blood return, repeat again. If there is no blood return after two operations, the needle should be withdrawn immediately.

In this case, replace it with a new indwelling needle and re-insert it.

After Zhou Can successfully removed the blood clot for the patient, he was afraid for a while. If the clot is not detected in time, the wound on the patient's leg will certainly continue to deteriorate. It is estimated that by tomorrow, nine times out of ten, I can only make a ruthless decision to amputate my leg to save my life.

It could be devastating for the family.

After amputation, the patient will be incapacitated, his wife may be in financial difficulties because of the family, and the husband will become disabled and will not be able to accept this outcome. Fierce family conflicts occurred, and finally divorced choice.

Her husband is also likely to be self-defeating.

In the end, it was the little boy who was pitied.

It's only a little bit bigger.

And according to them, there is also an eldest daughter in junior high school at home.

Two underage children, who will raise them when the time comes?

[Pathological diagnosis experience +1, bonus experience +100.]

[Debridement XP +1, Bonus XP +1000.]

[Special Medical Skills, Heart of Kindness XP +1, Bonus XP +100.]

Zhou Can didn't expect that just helping the patient take a blood clot would be able to harvest so many medical experience points rewards.

In particular, it is extremely difficult to obtain experience points for the Heart of Benevolence Healing Technique.

Rewarded him with 100 XP points at once, and it was as happy as winning the lottery. This special medical skill has not yet been upgraded.

Its role has always been a mystery.

According to Zhou Can's experience, the more difficult it is to improve the medical skills, the greater the effect.

For example, pathological diagnosis and pharmacological syndrome differentiation have been upgraded to level four, then he is the main level of internal medicine. Promoted to the fifth level, he is the deputy director level.

At present, his two medical skills are all level five, a proper deputy director level.

This is also the reason why he is more powerful than the deputy director of the department in many times in the later stage of training. Especially after the training in gastroenterology, this advantage becomes particularly dazzling.

There are often attending departments and even chief physicians asking him to consult with him.

To put it nicely, it's a joint consultation, and to put it bluntly, isn't it just asking him to come over and help?

After the pharmacological differentiation reaches level 5, it is directly reflected in the ability to prescribe medical advice.

Whether it is a temporary doctor's order, a rescue doctor's order, or an admission doctor's order, a postoperative doctor's order, etc., Zhou Can can gain the trust of senior doctors and have the right to cut first and then play.

What does it mean?

That is, when he encounters a situation where he wants to issue a medical order, he can first prescribe a medical order to save people, and then ask the senior doctor to add his signature.

"It's just a blood clot, how can the experience value of debridement increase as well? And for the first time, a thousand were rewarded. “

The experience value of pathological diagnosis rewarded him with a hundred, which is understandable.

After all, it was he who discovered a highly concealed arterial thrombus according to some clues. Neither the clinic where the patient was first treated, nor the doctors of the Provincial People's Hospital, nor the doctors of the Tuyapu Surgery and Emergency Department failed to discover the existence of this hidden lesion.

Zhou Can can discover it, which is a major breakthrough in diagnosis and the accumulation of diagnostic experience.

Debridement and thrombectomy, it seems that eight poles can't hit together!

After pondering for a while, Zhou Can had a hint of enlightenment. It seems that thrombectomy has nothing to do with debridement, but if the arterial thrombus is not removed, no matter how well he does the debridement of the patient's wound, it will be in vain.

This is a bit similar to the analogy that entrepreneurs often make, physical health is 1, and the money earned is zero after 1.

If you don't have health, it's useless to earn as many zeros as you want.

This arterial thrombus is directly related to the healing of the wound.

It seems to have nothing to do with debridement, but it determines the prognosis of debridement.

After the medical skill is upgraded to level 5, it is no longer a simple skill operation improvement, but begins to involve deeper pathologies and body mechanisms.

He had a feeling that maybe when he reached the sixth level, a small illness might require him to take the lesion as a point and consider all aspects of the three major cycles and nine major systems.

The human body is inherently a whole.

What seems to be a small lesion often involves the entire body.

This change in perception is more like forcing him to take a longer-term view and look at the overall situation. It is no longer limited to a narrow lesion, or a certain body system that is harmed by this lesion.

Taking off his heavy lead coat, Zhou Can walked out of the intervention room, a heartfelt smile on his face.

Nothing makes him happier than successfully treating a patient.

……

The next morning, during his rounds, he went out of his way to see the patient.

According to the patient's own reaction, there is no longer that faint feeling of swelling pain in the leg. Moreover, the patient's wound obviously showed some signs of improvement. This is a very good trend.

After the ward round, he went to the cardiothoracic surgeon.

"Dr. Zhou is here!"

"Doctor Zhou, it's early!"

Although the medical staff here still greeted him warmly as usual, he could clearly feel the dull and oppressive atmosphere in the air.

There also seems to be a lot fewer patients than before.

There are all kinds of signs that this once ace department is declining at an alarming rate.

It is in strong contrast with the prosperity and rapid rise of the emergency department.

Seeing this situation, Zhou Can's heart ached.

Director Hu Kan spent his whole life to create a cardiothoracic surgery department across the country. As a result, because there was no follow-up, the department quickly declined.

"Is Director Xue here?"

"She doesn't seem to have gone back yesterday, she seems to be in a very depressed mood, go and take a look! Right in the office! ”

After Zhou Can heard this, he felt a burst of self-blame in his heart.

After learning the news of her failed surgery yesterday, I should have called her as soon as possible.

She locked herself in her office, and you can imagine how sad she must have been.

"Yo, Xiao Zhou hasn't been to us for a few days!" Deputy Director He led two of his doctors, and when he walked, there was wind under his feet and his face was light.

The smile is about to burst out.

'Xiao Zhou', this is a kind of contempt for Zhou Can. There is also a suspicion of selling his identity in front of him and claiming to be a senior.

'Our side' means reminding Zhou Can that this is cardiothoracic surgery, and Zhou Can is just an outsider.

This old thing, I failed to compete for the head of the department last time, I'm afraid I have been hating it.

Now seeing that Director Xueyan had an accident, not only did he not help them tide over the difficulties together, but he was so happy that he almost didn't hum a little tune, which was too annoying. But that's what human nature is.

He was naturally happy to see that his competitors had fallen into bad luck.

If Director Xue Yan loses the position of section director this time, won't it be his turn to sit in this seat again?

"It's been a few days since I came! Director He looks good! ”

Zhou Can sees people talking about people, and talking nonsense when he sees ghosts.

To deal with this kind of person, you still have to do the things on the face.

"Haha, I've won a prize!" Deputy Director He immediately smiled happily.

"It's just ......" Zhou Can dragged out his voice, with a euphemistic look that wanted to speak and stopped.

"Just what?"

Deputy Director He couldn't help but ask.

"It's nothing, I suggest that Director He can go for a check-up when he has time." Zhou Can said lightly.

"What do you mean?"

Deputy Director He was obviously a little nervous.

Zhou Can's ability, he is clear. Whether it is a consultation in cardiothoracic surgery or ward rounds, the patients who are said to have problems by Zhou Can can basically be verified quickly.

Now the meaning of Zhou Can's words is obviously that his body is sick.

And looking at the tone and demeanor of this profound teaching, I am afraid that he is not lightly ill.

How could this not make Deputy Director He nervous?

"Uh...... I just casually gave a kind reminder, and Director He didn't have to take it too seriously. Just take the time to get it checked. I came to see Director Xue for some business, and I will go back to the emergency department in a while, so I have time to talk next time. ”

Zhou Can lifted it high and put it down gently.

It's to whet the appetite of this old thing.

What he is most unaccustomed to is this kind of villain behavior in the nest.

There are no eggs under the nest.

The Department of Cardiothoracic Surgery is really going to be finished, how much better can Deputy Director He be?

Where is the country broken?

But there are some people who are very stupid. is only concerned with competing for immediate interests, and does not care about the overall situation at all. Director Hu Kan refused to hand over the responsibility of section director to Deputy Director He until his death, and it is estimated that he saw through the nature of this old thing.

If a department is handed over to such a person, it will be finished sooner or later.

"Hey, hey...... Don't go, what's wrong with my body? ”

Deputy Director He was so anxious that he shouted in the back.

Zhou Can stopped and didn't turn around, but just turned around and smiled incomprehensibly at Deputy Director He.

"The body is yours, where is the problem, I believe you know better than me."

The trick has been effective for thousands of years.

As long as people suspect that their body is sick, then they are in trouble. Even if you don't have a disease, you can get sick.

When Zhou Can was in college, every time he went to class, the teacher introduced a certain disease, and he always felt that he also had this disease. I believe that many medical students have experienced this feeling.

Once a person becomes suspicious, until he finds the right answer, he is guaranteed to be trapped in the paranoidism all the time.

For example, a man suspects that his wife is cheating, and when he sees his wife getting close to a male colleague in the company, he will think, this Lao Li usually doesn't see sending my wife home, why did the two of them get together today? There must be something wrong with the two.

Seeing that his wife got an extra 1,000 yuan bonus this month, he would wonder again, is Manager Wang taking a fancy to my wife? If the two have no special relationship, why only give my wife an extra 1,000 yuan bonus?

……

It is guaranteed that the man will eventually become more and more neurotic and nerves more and more sensitive in the midst of countless doubts. Divorce is almost inevitable.

Zhou Can now planted a seed in Deputy Director He's heart, telling Deputy Director He that there was a problem with his body, but he didn't point out where the problem was.

Deliberately let Deputy Director He guess by himself.

Deputy Director He is in his fifties, and at this age, it is impossible to have a little itch on his body. I'm afraid he will live in fear and suspicion every day in the future, Xiao Zhou, that bastard, what does it mean that I am sick?

Today he has a stomachache and he will wonder if he has bowel cancer.

Then I will try my best to make an appointment for colonoscopy and do abdominal CT.

(End of chapter)