Pneumothorax can be divided into two categories: primary and secondary.

This patient had a pneumothorax for the first time after a roar, which is a primary pneumothorax. It is more likely to occur in men than in women, and can be as much as 6 to 1.

The main cause of pneumothorax in men is a rupture of the subpleural bullae.

In particular, some thin and tall people are more likely to develop spontaneous pneumothorax.

Through diagnosis, Zhou Can has determined that this patient belongs to the left spontaneous tension pneumothorax.

He had just used an 18-gauge thick needle to puncture the second intercostal space in the midclavicular line on the patient's left side to vent the thorax cavity. At present, the pneumothorax symptoms are still severe after treatment.

I thought it would be a simple case that could be cured, but I didn't expect something to happen.

He took the patient's chest X-ray and looked at it again, thinking quickly about the solution in his head.

"Left-sided thoracostomy to drain the gas out of the patient may be a good treatment."

After careful consideration, he decided to treat his patients with this procedure.

There are two important indications for thoracostomy drainage, first, the lungs are compressed by more than 30%. Second tension pneumothorax. The patient met both indications and was procedurally fine.

There are two methods of drainage and intubation for thoracostomy, one is the cannula method and the other is the incision method.

The incision is not a major surgery, and only an incorporation of about 1.5cm is required.

The two methods are basically the same principle, and each has its own advantages and disadvantages.

Zhou Can prefers the incision method.

This method is more straightforward and easier to achieve results quickly.

After communicating with the family, the family trusted him very much and agreed to receive further treatment.

This trust is very rare.

Because the first puncture treatment did not work, most family members will begin to question the doctor's level.

Zhou Can is so young, it is easier for his family members to feel that he has no hair on his mouth and is not able to handle things well.

It has to be said that the mutual trust between doctors and patients is indeed very important, which can greatly enhance the enthusiasm and autonomy of doctors in the treatment plan, and dare to let go of rescue.

If the family is more difficult and questions the doctor everywhere, this will lead to the doctor's instinctive self-preservation.

In terms of treatment plan, conservative treatment must be the mainstay.

Director Xue fully cooperated and quickly allocated a temporary room for Zhou Can to use during the operation.

After the patient's pleura is anesthetized, surgery is performed.

You don't need to go into the operating room, you can do it directly in the ward.

With the assistance of the instrument nurse, he held the willow-leaf traditional scalpel and made an incision of about 1.5cm directly on the skin of the patient's chest, cut the subcutaneous tissue, and bluntly separated the muscle layer to the pleura with a long-curved vascular clamp.

The whole operation was done in one go, fast and good.

After separating to the pleura, he carefully inserted the drain into the chest cavity along the separated orifice.

It seems easy, but there is exquisite surgical technique throughout the operation.

One minute on stage, ten years off stage.

After all, this minor surgery requires the placement of a drainage tube into the chest cavity, and the danger is self-evident.

Blunt separation of the muscular layer of the chest from the pleura, not to mention.

If it is not torn well, it can directly tear out a large gap in the patient's chest.

After the drain was successfully placed, he securely fastened the drain and connected it to the connecting tube.

"Can you hear me?"

Zhou Can looked at the patient.

"Yes!"

The patient's voice is still somewhat weak. It is easy to pull the pain in the chest when talking.

After a pneumothorax, breathing is painful.

Many people describe the feeling after falling out of love, saying that their hearts hurt so much that they can't breathe. The symptoms are actually quite similar to those of a pneumothorax.

"You try to take a deep breath!"

Zhou Can asked the patient to take a deep breath.

The purpose of this is twofold, the first is to observe the fluctuation of the water column in the water seal. Second, the patient's deep breathing is conducive to the early re-recruitment of the compressed lungs.

The patient's left lung is compressed by more than 90%, which is already very serious.

Early re-recruitment of the patient's left lung is beneficial to recovery.

"It hurts, it hurts!"

The patient tries to take a deep breath, and then halfway through, cries out in pain, and gives up.

"Procaine still has an anesthetic effect! Even though it's just a local anesthesia, it can relieve some of your pain. You can't stand the slightest pain like this, that's not okay. Keep taking a deep breath, you're a man. Don't worry, with me here watching, nothing will happen to you. ”

Zhou Can encouraged the patient to try to take a deep breath again.

For many patients, pain is one of the hardships they have to endure.

The patient took another deep breath and still cried out in pain, but it was much better than the first time.

"Okay, stop taking a deep breath first!"

Zhou Can called a halt, and at the same time frowned and observed the water seal bottle. Obviously, the tube has been successfully placed and connected to the connecting pipe, why does the water column in the bottle not fluctuate?

Fortunately, there is negative pressure.

If the water column does not fluctuate and there is no negative pressure, it means that the drain is leaking or has prolapsed out of the chest cavity and must be treated promptly.

Zhou Can just made sure that the drainage tube was fixed.

If there is negative pressure, it means that there is no air leakage.

There are only two cases, either the patient's lungs are already dilated or the drain is blocked.

It is estimated that the patient's lungs have dilated.

He speculated that the drain may have been blocked when it was placed.

Try adjusting the drain so that the person can breathe deeply again. This time, the water column fluctuated.

It's finally done.

It seems that the drain may have been inserted too deep and blocked by the tissue in the chest cavity.

"Come, keep taking a deep breath, it's good!"

Zhou Can guided the patient to continue to breathe deeply, and everything was normal.

Check that it is correct.

The patient was sent back to the inpatient ward, and then handed over to the doctor and nurse in charge of the bed, monitored the patient's vital signs in time, and actively gave the patient oxygen, anti-infection, bronchial antispasmodic and expectorant treatment.

Director Xueyan couldn't wait for Zhou Can to finally deal with this patient successfully.

A nurse was sent to urge him to rush to the operating ward to help.

To do some difficult surgeries, having Zhou Can by his side is equivalent to an extra talisman. Many difficult surgical parts, or cases with strong timeliness, can be operated by Zhou Can instead of her.

In case of sudden accidents during the operation, such as cardiac arrest, ventricular fibrillation, and rapid drop in blood oxygen, with Zhou Can by his side, he can rescue him in time.

In terms of the ability to rescue patients, Zhou Can is already powerful.

In the past two years, after studying with the director of the Department of Anesthesiology, his skills in this area have become more and more outstanding.

Twice, the patient had an accident during the operation, and even Dongfang Xueluo, the chief physician, had to ask Zhou Can for help.

……

The next day, Zhou Can was not worried about the pneumothorax patient, so he finished checking the room in the emergency department early in the morning, and deliberately went to the ward of the cardiothoracic surgery department to check the patient's condition.

After examination and inquiry, the patient's left chest pain was reduced, and the symptoms of dyspnea were greatly improved, and the symptoms were significantly improved.

The family was very grateful to Zhou Can, and the patient's mother and sister were very happy to see that the patient's condition had improved significantly after treatment. His expression was much more relaxed.

The nurse told Zhou Can that the patient's current body temperature was low-grade.

It is normal to have a low-grade fever.

Zhou Can asked for the nurse's stethoscope and carefully listened to the patient's chest sound.

"His breath sounds in his left chest are still a little small, but fortunately there are no wet and dry rales, so he can take more deep breaths. Also, do not move the drain, in case it becomes loose, you must find a nurse or a doctor in charge of the bed in time. ”

Overall, pneumothorax treatment still carries some risks.

When Zhou Can was training in cardiothoracic surgery before, he had seen a patient with pneumothorax drainage die.

The lesson was very painful, not only because of the carelessness of the nurse, but also because the doctor in charge of the bed was negligent, and because the family and the patient did not follow the doctor's instructions and moved the water bottle.

There are many dangers that families and patients simply do not see because they are not professionals.

Even some medical staff with insufficient professional level or low vigilance cannot detect the hidden dangers in time.

Even after several years, Zhou Can will still be very careful when treating such pneumothorax patients.

It is even more tireless to repeatedly tell the medical staff in charge of the bed that they must not be careless.

After more than 10 hours of drainage, the patient could still see a moderate amount of gas spilling out of the water seal bottle, and the bloody fluid drained was as high as more than 900 ml, and the color was bright red.

This indicates bleeding.

The doctor in charge of the bed did not call him, but effective measures have been taken.

These include blood transfusion, volume replacement, and intravenous cefradine to fight infection.

Intravenous aminotoluic acid is also given to stop the bleeding.

The use of these measures was timely and reasonable, and it also made Zhou Can impressed with the level of the doctor in charge of the bed.

After the Department of Cardiothoracic Surgery was poached more than 20 senior medical staff, the department received a large number of opportunities for young talents. It is also gradually starting to rejuvenate itself.

It's a weighted department, plus Tuya Hospital has a strong foundation.

There are many master's degrees who have completed regular training and have completed four certificates, and they are queuing up to squeeze their heads to enter this provincial tertiary hospital.

Many of these physicians are also clinical practitioners.

In fact, current clinical medical students are more inclined to general practice when choosing their field of study. Don't look at a lot of mentors shouting there, you can't chew it if you are greedy.

That's from the height of the guru to be qualified to say that.

For ordinary medical students, how to be more easily employed, how to squeeze into the weight departments of large hospitals, this is the most important.

General practice students are more competitive and have more opportunities to enter large hospitals.

Also, even if a medical student is a doctor like Du Leng, he still graduated from a famous overseas university. However, after working in the hospital, it is still necessary to relearn from the most basic practices.

If you keep raising your head arrogantly, you will have an embarrassing situation of being directly crushed and beaten by undergraduates like Zhou Can.

"I'm sorry, I'm sorry, just now the 55-bed patient had an arrhythmia, and I rushed over to deal with it. Dr. Chow, what instructions have you made, let me record them! ”

The bedside doctor wasn't the intern who fished patients out of the emergency room yesterday.

It was a young male doctor surnamed Pu.

He is in his early thirties, with a flat shaved head, a pair of rimless glasses, a round face, a broad and round forehead, and a square chin. The first impression is that it belongs to the kind of people who are down-to-earth, down-to-earth, and kind-hearted.

"Did Dr. Pu do the blood transfusion, stop the bleeding, and fight the infection for the patient last night?"

Zhou Can admired this doctor very much.

"Right...... I made it all by me. At that time, I thought it was already one o'clock in the morning, and you had the surgery close to twelve o'clock, so I didn't bother you. Is something wrong? ”

Dr. Pu is also a resident doctor, not to mention that he is several years older than Zhou Can.

At this moment, he is completely talking to Zhou Can as a lower-level doctor.

It's a gesture.

No one taught him, it was purely a personal decision to survive in the workplace.

"You're doing a great job. Patients with hemopneumothorax should be treated as such. In the treatment of such patients, as long as the drainage is effective, the lungs can be re-recruited and the bleeding site is compressed, and it can basically heal on its own. If persistent bleeding occurs, a thoracic tomy must be considered to stop the bleeding. When you take over the shift, be sure to explain it clearly to the doctor who takes over and observe it closely. ”

Zhou Can really didn't put on a shelf.

Usually, even if the attending physician talks to him, it is basically the same posture of asking for advice.

He used to try to talk to them politely. Then I found that it was particularly difficult to make the other party flattered and talk.

is always verbose and polite, Zhou Can really doesn't have that time to delay.

And he is more down-to-earth and direct, and he doesn't like hypocrisy and politeness. Later, it simply went with the flow.

"Okay, I'll make the handover."

Dr. Pu carefully wrote it down in his notebook.

"Dr. Zhou, can you please tell us about the cause of bleeding in this type of patient? There is still a big difference between the practice and the content in the book, so I want to learn more about the practical experience in this area. ”

He explained with a smile.

"The cause of hemothorax is mainly the tear of the adhesion zone between the visceral layer and the parietal layer of the pleura, and the bleeding is mostly the rupture and rupture of the small arteries at the broken end of the adhesion zone chest wall. Therefore, after the lungs are expanded, they can compress the bleeding site, which can have a hemostatic effect. Most hemorrhages in hemopneumothorax can be cured without surgery. You have a blood transfusion and intravenous hemostatic medication in a timely manner, which is handled very well. ”

While Zhou Can imparted some clinical practical experience, he also praised Dr. Pu.

"Clinically, hemopneumothorax is more common in young male patients, and the left chest is more common than the right chest. The occurrence of this disease is often highly insidious, not easy to detect, and the diagnosis is easy to delay. That's why I will tell you to observe the patient's bleeding more when I give the doctor's order. ”

After performing a closed chest drainage for this patient yesterday, Zhou Can gave some verbal medical orders.

However, it did not explain how to deal with the patient's hemopneumothorax.

Because he believed that the doctor and nurse in charge of the bed would definitely report to the senior doctor in a timely manner.

At that time, if he hadn't rushed to the operating room for two other major surgeries, Zhou Can would have directly found that the patient had hemopneumothorax as long as he observed for a while.

Judging from the patient's drainage last night, the bleeding is quite serious.

I hope I don't do a thoracotomy to stop the bleeding.

It's just that sometimes, the disease doesn't follow the doctor's wishes. Not to mention that the patient's family is very pitiful, so he will be soft-hearted.

The disease is relentless and often extremely cruel to the patient.

Therefore, the patient should also be closely monitored in case of accidents.

"Again, how long does it take to determine if further surgery is needed after thoracostomy in such patients?"

Dr. Pu carefully recorded the main points that Zhou Can said in his notebook.

A good memory is better than a bad pen.

There is so much for doctors to learn, and it's definitely a good thing to take more notes.

"Basically, if the drainage has not stopped for more than 24 hours, it is time to consider further measures. However, in most patients, there is persistent gas discharge from the water seal, which may take three or four days to slowly weaken until it disappears. Only a very small number of patients still have gas discharge for up to a week, then it is considered that the rupture is too large, and thoracostomy drainage is difficult to cure. A thoracotomy is required for surgical repair. ”

Whether it is a newcomer or an old comrade, Zhou Can basically knows everything and teaches patiently.

This kind of good character of being a good teacher was also passed on to him by Director Hu Kan, Dr. Xu, Director Shen and others.

The tutor Zhou Can has encountered, even if he is withdrawn and cold, as long as the question he asks is to the point, the other party thinks that he is indeed studying seriously, and basically will take the time to teach him patiently.

At least so far, Zhou Can has never encountered a situation where a senior doctor does not teach him.

Including Director Yu of the Department of Anesthesiology, such a cold doctor, and even took the initiative to ask Zhou Can to follow and learn.

(End of chapter)