Zhou Can carefully examined the patient, hoping to find a way to save the patient.

To be honest, if there is a problem with the lungs, even the use of extracorporeal lung membranes may not be able to save life. ECMO is by no means a panacea, it is only used to temporarily replace the cardiopulmonary work and help patients breathe and circulate.

It can't replace cardiopulmonary work for a long time.

Not to mention the extracorporeal lung membranes, even if it is just a simple ventilator, it can't be too long. Otherwise, the patient's body is easily dependent and the probability of infection is greatly increased.

In patients with this one-sided pneumonectomy, the lung function is suddenly reduced by 50%, and the respiratory and circulatory systems are put under tremendous pressure. It is equivalent to the original two people carrying two hundred pounds of heavy objects together, and suddenly one person slips away, and the remaining other person will be exhausted to death.

Therefore, the mortality rate and complications of one side of the pneumonectomy are very high.

Removing part of the lung lobe is relatively less risky.

In addition, the quality of life of patients with one side pneumonectomy can be greatly affected. I used to climb to the third floor easily, but now I may be out of breath and tired after climbing half a floor.

If the patient is younger, he or she may not be able to lead a normal married life.

When formulating the surgical plan for this patient, Zhou Can had carefully considered it, and there was really no other way, so he chose to help the patient cut his left lung to save his life.

The patient had surgery two days ago and today is the third day.

At present, the face and lips are cyanosis, including the nails, which is also abnormal cyanosis, which is a clear manifestation of hypoxia.

The patient has difficulty breathing, has large amounts of pink foamy sputum, and has a heart rate that is significantly much higher than normal. It reached 150 beats per minute.

The blood oxygen saturation has dropped to the bottom, and it has long fallen below the minimum warning line.

If the oxygen saturation is less than 95%, there will generally be obvious uncomfortable symptoms, and the doctor will be vigilant. The patient's oxygen saturation has fallen below 80% at the moment, and this is still the result of various rescue measures.

Zhou Can's face sank like water, and several chief physicians in the intensive care unit looked at him with solemn expressions. Everyone is really out of options, so they can only hope for him to see if they can think of a way to save them.

"Sister Yan, borrow your stethoscope to use it!"

Zhou Can said to Director Xueyan.

Percussion hammers and stethoscopes should be commonly used by cardiothoracic surgeons. Because both of these things may need to be needed at any time.

However, this is aseptic management, and outside items cannot be easily brought in.

Director Xueyan's stethoscope should be built into the intensive care unit.

Although every breath the patient takes looks like he may lose his breath at any time, and his appearance is very scary, Zhou Can is as steady as Mount Tai. Take the stethoscope and press it to the patient's lungs to listen to it.

"Filled with crackles and vesicles, combined with the patient's current symptoms and signs, there must be pulmonary edema. The first day after surgery was still fine, indicating that the patient's lung condition deteriorated yesterday, and possibly even this morning. Show me the infusion and medication list. ”

Zhou Can has now risen to level 6 in pharmacological differentiation, and he has the ability to start from many aspects when diagnosing and treating such critically ill patients.

Including pharmacology, pathology, disease symptoms, etc.

In the past, when it came to doctor's advice and medication, especially for some patients with complicated medications, he seemed to be weak and difficult to get started.

The deputy chief physician and the chief physician seem to be only half a level apart, but the level is very different.

In particular, the two core items of pharmacology and pathology are even more distinct.

Before Zhou Can's pharmacological differentiation was promoted, he was even inferior to nurse Jiang Wei in many drug fields.

Director Xueyan's theoretical level has always been very outstanding, and her pharmacological differentiation has long been at the level of sixth. Even now, Zhou Can is a little inferior to her.

At most, Zhou Can now has the qualifications to 'discuss' with her.

It's equivalent to everyone at this level, and she's just a little stronger.

Although Xue Yan, Deputy Director He and others had already checked the patient's infusion and medication, Zhou Can still wanted to check it again. Even if no problems are found, there is a clearer picture of the patient's treatment and medication.

Which medicines are used and how much they are used, and what the effect is after use, can give Zhou Can a good feedback.

After checking it, his original frowning brow loosened a lot.

"At present, the main rescue measures that have been implemented for patients are mainly mask oxygen and sedative drugs injected intramuscularly."

Maybe everyone does not dare to use drugs rashly when the diagnosis is not consistent.

"Zhou Can, looking at your expression, you have already found the cause of the patient's pulmonary edema, right?"

Director Xueyan has worked with him for a long time and has a deep understanding of some of his behavior and habits.

Seeing Zhou Can's brows relaxed, her heart relaxed a lot.

It's a trust that's built through long-term cooperation.

In the rescue work, Zhou Can will only show this expression if he feels that he has a high degree of certainty.

"Sort of!"

Zhou Can nodded.

"In fact, after we discussed it just now, we also thought that the patient was likely to have pulmonary edema, but when I saw pink sputum and the pathological mechanism was unknown, I didn't dare to act rashly. Rescue measures are also conservative. ”

Deputy Director He's words are somewhat face-saving.

After all, in the field of thoracic surgery, he is considered a veteran qualification of the department.

For a long time after Director Hu Kan's death, he regarded himself as the boss of the chest field.

It is undeniable that Deputy Director He's strength is indeed good, and his experience is extremely rich.

Pink sputum indicates hemorrhagic oozing or bleeding in the lungs.

Except for Director Xueyan, others really didn't know how the operation was done at that time. However, everyone is quite confident in Zhou Can's surgical level.

"I did the surgery and I do have a better understanding of the patient's situation. You and a few directors called me over to deal with it, and it was very stable. ”

Zhou Can praised the other party, and then continued.

"I just looked at the medication for the past three days and there is no problem. The patient's sudden onset of pulmonary edema should be related to his total resection of the left lung. To put it bluntly, there is no way to avoid this postoperative complication. After the removal of one side of the lung, due to the decrease of pulmonary blood vessels, the hydrostatic pressure in the blood vessels will increase, and the permeability of the capillaries will also increase, and a large amount of water will seep into the alveoli from the pulmonary capillaries, eventually causing acute pulmonary edema. ”

Zhou Can told his pathological analysis to the doctors and nurses present.

When we rescue all kinds of critically ill patients, it is also a process of learning and progress together.

Everyone's medical knowledge, as well as clinical experience, clinical application of knowledge, and thinking are different. Listen to other people's opinions and learn from each other's strengths. The next time you encounter a similar case, it can serve as a good reference.

Even better doctors can directly give different diagnosis and treatment opinions in this operation, and work together.

Avoid missed diagnoses and misdiagnoses.

Sometimes, when a patient in a department is in a problem, more than a dozen doctors and nurses surround it. The family didn't understand and felt like they were here to fight.

Not really.

In the hospital, the doctors felt that there was danger, and there would certainly not be a dozen doctors to confront the family together.

Unless the family members are already committing violence and beating people, the doctor will stand side by side to prevent the family members from continuing to commit violence in order to protect the female doctor and the female nurse.

When rescuing critically ill patients, a large group of doctors and nurses go at once, on the one hand, they attach importance to the lives of patients.

On the other hand, it also wants to gather the wisdom and strength of the group to save lives together.

This also ensures a higher success rate of rescue.

"So what are you going to do now?"

Director Xue Yan thought of almost using the extracorporeal lung membrane to save the patient's life, and couldn't help but feel a slight fever on her face.

Rush is chaos.

Chaos is unknown.

Not long ago, she was really frightened to see the patient's condition suddenly deteriorate and look like he might lose his breath soon.

The other chief physicians were also anxious.

If an oxygen mask does not work for an ordinary patient, a ventilator can also be considered. This patient's condition is very special, and everyone agrees that the upper extracorporeal lung membrane is the safest.

At least that's how it was.

Even now, if Zhou Can is not very calm to analyze the patient's situation and tell them that there is no abnormal bleeding in the patient's lungs and heart. Even if it's just acute pulmonary edema, they're afraid they'll still be as nervous and anxious as before.

The doctors present all have rich rescue experience.

They know very well how fragile the lives of patients are.

Sometimes, one second it is fine, and the next second it can be gone.

"I saw that the patient's heart rate was still a little too fast, and then 10mg of morphine was given intramuscular sedation, and then treated with cardiotonic and diuretic drugs to control acute pulmonary edema. In addition, the infusion of crystalloid fluid must be reduced, which is also associated with the sudden onset of acute pulmonary edema in patients. ”

When Zhou Can said this, he looked at the head nurse.

Doctor's orders are prescribed by doctors, and nurses have the responsibility and obligation to review drugs when using medicines.

If in the process of nursing, the patient can be more detailed, find that the signs are wrong, and report to the attending doctor immediately, it should not be caused by sudden acute lung fluid.

Of course, the nurse is not to blame.

This kind of thing, Zhou Can can't say it directly.

"Okay, I'll pay special attention to this patient in the next care."

She can be the head nurse, so she is naturally not stupid.

You can immediately understand the meaning of Zhou Can's words.

"I can only trouble Teacher Chang more! When the patient's condition improved, I asked the sister at the nurse's station to drink milk tea. ”

Zhou Can was very satisfied with the head nurse's statement.

What is needed is a good attitude.

There are only two head nurses in the intensive care unit, and one of them has spoken, which is guaranteed.

"Director He, there is one more thing to pay attention to. The patient should be extra vigilant when turning over. After total lung resection on one side, gradual lateral displacement of the mediastinum is very susceptible. In particular, this patient has severe pulmonary edema that is more likely to occur. ”

Zhou Can then explained to the chief physician of the intensive care unit.

This Director He was newly promoted after the two chief physicians of the intensive care unit changed jobs. His title is Deputy Chief Physician and he is currently the Chief Supervisor of the Cardiothoracic Surgery Intensive Care Unit.

The work is quite serious and responsible, but there is a gap between the level and the two directors who were originally poached.

Now the two chief physicians who have changed jobs are back, but the position of the head of the intensive care unit no longer belongs to them.

As an adult, there is a price to be paid for doing something wrong.

After one side of the total lung is resected, the lateral decubitus position is particular.

It can be understood that the lungs in the chest cavity were just crowded with two lungs. When the other lung is cut out, a space is freed up.

At this time, the other lung is squeezed into the middle, causing the mediastinum to shift.

Don't take it lightly.

When the mediastinal side is displaced, it causes surrounding structures to compress the unaffected bronchi.

If the patient is not very old, in his twenties or thirties, because the bronchial wall is soft, it will be stenosis and deformed after compression. At this point, difficulty breathing after airway obstruction occurs.

Experienced doctors often refer to this phenomenon as postpneumorectomy syndrome.

Another particularly interesting phenomenon is that this syndrome is more common in right-sided pneumonectomy.

If this happens, it is equivalent to curing a disease for the patient and creating a new disease.

In this case, because the patient has difficulty breathing, the ideal solution is to place a stent in the bronchial tube, which is crushed and deformed.

Despite the patient's age, the bronchial wall is much stiffer than that of a young person. At the same time, the left whole lung was removed, not the right side. However, postoperative syndrome is still common.

In particular, acute pulmonary edema leads to a sharp increase in the volume and weight of the remaining right lung, and if clinical care is not taken care of, it will lead to a second disease in the patient.

According to the treatment method given by Zhou Can, after a series of drug administration, the patient's condition gradually improved.

Everyone breathed a sigh of relief.

At this time, the atmosphere in the intensive care unit has also become significantly more relaxed.

Whether it is a doctor or a nurse, it is a kind of relief and happiness to not have such a fatal patient. Especially at night, nurses are afraid of the large number of patients who come to see the doctor, and they are also afraid of the condition of the patients who have already been admitted.

The bowl of rice for medical care is actually quite unpalatable.

It's hard, it's dangerous, and the key is tiring.

"It seems that the decision to invite Dr. Zhou over for a consultation was the right one. He performs surgeries on patients, and he knows the patient's condition best. I was worried that the patient had a pulmonary embolism! ”

Director He smiled lightly.

"Lao He, don't say it's Ling, even I'm more inclined to pulmonary embolism. If it weren't for the family's disapproval, I would have been in favor of ECMO for the patient. Fortunately, it was just a false alarm. ”

After hearing this, the others also smiled.

Seeing a critically ill patient being pulled back is a great sense of accomplishment and joy.

"Zhou Can, are the two major surgeries still done tonight?"

Director Xue Yan is more concerned about this matter.

After the crisis is resolved, there is still a new job waiting for her.

If a department wants to maintain its strength, it must insist on gnawing hard bones every day.

So far, Zhou Can is still the sharpest scalpel in cardiothoracic surgery, and there is no one.

In terms of surgical strength, Zhou Can is indeed well-deserved.

Steady knives, fast knives, he can use them.

The two are fused, and he can also be handy.

Then it doesn't matter if it's maintenance, hemostasis, ligation, dissection...... He can do almost anything.

It's almost impossible to find a doctor with such surgical skills.

The former Director Hu Kan far surpassed Zhou Can in terms of stabilizing the knife. However, in other fields, it is basically the director level, and even some surgical skills are still only at the level of the deputy director until death.

"Do, of course! I'll be on time for my appointments after work. ”

Zhou Can looked scrappy.

amused everyone for a while.

Now is the critical moment to secretly compete with the Third Hospital, and Zhou Can is desperately putting pressure on that side. The more difficult surgeries he performed, the better his reputation, and the greater the pressure on the Third Hospital.

(End of chapter)