medical simulator

"Professor Chen, I will try my best!" Zhou Cheng could only respond, and his pace accelerated a little.

Chen Tingye asked again: "Doctor Zhou, this time of being out of the body is a little over 24 hours, shouldn't it be a big problem?"

"I don't know about this either, let's go and see it first and then evaluate it." Zhou Cheng replied.

……

When he arrived in the operating room, Zhou Chengcheng saw that Ning Xihua was still seriously operating on the patient, assessing the blood supply status and other things.

"Doctor Zhou." Ning Xihua called out when he saw Zhou Cheng enter the operating room, put on his overalls and then go on stage.

I couldn't see the expression clearly, but his eyes seemed to be filled with a hint of pleading and longing. I don't know if he was afraid that his skills were not enough, so he would be troubled by the patient's family.

Zhou Cheng didn't reply, but looked at the leg first.

It should be a girl's right leg. The girl is not very old, she should be in her 20s. The skin above the broken end is still quite white and tender, but there is a little bit of blood at the moment.

Suddenly, I saw that the severed end of the amputated limb had been re-sutured.

Under the severed end, the skin color is white, which should be due to long-term ischemia.

"Did pan-heparinization treat the descending blood vessels at the beginning?" Zhou Cheng asked after sorting out the previous steps.

"It's been dealt with. After I went, this step was the first to be dealt with." Ning Xihua nodded.

Chen Tingye hadn't come yet, so he could only answer this question.

Zhou Cheng then looked at the connected hemodialysis machine, and found that the blood in it was not moving at all.It should be the case of blockage at the far end, otherwise.

The blood purifier must have started working.

Immediately afterwards, Zhou Cheng removed the arterial and venous ends of the connecting tubes to observe the blood supply respectively. At this time, Zhou Cheng found that there was liquid blood flow in both the arterial end and the venous end. Slowly oozing out.

This means that there is a certain amount of blood supply at the place where the blood purification device is connected, but after both ends are connected, there is no flow, which means that the lumen of the blood vessel must have stagnated again.

Another way to judge is that at this moment, the arteries and veins have channels to the outside world. If the flow is smooth, it must not be extravasation, but spewing out.

"Do you need an instrument for removing the bolt?" Chen Tingye asked Zhou Cheng.

In the current situation, everyone knows that there must be a blockage, and the greatest possibility is thrombotic blockage.

If there is a thrombus, it is natural to deal with the thrombus first, and then cause recanalization.

"No. Don't take it for the time being. This situation may no longer apply to interventional thrombectomy, and may require incision and thrombectomy." Zhou Cheng said with a serious expression.

"You decide, Doctor Zhou." Chen Tingye didn't force him just because Zhou Cheng said the word "possible", but gave Zhou Cheng the initiative.

After Zhou Cheng finished all this, he seemed to remember something, and then tried the back of the calf of the affected limb.

In such a situation, priority should be given to whether there is compartment syndrome, which compresses the weak compression of blood vessels, rather than thrombus.

"Doctor Zhou, I have already checked, and there is no increase in the pressure in the fascia chamber." Ning Xihua immediately reflected Zhou Cheng's purpose and responded immediately.

The pressure in the osteofascial chamber can be measured by instruments, which is better than touching it with hands.

"Take a syringe!" Zhou Cheng hurriedly ordered Xun Xun.

At this time, there is actually a simpler testing method.

That is to go along the shape of the artery and poke open one by one to see where it is. The situation is not very good.

It’s just that such an operation requires very rigorous and proficient knowledge of anatomy, and the shape of the blood vessels can be reshaped through the patient’s current posture.

"Syringe." Xun Xun immediately gave it to the equipment nurse, and the equipment nurse handed it to Zhou Cheng, without the insurance to remove the syringe.

After Zhou Cheng took it, he took apart the insurance jacket, and then pierced it against the deformed tibial artery, which was a little eight centimeters below the sutured end.

This plunge, after feeling a slight breakthrough, Zhou Cheng immediately saw that there was nothing in the syringe, as if it had been plunged into a vacuum!

At this time, Zhou Cheng chose to withdraw again.

During the withdrawal process, the pumping was very casual and effortless, and then I saw that a small amount of blood entered the syringe.

In this way, it seems to mean that the blood supply here is smooth.

"There seems to be no problem here, right?" Ning Xihua asked.

However, after Zhou Cheng took a closer look at the state of the blood in the syringe, he immediately remembered something.

"No, Professor Ning, there is something wrong with the blood. This patient must have arterial dissection after reperfusion!"

"Look at this blood, its color looks more like venous blood than arterial blood, but our blood collection site is an artery, so the blood inside should flow back."

"This may be an arterial dissection. We need artificial vascular stents. Does our hospital have this?" Zhou Cheng asked quickly.

Ning Xihua was stunned, but Chen Tingye chose to believe: "I'll call and ask right away!"

Vascular stents are instruments used in vascular surgery. Only by contacting the vascular surgery can we find the corresponding equipment suppliers.

Moreover, the diameters of vascular stents are different, and it may not be known whether there are stocks in the hospital.

Chen Tingye quickly dialed the phone number of the director of the vascular surgery department. After a while, the corresponding stent was brought into the operating room by the itinerant nurse. At this time, Zhou Chengcheng had already prepared the arterial sheath...

The position of the introducer sheath is further down.

Soon, Zhou Cheng pushed the vascular stent in with fluent operation.

And in the process of doing this, one end of the blood purification device finally started to move.It seemed that blood was slowly flowing.

"It's done!" Seeing this, Ning Xihua exclaimed happily.

However, Zhou Cheng was not happy about it.

Because he didn't see the flow at the vein end, which means that even after the artery at this place is recanalized, there are still blood vessels blocked at other locations, and the location is still unknown.

So under such circumstances, he seems to have to follow the current steps and do it again, maybe even more than once. A blind temptation like this is obviously not feasible...

Ning Xihua's smile only appeared, but soon became stiff again.

He looked nervous, but dared not say a word.

Chen Tingye also looked at Zhou Cheng, and at the same time his eyes were turning rapidly, thinking about ways and countermeasures.

The current case is estimated to have evolved into a special case. There is no previous treatment experience to learn from, and the current diagnosis is not clear.

It may be a thrombus, or there may be other avulsive dissection of the intimal layer of the vessel.

Although everyone didn't say a word, they all looked at Zhou Cheng, which made Zhou Cheng feel a certain pressure, but this pressure did not affect Zhou Cheng's thoughts. Zhou Cheng thought for a while, and said: "I don't know now. Is it because dissection and thrombus exist side by side, if you want to keep this leg that has been out of the body for more than the time limit."

"There is only one stupid way to do it. Let's open up and do the whole blood vessel dissection! Professor Chen."

Chen Tingye was taken aback when he heard the words, and immediately replied: "Xiao Zhou, it's okay to do blood vessel exposure, but I'm just afraid that there is not enough time. After finishing it, it still won't help."

Exposing blood vessels is actually time-consuming and laborious, let alone the whole process?

This kind of anatomical exposure of blood vessels is not just like digging eels and loaches, just dig along the hole.

It took a lot of time, and in the end the limb must have been necrotic. Even if it can be reconnected, there is no way to restore vitality.

"If the whole anatomical exposure is done and the necrosis is still in the end, then it is a matter of luck, and we can only do this now!"

"Professor Chen, call Yi Feng over here, let him be the arterial and venous circulation channel at any time. We have to do it little by little." At this time, stop being clever, and follow the simplest method honestly Find the cause.

This is not a simple theory or some accident or special case can find the cause.

"Okay!" Chen Tingye's suspicion was just a suggestion, not to refute Zhou Cheng's treatment plan.

He immediately arranged a tour and called Yang Yifeng.

Then when I looked back at the operating table, I found that Zhou Cheng's scalpel seemed to be cut open, and the knife went directly from the middle of the calf to the dorsal side of the foot. The smooth incision curve was not messy at all.

And the depth of the cut turned out to be just right——

There wasn't much blood oozing or even surging.

Is it because the blood supply is already blocked, so there is no blood?

Zhou Cheng's operation was too fast. While Chen Tingye was still thinking, Zhou Cheng had already started blunt peeling. Before he could react, Zhou Cheng had already stretched the muscle layer through blunt peeling, and stretched the shins. Part of the anterior artery had been pulled out.

As proficient as digging a bird...

Chen Tingye gulped two mouthfuls of saliva, and said silently, I take back what I just said, this kind of operation is the same as what I thought, but the stupid method Zhou Cheng mentioned may not be the stupid method I thought...

4 Chapter Seventy

The operation Zhou Cheng is doing now is actually very simple, that is, incision.

Incision is the first step in surgery, which refers to the surgical operation process of using some kind of instrument (usually a variety of scalpels) to make an incision on a tissue or organ. It is one of the most basic operations in surgery.

Basically, if you call an intern, he can also hold a knife and roughly do an incision.

During the internship, the interns were able to do a skin incision. Although it seems like Chinese New Year, it means that the entry level of this technology is very shallow, and it is not something unfathomable.Just need to grasp a few points.

For example, the principle of sterility, such as:

For larger incisions, the operator and assistants fix the skin on both sides or up and down of the incision, and the operator fixes small incisions on both sides of the incision with the thumb and index finger. The operator holds the scalpel and makes the belly of the knife perpendicular to the tissue to prevent For oblique cutting, the tip of the knife penetrates the skin vertically first, and then turns to form an oblique angle of 45 degrees with the skin surface. Use the knife to evenly cut the skin and subcutaneous tissue until the length of the predetermined incision is reached, and then turn the knife to 90 degrees to the skin surface. Vertically, lift the knife out of the cut.

Then get more proficient, master the strength of the knife when cutting, and try to cut the whole layer of skin at one time, so that the incision is linear and the edge of the incision is smooth, so as to avoid uneven incision edges caused by multiple cuts and affect healing.

Do not use too much force when cutting, so as not to accidentally injure important deep tissues.It is advisable to cut the subcutaneous tissue and the skin at the same time and keep the same length. If the incision length of the subcutaneous tissue is shorter than the skin incision, it can be cut with scissors.

After incision of the skin and subcutaneous tissue, the surgical towel is used to cover the surrounding area of ​​the incision (currently clinically, a sterile film is often used to paste the incision site before incision) to isolate and protect the wound from contamination...

However, in theory, the content presented in the textbook cannot describe Zhou Cheng's current operation process and fluency.

As the saying goes, laymen watch the excitement, and experts watch the way.

Ning Xihua, who knew that Zhou Cheng was tinkering with teaching theories, asked respectfully at this moment: "Doctor Zhou, if you follow the so-called skill level system that you taught your students when you taught them, this incision technique can be divided between different levels. , how to divide?"

When Ning Xihua asked such a question, his teacher Chen Tingye immediately took a look at him.

"Talk less, watch more!"

"Doctor Zhou, ignore him and continue the operation." Chen Tingye's tone was serious.

What time is it now, you are an associate professor, do you still need me to teach you these basic rules?

Don't lose face in front of outsiders. We masters and apprentices can do whatever we want when performing surgery, but outside, the most basic rules still have to be taught.

Zhou Cheng was not distracted. He heard Ning Xihua's question, but he didn't reply. Instead, he continued to quickly follow the shape of the artery, dissecting it one by one, and untied the human calf out of the artery like a cow. Out-of-shape gaps.

In the gap, arteries are exposed rapidly.

There is no such thing as wasting time or not having enough time as Chen Tingye said before.

In just a few minutes, Zhou Cheng exposed several arteries below the popliteal artery to outsiders, and separated them very clearly.

Such a blood vessel exploration technique can simply be called a miracle.

Who can basically expose all the arteries in just a few minutes?

"Huh!" Zhou Cheng breathed a sigh of relief.

"Ms. Chen, let's check the circulation of the blood vessels together. If it really doesn't work, let's temporarily make a short connection path to restore the blood supply first." Zhou Cheng suggested and invited.

"Okay, Doctor Zhou, you are in charge, and I will cooperate."

"Ning Xihua, help pull the hook and pass the equipment." Chen Tingye instructed his students again, shaving his eyes away.

Now it’s for your treatment, don’t make trouble for me any more, if you have any questions, ask them after the operation is over.

In fact, if the arteries are exposed to the current level, the operation is relatively simple. Under direct vision, the naked eye can see where it is unobstructed, which artery is not working, and if it is not working, how to deal with it next, After the blood is penetrated, even if there are small blood vessels that are still clogged, it can be treated with drugs after the operation.

It is basically quite clear that the surgery can do this.

And all this is clear only because Zhou Cheng showed a near-perfect incision technique.

Is incision difficult?

Not difficult!

but?Can incision work wonders?

If it was before, Ning Xihua would never ask himself such a question, but now, for the first time, he has some doubts about his own cognition.

After a while, Yang Yifeng stepped on the sensor door from the operating room and came in, and he had washed his hands at the same time.

When he put on his clothes and gloves and approached the operating table, his eyeballs popped out suddenly: "Professor Chen, did you do a good job of blood vessel exploration?"

Yang Yifeng was already good at vascular surgery, so he knew how to judge the level of this vascular exploration technique.

"I didn't do this, it was Xiao Zhou. You came at the right time, Xiao Yang. This patient had a limb replanted after amputation. Now the blood flow is blocked. There should be an avulsion of the arterial intima. So Zhou The doctor told you to deal with it. See if you can do a replacement or a short pass.”

"Can you call Professor Jin?" Yang Yifeng listened, smiled and replied casually, but immediately took the corresponding tools and started to operate.

However, the operation this time was much easier than most of the lower extremity vascular operations he had done before.