Chapter 421 What happened because of being thin
Chen Yan felt overwhelmed and began to feel anxious.
What does Luo Hao mean by that sentence? !
It is normal to meet and gossip a few words. But Chen Yan just felt that something was wrong with Luo Hao today. Was there something wrong with his surgery?
Could Ronaldinho be yin and yang himself? No reason.
Chen Yan frowned and pondered. After thinking for a long time, he didn't expect anything wrong.
After sending the patient out, Chen Yan explained to the patient’s family that he had sold enough favors, changed clothes and returned to the office.
He sat cross-legged on the chair, twirling his heart hair with his hand and began to read the medical records.
Sixth Sense told Chen Yan that Luo Hao said a lot today, and he must have something to say!
He knows Luo Hao, that guy is a bitch.
Coupled with the high level of surgery and the higher level of diagnosis, these words cannot be ignored.
What could happen to the patient? Chen Yan licked his hair and thought about it bit by bit.
A 60-year-old man suffered from acute epigastric cramping for 2 days, accompanied by radiating pain to his back, moderate nausea, and intermittent fever. His body temperature was 37.8°C at the time of treatment, with no chills.
In the past, similar symptoms had mild attacks, and coronary CT scan from another hospital showed mild myocardial ischemia, so he was treated with oral aspirin at a low dose.
Preoperative examination, blood routine: white blood cells 17.8x109/L, bilirubin, liver enzymes, and lipid levels were normal. Serum lactate dehydrogenase (LDH) was 820U/L, and other cardiac enzymes were normal. Abdominal B-ultrasound showed gallbladder stones, but the bile duct was not visualized.
Everything is normal, no longer normal, just a very common patient with cholecystitis.
What about surgery?
Set the abdominal CO2 pressure to 12mmHg, the surgical process is smooth, the hemodynamics are stable, and the end-tidal CO2 partial pressure is maintained at 35mmHg.
Intraoperative exploration revealed normal gastrointestinal tract but inflammation of the gallbladder, and intraoperative cholangiography showed no obvious abnormalities.
No problem, Chen Yan is sure.
Although Chen Yan thought about everything he should think about, he was still cautious.
Three hours after the operation, he went to the ward to see the patient.
Sure enough, if nothing else, the surprise really came.
The patient should feel pain from the incision after surgery, but it won’t be too painful. Chen Yan knows this.
But!
The patient reported severe pain.
His problem was abdominal pain, with obvious tenderness in the mid-abdomen, accompanied by rebound tenderness, and even Chen Yan could feel a little muscle tension.
When Chen Yan saw this scene, the hair on his beard and heart stood up.
[The pressure was high when establishing pneumoperitoneum. In fact, it was given as normal delivery, but the patient’s own conditions were limited, which meant that the boss was unlucky and encountered a surprise. 】
What Luo Hao said appeared in Chen Yan's ears while "chatting", and he never forgot a word.
What a crow’s mouth, Chen Yan sighed in his heart. Although he thought so, Chen Yan still picked up his mobile phone and called Luo Hao.
"Ronald!"
"Hello, Director Chen."
"The patient has abdominal pain after surgery. What do you think?" Chen Yan asked straight to the point.
“If the surgical procedure is confirmed, it may be ischemia caused by the establishment of pneumoperitoneum to compress the mesenteric arteries and veins.”
"!!!"
Chen Yan's hair exploded.
This kind of thing is extremely rare, especially since I determined that the abdominal CO2 pressure during the operation was 12mmHg and repeatedly confirmed it with the anesthesiologist and hospital manager.
Can mesenteric arteriovenous ischemia occur if the abdominal CO2 pressure is 12mmHg?
Just kidding.
"Ronald." Although he thought so in his heart, Chen Yan still asked cautiously, "What do you think we should do?"
"Let's take an angiogram and take a look at the situation. If there is really ischemia, intervene Surgery may be a solution."
Chen Yan was silent.
This is the first time he has encountered this situation. It is very strange, quite strange.
However, Chen Yan has seen similar cases in papers and case reports. He has never eaten pork, but he has seen pigs running away.
It's just that this time the pig came too suddenly and was caught off guard. Chen Yan almost missed being kicked over.
"Little Luo, is it true?" Chen Yan asked tremblingly.
“I don’t know.”
“Damn!” Chen Yan blurted out in one sentence.
"It's true, Director Chen, I didn't see the patient. But if it is according to what you described, there is no reason for postoperative abdominal pain. Postoperative angiography is available, right."
Chen Yan sighed, indeed.
I was cautious and walking on thin ice, but I didn’t expect that there would be problems.
"It's okay, Director Chen. If nothing happens, it means less surgery is done. As long as more surgeries are done, it will be the same. No one will have trouble." Luo Hao comforted.
"Then I'll consult with Shen Zizai." Chen Yan said.
"OK."
"Ronald, if something happens, you have to come back for surgery." Chen Yan begged, "Although Shen Zizai's surgery is very good, it's because of you. Can you spare the time?"
< br>"Yes, I've made all the arrangements. , drive back immediately. Pre-operative instructions... You and the patient's family should explain the matter clearly. We will talk to Lao Meng."
"Okay"
Let's talk about it. OK, Chen Yan let out a sigh of relief.
Whether it is or not, it is always good to be careful. If a cholecystectomy requires a second visit to the uterus and a section of intestines to be cut, things will develop in an uncontrollable direction.
It's always good to be careful. Chen Yan first called Shen Zizai, then went for another physical examination, and then explained to the patient's family.
Chen Yan did not trust his leading professors or hospital managers to do this kind of thing. He called the patient's family to the office, carefully told the ins and outs of the matter and made clear his "own" guesses.
Soon, Shen Zizai came for consultation.
He wanted to say something else, but when he heard that it was Ronaldinho's suggestion, Shen Zizai said nothing and directly called the interventional catheterization laboratory to prepare for the operation.
The directors pushed hard, there was no delay, and the ping value was good.
By the time the patient was pushed into the operating room, Meng Liangren had already completed the preoperative instructions, came to the operating room with the explanation sheet, and inserted it into the empty medical record.
Chen Yan's old face turned red with embarrassment. He had completed all the emergency surgeries, and the patient had already entered the palace for the second time, so the medical records were still empty.
When have you seen the medical records of Ronaldinho’s medical team that are not impeccable? This is really incomparable.
This is too much. The evil fire in Chen Yan's heart was directed at his little doctor, and he planned to emphasize the writing of medical records after this matter was over.
We can’t wait until every patient is discharged before scribbling and pasting the medical record.
If that doesn't work, ask Ronaldinho to bring a robot panda to educate them.
The robot panda is good, but it is too cute, not as powerful and domineering as the robot dog.
Chen Yan began to think about some random things in his mind and tried to calm down.
"Director Chen, have you ever encountered a similar situation?" Shen Zizai was a little confused and asked Chen Yan before taking the stage.
“I’ve never encountered it before.” Chen Yan shook his head, “But there are descriptions in the case reports in the paper. It’s an occasional case...how occasional is it? Look, I’ve done thousands of similar surgeries. This is the first time I encountered it.”
"This is too rare. I just checked and the patient does have abdominal pain. Speaking of which, you are very alert and noticed this. I thought that if such a mild patient was sent back, you would just give him an analgesic injection and that would be it."
Shen Zizai praised.
For similar patients, misdiagnosis is a high probability situation.
Postoperative pain is normal.
If there is abdominal pain, it is also considered to be traction pain, and the problem of mesenteric arterial and venous blood flow will not be considered.
For such a small operation, Chen Yan actually went for a physical examination in person after the operation and found problems. It cannot but be said that Chen Yan was very alert.
Chen Yan was ashamed when he heard this.
If he hadn’t just met Ronaldinho when he came out of the operating room, and he said a few incomprehensible words, he would definitely not have taken it seriously.
Going for a physical examination in person? It is a good idea not to teach patients to be "hypocritical".
"What if there is a blood vessel problem?" Shen Zizai asked.
"I didn't know, this is your business." Chen Yan began to blame.
Shen Zizai was very dissatisfied, but then he thought, "Ronaldo said he would come?"
"Well, he will come over as soon as he finishes his work there."
"Did he catch the bamboo?" Shen Zizai felt hot in his heart.
“Chen Yong went to pick up the bamboo, and Ronaldinho went to the University of Technology to use 3D printing to make a beak for a red-crowned crane that had broken off its beak, and prepared for surgery to replace it.”
"..."
Shen Zi was startled.
What Xiaoluonong is doing is simply too high-end, 3D printing the lower beak of a red-crowned crane? What does this thing mean?
After it was installed, the red-crowned crane became arrogant and domineering like the Blade Warrior.
However, Shen Zizai knew that time was tight, so he would do an inspection first. Once Ronaldinho thinks about something right, intestinal necrosis may occur later.
He didn't make any small talk, and turned around to brush his hands, go on stage, and take photos.
Ten minutes later, the imaging appeared in front of everyone.
Sure enough, there was incomplete occlusion of the duodenal horizontal segment of the mesenteric artery.
After seeing this, Shen Zizai thought for a moment, turned his head and saw Luo Hao already standing in the operation room.
My heart, which was still a little uneasy, suddenly calmed down.
Although Shen Zizai encountered this situation for the first time, he probably knew it well and knew how to treat it.
But when it comes to getting started, Shen Zizai is such a thief. There is nothing wrong with ordinary surgeries. If he can't afford to be blamed for others, he will definitely not do it.
After decades of experience in clinical practice, I have formed a mindset by doing as little as possible to wipe people’s butts.
If Luo Hao hadn't been there, Shen Zizai would have been pushed to the shelves and had to be on the shelves.
But now?
Without waiting to speak to Luo Hao, Shen Zizai turned around, tore off the disposable sterile clothes and threw them into the medical waste bin. He kicked open the air-tight lead door and strode out.
"Ronald, there is really a problem."
"Well, adult men, or elderly men, weighing less than 50kg, and women weighing less than 45kg, should pay attention to Risk of mesenteric artery occlusion.”
“Ah?”
Shen Zizai and Chen Yan were stunned together.
"Because I am too thin and have little body fat, there is no cushion in the thoracolumbar region of the lordotic spine.
Although the pressure given by Director Chen is not high, there is pressure after all. When establishing pneumoperitoneum, the mesenteric artery is close to The horizontal segment of the duodenum is pressed against the spine, causing bleeding. ”
“!!!”
“!!!”
“Similar situations have not yet been maturely discussed, but Director Qian has explored hundreds of relevant documents from all over the country. The medical records found one thing in common - the patient was too thin. ”
Gan!
This works too! !
Shen Zizai was a little confused.
Before and after the lockdown was lifted, some people said they should be fatter. Fat people are fighting with their fat when entering the ICU, while thin people are fighting with their lives when entering the ICU.
Because of this sentence, Shen Zi deliberately gained 10 pounds during that period, so that he could bear it with all his fat in case of any eventuality.
This was a bit exaggerated, but looking at it now, it seems to make sense. It's not good to be too thin. Wouldn't that be a problem?
"Okay, I'll do it then." Seeing that Shen Zizai had taken off his clothes, Luo Hao knew what he meant and went to wash his hands without hesitation.
"Director Shen, you..." Chen Yan twirled his heart hair and glanced at Shen Zizai.
"I haven't done it, Ronaldinho is definitely fine." Shen Zizai didn't feel ashamed and answered calmly.
After so many years of experience, Shen Zizai will never be as shy as young people. His face is thicker than the city wall.
As for the reason, it is not ready-made yet. I just give up and send Ronaldinho to take action.
"Director Chen, don't you know that thin patients are prone to this condition?" Shen Zizai asked immediately.
Chen Yan's hand shook, and there was a pain in his chest.
Damn it, I used too much force and broke a hair on my heart.
Chen Yan shook his head, a little confused.
I do have a lot of surgeries a year, but I can’t keep up with Union Medical College, not to mention that the first batch of Union Medical College alumni are all over the country.
If all this energy is taken into account, the amount of surgery is a surprising astronomical figure.
No one in Kequn has ever said anything similar. Even if Chen Yan could vaguely understand the reason, he would not pay special attention to it before the operation.
Alas.
Even Chen Yan was a little discouraged.
It seems that he is no different from Xiehe, but Luo Hao, who graduated from an eight-year undergraduate, master's and doctoral program, is so awesome.
Tsk.
On the screen, Luo Hao has already started operating.
While talking, the guidewire had already entered the incomplete obstruction segment and inserted one end into the newly formed thrombus.
Because the thrombus had just formed less than 3 hours ago, the guide drilled in without any effort.
Luo Hao then inserted the thrombolytic catheter.
As urokinase washes away, small blood clots are dissolved.
But Luo Hao did not directly perform another angiography. Instead, he replaced the patient with papaverine, which was administered intravenously slowly to dilate the blood vessels.
He withdraws the medicine very slowly and is very patient.
In less than 20 minutes, another angiography showed that the anterior portion of the horizontal segment of the duodenum of the incompletely obstructed mesenteric artery had been completely opened.
Luo Hao pulled out the guide wire and catheter and made a finishing movement sideways.
"Professor Luo's skills are really high. This surgery was done very quickly." Technician No. 66 said with emotion.
He completely failed to notice that his words were suspected of referring to Sang and Huai.
If Technician No. 66 is not lovable, his emotional intelligence is indeed insufficient. Meng Liangren stood behind and sighed.
When he saw that the operation was completed, he walked to the cath lab and "by the way" pretended to trip over Technician No. 66's chair and kicked the chair.
Kicking open the airtight lead door, Meng Liangren put on sterile gloves and began to apply pressure to stop the bleeding. Zhuang Yan followed behind Luo Hao to pick up the lead clothes and skirt.
"It's done, director." Luo Hao came out and reported to Shen Zizai obediently.
"This surgery...why does it look so familiar?" Shen Zizai was still pondering.
"Femoral head necrosis, the principle is similar." Luo Hao said.
"!!!"
"The principle is the same as the recanalization surgery for femoral head necrosis, except that this patient has a small thrombus, so I added a thrombolysis process."
"Understood "Yeah!" Shen Zizai was a little excited.
If Luo Hao spoke a bunch of technical terms, Shen Zizai would not be unable to communicate, but it would definitely not be as clear as it is now.
Chen Yan sighed when he saw this scene.
Professor Keluo intervened and turned against Tiangang. Now he looks like the director, while Shen Zizai looks like the resident boss under Luo Hao.
It's good. Shen Zizai is really lucky. Such a powerful helper fell from the sky. Chen Yan immediately started to envy him.
If Ronaldinho had parachuted into his department at that time, it would be him who was awesome now, not Shen Zizai.
"Director Chen, if the patient is given low molecular weight heparin for two days after the operation, he will be fine." Luo Hao and Chen Yan explained the postoperative treatment.
“Okay.”
"Nothing else, I'm going to do the surgery on the red-crowned crane."
"!!!"
"!!!"
"Ronald, the surgery on the red-crowned crane." Are you sure?" Shen Zizai asked.
“Orthopedics is all carpentry work, I know a little bit about it.”
"Hahaha." Shen Zizai particularly liked hearing what Luo Hao said now.
It’s just that nothing Luo Hao did seemed to be done by a doctor, including those few words that made Chen Yan cautious after just one look in the operating room.
Shen Zizai didn't know what the specific sentence was, but he had already guessed that Chen Yan, a hairy monkey, would definitely not be cautious just because of a laparoscopic cholecystectomy. In the end, he found that he had escaped A catastrophe occurred.
It must have been Ronaldinho who noticed something was wrong and casually reminded him.
Unexpectedly, one sentence saved a section of the patient's intestines and prevented a medical accident.
The more he looked at Luo Hao, the more he liked it. Shen Zizai patted Luo Hao's shoulder and said, "Go and get to work. After the red-crowned crane's surgery, show me its mouth."
"Okay! Director." Luo Hao responded simply and then left.
Shen Zizai is shy and full of pride.
"Director Chen, look at my successor in the interventional department."
￥#@&*￥#
Chen Yan cursed in his heart, but had a gentle smile on his face.
The ancestral tomb in Shen Zizai's home was really on fire. He was sitting in the core, but Luo Hao fell from the sky.
Why don’t I have such good luck?
Chen Yan sighed deeply in his heart.
"Go and tell the patient's family that nothing is wrong. Go quickly." Shen Zizai pushed Chen Yan, "Don't leave tonight, I'll treat you to dinner."
"What?"
"It's been a long time since we sat together and had a meal. You avoided such a big disaster. Old Chen, your luck is getting better and better." Shen Zizai praised loudly.
This is so true that it touches Chen Yan’s heart.
It was indeed good luck, especially after Chen Yan thought about an incident that happened in the hospital next door recently, he became more and more sure of it.
"Okay, I'll find you later." Chen Yan put the heart protector into the isolation suit and walked out of the interventional catheterization laboratory with a social step.
Just from the pace, it can be seen that Chen Yan's heart has changed from uneasy, anxious, and restless to proud.
"Director, you are awesome." Meng Liangren raised his thumb and praised softly.
“Tell the truth.” Shen Zizai glanced at Meng Liangren and said, “Old Meng.”
“Director.” Meng Liangren trembled and hurriedly bent down, “Can you Don't scare me."
"Hey, I just call you Lao Meng. What's wrong? I just call you like that, and you just answer, and you won't lose a piece of meat. Let's go to dinner together later, and call me Zhuang Yan. ”
Meng Liangren hesitated for a moment, looking troubled.
"Director, how about you and Director Chen go together?"
"Huh?" Shen Ziyi was startled.
The chief director, when he goes out to eat, he calls the little doctor under him. Not only is he lucky, but at the very least he has to be flattering, and it is not right to carry a bag in front and back.
How could there be someone like Meng Liang?
Usually Lao Meng flatters Luo Hao so smoothly and so smoothly, why can't he do it for himself?
However, even though Shen Zizai thought so, he did not scorn Meng Liangren and smiled slightly, "What's wrong, Lao Meng."
"Director, I am not from the infectious disease hospital. "
Shen Zizai suddenly remembered something and looked embarrassed.
The current chief director of the infectious disease hospital has been criticized in the past few days.
Because we went out to eat at noon and there were three of us, we were reported and finally criticized.
More than 3 people are considered a gathering, so please ask your superiors for instructions.
Who would ask for permission for such a stupid thing! Who to ask for advice! !
Shen Zizai cursed in his heart, but he couldn't say anything else except that Meng Liang was cautious.
At the cusp of the storm, don’t cause trouble.
Thinking about it, it seems to be for my own good.
"Okay, then you can eat it yourself." Shen Zizai patted Meng Liangren on the shoulder, remembering how cautious he was when he gave him gifts at the beginning of the year.
In less than a year, Meng Liangren had gained the momentum of a great professor.
Even the dog-like temperament is a bit similar to Luo Hao.
When Chen Yan came to find him, Shen Zizai told Meng Liangren what he meant, and then kicked everyone around Chen Yan away, so that he and Chen Yan went to have dinner.
It's a bit deserted, and Chen Yan isn't used to it.
When it comes to eating, especially when going out to eat, it’s better to have a cup of wine.
With just the two of them, it was a bit deserted, but Chen Yan knew that this was the general trend. He was not much older than me, so there was no point in saying weird things.
When they arrived at the restaurant, they ordered three dishes and started drinking beer. Chen Yan was not polite and just drank.
"Old Chen, what are you doing?"
"Damn it, don't mention it. I've been in a daze these past few days. I always feel like something big is going to happen." Chen Yan wiped his mouth with his hand, and the beer stained his beard, making it shiny.
Shen Zizai laughed, "Why, you have accepted Xiao Chen as your teacher?"
"Brother from the Chen family? Someone asked me recently and said he is pretty awesome. It's really difficult. Contact the second boss of Professor Luo’s medical team.”
"They are so impressive. Now they have opened up a publishing channel in "New England". Recently, it seems that they will publish a paper to the Department of Urology, and Xiao Chen will be the corresponding author."
Chen Yanyi Startled, this is the first time he has heard of this. Is this the corresponding author?
He was silent for a while and gave a thumbs up.
"Old Chen, tell me what's going on."
"That's right, my student, a doctoral student, graduated the day before yesterday and didn't stay to go back to his hometown. Sanyi from a county-level city The hospital, director of general surgery, is pretty good.”
Shen Zizi listened quietly.
“He called me in the middle of the night the day before yesterday. I was completely shocked. It was an appendectomy. The patient had no money, so he made a large incision with a 5cm incision.”
"Separate layer by layer, my student also knows how to use a big knife, and he never throws it away."
Chen Yan said in a messy manner.
But when he said this, he paused.
“Guess what I saw after opening the peritoneum?”
“Hahaha, Old Chen, are you telling me a ghost story? What did you see? You can also see a ghost doll. ”
"Yes!" Chen Yan slapped the table, "I saw a 10cm mechanized fetus."
(End of this chapter)