Chapter 10 Doubt
I don’t know what time it is in the middle of the night.
In the duty room, there was a knock on the door.
"Who, are you going to let me sleep?" Zhang Lin opened the door and shouted, his eyes were sleepy and he wanted to hit people.
There is a switch at the nurse's station. When pressed, the bell in the doctor's duty room will ring and the conversation can be broadcast. Zhang Lin thought the intern nurse didn't understand, so he came and knocked on the door.
"Director Tian?"
Zhang Lin was super embarrassed.
Director Tian was putting on his white coat, with an angry look on his face, no, a murderous look on his face: "Have you done the surgery?"
Zhang Lin rubbed his sleepy eyes: ‘Yes! ’
"You are so brave and irresponsible, is there such a thing?" If Director Tian hadn't had years of higher education, he would be scolding his mother now. Even if he didn't wait, he should have waited for Lao Jin to come to power.
Zhang Lin was frightened. When he was in the dressing room after the operation, he wanted to call Director Tian to report, but his phone ran out of battery and was afraid it would automatically shut down. He thought of going back to the ward to recharge before calling, but he fell asleep and forgot about Director Tian. .
After this fierce criticism, I remembered: Director Tian should have done this surgery because it was stuck on the road because of the traffic jam.
But what time was it? He came here just after the operation was done, and he knocked on the door angrily. Zhang Lin was dissatisfied, but he couldn't show it on his face.
After all, it is common for junior doctors to be scolded by superior doctors.
After being scolded by Director Tian, Zhang Lin immediately woke up and picked up Yang Ping, who was still sleeping.
Director Tian put on his white coat and went to check on the blood flow of the patient's severed finger. Zhang Lin and Yang Ping followed behind, saying nothing and not daring to fart.
In order to wake up, Zhang Lin quickly took out a box of wind oil essence and applied it to his temples.
The two figures, like primary school students who made mistakes, followed the dean.
It turned out that as soon as Director Tian arrived at the hospital, he went straight to the operating room. When he asked the nurse, he said that the operation had been completed and that it had been an hour since the patient came back.
Returning to the department, the nurse said that Yang Ping and Zhang Lin were sleeping.
He calculated with his fingers that it had been more than two hours since he received the call, and the patient had been back for an hour, which meant more than an hour of operation time.
In an hour, based on the skills of these two bastards, wouldn't they just do a larger debridement and suture? Could it be that these two bastards, regardless of whether he has arrived or not, can't wait, even the blood vessels and nerves. Nothing is connected, K-wires are used to fix the broken finger fracture, and the epithelium is directly sutured?
Is it so ridiculous? If so, this would be a fake operation.
Tianyuan's pace became faster and faster, the more he thought about it, the angrier he became, and blood rushed to the top of his head.
I don't care about disturbing the patient's rest. It's still a few hours after the injury. If there is still hope to go to the operating table again, wait until tomorrow morning. It will be too long and the finger will be necrotic. No matter how you repair it, it will be useless.
Director Tian imagined the patient's severed finger that was sewn on: pale, shriveled, cold, and without any blood luck!
There was a snap, the sound of a switch, and the lights in the ward were turned on.
The analgesia was done well and the patient was asleep.
Suddenly the lights were turned on, the bright light stimulated them, and they saw the doctor "killing" him next to the bed. The patient and his companion immediately woke up and squinted their eyes to avoid the stimulation of the bright light, not knowing what was happening.
"Ward round, look at the blood flow of the fingers!" Zhang Lin stood tremblingly beside the bed, explaining to the patient, and then turned on the small flashlight he carried with him.
Tianyuan squeezed Zhang Lin away, grabbed the flashlight, and shined the beam of light on the patient's injured thumb.
The end of the severed finger was exposed, full and ruddy, Tianyuan gently reached out and touched it, it was warm! Then squeeze it gently again, the finger pulp is full and elastic, and the capillary reflux test of the nail is normal.
How is this possible? It's unreasonable.
"Syringe needle!"
At this time, the nurse had already pushed the dressing cart, which contained dressing packs, cotton swabs, amriodine disinfectant, syringes, etc. The nurse handed over two cotton swabs dipped in amriodine, Tianyuan sterilized them twice, and handed over the syringe with the needle. Tianyuan carefully inserted three needles at different locations on the fingertips, just under the skin.
Bright red blood slowly emerged, starting out a little, then slowly expanding, and finally flowing to one side. Tian Yuan turned to look at Yang Ping and then at Zhang Lin.
"The blood supply is very good! Sorry to bother you, we have to check the blood supply every hour." Tian Yuan explained to the patient.
The patient and family members felt a little shocked and hurriedly said: 'It's okay, it's okay, thank you doctor. ”
When everyone returned to the doctor's office, they all sat down and the atmosphere was tense.
Tianyuan's thoughts were suddenly blocked. What happened? Did they really anastomose the blood vessels? It's impossible, it's only an hour, and there are three quarters, so I have to do it for two or three hours, and I have to be in good condition with the stage. It's impossible for these two boys to do it for an hour. Don't know where the problem lies? Or the time is wrong.
"When did the patient arrive at the emergency department? When did he enter the operating room? When did the operation start? When did the operation end?" Tian Yuan asked a series of questions.
"I arrived at the emergency department around ten o'clock, arrived at the operating room at ten-thirty to start debridement, officially started kissing blood vessels at eleven-thirty, and the operation ended at about twelve o'clock." Zhang Lin remembers it clearly, although the specific time is recorded. Not sure, but I remember the approximate time.
The nurse was also stunned by Tianyuan's expression, thinking that something big had happened. This nurse was more flexible and immediately brought the medical record folder over, and Tianyuan took it.
"It's okay. You go and do your work. Let's sit here for a while." Tian Yuan said to the nurse gently.
He carefully opened the medical records and found the anesthesia sheet and surgical care record sheet. He pressed his finger on the time on it and looked at it carefully. The time was not much different from what Zhang Lin said.
The actual operation only took half an hour, who are you trying to coax?
"Really the blood vessels were anastomosed?" Tian Yuan asked.
"Two arteries, four veins! Two fractures, each fracture is anastomotic like this." Yang Ping said seriously.
Tian Yuan adjusted his glasses: "The blood supply is good now, but the operation only took more than half an hour. Why is it so fast? Is it a complete disconnection?"
Tianyuan then realized that it might not be a real severed finger at all. There were still tissue connections. The blood vessels on one side were good. Whether the blood vessels were sutured or not during the operation, it would not affect survival. This was diagnosed as an open fracture of the phalanx, which was different from the separation. Breaking is two different things.
But - but - I have seen Zhang Linfa's picture, and it is clearly broken, and it still has three sections.
"Complete disconnection, two disconnection planes!" Zhang Lin relaxed his tense nerves, turned on his mobile phone, and called up the picture. He later realized that Tian Yuan suspected that he and Yang Ping did not anastomose blood vessels, but only performed simple sutures. In this case, there is no need to be nervous. You can see the whole operation process. Not only the blood vessels are anastomosed, but the quality is also very good.
This would be easier to handle. Let Director Tian watch the video. If I had told him earlier, I would have been so scared that I almost had a myocardial infarction.
"Director Tian, the video was recorded during the operation, why don't you watch the video."
Zhang Lin said immediately. He was so nervous just now that his head was in a mess.
Look at the video, this is a way, Tian Yuan nodded.
Zhang Lin copied the video and stored it on his commonly used computer in the office. Everyone gathered around the computer and Zhang Lin recalled the video. As the video played, Tian Yuan turned his head to look at Yang Ping suspiciously from time to time - is this guy doing the surgery in this video?
There is not a trace of jitter in the instrument under the microscope, and the movements are extremely skillful, smooth, steady and brisk, without any unnecessary movements, and every movement is done in one go. The quality of the anastomosis of blood vessels, nerves, and tendons is not generally good. Even if you are talented, there are hundreds of thousands of surgeries that cannot achieve this level of skill. Even the final skin suturing is perfect.
Operating under a microscope requires special training and a certain amount of talent. The hands must be well balanced and must not shake, because a little shaking will be magnified under the microscope and seriously affect the operation.
The requirements for anastomosis of blood vessels are extremely high. The tissue outside the broken end of the blood vessel, including the adventitia, must be cleaned. Otherwise, if a little bit of it is brought into the lumen of the blood vessel during the anastomosis, it will cause thrombus and block the blood vessel. The alignment of blood vessels must be precise without any misalignment, otherwise the blood vessels will be narrowed or uneven, resulting in abnormal blood flow, slowed flow or formation of vortexes, which may also easily cause thrombus and block the blood vessels.
Therefore, the anastomosis of small blood vessels requires the highest suturing technology in surgical operations.
A surgeon has to practice stitching countless mouse tails or rabbit ears under a microscope to acquire this superb stitching ability. Director Han, Director Tian, and Song Zimo all came here this way.
After Tianyuan finished watching the video, he turned the video upside down and watched the key steps again and again, for fear of missing details.
"You should rest, thank you for your hard work. The quality of the vascular anastomosis is quite high, but don't be careless. I told the nurse to pay attention to the blood supply and deal with any problems at any time." After watching the video, Tianyuan felt instantly at ease. As long as the surgical quality is good, the patient's safety can be guaranteed. As long as medical safety is concerned, there will be no problem.
Tianyuan wanted to say something more, but didn't know what to say.
"You guys go to rest. I'm going to the operating room. Lao Jin and the others haven't finished yet."
(End of chapter)