Chapter 546: Taking needles is a technical job
Sometimes simple things become complicated for some reason.
A family member of a patient suffered an acute myocardial infarction in the hospital, and the doctor stayed up all night to save the patient. This was originally a very positive thing.
But I don't know what happened, but it made all departments in the hospital feel extremely nervous.
Dean Sun was quite concerned about this matter, and so was Director Zhao, or even more concerned.
During working hours the next day, Dean Sun completed the general shift and handed over the matter to the medical office.
The general duty is held by the leaders of the administrative department in turn. During night off work or holidays, the administrative leaders are in rest mode. The general duty, as the temporary top leader of the hospital, handles emergencies, such as coordinating major rescues, handling various disputes, etc.
Once it is time for work, the overall duty of duty is automatically cancelled.
Director Zhao understood what happened in detail, took the matter very seriously, and believed that there were signs of a dispute.
When it comes to judging potential disputes, Director Zhao has never been emotional. He has his own method. He designed a scoring table himself. Each risk factor is given a certain score, and the incident is scored against the table. If it exceeds a certain score, , it is judged as high risk.
When he went to work in the morning, Director Zhao looked at the form, like a divination, scoring items one by one. After scoring, Director Zhao saw it - it turned out to be a high-risk event.
As for Xiao Minmin's surgery, it stands to reason that she should wait and see how things turn out.
Regardless of whether the old lady's condition is stable or not, the key to any dispute is their son.
Their son is currently in a detention center. It is still unknown whether he will be convicted. If he is not convicted, it is very likely that he will use this matter to cause trouble with the hospital, with a simple purpose of extorting a sum of money.
How could an adult man who was living off his old age and idle without a legitimate job let go of such an opportunity?
In fact, all medical disputes that are not willing to go through formal channels are without exception, and the direct purpose is money.
If you don't take the formal route, you will naturally choose medical trouble.
No matter how much they say it is not for money, but for justice, the ultimate goal must be money.
Because they know very well that they cannot make money by going through formal channels, conducting medical evaluations, and making judgments through courts.
I had no choice but to take a gamble and make a fuss, hoping to make some money.
Yang Ping is unwilling to postpone the operation, so the medical office must protect him.
Director Zhao sorted out the matter, asked the clerk to notify the neighborhood committee where the elderly lived, and also notified the police station handling Xiao Minmin's case, and then asked the clerk to make a trip in person.
The hospital's legal department lawyer, director of the publicity department, and director of the security department were all invited to the office by Director Zhao to intervene in advance and make preparations to prevent real disputes from happening and put them in a passive position.
Doing good deeds requires strength and skills. Sometimes without strength and skills, doing good deeds can easily lead to trouble.
In the past, Sanbo Hospital did not have a legal department, and the security department only had a few security guards in their 40s and 50s.
In order to strengthen the hospital's ability to handle medical disputes, President Xia established a legal department and a security department. The legal department not only has full-time lawyers, but also cooperates with a big-name law firm with the most experience in handling medical lawsuits in the city.
The Security Department recruits all young veterans to build a disciplined and combat-effective team.
If nothing else, it is to prevent doctors from being beaten or hacked.
When an outstanding young ophthalmology professor in the imperial capital was maimed by a patient, Dean Xia felt a pang in his heart. He sent four strong security guards to the building where Yang Ping worked that day, two in the lobby downstairs and two in the ward upstairs.
This is why the building where Yang Ping works has full-time security guards.
A rare talent must not have such a heartbreaking thing happen. Dean Xia was a little scared when he thought about it.
This is also a helpless move. To survive and develop in a complex environment, there must be a way.
After finishing his shift, Yang Ping took Song Zimo and Xu Zhiliang to the CCU to visit Minmin's grandma. The rescue was timely and things were going well. The old lady was awake and could have simple conversations.
She recognized Yang Ping immediately and asked Minmin if she had done the surgery. Yang Ping said she would do it later.
The old lady said that Professor Yang must worry about it.
Yang Ping asked her to rest assured and recover from her illness.
Yang Ping returned to the department and Minmin had been sent to the operating room.
Zhang Lin's wife, Dr. Li, a pediatrician, was preparing to leave with her belly full and an empty lunch box. She was bringing breakfast to Zhang Lin.
Seeing Yang Ping, Dr. Li respectfully called out: "Professor Yang!"
"Still working now? No rest?" Yang Ping greeted.
Zhang Lin took over: "Corey asked her to take leave, but she didn't want to. The pediatric department is short of manpower. She is not on duty now. She usually goes out to the outpatient clinic. If she really wants to give birth, she will be pushed directly to the delivery room."
Nurse Cai came over at this time and took Dr. Li's hand: "When is the due date?"
"Just these few days!" Zhang Lin said.
The head nurse said to Zhang Lin: "You always talk about these days, it's almost half a year."
"It's really just the past few days." Zhang Lin chuckled, and the voice of the man who was about to become a father became a little less aggressive.
The head nurse blamed Zhang Lin: "You are about to give birth, and you still ask your wife to bring you breakfast?"
Dr. Li said with a smile: "I have nothing to do. Walking around is more conducive to production. He is working hard."
A few people stood in the corridor of the ward chatting for a few words, and then hurried to the operating room.
——
Xiao Minmin's surgery started as usual, and she was out of pain as soon as possible.
Fatty Liang moved quickly, asking Minmin to inhale some anesthetic, quickly completed the intubation, and connected the anesthesia machine.
Zhou Can got an indwelling needle for Minmin's scalp and placed the color Doppler ultrasound machine nearby.
After washing hands, disinfecting the shop and dressing up, everyone was chatting and opening the stage, and the atmosphere was very relaxed.
It’s easy first and then difficult. The fine needles on the limbs are relatively easier to remove than the fine needles on the chest and abdomen.
The groin area of the thigh is also the area where nerves and blood vessels are concentrated. The femoral artery, femoral vein, and femoral nerve pass through here.
The ultrasound probe used during the operation is sterile, and the coupling agent is also sterile. Yang Ping applied coupling agent on Min Min's skin, and pressed the ultrasound probe to the groin area, and the sound of blood flow was immediately heard.
Various images of subcutaneous, fascia, muscles, blood vessels and nerves appeared on the screen. Slowly, the needle also appeared on the screen. Following the planned extraction direction, Yang Ping used a sharp knife to make a small opening of 0.5 cm. Put the mosquito vascular forceps in from the small opening. Under the supervision of color ultrasound, watch the forceps tip steadily avoid the nerves and blood vessels, tightly clamp the tail of the thin needle, and then slowly withdraw the mosquito forceps, and the first needle Appears in the bend.
Color ultrasound images are flat. It is actually very difficult to locate the fine needle in three-dimensional space based on the flat image.
Even an incisional operation would not be so smooth, but Yang Ping got it right in one go.
The needle is like a fish in the water. If the fish swims in the water, the picture that the person gets does not have three-dimensional vision, but is just a flat image. Then all the fish, regardless of depth, swim on the same plane, and the person who catches the fish cannot Distinguishing its depth makes catching fish very difficult.
The tissues of the human body are not water, but layers of solid tissues. These solid tissues are just a flat image on the color ultrasound screen. It is difficult to find a needle hidden in any layer.
This is why the surgery to remove a small foreign body looks close at hand on the X-ray, but cannot be found.
The surgical area is irrigated, the small incision is sutured, and a fine needle is removed from the groin area on the other side.
After making a small incision, he inserted the mosquito-type vascular forceps, clamped the needle tail, and then pulled out the fine needle. The action was done in one go. There was no need to repeat any action twice. Yang Ping easily removed the fine needle from the entire lower limb in this way.
Next, four thin needles were removed from the chest, and the special thoracoscope instrument borrowed from the Provincial Maternity and Child Surgery Department for pediatric surgery came in handy. First, color ultrasound was used to detect the position. A small opening was made in the intercostal space on the left side of the chest, and the lens was inserted. Yang Ping carefully Under the microscope, cut the pericardium bit by bit, a few millimeters, and separate it slightly.
Under the microscope, you can see a little needle tail, and the pericardial incision is just at the needle tail.
Song Zimo and Xu Zhiliang looked at the young professor at the same time. He was really amazing. How could he have such a strong positioning ability?
No matter how many times he had to look for it, he got it right at once, as if he had inserted the needle.
It's like a hidden object game. A small toy is hidden in the room for you to find, and you find the toy directly.
Either you hid this toy, or you watched someone else hide it, otherwise you have to look for it anyway.
And this is not a needle, the needles in the limbs are like this, and now the needles in the pericardium are like this.
Could you please act normal?
Song Zimo drew ten thousand question marks and exclamation points in his heart.
Clamp the end of the thin needle with the grasping pliers, carefully pull it out, and place it in the bending plate.
Sure enough, the needle was rusty, and the tip had penetrated the heart wall for at least two millimeters. Fortunately, the needle was pulled out in time, otherwise it would slowly penetrate deeper and deeper with the contraction of the myocardium, and finally penetrate the heart wall. Broken heart.
"How did this needle go in? From the intercostal space? How could it go so deep?" Zhang Lin asked.
Xiao Wu replied: "The needle does not stay still after entering. With the breathing movement of the chest and the contraction of the heart, the needle will continue to move. The current position is not the original position."
Two good buddies stood on the operating table with nothing to do.
The patient was a baby, and there was no room to stand in the crowd, so the two brothers stayed away from the operating table and simply chatted.
Larger, blunt foreign objects, such as shrapnel, rarely move.
However, such sharp and thin needles can move easily, and some needles can enter blood vessels, which can be life-threatening.
Based on the positioning of the color ultrasound, Yang Ping used a thoracoscope to find three other needles, one hidden in the mediastinum, one in the space between the two lobes of the right lung, and one attached to the wall of the aorta.
The remaining three needles in the chest were found, especially the thin needle attached to the aortic wall, which made everyone sweat.
"Mother Xipi, how dark-hearted can you be to kill such a young child?" Zhang Lin cursed.
Xu Zhiliang raised his head and turned to look at Zhang Lin.
Zhang Lin thought that Lao Xu was going to scold him again, so he immediately put on a smile.
"His grandma, this is not human at all!" Xu Zhiliang cursed and lowered his head to perform the operation.
The surgery continued and began to remove fine needles from the abdominal cavity.
At this time Director Zhao came in: "How about it, Professor Yang!"
"Oh, is this really a thin needle inside? It makes my scalp numb."
Director Zhao looked at the curved plate on the instrument table and saw that there were already twenty or thirty needles. He felt very uncomfortable.
"There are still six abdominal tubes that have not been removed, and we are about to remove them."
Song Zimo sutured several small incisions on the chest, and Yang Ping was using color ultrasound to locate the six fine needles in the abdominal cavity. Sure enough, the positions of two of them were completely different.
As for the title of Professor Yang, in fact, every time these big guys call him, Yang Ping will say: "Call me Xiao Yang, or Dr. Yang."
But it seems that this has no effect. Even Dean Xia is like this, still talking about Professor Yang.
Yang Ping simply stopped being polite, it was just a title.
However, the title Professor Yang is more pleasant to the ear.
"Removing needles is a technical job, don't rush, take your time." Director Zhao said a few words politely.
Dr. Jin from the Department of Traumatology and Orthopedics didn’t know when he appeared behind Director Zhao. He said, “It’s true.”
The voice happened to be close to Director Zhao's ear, which startled Director Zhao. When he moved away, Dr. Jin suddenly appeared behind him.
"I used to take out a fine needle and use a high-pressure air gun used by workers to penetrate it into the right upper arm. The patient had no obvious symptoms, but asked to take it out. I had no choice but to cut it open and take it out. After repeated C-arm X-ray machine fluoroscopy, it was done. After four or five hours, I just couldn't find the needle. I couldn't find the needle when I saw it in this position. It was really annoying. Then I touched the tissue layer by layer with my hands. I kept touching for more than an hour, but still couldn't find it. , I had to give up the operation. The patient was discharged from the hospital and came to see me for a follow-up consultation. He said that he didn’t feel any discomfort at that time, but now his right arm is in a wrong posture, and his right hand is numb and painful like a needle prick.”
"Did this thin needle go from the upper arm to the mouth of the hand? Is it so evil?" Zhang Lin was very interested.
Dr. Jin continued: "I thought at the time, it's not that evil. Then I went to Director Han for advice. Director Han said, if you take another X-ray, if the needle is still on the right upper arm, there is a high probability that it will be there." Inside the radial nerve ”
"Later, I did as Director Han said. The needle position did not move and remained in place. I performed palpation on the patient's upper arm surface projection of the radial nerve. Sure enough, when I pressed it, there was something strange in the patient's right radial nerve control area. The feeling, especially in the tiger’s mouth area, is that it feels like acupuncture.”
"I immediately suggested that the patient undergo another surgery. The patient was quite obedient and agreed to the surgery. This time I opened the epicardium of the radial nerve at that location according to the position on the X-ray. My dear, the very small needle was lying vertically. There.”
Lao Jin told this clinical case with ups and downs.
At this time, Yang Ping had already completed pneumoperitoneum, inserted the laparoscope, and began to search for the six needles in the abdominal cavity.
(End of chapter)