Start as an Emergency Physician

"Please, doctor, give me a cotton..."

Zhou Yuan glanced at it and took a piece of cotton, "Here you go, one." "

“......"

Zhou Yuan: "Are you going to plug your left ear or your right ear?"

Soon, another circumcision was completed.

Several doctors in the urology department saw that their hands were itchy, and the next surgeries were divided by them.

Zhou Yuan, who had no use value, was sent back to the emergency department, and by the way, he earned a wave of surgical commissions.

A circumcision is very short, about ten minutes, and Zhou Yuan can get one or two hundred yuan.

However, this kind of money is an extra income for urology doctors.

After all, there are so many finch, and there are circumcisions during the winter and summer vacations every year, and who comes to the hospital to get circumcised at other times?

After returning to the emergency department, Zhou Yuan rested for a short time when the sound of the ambulance sounded again.

Zhou Yuan hurriedly got up and was about to walk out, when he saw a panicked Zhang Ling running over.

"Doctor Zhou, it's not good..."Zhang Ling leaned against the wall and gasped.

I feel a little proud in my heart: It seems that Zhou Yuan already has a heart for me!

Zhou Yuan ran over with Zhang Ling and asked, "What's the situation?"

"There was an old man in the ambulance, and the abdominal pain was so severe that he couldn't walk, so he was sent by ambulance. "

Zhou Yuan nodded: "Where did you send it?"

"In Observation Room One, the situation is being observed right now!"

Zhou Yuan immediately went to Observation Room No. 1.

He Jianyi was also in the observation room at this time, with a serious expression.

"Teacher, what's wrong?"

He Jianyi sighed: "The patient's condition is a little complicated..."

"Complicated?"

He Jian handed the medical records to Zhou Yuan and said, "The family members who came with the car brought the old man's medical records, you can take a look..."

Zhou Yuan immediately opened it.

The old man's name is He Jianguo, 72 years old, with primary IgA disease.

Patients with primary IgA disease have abdominal pain, flank pain, muscle pain, or low-grade fever. A small number of patients have persistent gross hematuria and varying degrees of proteinuria, which may be accompanied by edema and hypertension.

It is not easy to distinguish and is likely to be confused with lupus nephritis, purpura nephritis, and occult nephritis, and severe primary IgA disease has similar symptoms to chronic glomerulonephritis.

"Past medical history, high blood pressure, gout..."

Like most old people, He Jianguo has a variety of illnesses, which can almost be called a medicine jar.

"Have you had hemodialysis before?"

Zhou Yuan took a closer look at the hemodialysis disease.

On July 7, 2017, the right internal jugular vein was implanted with CUFF dialysis catheter, and hemodialysis treatment was started at the same time.

On 2017-09-25, laparoscopic peritoneal dialysis catheter implantation was performed, and peritoneal dialysis was started at the same time, and the cuff catheter that had been placed two months ago was removed.

On 2018-05-21, autologous arteriovenous fistuloplasty was performed on the left forearm, but in this examination, it was found that the patient had poor compliance with peritoneal dialysis and poor ultrafiltration, so he planned to change to hemodialysis.

2018-09-08, acute peritonitis suddenly, it was decided to undergo fistula surgery, and at the same time remove the peritoneal dialysis catheter, and perform outpatient dialysis according to the schedule.

2018-11-24.Due to the insufficient flow of the internal fistula, the venous outflow tract stenosis was found after color ultrasound, and the internal fistula balloon dilation was performed.

Three years of dialysis, as well as various complications and physical ailments.

There is no doubt that this is a critical patient, and the slightest carelessness may lead to an accident.

Zhou Yuan stepped forward and carefully examined the cephalic vein of the forearm, and found that the cephalic vein of the forearm pulsed strongly, but the trills became extremely weak.

"Teacher, do color ultrasound?"

He Jian nodded, "I have already finished the color ultrasound, and the results will come out soon." "

Soon, the color ultrasound results came out.

Zhou Yuan looked at it: "The cephalic vein aneurysm in the upper part of the forearm has been dilated, accompanied by thrombosis. Returning blood flows into the collateral branches, forming a thrombus, and venous return is blocked. "

"There are two venous thrombosis, cephalic vein thrombosis and perforator vein thrombosis. "

"Teacher, I suspect that it is high venous pressure with internal fistula pain. "

He Jian nodded: "I also suspect that the venous pressure is high with internal fistula pain, the blood clot is serious, and the blood clot may need to be dredged, but I don't know what the blood clot is." "

"The vascular surgeon came right away. "Oceanway.

Soon, several doctors in white coats walked in.

After carefully examining it, his face was a little serious, and he said: "The patient is very old, a high-risk patient, and he is accompanied by a variety of diseases, so the operation is very difficult. "

"Doctor, save my dad!" said a middle-aged man.

"Didn't you say that hemodialysis can still live for a long time, why can't it be now..."Another middle-aged woman is He Jianguo's daughter.

The doctor of vascular surgery said in a deep voice: "The operation is too difficult, the blood clot is difficult to dredge, and the patient's body function may not be able to support the whole operation..."

"Why not do saphenous vein graft bridging?"

Zhou Yuan, who had been checking the results on the side, said suddenly.

He Jianyi and the others were stunned.

Zhou Yuan continued: "The vein of the patient's elbow has a thrombosis, blocking the main blood vessel where the thrombus occurs, and then refluxing through the collateral branches to establish a pathway back to the heart. "

"I've seen color ultrasound, although the thrombus here is blocked, but the bypass blood vessels are dredged, my idea is to block the blood vessels first, cut the blood vessels to take out the embolus, and open the vein. "

"Why not give up the fistula and get a CUFF catheter for implanted dialysis?" asked a vascular surgeon.

This is also a solution, but of course, there are also huge risks.

"This method is indeed possible, but considering the advanced age of the patient and the fact that he is still sick, the success rate of giving up the fistula and then performing dialysis with a CUFF catheter implant can be said to be almost zero, and even if it is successful, it will take a long time for the patient to recover. "

"But... It is also very difficult to perform a vascular graft..."

Zhou Yuan didn't speak, picked up the marker, drew it on the old man's arm, and marked the upper thrombus on the superficial skin except for the thrombosis through the veins, the anastomosis, the expensive vein of the upper arm, and the head vein of the forearm.

Zhou Yuan pointed to the place where the vein thrombosis was pierced and said, "A blood clot has occurred here, then, we can do a vascular graft here..."

As he spoke, Zhou Yuan took a marker and connected the thrombosis site of the vein and the expensive vein of the upper arm on the outside: "In this way, the blood of the vein of the upper arm can also enter the vein, and the blood flow will be restored!"

Several doctors in vascular surgery were stunned, the idea... By connecting the valuable veins and veins next to them, they can restore blood circulation and solve the problem of blood clots, which they have not thought about.

"But... It's a very difficult operation!" a vascular surgeon asked the biggest question.

Zhou Yuan smiled: "What can be solved with technology is not a problem." "_

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