Start as an Emergency Physician

"Where's Dr. Zhou?" asked the nurse on duty directly.

The nurse pointed to the operating room, "Surgery... Do you have patients in your department who need Dr. Zhou's help?"

"What do you mean—" Ichisuke was stunned for a moment.

"Oh, many departments have come to see Doctor Zhou recently, but they are not very urgent, and their own doctors are fully capable of doing it independently, just to let Zhou Yuan do a teaching demonstration..."The gauntlet said, his tone was a little complaining.

Zhou Yuan's hard work, these nurses know best.

Just taking care of this patient was so tiring, they couldn't believe how Zhou Yuan persevered...

"No, I'm a life-saving operation, can you go into the operating room and say something?" Ichisuke said solemnly.

The nurse on duty stared at Ichisuke for a few seconds before nodding, "Okay, I'll go in and make a report." "

After completing the disinfection work, the nurse entered the operating room, and Ichisuke followed along.

"Aortic dissection, chronic obstructive pulmonary disease?"

Zhou Yuan frowned after listening to Ichisuke's explanation.

Zhou Yuan is not proficient in COPD, but he has previously mastered double lung transplantation, which is the most advanced technique in lung diseases.

With all the experience of double lung transplantation, although I am not as proficient in dealing with COPD as an expert in this field, I am still passable, at least at the expert level.

"Zhou Yuan, what should I do over here?" Wu Guohui's face also became heavy.

The old man on the thoracic surgery side is in danger, and the patient on Zhou Yuan's operating table only loses two toes even if the operation fails, and there is no need to judge which is more important than the other.

The doctor's thinking is very simple - the most important thing is to save more people.

Zhou Yuan lowered his head and thought about it, and after a while, he raised his head and looked at Wu Guohui: "You do it." "

Wu Guohui was stunned: "I won't!"

He has only seen the operation for more than ten days, although he is in Yisuke, he has learned the most, but it is still difficult to perform this operation.

Zhou Yuan: "The operation has just begun, and the separation of the toes has just been completed, you choose the less difficult blood vessel suture first, and I will finish the operation there as soon as possible!"

As he spoke, he put down the scalpel and looked at Wu Guohui: "Think of the patient as the third and twenty-second generation of Dabai, take it easy." "

Wu Guohui was silent for two seconds, and said hesitantly: "My family's three hundred and twenty-one generation Dabai is not dead yet..."

Zhou Yuan: ...

At this time, Zhou Yuan couldn't care whether Wu Guohui's surgery could be counted in the system count, and his life was at stake.

After explaining several key surgical links, Zhou Yuan followed Yizhu to the thoracic surgery department quickly.

......

Drip, drip, drip.

Drip, drip, drip.

There was silence in the operating room, only the sound of dense medical instruments.

Every sound made the hearts of the doctors in the operating room sink a little.

The patient's condition has deteriorated, and if it is delayed, it is a question of whether he will be able to get off the operating table alive.

The chief physician's face was gloomy at the moment, and he was blaming himself.

It is not without such cases internationally, and before this chest fire, there were six other cases of surgery with chest fire.

The environmental conditions in these cases involved dry surgical kits, rising oxygen concentrations, working electrocautery, and patients with lung disease...

This type of case is very rare, and he specially marked it at the time, but he didn't expect to recall it in time during the operation...

If it hadn't been for this chest fire, perhaps the operation would have been done and the patient wouldn't have had to go through so much pain at all!

"Director, Zhou Yuan is here!"

A voice seemed to pierce the darkness as if light, and Chief Physician Huo Ran raised his head and looked at the door.

Zhou Yuanping held two disinfected hands and walked in slowly.

The nurse hurriedly stepped forward and put on a surgical gown for Zhou Yuan.

"Zhou Yuan!"

The chief physician also couldn't explain that he was excited for no reason.

He only knew that he was relieved, and he knew that he couldn't, but Zhou Yuan might be able to...

The chief physician also has no ability to rejuvenate his hands.

In hospitals, there is a very surprising phenomenon that the success rate of many director-level doctors is not as good as that of those attending physicians and even resident doctors.

It's not because their skills aren't good, it's because their high status means that they will have access to more difficult surgeries, some of which are beyond the reach of manpower...

"You're finally here!"

The chief physician silently retreated to the position of a helper, and reported without waiting for Zhou Yuan to ask.

"Patient Zhao Mingshi, aged 61, was diagnosed with Stanford-A type aortic dissection after hospitalization, combined with chronic obstructive pulmonary disease, hypertension, hyperlipidemia, and heart disease. During Stanford-A aortic dissection, the electrocautery device accidentally came into contact with the dry scalpel in an environment with high oxygen concentration, causing an instant fire, which we immediately extinguished, but the artery was damaged and it was impossible to determine the aortic intimal rupture..."

Zhou Yuan nodded silently.

Stanford-A aortic dissection is a relatively rare disease, with an incidence of between 1 in 100,000 and 1 in 200,000 per year.

In the case of aortic dissection, the aortic wall dissection site begins at the root of the ascending aorta, and the intimal break generally begins in the anterior wall of the proximal ascending aorta and extends to the distal end of the aorta to the descending aorta.

In such patients, aortic regurgitation is often caused by dilation of the aortic annulus or proximity of the dissecting lesion, resulting in loss of support for the valve.

"Acute or chronic?" Zhou Yuan asked.

Acute aortic dissection and chronic aortic dissection are very different.

Acute dissection is usually an arterial dissection that occurs within 2 weeks, and 2 weeks after the onset of the disease is called chronic arterial dissection.

In terms of clinical manifestations and prognosis, the mortality rate of acute aortic dissection can reach 36%~72% within 48 hours due to aneurysm rupture or acute cardiac tamponade, and the mortality rate within 2 weeks is 57%~89%. In the chronic phase, the number of deaths due to rupture is significantly reduced, but 90% of patients die from arterial dissection rupture within six months of the onset of the disease.

The former is emergency surgery, which is mainly life-saving, followed by treatment. And the latter's first priority is treatment.

Although the surgical methods are different, one thing is clear... It is an extremely lethal condition.

"Chronic. The patient has been ill for three weeks. "

Zhou Yuan stepped forward and took a closer look, "Only the median sternal incision was made, are cardiopulmonary bypass and myocardial protection ready?"

The chief physician shook his head slowly: "It's too late." As soon as the chest was opened, we were ready for the electrocautery incision for separation and it caught fire... What do you think should be done now?"

The surgical field is not good, the patient is critically ill, the cardiopulmonary bypass has not been established, and it can only be maintained by a ventilator, and the peripheral arteries have also been clamped, and the blood supply has stopped... The current situation is not an exaggeration to describe it as a life of nine deaths. _

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