Start with the emergency physician

“Doctor, please, 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 itching, and the next surgery was divided by them.

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

A foreskin operation took a short time, about ten minutes, and Zhou Yuan was able to get one or two hundred yuan.

However, this money is an additional income for urology doctors.

After all, there are so many finches, there is circumcision during the winter and summer holidays every year, and who has nothing to come to the hospital to cut a circumcision at other times?

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

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

“Doctor Zhou, it’s not good…” Zhang Ling leaned against the wall and gasped.

I was a little proud in my heart: It seems that Zhou Yuan already has a spiritual rhino with me! Now there is no need to bark!

Zhou Yuan ran over with Zhang Ling and asked, “What is the situation?” ”

“An old man came down from the ambulance, the abdominal pain was particularly severe, and 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 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 situation is somewhat complicated…”

“Complicated?”

He Jianyi handed the medical records to Zhou Yuan and said, “The family members who came with the car brought the old man’s medical records, 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, low back 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.

This disease is not easy to identify, and is likely to be confused with lupus nephritis, purpuric nephritis, 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 that can almost be called a medicine jar.

“Have you done hemodialysis before?”

Zhou Yuan carefully looked at the disease of hemodialysis.

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

2017-09-25, laparoscopic peritoneal dialysis catheter implantation was performed, and peritoneal dialysis began at the same time, removing the catheter with CUFF placed two months ago.

2018-05-21, autologous arteriovenous fistuloplasty of the left forearm was performed, but in this examination, it was found that the patient’s peritoneal dialysis compliance was poor and the ultrafiltration of the sneak attack was poor, so he planned to change hemodialysis.

2018-09-08, sudden acute peritonitis, decided to perform internal fistula surgery, while removing the peritoneal dialysis catheter, and regular outpatient dialysis.

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

Three years of dialysis, as well as various complications, physical conditions.

There is no doubt that this is a critically ill patient, and the slightest mistake may lead to accidents.

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

“Teacher, do color ultrasound?”

He Jian nodded, “The color ultrasound has been done, and the results will come out soon.” ”

Soon, the color ultrasound results came out.

Zhou Yuan looked at it: “The head vein tumor in the upper part of the forearm has expanded, accompanied by thrombosis. Blood flows into the lateral branches, forming a thrombus and obstructing venous return. ”

“There are two venous thrombosis, cephalic vein thrombosis and perforating vein thrombosis.”

“Teacher, I suspect 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 thrombus may need to be unblocked, but I don’t know how the thrombus is.” ”

“The doctor from the vascular surgeon will come right away.” Ocean Road.

Soon, several doctors in white coats walked in.

After carefully examining it, his face was a little serious, and said: “The patient is very old, a high-risk patient, and there are many diseases on his body, and the operation is very difficult. ”

“Doctor, save my father!” A middle-aged man said.

“Didn’t you say that hemodialysis can still live for a long time, why can’t it not be done now…” Another middle-aged woman is He Jianguo’s daughter.

The doctor of the vascular surgery said in a deep voice: “The operation is too difficult, the thrombus is difficult to dredge, and the patient’s physical function may not be able to support the entire operation…”

“Why not a saphenous vein graft bridging?”

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

He Jianyi and the others were stunned.

Zhou Yuan continued: “The vein in the patient’s elbow has a thrombosis, blocking the main blood vessels where the thrombus occurs, and then returning through the lateral branches to establish a pathway to return to the heart. ”

“I have seen color ultrasound, although the thrombus is blocked here, but the blood vessels in the bypass are unblocked, my idea is to block the blood vessels first, cut the blood vessels to take out the emboli, and open the veins.”

“Why not give up the internal fistula and take a CUFF catheter for implantable dialysis?” A vascular surgeon asked.

This is also a solution, and of course, there are also significant risks.

“This method can indeed be done, but considering the patient’s advanced age and the fact that the body is still sick, the success rate of abandoning the internal fistula and then undergoing dialysis with CUFF catheter implantation can be said to be almost 0, and even if it is successful, it will take a long time for the patient to recover.”

“But… Blood vessel transplantation is also very difficult…”

Zhou Yuan did not speak, picked up the marker, scratched it on the old man’s arm, and marked the position of the thrombosis at the superficial surface of the skin except for the perforating vein thrombosis, anastomotic port, upper arm noble vein, and upper end of the head vein of the forearm.

Zhou Yuan pointed to the place of perforating vein thrombosis and said: “A thrombus has occurred here, then, we can completely do a vascular transplant here…”

Saying that, Zhou Yuan took the marker and connected the vein thrombosis site with the outer upper arm vein: “In this way, the blood from the upper arm vein can also enter the vein, and the blood flow will restore circulation!” ”

Several doctors in vascular surgery were stunned, this idea … By connecting the nearby vein and perforating vein, thereby restoring blood flow and solving the blood clot problem, they did not think about it.

“But… This operation is very difficult! “A doctor in vascular surgery asked the biggest question.

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

To see the ununderlined version of the novel, please download the Feilu Novel AP