super anesthesiologist

Chapter 29

Liu Xu seemed to be out of spirits and depressed when she shifted work in the morning.

"Don't be anxious? There are still several days left?" Lin Xiaobei enlightened.Based on his understanding of her, he probably didn't find any relevant information last night.

"I want you to take care of it." Liu Xu said angrily.

"Jo, I'm really angry." He teased.

"Humph!"

"Isn't it just such a thing? Look at how anxious you are!"

"What is it, what do you know?" Liu Xu wanted to eat gunpowder.

"Hey, didn't I kindly persuade you?"

"Who wants you to be kind!"

"Okay, okay, okay, I don't want to bother with you." Lin Xiaobei was annoyed, and said sullenly, "Don't beg me."

The two have not spoken since then, but they still have the same tacit understanding as before during work.When Lin Xiaobei needed help, Liuxu would always appear by his side in time. When Liuxu encountered problems and looked sad, Lin Xiaobei would also silently give him guidance.

At noon, Director Lin Chaobing came to the operating room and said, "Lin Xiaobei, you will be responsible for an important operation this Saturday."

"Ah?" Lin Xiaobei wondered, he was not on duty this Saturday, why would the director arrange for him to have surgery?

"Director Hu Wenmao personally made the roll call." Director Lin said meaningfully.

"Oh!" Lin Xiaobei was secretly surprised. He was not familiar with Director Hu Wenmao, and he had only cooperated with him a few times, so his impression was not deep.

Director Lin didn't directly say the reason, and Lin Xiaobei didn't ask much.

"They will hold a general hospital consultation on that case at 4:[-] p.m. in the first general surgeon's office. You go to attend." Director Lin said the key point.

"Okay, I know."

After Director Lin left, Lin Xiaobei immediately called Director Hu Wenmao.

"Hello, Director Hu, I'm Dr. Lin Xiaobei, the anesthesiologist. First of all, thank you for your appointment. I want to ask what kind of patient it is?"

"Doctor Lin, hello. I'm sorry to trouble you. This patient is a bit special. I couldn't explain it clearly on the phone. How about this? You can read his medical records first, bed 38, Wang Yuansheng. Members will consult, and then you will come to participate in the detailed discussion.”

After hanging up, Lin Xiaobei cursed inwardly, "It's a bit special and does it require a hospital-wide consultation?"

"What patient?" Liuxu, who had been silent, finally spoke. The saying "curiosity killed the cat" couldn't be more appropriate for her.

"I don't know, the 38th bed in Puyi, Wang Yuansheng. Let's check the medical records first."

The first department of general surgery is hepatobiliary surgery, which treats mostly patients with lesions in the upper abdominal organs, most of which are in the liver.

This kind of patients is fine with mild symptoms, most of them are simple cholecystitis, gallstones and so on; severe cases are very complicated, the patients are often older, have many basic diseases, and the operation is complicated and traumatic, which is harmful to doctors and patients themselves. is a huge challenge.

After Liu Xu opened it, Lin Xiaobei frowned after watching it for a while.

The first leg is as follows:

Patient, Wang Yuansheng, male, 76 years old.

Features of a case:

1 Chief complaint: epigastric pain for three days.

2. History of present illness: The patient had persistent pain and discomfort in the upper abdomen without obvious incentives three days ago, which could not be relieved by taking painkillers (unknown details).Now come to our hospital for further treatment.Since the onset of the disease, the patient had poor mental sleep, normal bowel movements, and no significant change in body weight.

3 Past history: general health status, history of respiratory system diseases such as emphysema and bullae; history of hypertension, coronary heart disease and other circulatory system diseases; history of diabetes and other endocrine system diseases; cerebral infarction; spinal T8-9 tuberculosis Medical history... No history of vaccination, nothing else.

4 Physical examination: body temperature: 37.5 ℃, pulse: irregular, 68 beats/min, breathing, wheezing respiration, 19 beats/min, blood pressure: 185/98mmHg.Confusion, sinus arrhythmia on cardiac auscultation, moist rales in both lungs, abdominal tension, and edema in both lower extremities. …There is obvious tenderness in the upper abdomen, Murphy (Murphy’s sign) +++, percussion pain in the liver area +++, no percussion pain in the kidney area…

5 Auxiliary inspection None
Two diagnoses: 1 Abdominal pain awaiting investigation; 2 Intrahepatic bile duct stones, common bile duct stones, obstructive jaundice; 3 Emphysema, pneumonia; 4 Coronary heart disease; 5……

[-]. Diagnosis basis: characteristics of the same case as above
Four Differential Diagnosis: Further examination is needed to differentiate.

Five diagnosis and treatment plans: 1 Consult the superior physician to complete relevant auxiliary examinations (three routines, liver and kidney function, tumor markers, electrocardiogram).

2 Adjust the treatment at any time according to the condition.

……

Relevant inspection data later:
Cardiac color Doppler ultrasound showed: left ventricular dysfunction, moderate mitral valve regurgitation; left ventricular diastolic function was limited, ...pulmonary artery pressure was 98mmHg.

Chest X-ray: multiple nodules in both lungs, pneumonia.

Head CT: multiple cerebral infarctions.

……

"I'll go, why does this grandfather have all kinds of illnesses?" Liu Xu also frowned after reading it.

"Of course, otherwise, why would they hold a full-staff consultation."

"What exactly does Puwai want to do?"

Lin Xiaobei laughed, he was a student after all, and he hadn't seen the root cause of this old man yet.For intrahepatic bile duct stones, common bile duct stones, and obstructive jaundice, the problem of obstruction must be resolved.

Common bile duct stones can easily cause obstruction and poor bile reflux. After stasis, they can cause abdominal pain (subxiphoid colic is the most obvious), chills, high fever, and jaundice. Medically, this is called "Charcot's triad". If the condition worsens, infection may occur. Sexual shock (coma) and central nervous system symptoms, known as "Reynolds' pentad", patients are prone to secondary multiple organ failure and rapid death.

"Exploration of the common bile duct, and part of the liver may be removed." He said seriously.

"Ah, is it so serious?" Liu Xu was taken aback.

"if not?"

"Can grandpa bear such a major operation?" Her worry was not unreasonable.The hospital-wide consultation for general surgery is not about worrying about problems on the operating table, but about how to prevent postoperative complications.

"If you can't bear it, you have to do it. If this bile duct obstruction problem is not solved in time, it will easily kill people." Lin Xiaobei said bluntly.

Their operation was finished at three o'clock in the afternoon.

"Do you want to go with me?" He asked Liu Xu.

"I, what can I do?" She was a little flattered.

"Study, such an opportunity is rare. Do you want to go?" If it was someone else, Lin Xiaobei might not be willing to take it with him.

"go with!"

"Okay, get ready and write down the basic information of this patient."

The office of the first general surgeon is on the eighth floor of the surgery building. When Lin Xiaobei and the others rushed there, it was already full of people, including the directors of various departments and relevant medical staff of the department.

"Doctor Lin, sit here." Director Hu Wenmao greeted Lin Xiaobei enthusiastically.

"No, no, no, I'll sit here." Lin Xiaobei resigned. Director Hu was the initiator of today's discussion. Sitting next to him would be too conspicuous, not to mention Liu Catkin was still with him.

"This is a seat specially reserved for you." Hu Wenmao said meaningfully.

"Ah, what's the point?" Lin Xiaobei couldn't refuse in front of so many people, and said to Hu Wenmao, "Director Hu, there are two of us."

"Oh, that doesn't matter, just arrange another seat. Well, Zheng Quan, bring a chair over."

As soon as Lin Xiaobei and Liu Xu sat down, all eyes glanced at them.

"Well, everyone is here, let's start a discussion." Director Hu Wenmao saw that the situation was not right, and quickly switched to the topic.

First, Zheng Quan reported the medical records, which were similar to what Lin Xiaobei reviewed in the anesthesiology department.

"The main problem of this patient is the obstruction of the common bile duct, so a series of related complications have occurred. We have invited relevant departments for consultation and have dealt with various situations accordingly."

He paused and continued: "But because the patient's obstruction could not be effectively relieved, the result after treatment was unsatisfactory. Surgical treatment is urgently needed to solve the fundamental problem, but due to the serious complications of various systems, I would like to invite experts to express their opinions. "

On the round desk, the directors of various departments whispered to each other.

"Okay, everyone, please speak in turn."

First start from the endocrine director: "The patient's current fasting blood sugar is 13.5 (mmol/L), and the postprandial blood sugar is 19.8 (mmol/L). Although it is higher than the warning value, it should not drop too fast to avoid hypoglycemia. It is recommended to use insulin Control it at around 10 (mmol/L)."

Department of Respiratory Medicine: "The patient's lung infection is serious, and it is recommended to continue to control the infection."

Director of ICU: "It is recommended to stay in ICU for observation after surgery."

Department of Cardiology: "Continue to control blood pressure and maintain it at 150/90 (mmHg)."

……

Hu Wenmao smiled helplessly. These directors all looked at the problem from the perspective of their own departments. They were all handsome men, and they were unwilling to take risks.

"Dr. Lin, please evaluate the feasibility of this operation from an anesthesia perspective." He pinned his hope on the anesthesiologist.

The reason why he chose Lin Xiaobei was because his good friend Yu Zhendong praised him for his excellent skills as an anesthesiologist.He also visited that patient and was very impressed. After the discussion, the unanimous suggestion was to send the patient to the ICU after the operation.

The key to the success or failure of many surgical operations is not the skill of the surgeon, but the level of the anesthesiologist.

Hu Wenmao hoped that Lin Xiaobei would continue to produce miracles, so that the patient could be sent back to the ward in time after the operation.He didn't expect to be able to walk out of the operating room like the legendary chest patient, he could just lie down, as long as the endotracheal tube could be pulled out and he could resume spontaneous breathing.

Lin Xiaobei roughly guessed what Hu Wenmao meant. He definitely didn't want the anesthesiologist to give this patient general anesthesia, otherwise he wouldn't be appointed to perform the anesthesia.

Since Lin Xiaobei had mastered the basic information of the patient, he also rejected general anesthesia from his heart.The general condition of this patient is worse than that of the old chest doctor. Once his breathing is disturbed and the endotracheal tube is removed, he may lie in the ICU for ten and a half months.

This is not only a torment for Director Hu Wenmao, but also a huge medical expense for the patient's family.

But when he scanned the case just now, he found that this old man had suffered from spinal tuberculosis, and it was still in a critical segment.This almost ruled out the feasibility of neuraxial anesthesia.

The reason why the grandpa of the thoracic department can do paravertebral nerve plus intercostal nerve block is because thoracoscopy does not have very high requirements for muscle relaxation.

However, this grandpa’s surgery requires much higher anesthesia requirements, because the incision is deep and the upper abdominal muscle tension is high, so sufficient muscle relaxation must be required for the operation.

Whether it is a paravertebral nerve block or other local anesthesia methods, it is difficult to sustain.

Lin Xiaobei didn't express these concerns. Since Hu Wenmao believed in him, he couldn't beat him to death with a single blow and leave no hope behind.He thought that after getting familiar with the cases, he would go back and study carefully, and there would always be an ideal anesthesia method.

"Director Hu, I don't know much about the specific situation of this patient. I want to see him before making a comment." He said after careful consideration.

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(End of this chapter)