Auto chess in the operating room

Chapter 92 Sudden, perforated appendix!
Tanglou is now familiar with incision. Marking, disinfection, draping, and skin fixation follow the Maxwellian incision. The patient's skin, subcutaneous tissue, and external oblique aponeurosis are separated under Tanglou's knife in an orderly manner. .

Tian Linsheng was concentrating on it. After the cooperation last time, he was used to Tang Lou's speed. I have to say that Tang Lou's rhythm is really good, which is much more comfortable than cooperating with Ma En.

Soon, Tang Lou lifted the peritoneum and fixed it on the skin.

Taking advantage of the gap, Tian Linsheng glanced at Ma En and Wang Daquan beside him, and they were really shocked, especially Ma En, who was really unacceptable.

Tang Lou's movements were too standard and too fast, it made me sigh!

"Doctor Qing, Tang Lou has done a lot of appendicitis in the county hospital, this is too proficient."

Ma En finally got rid of his doubts, which is reasonable, otherwise he would be the first to do the surgery with one help at a time, so that he could buy a piece of tofu and kill him after suffering for several years.

After all, Ma En couldn't hold back and asked Doctor Qing about it.

"Oh, I haven't done a complete appendicitis, but it's the fifth case of incision."

Qingping said in a calm tone, but he had some bad taste in his heart, how can he drink alone after being hit by a genius?
Sure enough, when he heard the number five, Ma En's face seemed to be constipated, and he couldn't say a word for a long time.

Under the cover of the mask, Qingping secretly grinned and regained his composure.

Tang Lou on the operating table has already begun to try to find the appendix.

After the one-star appendectomy, Tang Lou already had the general level of attending, so he couldn't trouble him at all, and started to search for the ascending colon in the most conventional way.

"Huh? This is."

Tang Lou touched a mass of about 3*4 cm in the inner circle below the McBurney's point in the right lower abdomen, with poor mobility, clear boundary, and tough texture.

Amid doubts, Tang Lou continued to search for the appendix along the colon, and quickly found the appendix, but this appendix was adhered to the front abdominal wall, and the appendix was congested and edematous, accompanied by a large net wrap.

It was only then that Tang Lou realized that the tumor touched before was the patient's appendix.

The previous diagnosis was a bit off!
But Tang Lou didn't panic, he was as steady as an old dog.

Qing Ping and Ma En stood aside, watching Tang Lou's movements, pausing for a while, watching for a while, and finally regained a little confidence, which made him look like an intern.

They waited patiently for Tang Lou to complete his first appendectomy or to seek help in embarrassment.

However, before it was too long, Ma En was a little curious, so he leaned over.

Then, when he saw Tang Lou's appendix mass separating and sticking, Ma En stared. After all, he was a resident doctor and had a lot of experience in appendicitis.

Tang Lou's dissociated appendix can be seen at a glance, it is definitely not simple appendicitis, it is suspected to be gangrene or perforation!
"Doctor Qing, Doctor Qing!"

Ma En called directly, Qingping also frowned, got up immediately, stepped forward, and saw Tang Lou's free appendix.

The tail of the appendix where the incision was made had a perforation, and there was clearly a bezoar present and perforation.

The change in Qingping's face was not discovered during the previous examination, or in the last few hours, the patient has experienced an unexpected deterioration.

Appendicitis perforation, the method used is different from that of simple appendix. According to Qingping's experience, total appendectomy is required.

Moreover, if the appendix is ​​perforated, and there is purulent exudation in the right iliac fossa or pelvic cavity, it needs to be flushed, otherwise there is a risk of infection of the abdominal cavity.

Qingping immediately made a judgment that appendicitis surgery here was no longer suitable for Tanglou practice.

"Tang Lou, stop immediately. The perforation of the appendix is ​​more complicated. I will take over."

Qingping immediately issued an order. The pre-operative examination was negligent, but it was normal. This is also the reason why the subordinate doctor was accompanied by the superior doctor during the operation. If there is an accident, he can immediately take over.

The appendix perforation was not a serious situation for Qingping, it was just a nervous tension.

Ma En sensiblely left to make way for the passage.

Wang Daquan was also nervous all over, he shrank to the side and peeped. It seems that Tang Lou's first knife was messed up.

However, Tang Lou's body did not move.

"Tang Lou, you?"

Qingping, Ma En and the others were stunned, but Tang Lou was still going on.

"Doctor Qing, the appendix is ​​connected to the omentum. I have already dissociated. If I change it now, it may contaminate the abdominal cavity, and all previous efforts will be wasted."

While explaining, Tang Lou stretched out one hand to the equipment nurse and glared, "Pliers!"

The equipment nurse glanced at Qingping, who nodded before handing over the pliers.

The beautiful eyes blinked, this intern is too ignorant!

Tang Lou decisively and directly chose to remove the adherent omentum inflammatory tissue and appendix together.

".ligature thread."

Tang Lou didn't have time to explain, and directly issued the second instruction to the equipment nurse.

Beside Ma En, his panicked heart almost jumped out. Tang Lou is too reckless, isn't he afraid of making mistakes?
When the superior doctor calls to stop, continue to operate, if something goes wrong.
Ma En looked at Tang Lou who was still unmoved, and his heart trembled, what a ruthless person!
Not only is he technically excellent, but he is also too calm mentally. Seeing his continuous operations, Ma En admires him even more.

Tang Lou's judgment was correct, and it was not as safe for him to continue coming if he changed people midway.

And how does this look like a novice?

Tang Lou controlled the appendectomy line at a distance of 0.5cm from the root ligature line, and controlled the stump neither long nor short.

Qing Ping on the side also regained his composure. From observation, Tang Lou's actions had already demonstrated his rich reserves of knowledge.

If the stump is too long, it may form a residual cavity abscess. If it is too short, the ligature may be loosened due to tension in the cecum, and fecal fluid will leak out, causing intracavitary infection.

".carbolic acid."

Tang Lou continued to operate without distraction, and with the addition of talent concentration and tenacity, he completely forgot about the people around him.

During carbolic acid disinfection, Tang Lou controlled it extremely precisely, and none of it was applied to the serous membrane.

Qingping on the side nodded. If carbolic acid is applied to the serosa, it may burn the serosa and increase postoperative adhesions. Tang Lou's control is obviously just right, even he can't fault it.

But he was still a little displeased.

After finishing all this, Tang Lou asked the nurse for normal saline to wash the abdominal cavity partially, of course, to control it within the range, and to expand the washing, there is a risk of the infection spreading to the whole abdomen.

".Drainage tube."

Tang Lou issued another precise instruction.

Ma En's hanging heart was also relieved. The drainage tube is a step that many doctors tend to forget in the perforation of appendicitis.

Ma En once made a mistake, the appendix was perforated. When the operation was successful, it was judged that there was not much exudation, so no drainage tube was placed.

Later, the wound was infected and the preperitoneal space was infected, which almost led to medical disputes.

There was even a doctor who was dissatisfied with the treatment of the stump during the operation and was afraid of stump fistula, so he placed two drainage tubes, one for the right iliac fossa and one for the pelvic cavity.

When Ma En was feeling emotional, Tang Lou's movements did not stop.

".needle holder, suction thread."

Tang Lou's voice resounded in the operating room, covering even Qingping's aura. At this time, Tang Lou was the center of the operating room.

Perforation of the root of the appendix often causes inflammatory changes in the cecal wall and obvious edema, making it difficult to embed the stump of the appendix in the purse-string suture.

Therefore, Tang Lou chose to do interrupted mattress sutures on the cecum wall on both sides of the stump, no more, no less, a total of 5 stitches were sutured, and each stitch was ligated separately. The three-star suture technique is naturally impeccable. The stump is embedded.

Qingping was already fascinated by what he saw. Tanglou's operation and judgment of the condition were so accurate that even if he were to do it, he couldn't do it better.

"Pretty!"

Just as he was about to leave, when he thought that Tang Lou was just his intern, his expression instantly remained cold, with a superior demeanor.

After an hour and a half.

Tang Lou completed the final abdominal closure.

[Ding, task, the first complete appendicectomy in life is completed, 2 gold coins will be rewarded, and the reward card library will be refreshed]

[Card library refresh: Appendectomy (one star, 2), appendectomy (one star, 2), hernia repair (one star, 2), hernia repair (one star, 2), thyroid surgery (one star ,2)】

Tang Lou picked up two more appendectomies (one star, 2)

[Appendectomy (one star, 2), Appendectomy (one star, 2), Appendectomy (one star, 2) Synthetic Appendectomy (two stars, 6)]

Duang! Duang! Duang!

The panel of the tenement building is updated again:
Level 5: Upgrade 24
Operation column (5/5): Suture (three-star, 9), diagnosis (one-star, 3), appendectomy (two-star, 6), dressing change (three-star, 9), incision (three-star, 9) )

Gold: 0
羁绊（1/1）：1.外科圣手（二级，4/5）：减少30%感染率，增加30%愈合，减少患者30%疼痛
天赋（4/4）：1.缝合流水线（已激活）2.聆听3.专注4.韧性

Storage column (5/9): Exposure (three stars, 9), hemostasis (three stars, 9), emergency general (three stars, 9), appendectomy (one star, 2), debridement (two stars, 6)

(End of this chapter)