Back in 2002 as a doctor

"Shen Lang, take a 1ml syringe and draw 95% alcohol."

"Ah? What are you going to do?" Shen Lang was startled.

"I saw a parasite in the patient's nasal cavity."

"!!!"

Chapter 0377 Steady and ruthless

"Young man, I'm just here to watch the excitement. I don't have any other intentions. Don't scare me." The patient was about to cry, and said frightenedly.

While talking, she thought in her heart, doctors are indeed monsters, talking nonsense, brains and parasites.

I just got angry and got some nosebleeds, and I was curious to see the excitement, how could there be so many things.

No one knew what Zhou Congwen was going to do, only Shen Lang's eyes were burning with gossip.He knew Zhou Congwen well and knew that this guy never did useless work, so Shen Lang especially wanted to know what Zhou Congwen was going to do.

Nasal cavity, bleeding, absolute alcohol, is there such a way to stop bleeding?

The so-called parasite is probably Zhou Congwen scaring the patient, but why scare people?

Shen Lang felt the fire of gossip crackling behind him, and he could hear the sound.

"Auntie, don't be afraid, it will be over in a few seconds." Zhou Congwen said lightly, "I guess, you accidentally came into contact with raw water when you were traveling in Yunnan."

"No... There must be something like a creek, but it has nothing to do with nosebleeds."

Zhou Congwen saw that Shen Lang started smoking absolute alcohol, so he asked his aunt to look up at the floor lamp.

"There are a lot of things to pay attention to when traveling to places like Yunnan. If you live in a homestay, the boss will do it for you..."

"What is a homestay?"

"Uh..." Zhou Congwen was taken aback, then sighed. He didn't know when the homestays emerged. They still seem to be youth hostels, and some places are even old state-owned enterprise guest houses.

"It's business, don't interrupt." Zhou Congwen said, "The most dangerous thing is to eat mushrooms with the locals. The mushrooms in Yunnan are delicious, but many mushrooms are poisonous, and the locals are used to it. I know a classmate from Yunnan. Every year They all brought back a lot of mushrooms."

While talking, Zhou Congwen stretched the patient's nasal cavity, and stretched out his hand, Shen Lang put the syringe in Zhou Congwen's hand.

"No needles." Zhou Congwen said softly, "In the first year, we didn't know how powerful the mushrooms in Yunnan were, so we boiled a pot in an alcohol stove, and we all ate noodles with mushroom soup. As a result, all of our dormitories were poisoned..."

"Poisoning?!" Auntie asked curiously, having forgotten about the brains and parasites.

"Yes, we didn't go to the evening self-study. Others said that we were singing and dancing in the dormitory, and it was really fun. Later, I told the counselor that our alcohol stove was confiscated, and each of us almost got a major demerit."

"Why do you have to remember a big demerit?" Auntie also started gossiping.

While talking, Zhou Congwen inserted the 1ml syringe into the patient's nasal cavity and pushed it gently.

"Open flames are not allowed in the school, but we all have alcohol stoves, electric blankets and so on in private. If we are found out, we will definitely be punished, so I never dared to eat Yunnan mushrooms after that. It was really scary."

Before the patient could speak in a low voice, she felt her nose loosened and her breathing became much smoother.

At the same time, Zhou Congwen's tweezers came out of his nasal cavity, holding a black bug about 3cm in size.

"Oh~~~" The patient was startled and let out a scream.

Li Ran was concentrating on watching the bug that Zhou Congwen brought out, but he didn't expect there to be a scream.

He originally had a serious expression, but with a three-point coldness, three-point ridicule, three-point carelessness, and one-point contempt, he was completely frightened and disappeared, leaving only a serious and rigid face.

"Leeds, we don't see them very often here. Farmers who grow rice fields may have seen them, but there are no more in the city." Zhou Congwen said, holding the leeches with tweezers.

At this time, the two aunts were not afraid anymore, and looked curiously at the leech that was still twisting its body.

It's so disgusting, this thing has been in my nose?The patient suddenly felt nausea and vomiting.

"This doctor, what's going on?"

"The adults or larvae of leeches attach to the upper respiratory tract through mucous membranes, such as the nasal cavity, mouth, and throat, and cause repeated bleeding during the blood-sucking process." Zhou Congwen explained, "Your nasal bleeding appeared after returning from Yunnan. It might be a leech, so I took a look."

"Why use alcohol?" Shen Lang asked.

"When the adult leeches are attached to the skin, they must be removed together with the sucker. If it is the outer skin, you can pat the area where the leeches are attached.

But the nasal cavity, forget it, isn't that a slap in the face.

In this case, you can use salt, vinegar, wine, cool oil, etc. to smear and stimulate, and the leeches will come out naturally. "

"Uh..." The two aunts looked at each other.

They are all from the northeastern cities, and it is rare to see such creatures as leeches.

"Leeches have suckers. If they stay in the body, they will cause infection. The nasal cavity is still a dangerous triangle. Once infected... I met a similar patient. It stayed in the nasal cavity and finally got an intracranial infection, so I didn’t die.”

Zhou Congwen explained flatly.

Some things are just a trivial matter in the hands of experienced doctors, but if they are not handled properly, they will lead to life-threatening.

Zhou Congwen's handling seems simple, but in fact, accurate vision, steady hands, and rich experience are all indispensable.

In particular, the accuracy of the tweezers in catching the leech and the timing of the loosening of the leech's sucker under the stimulation of alcohol are commendable, and Zhou Congwen himself is very satisfied.

It's a pity that no one in this room can understand the difficulty of operation.

"Do you keep the leeches?" Zhou Congwen asked "understanding". Some patients are interested in this thing.

But the aunt in front of her obviously had no love, she was terrified and waved her hands repeatedly.

"Then I'll throw it away." Zhou Congwen squeezed the tweezers in his hand, and with a crisp sound, the leech was crushed to death and thrown into the medical waste bucket.

"You guys are busy, Li Ran tidy up the disposal room." Zhou Congwen turned around and left the disposal room after speaking.

"That doctor just now looks amazing!" The patient said, looking straight at Zhou Congwen's back.

"Responsible attending physician." Li Ran said seriously.

"He has a girlfriend, and he plans to go home soon and let his parents take a look." Shen Lang added.

Auntie is a little sorry.

……

……

Zhou Congwen left the disposal room and saw Li Qinghua coming out of the director's office.

"Congwen, come here." Li Qinghua beckoned to Zhou Congwen.

"Director, what's the matter?"

"I have a new idea, let's discuss it with you."

When Zhou Congwen walked into the director's office, Li Qinghua closed the door and said with a smile, "Congwen, I wish the director a thoracoscopic wedge resection a while ago."

"Oh, did it go well?" Zhou Congwen was not surprised.

The information had already been given to him through Li Qinghua. If Zhu Jun didn't even try, then this person was hopeless.

"Not smooth."

Chapter 0378 Li Qinghua's thoughts

"No nodules found?" Zhou Congwen asked.

Li Qinghua nodded, "Congwen, every time you took out the small lung nodules with a pair of pliers, I didn't find it difficult at first, but after knowing what happened to Director Zhu, I thought about it carefully and felt that this step is very important. Accurately find small pulmonary nodules? What are the techniques?"

Zhou Congwen smiled slightly. He has performed tens of thousands of wedge resections of lung lobes by himself. From the very beginning, he took the risk to find the location, and then to the precise location.

Only familiar with hands.

But this cannot be said to Li Qinghua.

"Is it talent?" Li Qinghua asked.

"Director, when did the pulmonary nodules not found there?"

"Xiao Li and Da Chengzi didn't take long after the surgery."

Zhou Congwen nodded, "Director, after such a long time, have you come up with any solution?"

"I'm going to discuss it with you." Li Qinghua said, "I consulted many classmates and teachers, especially those who work in European and American hospitals, and they provided some advice."

Zhou Congwen smiled. Li Qinghua was still very concerned. This person has a bright future.

"In 1994, Dr. Lenglinger's team first used methylene blue for CT-guided localization of small pulmonary nodules. Now hospitals in Europe and the United States mostly use methylene blue for localization before surgery for small pulmonary nodules. Do you think it will work?"

"What else?" Zhou Congwen asked.

"Medical glue is more advanced than agar blue, but it is a high-value consumable. It is said that it is still in the research stage, and it is not available in China." Li Qinghua said.

Zhou Congwen knows about medical glue, which is a special product that is injected near small pulmonary nodules. When it encounters blood, body fluid or tissue fluid in the human body, it will solidify into a film and be tightly embedded with the surface of the tissue in contact.

When doing thoracoscopic surgery, after opening it, you can see that the place where the medical glue is injected is different from other places.

Although it is absolutely impossible to inject into the small pulmonary nodules, 1cm nearby is enough. After all, it is impossible to resect the small pulmonary nodules by wedge cutting.

The principle of methylene blue is similar. After entering the endoscopic lens, you can see a large area of ​​blue at a glance, and there are small pulmonary nodules nearby.

Li Qinghua was really willing to think about it, Zhou Congwen looked at him with a smile, "Director, you are amazing."

"Don't talk about this, do you think methylene blue is okay?" Li Qinghua asked seriously.

"Of course, but do you know the shortcomings of methylene blue?" Zhou Congwen asked.

"Disadvantages... prone to traumatic pneumothorax?"

"The occurrence rate of traumatic pneumothorax is not high, and generally speaking, I think it should be CT positioning within 1 hour before the operation. After the injection of methylene blue, the patient is sent directly to the operating room. Even if there is a small amount of pneumothorax, there will not be any question."

"Uh..." Li Qinghua broke apart Zhou Congwen's words and thought them over carefully.

Zhou Congwen opened a brand new window.

In Li Qinghua's imagination, a similar positioning should be done the day before the operation, but in that case, the secondary injury is a very important complication, which must be considered.

But Zhou Congwen said one hour before the operation... If so...

"Methylene blue is a better choice now, let me talk about its shortcomings first." Zhou Congwen said with a smile.

"First of all, the methylene blue solution diffuses quickly, and it is difficult to identify the specific location of the lesion during the operation, which limits the time for surgical connection after the marker positioning. Therefore, it is best to use methylene blue for positioning, and it is best to send it directly to the operating room after positioning."

It turned out to be like this, Li Qinghua nodded.

Methylene blue is a commonly used positioning agent in clinical practice, but Li Qinghua does not know the specific diffusion speed.

He secretly memorized Zhou Congwen's words and prepared to try it himself.I can't always say what Zhou Congwen said, because I am completely out of my mind.

"Congwen, how long will it take?"

"3 hours." Zhou Congwen continued, "Secondly, for patients who are older, have been smoking for a long time, have been engaged in mining work for many years, or have been exposed to dust for a long time, due to the deposition of carbon powder in the alveoli, the surface of the lungs will turn black, and methylene blue is not easy. Identified."

"It turns out that there are limitations in its use." Li Qinghua sighed.

Even for non-smokers, when the chest cavity is opened during the operation, the lung lobes are basically covered with black spots, but the patients who smoke are more serious.

The real pink and tender lung lobes can only be seen in the operation of young people in their 20s.

"It's not bad, it's amazing to think of using methylene blue." Zhou Congwen praised sincerely.

But when Li Qinghua heard this sentence, it was a different concept.

Zhou Congwen is like his own teacher, is he such a young teacher?Although it is said that the master is respected, medicine must talk about experience after all.

Li Qinghua smiled and stopped thinking about these "useless" things.

"third……"

"sixth……"

"ninth……"

Zhou Congwen continuously talked about the nine shortcomings of Methylene Blue's positioning, which stunned Li Qinghua.

The things I racked my brains to come up with were worthless in Zhou Congwen's mouth.

He was a little frustrated.

"Director, don't think that you can't do it. In fact, Yajialan's positioning is still very good." Zhou Congwen smiled, "Especially when you are just getting in touch with it, you can think of the positioning, which is quite powerful."

Li Qinghua smiled helplessly.

"I've already started working on a solution. I asked Olida's regional manager... Wang Xueteng, do you still remember?"

Li Qinghua nodded. Wang Xueteng is a standard beauty, smart and capable, and an urban beauty.