Back in 2002 as a doctor

Although Zhou Congwen's words were a little bit forceful, Deng Ming's sound changed.

Compared with Zhou Congwen, he is like a junior brother, but he is the big brother.

"Don't worry, Director Deng." Zhou Congwen said, "with me here, the things you worry about will not happen."

"..."

"I have eighteen laparoscopic surgeries tomorrow and the day after tomorrow, and I will fly directly to the imperial capital after I finish." Zhou Congwen said, "Let's meet and chat."

"Okay, I'll pick you up then." Deng Ming didn't insist anymore.

Although he saw the simple to crude demonstration made by the boss and understood the principle of the new technique created by the boss, he was still worried.

But both the boss and Zhou Congwen insisted on it, and they didn't seem to care about the embarrassment in the society if the operation failed... Alas, thinking of this, Deng Ming sighed deeply.

One is that old horses know the way, and the other is that newborn calves are not afraid of tigers. I hope it will work.

After hanging up the phone, Zhou Congwen hurried to the circulation department.

"Xiao Zhou, you're here." Seeing Zhou Congwen striding in, Teng Fei was overwhelmed with joy.

"What patient, Director Teng." Zhou Congwen went straight to the point.

"For a patient after interventional surgery, the coronary arteries have been opened, but the patient's vital signs are not stable, and there is pain in the precordial area."

"I read the medical records." Zhou Congwen said.

Zhang You stood aside with his big teeth bared. Seeing Zhou Congwen coming, he felt a little unhappy, but he still smiled, "Now our hospital has more and more staff, and we will go to the surgery to check the gaps for Director Teng. Xiao Zhou, you are the chief surgeon. I'll be your assistant."

There is nothing wrong with saying this, but the yin and yang in the subtleties made Tengfei very unhappy.

Zhang You is like this, although he will come to him for consultation and surgery, but from time to time he always catches the problem of interventional surgery and sneers, which makes people very unhappy.

Zhou Congwen glanced at Zhang You and gave him a smile.

Talking trash, Zhang You's level is far inferior to his own.

In his last life, he rose up suddenly, from the Third Hospital of Jianghai City to the second year of Medical University, to 912, Mayo, and Cleveland, all the way spraying his opponents to death.

But after being reborn, Zhou Congwen felt that he was much more stable, and he was very satisfied.

While he was looking at the test sheet in the medical record, Teng Fei introduced the patient's situation.

Patient female, 79 years old.Because of repeated chest tightness and palpitations for 2 years, he was admitted to the hospital after 1 week of exacerbation.Has history of hypertension for 3 years, denies history of diabetes.

Coronary angiography was performed on the 9th day after admission, a 6F sheath was inserted through the right femoral artery, and a guide wire was sent into the J14 angiography catheter.The patient's internal iliac and abdominal aorta were severely twisted, and the angiography catheter could not go up with the guide wire when it was sent to the descending aorta.

Therefore, the 25cm arterial sheath of Johnson & Johnson was used, and the guide wire was first sent into the R3.5 angiography catheter for right coronary angiography examination, which showed normal results, and then sent into the angiography catheter for left coronary angiography examination.

When the angiography catheter popped into the opening of the left coronary artery, the measured pressure was 120/70mmHg.

Then the position of the C-arm machine tube of digital subtraction angiography was adjusted. After injecting the contrast agent, the proximal anterior descending artery was completely occluded.

At that time, the electrocardiogram showed: heart rate 90/min, atrial fibrillation, and ST segment elevation in V1~V6 leads was arched.Suggesting acute anterior myocardial infarction.

Dopamine and epinephrine were injected intravenously immediately. After 5 minutes, the intraarterial pressure was measured at 170/90mmHg and the heart rate was 150/min. Atrial fibrillation was still present. Nitroglycerin was injected into the coronary artery, nifedipine was taken sublingually, and nitroglycerin was infused intravenously.

The patient's symptoms were relieved within 10 minutes, and the measured arterial blood pressure was 140/80mmHg, and the heart rate was 110/min, but the sinus rhythm had not yet recovered.

Coronary angiography showed that the occluded coronary artery in the proximal anterior descending artery had been completely dilated, and the TIMI blood flow was grade 3.The patient was sent back to the ward with stable vital signs. After 4.5 hours, the patient complained of chest tightness, palpitations, profuse sweating, and pain in the right middle abdomen.

After Teng Fei reported the medical history, Zhou Congwen also read the medical history.

Although there were turmoil during the operation, it was not a major event. The coronary artery was opened and the TIMI blood flow was grade 3. The operation was successful.

"What do you say?" Zhou Congwen asked.

"Consider pancreatitis."

"No." Zhou Congwen said with certainty, "The hemoglobin decreased progressively. Considering the situation during the operation, I don't think it was pancreatitis or appendicitis caused by surgical stress."

"That is……"

"There must be a problem with the opening of the coronary artery. The pain in the patient's precordial area explains everything." Zhang You interjected, "I suggest to be conservative first. If it doesn't work, tell the patient's family to prepare for the chest surgery."

With that said, he glanced at Teng Fei.

"Interventional surgery is like this. It is opened during the operation and then blocked. It is better to do bypass surgery at the beginning."

Teng Fei's mentality collapsed a bit.

The surgery itself is extremely difficult, at least for Teng Fei.She performed super-level and won the operation, and the test results during the operation were quite good.

However, the patient's precordial area still hurt after the operation, so how could Tengfei's mentality be good.

At this time, Zhang You always said that interventional surgery is not as good as heart bypass, like a mosquito, buzzing around in the ear, really disturbing.

It would be great if I could still cooperate with Chen Houkun, Teng Fei felt a little nostalgic for the old days.

"Director Zhang, you have misread it." Zhou Congwen said lightly, "The blood supply to the heart should be fine. I highly suspect that the renal artery is ruptured."

"..." Teng Fei was taken aback.

"..." Zhang You was also taken aback.

Renal artery, what a big blood vessel!Although the persistent drop in hemoglobin may be caused by bleeding, it should not be from the renal artery.

Although doubtful, how could Zhang You dare to question Zhou Congwen casually.I have had enough of being beaten, and Zhang You is not cheap.

Let's wait and see, if Zhou Congwen's diagnosis is wrong, we will even spray him at that time, Zhang You sneers in his heart.

"Do a CT scan of the abdomen. If there is retroperitoneal hematoma, it proves that my judgment is correct." Zhou Congwen said.

Tengfei scratched her head a little.

She originally thought that the patient might have a refractory myocardial infarction, or that she had some unknown disease that caused the patient to still have symptoms of myocardial infarction after the coronary artery was opened.

But Zhou Congwen said that it had nothing to do with the myocardial infarction, it was a rupture of the renal artery and a retroperitoneal hematoma.

Is there a problem with your own surgery?

This complication does exist, but Tengfei has never encountered it.

What is written in the book, what you hear with your ears, and your own personal experience are definitely two concepts.

Teng Fei hesitated for a moment, and at this time Zhou Congwen said, "Give the doctor's order. Let's take the patient to have a CT scan, bring the emergency medicine with us, and check it before leaving. Don't run out of medicine if the CT patient has a problem."

"Xiao Zhou, it's probably not what you thought." Teng Fei said hesitantly.

"Have a look, the relevant examinations are still needed. If not, let's think about it from another angle." Zhou Congwen didn't insist, and said a very ambiguous, professional doctor's words.

"Xiao Zhou, have you ever seen a similar situation? After the coronary artery is opened, the patient still has corresponding symptoms?" Zhang You asked.

"I have." Zhou Congwen said, "but the patient in front of me is not."

"..."

"In percutaneous angioplasty for renal artery stenosis, the incidence of iatrogenic perirenal injury is 6.5% to 22.8%. The most common cause is renal artery perforation caused by the distal end of the guide wire. I think it is because of renal artery perforation during the operation. The arteries were too tortuous, the guidewire punctured the vessel, and a hematoma appeared."

Without objective auxiliary inspection, everything is guesswork.Teng Fei had no choice but to take the patient for an examination.

Just like Zhou Congwen's "guess", hematoma was found in the patient's retroperitoneum.

The cause of the patient's blood pressure drop and persistent chest pain after the operation was found—the renal artery was punctured.

Looking at CT, Fujifi felt very helpless.

I have been very careful in the operation, but in the end there is still a problem.

Zhang You was also stunned, the renal artery, that is the renal artery, is it okay if it is broken?It is possible that the guide wire is too thin and the incision is only oozing blood.But even the bleeding can be deadly.

Who's next?

Zhang You immediately thought of Director Jiang of the Vascular Department.

Urology should not be able to deal with similar situations. Whether it is stenting or suturing blood vessels, it is the work of vascular surgery.

"It's okay, Director Teng." Zhou Congwen comforted Teng Fei after confirming his point of view, "Similar situations often occur, the ascending blood vessels are tortuous, and some complications are also normal. You and the patient's family will explain it."

"Then?"

"Perinephric hematoma is mainly supported by infusion and blood transfusion, and surgical treatment is generally not considered in the early stage. If bleeding persists, balloon compression and embolization with stents or polyvinyl alcohol foam embolization particles can be used."

After Zhou Congwen explained, seeing that Teng Fei was still depressed and confused, he smiled.

"Under normal circumstances, the patient's condition will be stable within 2 days. If it is not stable, I will ask Director Jiang for surgery, and there will be no problem."

……

……

Zhang You kept an eye out, and contacted Director Jiang after returning home to find out about related matters.

After making an appointment to drink together in the evening, Zhang You pondered silently.

Most of his thoughts were not on the patient's condition and how to perform the operation, but on Zhou Congwen.

Precordial pain after percutaneous coronary intervention, Zhou Congwen gave a definite diagnosis after taking a look at the patient and reviewing the medical records. Zhang You had already gradually gotten used to his style.

But Zhou Congwen is robbing his own bowl of rice, which is intolerable or unbearable.

But even so, Zhang You had no good solution, let alone daring to turn against Zhou Congwen.

After thinking for a long time inexplicably, Zhang You seemed to be thinking a lot, but he didn't think about anything.

With Zhou Congwen lying in front of him, if he can't be solved, no matter what he thinks, it will be wishful thinking.

In the evening, taking Director Jiang to have dinner with the other two directors, Zhang You found an opportunity to ask Director Jiang quietly.

"Old Jiang, Teng Fei underwent surgery today, and a retroperitoneal hematoma occurred after the operation. She considered penetrating the renal artery."

"Oh?" Director Jiang regained his spirits all of a sudden, "Why didn't you ask me for a consultation?"

"Xiao Zhou is here."

Zhang You stared at Director Jiang like a torch. Zhou Congwen not only did something to him this time, but also reached into Director Jiang's job. I don't know what he will do.

"Xiao Zhou gave the diagnosis, so let's do it." Director Jiang said indifferently.

"..." Zhang You was taken aback.

Director Jiang is not a good-tempered master, he is very protective of food.

For thoracic aortic dissection, Director Jiang appeared in an extremely aggressive manner during the pretentious operation. Back then, he put on a dead-end posture and abruptly snatched this operation away from his mind.

But why didn't he respond at all this time? !Zhang You looked at Director Jiang in astonishment.

"Old Zhang, what's your expression?" Director Jiang asked.

"Ah? What's my expression?" Zhang You tried to squeeze out a smile.

"What do you want to say? There is a problem with Xiao Zhou's diagnosis? Impossible." Director Jiang laughed.

Zhang You really has nothing to say.

Why didn't Director Jiang give tit for tat?Why did he act so docile and humble, he didn't have any doubts about Zhou Congwen, he believed in everything.

Director Jiang is also a fine person, he has already guessed a little bit from Zhang You's expression.

"Old Zhang, you have very good eyes. I heard that you went to the hospital to ask for policies a while ago. If you want to introduce talents, you must introduce Xiao Zhou."

Speaking of this, Zhang You sighed deeply.

"It's a pity that Xiao Zhou is not an ordinary person, so let's forget about our level. At that time, Academician Chu wanted to accept Zhou Congwen as a student, but he refused. Everyone in the hospital and the internal medicine department knew about it."

Zhang You nodded. He also knew about it, so the conditions for the offer were very high.It's a pity that Zhou Congwen rejected him without even thinking about it, and even said a lot of "weird" words, trying to pull himself into interventional surgery.

"Xiao Zhou is very good, very good. The first time I saw him was because Jianghai City had a dissection surgery for a leader. Director Gou and I both went there. With this combination, it can be said that there is no better one in the province." .”

"The conditions there are limited, there is not even a DSA machine, and Director Gou and I can't cooperate with the operation under the fluoroscopy machine. Later, Xiao Zhou went up... Hahaha, I am ashamed to say that the first time I sent the guide wire in, I dragged it out. gone."

"..." Zhang You was silent.

He can think of the situation at that time.

Zhou Congwen must have smiled slightly, he didn't care, and the guide wire went in smoothly the second time.

Sure enough, Director Jiang said immediately, "Xiao Zhou didn't say anything, and downloaded it again. The first time may be said to be a coincidence, and the second time he went in, it shows that his technical level is higher than that of Director Gou and me."

Zhang You bared his teeth, "What if it's just a coincidence."

"Old Zhang, it's not right for you to be picky here." Director Jiang looked at Zhang You with a smile, "No matter what you say, we are like a mirror in our hearts. His level is high, and he is not too high. 01 : 30 o'clock. I have to admit this, if I lie to myself, I guess my face will be swollen in a few months."

"..." Zhang You sighed.

Why is Zhou Congwen not a doctor in the vascular department? Director Jiang stood aside and talked without back pain. Didn't he know that Zhou Congwen was amazing!

But he wants to grab his own job.