Back in 2002 as a doctor

"Zhou Congwen, you also read the medical records, tell me what's going on." Huang Lao said.

Zhou Congwen heard the sound of the task being completed. Although the task looked simple, it was actually extremely dangerous.

Hearing the boss asking himself, Zhou Congwen pondered for a while, and immediately said, "Boss, I suspect it was caused by the patient's chemotherapy for a malignant tumor of the parotid gland ten years ago."

"!!!" Li Sheng was re-disinfecting, and he couldn't help but froze when he heard Zhou Congwen's words.

Chemotherapy ten years ago...

Zhou Congwen was sure he wasn't joking.

"Well, continue." Huang Lao glanced at Zhou Congwen.

"Chemotherapy drugs are very likely to cause varying degrees of fibrosis in the lungs. The fibrotic remodeling and honeycombing of the lungs lead to reduced lung compliance and therefore increased lung vulnerability. During one-lung ventilation, high-pressure gas is more likely to damage lung tissue .”

"Then there is compromised elasticity and compliance of diseased lung tissue; high pressures from intraoperative ventilation may affect delicate lung tissue and lead to pneumothorax."

After Zhou Congwen finished speaking, he met Huang Lao's eyes.

"Probably this is the reason." Huang Lao said, "Today's luck is very bad. Patients after chemotherapy are less likely to develop tension pneumothorax during general anesthesia."

Hearing what the boss said, Professor Li suddenly felt as if he had received an amnesty, and a stone fell from his heart.

"The boss is right." Zhou Congwen continued to flatter him like a licking dog.

"One-third of the intraoperative diagnosis of tension pneumothorax is determined by auscultation, which is also the simplest and most convenient clinically.

However, clinicians and anesthesiologists need to have a deep understanding of this intraoperative complication.

Two-thirds are judged by imaging examinations such as CT and B-ultrasound, which alone will greatly interrupt the process of surgery and anesthesia. "

"The anesthetist's handling was very appropriate, and there was nothing to criticize about the rescue steps at that time."

"It's just bad luck."

Zhou Congwen finally said in an affirmative tone.

Huang Lao glanced at Zhou Congwen, didn't comment on his words, turned around and walked out of the operating room with his hands behind his back and his waist bowed.

Zhou Congwen followed, and out of the surgery room, Huang Laoyou asked, "Zhou Congwen, although tension pneumothorax is rare during surgery, it is not uncommon."

"The problem has been solved. It's not good to be too strict." Zhou Congwen said, "There is indeed a small problem with the anesthesiologist's treatment. He should auscultate the patient immediately, but he also performed a bronchoscopy, so he missed this point."

Seeing Zhou Congwen's clear words, Mr. Huang turned his head to look at him again.

"Lung compliance decrease caused by chemotherapy is indeed very rare, boss." Zhou Congwen knew that the boss was a little unhappy, but he insisted.

"Do you think there is room for improvement in your work?" Elder Huang didn't bother with Zhou Congwen's attitude, but asked as he walked.

“我认为术中麻醉应该给低潮气量，按照情况给与4~6ml/kg，PAP低于30cmH2O和PEEP水平，0~5或5~10cmH2O。”

"anything else?"

"CT and radiation are not suitable, but B-ultrasound is portable, and we will put one in the operating room in the future." Zhou Congwen said, "But...boss, there are not many people in our 912 who can use B-ultrasound to see pneumothorax."

"It's nothing difficult." Huang Lao said, "If there are lung sliding signs, B-lines, lung pulses, and M-shaped beach signs in the B-ultrasound image, it is definitely not a pneumothorax, and the presence of positive lung points is a highly specific sign of pneumothorax. sign."

Zhou Congwen was speechless, the boss was in the rhythm of organizing his studies again.

Everything is good at 912, but once the boss finds out some minor problems, he will organize learning.

Other hospitals and other departments are always organized by the nursing department to learn, but 912 Cardiothoracic Surgery, organized by the boss, has to learn.

Zhou Congwen smiled. Could it be that the technology of B-ultrasound to see pneumothorax was also promoted from 912 Cardiothoracic Surgery?

It is now 2003, and 99% of doctors in the country may not know the existence of the technology of using B-ultrasound to diagnose pneumothorax.

From this point of view, the boss is really at the forefront of the times all the time.

Chapter 0901 how much appetite to eat how much food

Zhou Congwen accompanied his boss back to the office, and Huang Lao took him to start the resumption of surgery.

This is the time Zhou Congwen enjoys the most.

This is also a weakness of the almost omnipotent system space.

In the system space in the previous life, Zhou Congwen had almost endless time to hone his own operations, find faults, and improve himself.

But everything is done by myself, the subjectivity is too strong, many problems cannot be found, and I am spinning in a dead end.

As for the technical moves, they were all marked with Zhou Congwen's own brand, which could not be erased at all.

This is the disadvantage of "Ye Luzi"'s background.

Just like the teenagers who came out of playing wild ball on the court, it takes a long, long time to erase many bad habits. Without the blessing of talent and the guidance of famous teachers, it may be the same for a lifetime.

Fortunately, Zhou Congwen met his own boss in his last life.

Huang Lao has brought out countless students in his life, and his own level is also the top. After seeing Zhou Congwen, he has been carving him as a rough jade.

Many bad habits that Zhou Congwen couldn't figure out and developed in the operating room of the system were all corrected by Mr. Huang through repeated postoperative review.

For Zhou Congwen, deep down in his heart he regards his boss as his father.

Zhou Congwen cherishes this opportunity to listen to his boss's opinion on his surgery again.

As for the boss's opinion, Zhou Congwen didn't say what the boss said as usual, but started a discussion on the technical details of each boss' opinion.

The sparks of thought collided and ignited, and the old and the young sat and discussed, as if there was an invisible operating table between them, and the experimental subject was lying on the operating table, aiming at each of the operations performed by Zhou Congwen in the past few days. The details of the problem” are exhaustively debated.

Deng Ming sent the patient back. Seeing that the patient's vital signs were stable after waking up from anesthesia, he was careful not to extubate, but told the ICU doctor to observe for 4 hours.

After 4 hours of observation, it is necessary to go directly to the ventilator to reduce the cardiopulmonary load, at least in Deng Ming's opinion.

After finishing his work, Deng Ming went to change his clothes, thinking about what the boss and Zhou Congwen were doing.

"Director Deng." A professor who led the group came to the locker room as if he had something to do.

"what happened?"

"It's really not our place for Xiao Zhou to lead the team to participate in the surgery competition this time." The professor who led the team smiled and asked in a gentle and joking tone as much as possible.

"It's decided by the boss." Deng Ming glanced at him, "You also want to participate?"

"Of course, do you think I can do it? Just make up the number."

"Do you know why the boss gave Zhou Congwen a chance?"

"Xiao Zhou's level is high, I admit it. I'm also surprised. Director Deng, how old is Professor Zhou? Subconsciously regarded him as Huang Lao."

The professor leading the group knew what Deng Ming was going to say, so he dragged the topic to the side.

"It's just one thing to have a high level. On the other hand, Zhou Congwen is willing to stay in a remote province, which belongs to the branch." Deng Ming smiled slightly and brought the topic back.

"He was over there." The professor with the group muttered in a low voice.

Deng Ming smiled slightly, "Should I throw you to Inner Mongolia? Carry out thoracoscopic surgery, when will you finish 5000 sets and come back. If you think it's too much, 3000 sets is fine. As long as it can be done, you can get what you want."

"..." Professor Dai was taken aback, as if he had eaten bitter melon, the muscles on his face gathered together and spasmed slightly.

"Can't do it?" Deng Ming squinted at Professor Dai.

"Director, it's very difficult." The professor with the group said, "In 912, I worked so hard for two or three years to complete so many operations. But if I go to a basic hospital, how difficult is the job there? knew."

"Some time ago, I went to a primary hospital for surgery and reported it to you."

Deng Ming nodded.

"There are things that will happen later, I don't even bother to talk about it." The professor with the group sighed, "The patient is still alive."

"Huh? About the surgery?" Deng Ming asked intently.

"No, I don't say how good the operation is, but it's definitely not bad." The professor leading the group said, "And our 912 habit, whether it is before or after the operation, I do it myself, which is definitely better than other flying knife professors." Do your best."

"But who would have thought that after I came back, the nurse would connect the infusion tube and the closed chest drainage tube when changing the drip on the third day after the operation."

"..."

Even an old man like Deng Ming was stunned when he heard the words of the professor leading the team.

The closed chest drainage tube is as thick as a small finger, because a slightly thinner tube is likely to be blocked the next day due to the solidification of the exudate in the chest cavity.

How thick is the infusion tube?How thick is the closed chest drainage tube?Can these two things be connected together?

Deng Ming looked at Professor Dai with a look like an idiot.

"Director, no matter how I asked the local hospital later, I didn't tell me, and I didn't know how it was connected. Just this, the deputy director who asked me to do the operation told me secretly."

"How did you solve the problem?" Deng Ming asked.

"Losing money." The professor leading the group shook his head, "The level of primary hospitals can be said to be beyond words."

"Too."

"With this level of care, let alone 500 surgeries a year, 300 surgeries a year is too much for me."

"Zhou Congwen's surgery volume has exceeded 300 since the New Year's Eve." Deng Ming said expressionlessly.

"!!!"

"You know the boss's temper, and you have bright eyes. Don't try to lie to him." Deng Ming said, "If you want honor, the boss will care? But you have to do the job."

"Zhou Congwen performs 6000 operations a year. No matter what ranking he gets in the World Series, this honor must be given to those related to him. Otherwise, do you think the work of primary hospitals is so easy?"

"Director, I know." The professor leading the group sighed, it seemed that he couldn't do it.

"Work hard, the boss can see it." Deng Ming smiled.

The boss saw it in his eyes, so why didn't Zhou Congwen see it in his eyes.

Pressing himself all the way, Zhou Congwen looked like a wild horse, but he was like a mirror in his heart.

Cooperating with the boss to perform an operation on the queen, Zhou Congwen ignored all the honors after the operation, and threw them directly to himself.

The Ministry attached great importance to this matter, and Deng Ming received countless benefits.

It's just an award, it's a trivial matter, more invisible benefits haven't been revealed yet, Deng Ming knows all about these things.

In the next year or two, we will go half a step further, and the honor "thrown" by Zhou Congwen is very important.

What he took from him, he repaid ten times, a hundred times. This kid is really sensible.

Deng Ming stood up and patted Professor Dai Group on the shoulder, "We don't talk about that on 912, the boss is here, just work hard, eat as much as you want, what do you think?"

0902 Collision

Deng Ming came to the door of the boss's office with a thermos cup in his hand. Through the door, Deng Ming heard his boss say in a voice that he would never use at ordinary times, "It's wrong for you to do this. The last stitch of the two-point intermittent suture method It needs to be opened to see if there is any accumulated thrombus in the blood vessel."

"Boss, the surgical incision is not big, and I have seen it all. I know what you mean, the benefits of three-point continuous suture are great, but..."

As Deng Ming listened, his hands holding the thermos cup froze slightly.

Two fixed-point interrupted sutures and three fixed-point continuous sutures are two methods of end-to-end anastomosis of blood vessels. Zhou Congwen's operation is very good, and the fact proves that the patient has no problems after surgery.

And he was actually discussing the subtle differences between the two matching methods with his boss.

This kind of discussion is meaningful, but the meaning is almost zero for ordinary doctors.

Ordinary doctors, regardless of whether it is two-point or three-point, as long as the operation can be completed, the blood vessels are anastomosed well, no thrombus is left, and there is no or less bleeding after the operation.

As for two fixed points or three fixed points, does that make sense?

Let alone an ordinary doctor, Deng Ming knew that even he himself would not be able to get in touch with such advanced detailed skills for the time being.

However, Zhou Congwen and the boss were discussing the subtle differences between the two methods.

Deng Ming's hand holding the thermos was unconsciously exerting force, and his nail bed was pale.After a moment of hesitation, he opened the door and went in.

Sure enough, both his boss and Zhou Congwen turned a blind eye to him coming in.

The boss took a pen and drew a pattern of blood vessels on the medical record paper, and was talking about the benefits of three-point continuous suture.

However, Zhou Congwen was not like in the past, no matter what the boss said, he nodded and said yes, and pointed out the shortcomings of the three-point continuous suture mercilessly.

These two people... Deng Ming looked helplessly.

He is very clear that the boss and Zhou Congwen are most likely to have a collision of ideas, and the spark that emerges from the collision may be the next clinical standard matching method after continuous improvement.

What two fixed points and what three fixed points are all in the past tense, and the latest matching method is the most suitable.

It's like the classic crush technique has evolved into a DK-crush technique.

But it is easier said than done.