medical simulator

After strictly binding the two silk threads, Yan Haihan couldn't help looking at Zhou Cheng who had helped him.

I found out that Zhou Cheng opened the wound, exposed the wound of the femoral artery, and was still 'playing' with the femoral nerve and accompanying femoral vein...

In fact, it is checking whether these two things are injured.

It's just this skillful technique that made Yan Haihan become the second monk.

MLGB's is undergoing surgery now, you are tossing and turning.

Only at this moment, Yan Haihan saw again that the vascular forceps in Zhou Cheng's hand seemed to be fine, and he did not know where to pry it, and it seemed that the inner great saphenous vein was pulled out from the wound, and the wound was healed. After the pressure, blood gushed out.

Zhou Chengcheng said, "Are there any sutures for vascular surgery? Open a few."

"Yes!" The itinerant nurse replied immediately. Although she didn't know which department and which surgeon wanted it, she just wanted to obey orders and didn't bother to care about it at all.

Yan Haihan and the others immediately glanced at Zhou Cheng when they heard the words.

This patient is going to be amputated. What do you do with vascular sutures?

Of course, it also includes Li Changhong from the Department of Orthopedics.

Zhou Chengcheng said: "Director Yan, I think the plane of the amputation can be slightly lowered, so that the prosthesis can be installed in the future, and the arteriovenous tear here is not big, so it can be sutured."

Although it is an amputation, how much is left and how much is amputated is completely different.

Amputation from the base of the thigh is amputation, and amputation from the ankle is also amputation. The degree of function preservation is completely different.

Yan Haihan heard the words and thought it made sense.

Without saying anything, Luo Yun secretly gave Zhou Cheng a thumbs up.

Although amputation is cruel, as long as possible, stay as long as possible. This is also for the benefit of patients. I'm afraid that's all that can be done now.

People in orthopedics are not very proficient in vascular surgery. Vascular surgery cannot solve the problem of blood vessels, so the orthopedics can only leave as many stumps as possible to make up for it.

After Zhou Cheng got the blood vessel sutures, he quickly sewed up the great saphenous vein first. The great saphenous vein has only a small opening, and there is no need for the three-point blood vessel suture method of amputated limb replantation. The saphenous vein was replenished.

The same goes for the femoral artery...

After hearing Zhou Cheng's words, Yan Haihan's heart ached secretly. If Zhou Cheng hadn't said this, then he really planned to amputate his limb from the injured place. It was simple and rude, but Zhou Cheng said so.

As the director, Yan Haihan was embarrassed to say that the range of amputation here was shorter than Zhou Cheng's, so he also ordered blood vessel sutures, and then began to sew them up.

However, when Yan Haihan finished stitching, he was about to see what Zhou Cheng was doing.

Suddenly found something not quite right——

Because Zhou Cheng is now using a knife on the back of the patient's shin!

And skillfully--

What is he doing?

After Zhou Cheng used the round knife to cut the skin, he didn't use the sharp knife to go deep. Instead, he used blood vessel forceps, as if entering his own house, bluntly opened the muscle layer, and went straight to the posterior tibial artery...

One minute later, the sharp knife pierced the blood vessel wall of the posterior tibial artery, and pulled out a thrombus the size of a little finger from the blood vessel cavity like a carrot, like a black loach...

Obviously, this is the arterial embolism that Zhou Cheng found from the branch of the downstream artery of the femoral artery!

He's doing an arteriotomy!

The expressions of Yan Haihan and Luo Yun changed immediately, and even the expressions of Li Changhong and Wang Yaoxiang were a little unnatural.

Zhou Cheng is doing arteriotomy and thrombectomy, how does he know where the thrombus is?

This is the first point.

The second point is, if Zhou Cheng now saves his limbs below the knee joint, what should they do?

Can I amputate above the knee joint or above the elbow joint?

Doesn't this mean that he and others are inferior to Zhou Cheng?

However, what can be done if the amputation is not here?Will they know what Zhou Cheng is doing now?

will not.

Yan Haihan regretted it, regretted why Luo Yun was brought down, and regretted why Luo Yun brought Zhou Cheng.

Zhou Cheng discovered that Yan Haihan and Luo Yun were looking at him.

Thrombectomy of the femoral artery is a branch of level II surgery, so Zhou Cheng really knows how to do it!

In terms of surgical authority, arteriotomy and thrombectomy are also authorized in the category of orthopedics.

After Luo Yun took a deep breath, he asked, "Do you know how to perform arteriotomy and thrombectomy?"

This is not asking, this is affirming.

Zhou Cheng was suturing the incision of the posterior tibial artery where the thrombus was taken out, nodded, and replied naturally: "Yes, Mr. Luo, after I got the level II operation permission, I went to watch the video to learn this operation."

"Arteriotomy and thrombectomy is the 2011nd item in the 22 surgical classification list in my country, the orthopedic classification II surgical classification table..."

"So I thought I might encounter such an operation, so I went to video school."

Although Zhou Cheng's words were very straightforward and direct, they were even well-founded.

Even the National Health Commission was not called this name back then, it was the contents of the official document issued by the Ministry of Health that told it.

The first few items have been told to you.

creak!

When Zhou Cheng was speaking, he could clearly hear several screeching sounds of rubber slippers rubbing against the ground!

Such a fresh and refined reason!

Indeed, Yan Haihan, Li Changhong and others were caught off guard.

Myocardium almost died.

After you got the level II surgery permission, you went to learn one by one according to the list of level II surgery from the Ministry of Health?

Is this too much?

Actually not too much.

It's just that I don't know how to say it.

……

The muscles at the corners of the mouths of Yan Haihan and Li Changhong, like heart muscle, became integral and began to twitch at the same time.

Either twitch or not, very uniform.

Luo Yun took a step back, not standing still.

Zhou Cheng really dares to say——

The reason for prevaricating oneself is spoken out on this occasion.

Then I saw that Yan Haihan and Li Changhong glanced at Huang Shinan intentionally or unintentionally, their eyes were full of strangeness and complexity...

Brother, why don't you come and see if this is an operation in your department?

Huang Shinan felt that today must be his doomsday. First, a lot of unlucky things fell from the sky like money.

Then, an orthopedic doctor, Yang Yifeng, appeared in the middle, acting as the savior for half a minute.

After asking him to be the chief surgeon, he forcibly refused.

Now a little orthopedic doctor has come out to make a fuss!

Damn, which god did I offend today?

I followed the surgery videos on the Internet, so I will.

It means that Huang Shinan didn't follow the surgery videos on the Internet, so I can't?

Then, Zhou Chengcheng continued to the next step, first to sew up the opening of the artery!

Then he let go of the ligated silk thread, and it turned out that the posterior tibial artery began to fill, and no blood leaked out.

Immediately follow the shape of the posterior tibial artery with both hands and feel the beating of the artery from top to bottom!

The shape of the femoral artery is from the upper outside to the lower inside, and the beating of the posterior tibial artery extends from the rear to the lateral malleolus.

Therefore, when Zhou Cheng's hand reached down to the dorsalis pedis artery, he was startled immediately.

Then he retracted his hand in disbelief, and tried again with his left hand.

I also felt the pulse of the dorsalis pedis artery!

Now Zhou Cheng began to struggle, and whispered to Luo Yun, "Mr. Luo, I just want to stay longer."

"But now the dorsalis pedis artery is pulsating."

"Is it still possible to amputate?" Zhou Cheng asked Luo Yun sincerely.

But when Luo Yun heard this, his eyes almost rolled to the top of his head...

NMB!

Chapter 132 You Are Not As Important As You Think!

Is such that--

Li Changhong thought to himself that he exposed the brachial artery much faster than Yan Haihan. Later, after tying the brachial artery, Wang Yaoxiang still looked at Yan Hanhan calmly.

As you continue to speed up your movements, you think, with Yan Haihan at your level, do you still have the heart to fight for the position of chief director?Even doing a simple amputation is so frustrating.

The subsequent actions were swift!

Amputation is already in the process.

Li Changhong's speed was faster before, and after finishing the bandage to stop the bleeding, he has already cut two muscles neatly!

I even feel a little smug that although I haven't had an amputation for a long time, my current level has not fallen behind!

He was explaining to the Zhupei that he brought, and felt that he could teach local anatomy by the way.

Amputation is to amputate the limb anyway, and it is used as a teaching tool, so make the best use of it.

It is also in line with the reputation of the teaching hospital that the Eighth Hospital is currently preparing to fight for.

But now I am embarrassed here, and quickly covered the incision with a salt water pad, then raised my head, looked around calmly, and tiptoed to look in the direction of Zhou Cheng's leg...

Amputation, as the name suggests, aims to amputate a limb.

It is defined as the therapeutic measure of amputating a limb that is necrotic, mutilated, severely diseased, painful and life-threatening, or completely disused and impairs function.

It's intended to be therapeutic, though.

Amputation will inevitably cause disability, so it should not be used lightly.

Amputation should be considered for the future installation of prosthetics as much as possible.

The purpose of amputation is therapeutic, but it has strict indications:

① The main blood vessels of the limbs are damaged, and the opportunity for repair is missed. The limbs have been ischemic and necrotic.

② Limb necrosis caused by major vascular diseases (such as thromboangiitis obliterans, diabetes, arterial thrombosis, etc.), and the blood supply of the limb cannot be restored or reconstructed by other methods.

and many more. (In order to save the word count, the rest of the adaptations will not be released.)

However, since amputation is an operation, it also has its requirements.

When amputating, you should try to choose the appropriate length:

For example, the amputation of the foot should be at the metatarsal bone, and should not be shorter than the tanarvicular joint. Otherwise, due to insufficient dorsiflexor attachment, it is difficult to resist the contraction force of the plantar flexors, resulting in foot drop and hindering weight bearing.

The lower 1/3 of the calf has poor blood supply, and the stump cannot bear weight, so it is generally not selected as the amputation site.

The junction of the upper and middle 1/3 of the calf has good blood supply and rich soft tissue, so it was selected as the amputation site of the calf, but the residual limb should not be shorter than 10 cm below the tibial tuberosity, because the calf is too short to control the artificial limb.

For thigh amputation and upper limb amputation, limbs should be preserved as much as possible.

This patient was in an indication for amputation and thrombus occurred.

A thrombus is similar to a stone stuck in a water pipe, resulting in no blood supply to the distal end of the squeeze.

This is equivalent to cutting off the blood source of remote cells and tissues.

We humans will die if the water source is cut off, but we can move freely and find ways to get water.

But the cells and tissues in our limbs are established and cannot move freely, so we can only wait for death.