medical simulator

Brother, what you did was femoral venipuncture?

Not the chest cavity, and not the venules!

Next to it is the femoral artery and the femoral nerve!

Qin Dingmo didn't even know how to describe Yang Yifeng's behavior at the moment.

However, Yang Yifeng didn't feel anything, chose a suitable angle, and pushed the puncture needle into the back.A 14F arterial sheath catheter was placed.

Although the puncture is a vein, the arteriovenous catheter is universal, and Yang Yifeng has long considered putting the filter into the inferior vena cava, the inferior vena cava is the common path for the venous return of both lower extremities!

So I chose the filter model in the inferior vena cava, which is 14F!

Once the catheter is in, it's time to place the guide wire!

In the process of placing the guide wire, Yang Yifeng did not start blindly, but pushed the color Doppler ultrasound instrument to his side, and then used the probe to accurately detect the shape of the vein and the guide wire tip, and then began to gradually insert the guide wire. Follow the direction of the vein back to the heart, first enter the iliac vein, and then return to the inferior vena cava.

After roughly seeing the distal end of the guide wire pass through the renal vein, Yang Yifeng stopped entering.

Under color Doppler ultrasound, after roughly determining the lumen of the vein, a bird's nest filter was selected.

Under the guidance of the exchange guide wire, the insertion of the inferior vena cava filter...

This process was also quite smooth. After putting it in, Yang Yifeng monitored it again for a while, and after seeing that the blood flow was still unobstructed, he took out the guide wire, pulled out the arterial catheter sheath, and bandaged it with pressure.

But after the pressurized bandage, Yang Yifeng left the ultrasound head on the filter for the sake of stability, continued to monitor, and said to Qin Dingmo: "Professor Qin, let me observe the blood pressure again now." It’s out of shape, if you want to use the monitoring of fat particles in the heart later, you can just take it away.”

Although Yang Yifeng had completed the operation, he was still a little apprehensive.

After all, when he operated on his mother before, her mother died on the operating table. Although the risk of that operation was exponentially higher than the current one, it was still a vascular operation!

If it wasn't for sending the eldest brother in, Yang Yifeng felt that he would not be able to pick up the operating equipment this time.

However, Yang Yifeng felt an unspeakable hatred in his heart when he thought of the murderer who caused the death of his parents to be released on bail for medical treatment and get away with it.

Qin Dingmo nodded, and said: "It's okay, you should look at yours first. Orthopedic surgery, only when the bone marrow cavity is washed, will a large amount of fat drip back into the blood system."

"The patient himself does not have the three high fats, so he can use it temporarily."

As a top professor, Qin Dingmo is quite familiar with the situation of each department.

Fat embolism, in addition to mostly occurring in patients with three highs, is more common in joint replacement in joint surgery.

That's because during the process of grinding the bone marrow cavity, fat particles will enter the bone marrow cavity, and at this time, the stability of the fat droplets will be affected, and they may be deposited as thrombus.

If you have a clear theory, you will naturally not be afraid. This is how to handle it.

Not a little more useless work and preparation, just right.

However, about 5 minutes after Yang Yifeng finished the operation and went to the next timing panel, Cai Dongfan, Luo Yun and others happened to reopen the patient's previously debridement and suture incision.

The door of the operating room was kicked open.

Then Zeng Yi turned his head and saw Huang Shinan, the director of the Department of Hepatobiliary and Pancreatic Surgery, but with the brand name of Vascular Surgery, walked in.

After he came in, he saw that the operation of Cai Dongfan and others had just started, so he asked with a smile: "Director Cai, it seems that I came at the right time. Your operation has just started?"

Cai Dongfan didn't turn his head when he heard Huang Shinan's voice, but just nodded: "Well, our operation has just begun."

When Yang Yifeng said that he was going to have a venous filter implantation operation, he was actually a little flustered, so he called Huang Shinan and asked him to come to the operating room to take the helm and judge for a while.

Otherwise, no one else would know how Yang Yifeng is doing?

Cai Dongfan really took great pains for this patient.

It's just that Yang Yifeng has finished all the operations, and Huang Shinan hasn't come yet, so even if he didn't do well, there is no room for salvation.

I don't know why Huang Shinan stepped in at this point.

But Cai Dongfan didn't tell the truth, Huang Shinan is also the director of a department after all, so he should be sympathetic.

Only then did Huang Shinan see that there seemed to be an elastic compression bandage on the opposite side of the femoral sheath of Cai Dongfan and others, and there was a tall pile of sterile gauze and saline pad underneath.

This seems to be a sign that the war has ended?

Seeing this, Huang Shinan panicked a little, and looked at the time. It was only half an hour since Cai Dongfan called him. At that time, Cai Dongfan said he was only picking up patients, could it be?

Then he glanced at Yang Yifeng, and found that Yang Yifeng was already under the timing panel in the operating room, and the old monk was in meditation.

"Director Zeng? Is the venous filter finished?" Huang Shinan asked in a low voice as he walked to Zeng Yi who was making soy sauce.

Qin Dingmo couldn't figure out Huang Shinan's origin, so he stepped aside a little bit, but he still put the probe of the color ultrasound at the heart position, and opened the venous catheter of the upper limbs, ready to rescue the patient at any time preparations.

Zeng Yi let out an "ang" and looked at the operation timing panel.

"It ended about 4 minutes ago, Director Huang." Zeng Yi is also the director, and he is also the chief director of the anesthesiology department. He is on the same level as Huang Shinan.

Then Zeng Yi saw the familiar confusion and astonishment in Huang Shinan's eyes.

When Yang Yifeng was under anesthesia, he also showed this look, so he was familiar with it, and he smiled a little, feeling balanced!

Because he was able to observe at any rate, and Huang Shinan was left with only confusion and astonishment.

Huang Shinan suddenly groaned secretly in his heart, rubbed his head, turned around and walked away silently in embarrassment.

Just out of the operating room, Huang Shinan still couldn't figure out how Yang Yifeng put the venous filter in so quickly. He didn't see the process, so naturally he couldn't judge the filter implantation he did. How is the level.

Of course, with such a fast speed, this guy must be blind piercing!

How much confidence do you need to put a filter in the inferior vena cava blindly?

Or conceited?

It's hard for Huang Shinan to say, but from Cai Dongfan's tone and meaning, it can be heard that they made the most extreme preparations in order to allow this patient to be discharged from the hospital quickly and turn around.

If you don't die, don't go back to the ward, don't go to the ICU, you have to pass the 120 ambulance directly from below when you get off the operating room, and then transfer to the prison!

One of the prerequisites for medical parole is that if the prison doctor cannot treat the situation, it must be transferred to a more professional hospital. However, post-operative care and doctor's orders after the operation are still no problem.

……

Huang Shinan's departure, like his coming in, did not have any impact on the operation process.

Cai Dongfan and Luo Yun will take on the role of chief surgeon, which has been discussed before.

The reason why Zhou Cheng hasn't started to take the stage yet is because, before he takes the stage, what Zhou Cheng needs to do to prepare for the operation is the key part, and the time for the key part will not be particularly long!

Therefore, after Cai Dongfan and Luo Yun completed the debridement, opened up the ends of the femurs on both sides, and confirmed that there was no blood vessel damage, Zhou Cheng immediately used a measuring stick to measure the diameters of the upper and lower femur ends.

Although this operation can also be carried out on flat film, but after all.

The scope of the femoral bone defect is too large, and the upper and lower ends are stretched and deformed by the attached muscles, making it impossible to measure accurately and objectively.

After finishing the measurement, Zhou Cheng withdrew from the main stage of the operating table, then glanced at Yang Yifeng, lowered his voice and asked, "Brother Yifeng, I'm going to start titanium mesh shaping, do you want to come and discuss it together?" a bit?"

When Zhou Cheng said this, he was actually a little hesitant in his heart. He shouted so that he wanted Yang Yifeng to learn the surgical plan design and skills of bone grafting for large segmental defects.

There are several main reasons.

First, Yang Yifeng is a doctor of trauma surgery. Although due to an accident, his heart is no longer in medicine, and he only thinks about writing novels.However, his talent, his interest in medicine, is still there.

Otherwise, it would be impossible for him to blast him out during the process of simulating the dungeon, and he would have accompanied him all the way until he was 50 years old.

Yang Yifeng reset his life to zero again and embarked on the road of writing.

Second, since Yang Yifeng is interested in this, and the reality is that Zhou Cheng already has a perfect bone graft for bone defects, then he doesn't mind letting Yang Yifeng obtain a mature theory directly, leaving him alone. Doubts and regrets in my heart.

As for how Yang Yifeng will choose in the end, Zhou Cheng has no control over it.

However, with Yang Yifeng's talent, if he can enter the palace of medicine again, it will be a blessing for the sick.

A single thread does not form a thread, a single tree does not form a forest, how many nails can be driven by a body covered in iron?

There are many patients in the real world, and there are also many people in Huaguo.

The top medical resources are always too empty.

Why are all the top hospitals overcrowded these days?It is because of the serious shortage of top-level medical resources, and the supply exceeds the demand.As for Yang Yifeng, he is already on this road, and he has traveled far and tall.

If he can continue to study, his future achievements will definitely not be low.

Yang Yifeng heard Zhou Cheng's invitation, looked up at Zhou Cheng, smiled and said, "Okay, brother Zhou Cheng."

Yang Yifeng originally went to the operating room, in addition to saving the patient's life and using the best anesthesia, the purpose was to see Zhou Cheng's specific level.

Now that Zhou Cheng dared to take off his own shell, stood in front of him, and let him figure it out, that was naturally the best thing.

However, Yang Yifeng felt a trace of sincerity in Zhou Cheng's gaze.It seems that Zhou Cheng sincerely invited him to discuss the operation plan and modeling together, not for showing off or anything else!

Yang Yifeng stood 10 centimeters away from the equipment nurse's operating table, while Zhou Cheng stood in a corner, and after putting down the measuring ruler, he began to cut the titanium mesh.

Titanium mesh, or medical titanium mesh, is a great tool to solve bone defects!

It has a strong structure, can be used to replace bone material, and is inexpensive.

The most important thing is that the structure of titanium mesh is very conducive to the crawling and shaping of bone.

Bone defect is also a kind of fracture, and the principle of treatment cannot be separated from the principle of fracture treatment itself.

First, reset.

Second, firm fixation - it is necessary to borrow external fixation brackets for external fixation.

But the difference is that after a bone defect, in order for the bone to grow, a skeleton must be built, that is, a skeleton for bone cells to crawl.Titanium mesh can just provide such a framework for bone cells to crawl.

However, the shaping of titanium mesh is very troublesome, because its routine use process is generally for acetabular capping, or bone-fitting internal fixation after a femur is broken. For bone defects like this, titanium mesh should be used for shaping. It is extremely difficult to form a support.

Yang Yifeng stared carefully at Zhou Cheng's movements, and then saw that under Zhou Cheng's hands, the originally strong titanium net was slowly shaped into a cavity shape, and the diameter was the same as Zhou Cheng's. As measured, there is not much difference!

and!

Yang Yifeng noticed with his eyes like a falcon that the column structure formed by this long section of titanium mesh structure, the upper and lower lumens are still different, as if the upper end is consistent with the fracture stump of the proximal femur .

The lower end is consistent with the fracture stump of the distal femur.

Yang Yifeng immediately had an absurd thought in his heart: "Brother Zhou Cheng, are you going to use titanium mesh to reshape a patient's femur?"

Yang Yifeng has a wide range of knowledge. According to the fracture situation of the patient, there are some methods to reshape the patient, but that is 3D printing!

That's a field!

3D printing is a combination of informatics technology and bone material technology, which can reshape a bone prosthesis according to the patient's own condition.

That's mechanized.

What can be made by mechanization, can be made by our hands?

Yes, but can it be done so quickly?

Zhou Cheng nodded, and said casually: "Well, otherwise there is no other better way. Even if it is 3D printing, the printed prosthesis is not easy to install, so I can only make one myself with a titanium mesh."

The muscles of Yang Yifeng's limbs became stiff, and his right hand held the phone tightly, as if the shell of the phone was about to be broken by him.

What are you talking about?

Do you think titanium mesh is mud, and you can make a femur based on the patient's femur?

However, Zhou Cheng continued to tap and tap, and then slowly, the traces of the outer femur tube emerged.

It was as if, in Zhou Cheng's hands, the titanium net was like sand for children to play with, it could be whatever it wanted to be.

Yang Yifeng couldn't see the specific details at the moment, so he quickly read the medical encyclopedia, and then carefully observed the shape of the femur, comparing it with the titanium mesh coat made by Zhou Cheng!

Then the eyes straightened in an instant.

Laymen watch the excitement, experts watch the way!

If everyone's hands were as stable as Zhou Cheng's, then the treatment of large bone defects would still become a hindrance in the medical field?Become the ceiling of it?

will not!

It's just that when Yang Yifeng carefully looked at the titanium mesh casing, he discovered that Zhou Cheng had actually squeezed out a smaller titanium mesh cover from the titanium mesh at this very moment!

Bone is a tubular bone.

Outer is cortical bone, inner bone marrow.

The marrow cavity is also a tubular structure.

Zhou Cheng's thinking is easy to understand, he not only wants to reshape the shape of the bone, but even the bone marrow cavity!

Is this a genius or a lunatic?

Yang Yifeng's mouth opened slightly wider.

The corners of his mouth began to tremble slightly. At this moment, he even felt that he was a little funny. What was he thinking, to find Zhou Cheng's mistakes in the details?

Zhou Cheng's thinking was normal, but it was also very abnormal, outrageous.