medical simulator

The atmosphere in the operating room became a little quiet for a while, without any dirty jokes, and it was only a soft-spoken sentence to ask for equipment, tweezers, thread scissors...

Tan Yuanwu, a big man, his face was covered by a green sheet at the moment, finally leaving him a special private space, and his helpless tears finally turned into lines, rolling down, dripping down the ears and onto the operating table superior.

He couldn't figure it out.

I haven't figured it out yet, he has been running around for hours for his nephew, and he hasn't eaten any food—

Zhou Cheng was in charge of the left arm, where the deltoid, brachialis, and biceps were completely severed. Fortunately, the wound was on the outside, so the brachial artery and great nerve were not injured.

Moreover, it has been rinsed and disinfected before, so the debridement and suturing of this part of the injury are the easiest.

Zhou Cheng only needs to sew up the broken ends of the muscles after finishing the debridement.

After Zhou Cheng put on his clothes, a nurse sat across from Zhou Cheng, and then carefully looked at this little doctor who did not belong to the hospital, as if curious.

However, after Zhou Cheng sat down and faced him.She saw Zhou Cheng's eyes, which were very energetic, as if these eyes had a magical charm, which made her a little blush, thinking that this doctor must be very handsome.

"Hello, can you help me get the knife and hook?" Zhou Cheng said to the nurse.

Qin Yuanwu is a doctor in this hospital, so today's nurses are fully equipped, four nurses can be on duty, and there are three equipment nurses alone, one tour should be enough to run.

The head nurse said that she can come on stage for anyone who needs help.

She immediately turned around and brought all the basic equipment.

After Zhou Cheng got the scalpel and tweezers, he first took the initiative to put the retractor in the proper position, and handed the other end to the helping nurse.

He quickly cleaned up the operation area he was in charge of.

Debridement is the basis of any surgery, and Zhou Cheng's debridement has reached the perfect level.

Perfection is being able to judge well how to define debridement——

The dead tissue has to be cut off, and the surviving tissue has to be left behind.

Muscles with insufficient blood supply have a high probability of necrosis, so they must be cut off to avoid subsequent muscle necrosis, affecting healing, and releasing a large amount of potassium ions to cause electrolyte balance disorders.

And it's best to cut it when there is blood supply, so as to facilitate recovery.

Therefore, Zhou Cheng started to cut the sub-necrotic muscle directly with a round knife. Originally, he planned to use a sharp knife or an electric knife to slowly coagulate it, but that was too slow.

If you just use a round knife, it seems a bit drastic!

It's like a butcher chopping meat...

It frightened the nurse opposite.

Fuck, is this little doctor so fierce?You are selling meat in the vegetable market, cut a little more to get more business and make more money?

She was a little anxious, but when she looked at Chen Kelong and Liu Yong, she found that Liu Yong had two jobs, helping each other back and forth, and couldn't spare time at all.The main surgeons, Chen Kelong and Luo Zailin, stared at the wounded area carefully, not daring to be distracted.

As a result, Zhou Cheng was actually in a state where no one could control him.

About seven or eight minutes later.

"Stitches!" While Chen Kelong was still slowly scraping the blood scab layer by layer, Zhou Cheng already needed stitches for the equipment nurse.

These words made Chen Kelong and Luo Zailin, who were in charge of the knife, tremble at the same time, sat up straight suddenly, and looked towards Zhou Cheng.

On the other hand, the equipment nurse hesitated whether to suture or not, and looked at Chen Kelong.

Chen Kelong's eyes were narrowed into a line, and the crow's feet at the corners of his eyes were also exposed to Zhou Cheng. He asked in an unnatural tone: "Xiao Zhou, why are you doing debridement so quickly?"

"Even if the operation on your side is over, it won't help the patient's final recovery much, will it?"

The faster the operation, the greater the probability of errors and infections. Even Chen Kelong couldn't estimate whether Zhou Cheng's current operation could meet the disinfection standard.

Who is this forcing, why did I let him do the debridement there?

The reason why he didn't say it outright was to save face for Cai Dongfan, after all, Cai Dongfan brought him.

Chen Kelong also saw Zhou Cheng's speed and felt that it was too fast, so he said, "Xiao Zhou, this operation must take a long time, there is no need to take unnecessary risks."

When the replantation of severed fingers is not finished, Tan Yuanwu will not step down, nor will he reduce the overall operation time.

After hearing this, Zhou Cheng said: "Director Chen, I want to come over to help you guys later, this big brother is a bit tired because he has two uses for one person!"

"The debridement on my side is already in place. I checked the nerve bundles, brachial artery, and radial nerve. You see, there is no injury in these positions." Zhou Chengtao showed Chen Kelong one by one.

"The wound surface is quite neat, and the debridement site has blood flow." Zhou Cheng also deliberately scraped open the section of the muscle, and the blood slowly overflowed.

These movements are neat and clear, as if they are not proving to Chen Kelong, but teaching surgery.

Only then did Chen Kelong shut his mouth, and then lowered his head.

He didn't see any flaws, so it can't be said that Zhou Cheng did something wrong.

Chen Kelong could only nod his head, and said, "That's fine, after a while, the little brother who has worked so hard will come over and help."

The circulating nurse just passed the sutures.

Zhou Cheng's sewing skills are not low, and his speed is not slow!

Moreover, muscle suturing requires less attention than tendon suturing. Therefore, in order to save time, Zhou Cheng didn’t bother to ask the equipment nurse to cut the thread. He held the needle-holding forceps and thread scissors with one hand, and the rotary autologous suture scissors were like acrobatics. .

In just over 4 minutes, Zhou Cheng sewed up all the skin.

There is no particular about cosmetic sutures, just vertical interrupted sutures.

time is life.

In this way, when Zhou Cheng finished debridement of the wound, Chen Kelong brought up all the microscopic instrument kits from Chen Kelong's side.

The equipment nurse opposite Zhou Cheng stood up in a daze, and walked back to the surrounding nurse team with a puzzled expression on her face, then looked at the timing panel in the operating room——

00:08:25!

In 8 minutes, the wound was debrided and sutured.

And after Zhou Cheng finished the debridement that didn't have much technical content here, he immediately replaced the two pairs of gloves!The most rigorous way to change the site of debridement is to re-wash hands and change gloves. However, in order to save time, the same patient does not need to change clothes, but gloves must be changed.

Then he naturally took over the washing position of Chen Kelong, and finally liberated Liu Yong.

Then Zhou Cheng sat firmly in the assistant's seat, watching Chen Kelong Qingchuang quietly.The heart is full of excitement.

After a while, Cai Dongfan came in again from the door of the operating room, and after a sigh of emotion, he said, "Director Chen, you may have to deal with this severed palm yourself. I just made a few calls."

"But they didn't call to make an appointment, and none of them were free to come. But the director of our hospital, Zeng, is already on his way."

When Chen Kelong heard the first half of what he said, his heart turned cold.Finally, he turned happy and said, "Is Director Zeng here? Then I can rest assured."

To be honest, Chen Kelong was under a lot of pressure to personally cut off his palm and replant it. Tan Yuanwu was his own brother. If something went wrong, he might not be able to explain clearly.

Zhou Cheng's out-of-the-ordinary words startled Chen Kelong.

"Director Cai, what's the situation with my nephew?" Tan Yuanwu hurriedly asked when he heard Cai Dongfan's voice.

"There's nothing I can do, the artery is clotted. I was thinking about getting the clot, but I couldn't help, so I came here."

"However, your nephew's luck is better than yours. He contacted the professor of vascular surgery at the Provincial People's Hospital and sent someone to pick him up." Cai Dongfan sighed.

Because Chen Kelong was talking to Cai Dongfan right now, his movements were frozen, so Zhou Chengcheng stood up, walked to Cai Dongfan's side, and whispered a few words.

Cai Dongfan immediately narrowed his eyes, his pupils almost narrowed into a line: "Shall we replant the severed finger?"

Zhou Cheng pursed his lips, and Cai Dongfan started talking, so he could only continue: "Anyway, there is no other better way, Teacher Cai, can you take me to do it together? I think you should give it a try."

When Chen Kelong and Liu Yong heard this, they raised their heads one after another and looked at Zhou Cheng who was beside Cai Dongfan, their brains a little bit down.

While Cai Dongfan was still hesitating, it was Tan Yuanwu who pondered for a moment, then gritted his teeth and said, "Director Chen, please use the microscopic equipment. Director Cai, I can't find anyone else now, no matter what the final result is!"

"It's all life, I admit it, don't keep it if you work hard!"

Qin Yuanwu felt that the rumors in the circle that Cai Dongfan could save his limbs were definitely not false, because although Cai Dongfan had a wide range of contacts, it would not allow so many people to take the initiative to flatter Cai Dongfan!

Zeng Yi, a hand surgeon, has done replantation of amputated fingers, but he has never heard of any disturbances in the industry.

Therefore, rather than waiting to die, it is better to take a risk.

After all, Cai Dongfan and Tan Yuanwu knew something about him. He was open-minded and easy to make friends. He was also quite outgoing and had a quack air.But his strength is definitely there.

Tan Yuanwu spoke up in person, Cai Dongfan became entangled again, and looked at Zhou Cheng.

If he remembered correctly, this was one of the few times when Zhou Cheng took the initiative to ask for some kind of operation.

He should have some sense in his heart, so he said: "Yuan Wu, if the final result is not done well, don't blame me, and don't sue your sister-in-law or anything."

"Certainly not. Brother Cai, you said that. Can I be such a person?" Tan Yuanwu laughed immediately, but his heart became bitter.

If he hadn't had a sudden accident, and the replantation of the severed finger should be done as soon as possible, he would have taken 120 drops to the Affiliated Hospital of Shonan University long ago.

When Cai Dongfan went out to wash his hands and put on his clothes, Chen Kelong had no choice but to act as a living doctor. He said to the itinerant nurse, "Take the blood vessels and sutures. 9-0 prepares Kirschner wires."

Although Chen Kelong does not engage in replantation of amputated fingers, the basic principle is still clear, giving priority to blood vessels and nerves.

Zhou Cheng heard the words, but said: "Director Chen, Mr. Tan's severed finger is not long, the restoration of blood vessels can be delayed for a while, let's fix the finger bones first."

"Within 6 hours, priority should be given to fixation and smooth blood supply."

What Chen Kelong said is correct. The key to replanting a severed finger is the suture of blood vessels, but that also depends on the situation. If the severed finger lasts for a long time, it means that the ischemic time of the distal end of the limb is also long. At this time, priority should be given to restoring blood. transport.

However, in the case of Qin Yuanwu, he was pulled into the operating room for treatment in a timely manner, so he could fix the phalanx first, and then consider the suture of blood vessels and nerves.

Chen Kelong frowned slightly, his plan was rejected by Zhou Cheng!In fact, it was a bit uncomfortable, but considering what Zhou Cheng said just now, he planned to let Zhou Cheng try it. If it didn't work, Cai Dongfan would definitely stop Zhou Cheng's operation immediately.

"Let's change positions, Xiao Zhou." Chen Kelong offered.

Since Zhou Cheng is willing to do it, let him do it and see what he can do.

Zhou Cheng immediately returned to the left side.

The broken ends of the fingers of the left hand are at the metacarpophalangeal joint of the ring finger and the second phalanx of the middle finger!

Zhou Cheng just glanced at it, and Chen Kelong's debridement has been done in sevens and eighties.

Although it will be trimmed later, it can be done later when it is stitched.

The current severed end is the distal severed finger. The more distal, the better the reconstruction of the broken bone. If it is a severed limb, the bone is too big, and it will waste a lot of time.

The phalanx is a bone that can be fixed with a few Kirschner wires.

Zhou Cheng held an electric drill with a Kirschner wire in one hand, and fixed the broken end and stump of the middle finger with the other hand. With just a slight turn of the hand, the Kirschner wire came out from the distal end of the middle finger. The needle was inserted, directly perpendicular to the distal phalanx.

Severed fingers also have fractures, so the principles of treatment still apply.

Reset and fix firmly.

The Kirschner wire is a fixed tool, and reset is the key to this step.Zhou Cheng held the severed finger, moved it for a while, and then inserted the needle again without hesitation.

All the way to the proximal phalanx, and then to the inside of the metacarpophalangeal joint.

Zhou Cheng shook it a little, and after confirming that the bones were basically fixed, Zhou Cheng called the itinerant nurse to take the second Kirschner wire!

Go up to the electric drill, insert the needle from the proximal interphalangeal joint of the ring finger, and nail the Kirschner wire to the triangle bone and hamate of the metacarpal bone.

However, at the metacarpophalangeal joints, a Kirschner wire was still difficult to fix, so Zhou Cheng inserted a crossed Kirschner wire from the side, and the needle was inserted far beyond the capitate bone of the metacarpal bone——

Zhou Cheng's speed of bone fixation directly stunned Chen Kelong and Cai Dongfan who entered the operating room.

From Chen Kelong's point of view, Zhou Cheng's K-needling was like a game.

Looking at Cai Dongfan, did you bring this thing?

Cai Dongfan immediately approached, grabbed Zhou Cheng's hand, and stopped him from playing!

He didn't speak, but his eyes stayed on Zhou Cheng's body for a while, and then he began to check Zhou Cheng's fixed broken bones.

Although Cai Dongfan is not a specialist in hand surgery, he still knows the degree of recovery from broken bones.

After checking for nearly ten seconds, Chen Kelong and Cai Dongfan were also looking at the joints of the broken bones.

Then, both of them turned pale with fright.

With a sudden force on both feet, he stood up, and then fell down!

At a loss, they were so scared that they grabbed the anesthesia machine next to them!

Just stand still.

It can be polluted!

It almost knocked down the anesthesia machine.

The anesthesiologist scolded there: "Director Chen, what the hell are you doing? Why are you touching my anesthesia machine?"

Then he began to wipe the blood on it with a little disgust.

After Chen Kelong and Cai Dongfan finished watching, they immediately apologized.Then go out again and wash your hands again.