medical simulator

It's as stable as a dog.

He looked at Zhou Cheng, then at Cai Dongfan, and finally said meaningfully: "Director Cai, you student is really amazing!"

Thumbs up.

Cai Dongfan smiled honestly.

The mood improved a lot, and he said modestly: "It's okay, it's okay, I need Director Mi and Director Chen to take care of you seniors in the future."

Mi Huan and Chen Kelong's faces darkened slightly.

Chapter 152 The Inexplicable Account

Isn't it nonsense to ask them to take care of Zhou Cheng?

I'm afraid Cai Dongfan thinks we are old, so it's easy to talk about it.

The two smiled, nodded and responded: "Director Cai just confesses, it's easy to talk about, and I will have to trouble Director Cai to move around more in the future."

Mi Huan thought to himself, although Cai Dongfan is younger than him.In the past, he was quiet in the circle, but outsiders know that Cai Dongfan has a wide social circle. He is said to drink very well, and the wine quality is not very good, but he can drink with wine and has many friends.

But now it seems that this Cai Dongfan is not only the bastard he heard on the surface, he will definitely be someone who can stir up troubles in Shashi in the future.If you can make friends with it, you may have the upper hand in the future.

Mi Huan was thinking.

Tan Yuanwu, who was not fully anesthetized, suddenly interrupted and said, "Director Cai, can you and Dr. Zhou work hard to see how my nephew is doing? Just take a look at it?"

Qin Yuanwu's words immediately changed the expressions of Mi Huan, Chen Kelong and others.

Mi Huan immediately said, "Tan Yuanwu, it's time for dinner, Director Cai and Doctor Zhou are both hungry, what nonsense are you talking about?"

Cai Dongfan came here because of you, Tan Yuanwu, not to starve and suffer from cold. Can you be reasonable and humane?

Chen Kelong also hurriedly interrupted: "Director Cai, Dr. Zhou, you must be starving, right? It's almost six o'clock, let's go eat quickly!"

The operation has been going on for more than three hours.

During this period, Zhou Cheng almost kept performing the surgery without resting for a moment, and the replantation of severed limbs and severed fingers was not a minor operation of debridement and suture.

Although the speed is fast, the steps are actually done in place.

I was exhausted long ago, and Zhou Cheng was required to do other operations. Wouldn't it mean that people are not treated as human beings, but just used as machines?

Cai Dongfan's expression darkened a little, but he asked jokingly, "Tan Yuanwu, tell me the truth, is this child your illegitimate child? That's why you care so much about him?"

Tan Yuanwu immediately replied with an oath: "Director Cai, don't talk nonsense! This is not a matter of human relations?!"

Then the tone became a little more formal: "It's just, Director Cai, I think it's my brother who did this, and it has nothing to do with the younger generation. And it's a good thing that the injured person is me and not someone else. So?"

When Cai Dongfan heard what Tan Yuanwu was still explaining, he sighed and said, "Tan Yuanwu, today, I won't tell you much. I'll just tell you directly."

"I came here just to look at your face. I don't know who your brother and nephew are at all."

"I don't know how they usually behave, but I just hold back my anger."

"After all, you were the one who spoke before. I went and read it."

"People don't die, but it's hard to keep their legs."

"Now you let Xiao Zhou watch it again, I can take him there, just?" Cai Dongfan didn't say the rest.

Then said:

"I'll take someone to see it."

"Xiao Zhou, come with me."

After speaking, he called out to Zhou Cheng, and walked out of the operating room.

"Director Cai, Director Cai, don't be angry. Yuanwu him." Seeing Cai Dongfan's back, Mi Huan immediately stepped forward and pulled Cai Dongfan, but he didn't pull Cai Dongfan.

Zhou Cheng followed behind Cai Dongfan without saying a word, letting Cai Dongfan decide.

Mi Huan then walked back to the operating room and said to Tan Yuanwu, "Yuan Wu, why are you doing this?"

"Director Cai has no medical relationship with your nephew. He came here because of your favor. He was only on good terms with you. Although your elder brother didn't do it on purpose, what he did was called human affairs?"

"Have you thought about it, if Director Cai arrives early, then he is the one lying on the operating table now!"

"You still ask him to go again and again at this time, isn't it difficult for others?"

"Do you have to waste this last bit of favor here?"

Tan Yuanwu pondered for a moment, and then sighed: "Director Mi, no matter who is right or wrong about this matter, this is the result now, and I can't go back to the clinic anymore. I will go to the auxiliary department at most in the future."

"After leaving the department, you are no longer in the same circle. Where is there any human friendship?"

"I don't look at my brother's face, I also want to look at my mother who is still alive, and I can't let my nephew have a chance to save his limb. Even if it is just a glimmer of hope."

Speaking of this, Tan Yuanwu's voice was exhausted: "When friendship is exhausted, it will gradually fade away if it is not used."

"Director Cai's departure may have nothing to do with him from now on, but in this way, I have a clear conscience."

"I've tried my best. From then on, no matter how I get along with you, I don't have to bear anything anymore."

"I had good grades back then, but my family was very poor. My brother dropped out of school and asked me to go to school. This debt is very tiring..." Tan Yuanwu said calmly, with a feeling of suddenness.

When Mi Huan heard what Tan Yuanwu said, he stopped talking.

Don't persuade others to be kind without suffering from others, don't say that people are absurd without other family affairs.

Qin Yuanwu is not a fool.

Chen Kelong patted Tan Yuanwu on the shoulder and said, "Take a good rest and don't think too much. Your operation today is very good."

"It may not be time to return to the clinic. Don't be discouraged, the brothers in the department will be waiting for you."

"There is still your place in the department."

Tan Yuanwu has been with Chen Kelong for more than ten years, conscientious and diligent, not to mention how superb the surgical technique is, but he is reliable in his work.

Chen Kelong couldn't do the bottom line thing. He was willing to leave a place for Tan Yuanwu in the department, or as an outpatient.

"Thank you, Director Chen."

Chen Kelong didn't take Tan Yuanwu's thanks, but followed Mi Huan to the operating room where Cai Dongfan went.

When Cai Dongfan and Zhou Cheng arrived at the operating room, they saw that the people in the Second Department of Orthopedics had already amputated their limbs, and they had cut off all the bone segments of the right lower limb, and they were now doing muscle storage.

On the other side, a general surgery doctor was laboriously performing angiotomy and thrombectomy, but it was obvious that he was sweating profusely.

Zhou Cheng actually felt that his stomach was a little empty at the moment, but seeing this scene, he suppressed his hunger and asked Cai Dongfan, "Teacher Cai, what's going on here?"

Cai Dongfan said: "The preoperative examination showed atrial fibrillation and multiple arterial embolisms. When I came back, the most serious one was left renal artery thrombosis."

"Fortunately, there were no blood clots in the coronary arteries and lungs, nor did they enter the brain vessels. Otherwise, there would be no way for people to be saved."

"Director Yang, has the thrombus in the left renal artery been removed?" After Cai Dongfan explained to Zhou Cheng, he asked the director of general surgery, Yang Min.

The vascular surgery department in a hospital in Shaxian County is classified as general surgery department.

Although Yang Min is only the director of general surgery, he actually does everything from gastrointestinal surgery, hepatobiliary surgery, and vascular surgery. His business volume seems to be extensive, but he is not particularly proficient in any of them.

Yang Min's head was covered with sweat at the moment, he turned his head and said to the people around him, "Wipe off the sweat for me."

The assistant quickly leaned over and leaned towards Yang Min with his shoulder.

After Yang Min rubbed his forehead left and right on the assistant's back, he turned around and said to Cai Dongfan: "Director Cai, the thrombus from the left renal artery was removed, and the thrombus from the right femoral artery was also removed, but the downstream blood vessels Still not clear. Can only be amputated."

"Whether the left lower limb can be preserved or not is uncertain. We are trying our best to protect it."

As Yang Min said, she moved back the stool slightly, then twisted her neck, and let out a long sigh.

Today's operation took a lot of his physical strength and energy, and he is still supporting it for the sake of his colleague Tan Yuanwu.

This kind of thrombus caused by atrial fibrillation produced a lot of emboli, and CTA was performed before the operation.

Zhou Cheng walked to the viewer and saw it.

Sure enough, there were thrombi in the left renal artery, the double femoral artery, the internal pudendal artery branched from the femoral artery, and the superior pudendal artery branched from the internal iliac artery.

The distant part of the femoral artery cannot be visualized.

This surgery is not easy.

Yang Min has taken out the thrombus in the left renal artery and superior pudendal artery.But the thrombus in the internal pudendal artery has not been exhausted yet.

The superior pudendal artery and the internal artery supply blood to the little brother. If this thing is not cleared, the consequences will not be too good, but in order to save life, we can only wrong the little brother for the time being.

Cai Dongfan nodded, took a few steps back, went to Zhou Cheng, and asked Zhou Cheng: "In this situation, do you think it is possible to save your limbs?"

Zhou Cheng asked: "How many hours has it been since the injury?"

If the embolism time of both lower limbs exceeds six hours, it is time to amputate or amputate, don’t struggle anymore, otherwise, once the soft tissue is necrotic and the lysate and metabolite return to the blood circulation along the vein, the person will be paralyzed.

This is reperfusion injury.

"A little more than four hours." The elder brothers of the orthopedics department who had completed the debridement and amputation on the opposite side were more precise in controlling the time.

"Then you can try it. If the speed is fast, it is still possible. It is the moment when the blood vessels recanalize. It may take a lot of work for the anesthesiologist." Zhou Cheng said objectively.

Reperfusion injury is no joke, it is fatal.

But whether this level can be overcome depends entirely on the strength of the anesthesiologist.

At this moment, the doctor in charge of anesthesia frowned and said, "Reperfusion after five hours of embolization, you are giving me a problem."

"But before dredging the blood vessels, tell me first, you can take a risk and try it." The anesthesiologist smiled and said under pressure.

"Wash your hands and go on stage." After Cai Dongfan said something to Zhou Cheng, he whispered in Yang Min's ear for a while.

When Yang Min heard this, she turned her head and asked, "Director Cai, did you say that Xiao Zhou had rescued such patients in your hospital before?"

"Yes! Anyway, the worst result is amputation." Cai Dongfan explained.

"Director Yang, if you don't take a break and just stand aside, it will be treated as Xiao Zhou's care. It's also a good turnaround."

Zhou Cheng, a young guy, was exhausted after three hours of high-intensity surgery. At Yang Min's age, the continuous surgery lasted longer than Zhou Cheng's, so he must be exhausted.

Yang Min also nodded. It would be great if someone could take over for him at this time.

It's just that these young people in his department are too weak to reassure him.

This Zhou Cheng?

But he can only be a dead horse as a living horse doctor, he can't remove the embolism in his left lower limb now.

……

The child was injured because of a fight, and the debridement has been done, but I don't know why there is atrial fibrillation, which leads to multiple embolisms.

Moreover, after trauma, the blood will be hypercoagulable due to stress.

Zhou Cheng quickly washed his hands and went to the stage, Yang Min stepped off the stage, but Bu Hao, who was in his group, stayed on the operating table to help Zhou Cheng.

After Yang Min stepped off the stage, she found a nearby stool and sat down, not far away from the stage.

His back was completely drenched with sweat, and a large area was wet.

The wind from the central air conditioner was blowing down, it was a little cold, but it also made him a little more awake.

As soon as Zhou Cheng put on his clothes and gloves, he immediately went to Yang Min's place to check the progress of the operation.

The shape of the femoral artery has been exposed, and the embolus of the femoral artery has been removed, and what is being done now is the embolization of the deep femoral artery.However, Yang Min's exposure of the deep femoral artery is a little problematic at this moment.

Zhou Cheng took the hooks from several assistants and made changes one by one.

Using the S retractor to change a few directions, immediately, it seems that the surgical field has been expanded.

Seeing this, Yang Min's eyes lit up immediately, and he sighed from the side: "It turns out that when the deep femoral artery is exposed, it is better to be in these positions."

"Director Cai, you just told me that Xiao Zhou can perform thrombectomy. I was a little skeptical, but now, I believe it."

Being able to know how to expose the deep femoral artery so clearly proves that he really understands the anatomy of the deep femoral artery and knows the anatomical approach to expose it, not joking.

Cai Dongfan just laughed along and didn't reply.

He also only heard that Zhou Cheng had undergone limb salvage surgery, but he didn't witness it with his own eyes, so he was still a little uneasy.

However, Zhou Cheng's control of the surgical field is really in place, the same incision, but Zhou Cheng achieved different exposures.

In surgery, the wider the exposure and the larger the surgical field, the easier the operation will be.

Then Zhou Cheng held two vascular forceps in both hands, and without knowing how, he bluntly opened the intermuscular tissue, and then Zhou Cheng quickly pulled out the branch of the femoral artery, because the femoral artery had already been tied off the proximal end.

Therefore, Zhou Cheng was not worried about bleeding.