medical simulator

Before Zhou Cheng could speak, Cai Dongfan hurriedly rejected Director Li's words: "Director Li, if Xiao Zhou wanted to work, I would have left him a long time ago. Xiao Zhou has already planned to go to the academician team to study next month. Got it."

Li Wenzhuang instantly felt the critical damage coming from his head.

One, I left him a long time ago, studied for a Ph.D. with the academician team, and directly killed Li Wenzhuang.

He shrank his neck resentfully, and said, "Well, then congratulations, we have another talent in Xiangzhou."

He also looked at Cai Dongfan with some apprehension, cursing in his heart, "Damn it, it's not your Cai Dongfan's people, why are you burying people like this, you might as well say that you want to stay in Shashi for development."

Academician, Ph.D.

No matter which one, it is estimated that it will be difficult to go back to Xiangzhou, even if it is his hometown, unless it is a person with a high level of consciousness!

Cai Dongfan didn't care. Although he was happy now, he was also full of grievances and wanted to kill him.

Who will kill who, everyone is not too good, why should I be wronged alone?

It's a pity that Cai Dongfan's voice just now was a bit loud, and he was planning to get close to the person next to him, but after hearing his words, he quickly sat down on his buttocks again, not daring to come up.

Stop playing, thankless.

The academician team, it is not easy to arrange a job for Zhou Cheng?

You should never underestimate the energy and influence of a little old man with the title of academician, that thing has thorns.

It's better to forget about robbing students with them, and don't play yourself off.

……

Cai Dongfan was idle for a while, and then he asked Zhou Cheng, suppressing all the complicated emotions in his heart: "Xiao Zhou, when are you planning to go to Shanghai? Can you still make it to this month's class?"

"Go ahead, Teacher Cai!" Zhou Cheng said hastily.

Naturally, he had to go to work, so it can't be said that when he went to Mr. Zeng's place, he just had a bad relationship with Cai Dongfan, and he didn't even go to the rest of the class.

Although it was reasonable, he said it, and Cai Dongfan agreed.

However, Cai Dongfan was also kind to him, and because of his kindness, it cannot be said that because Cai Dongfan didn't give enough, he stopped treating Cai Dongfan as a human being.

not like this.

For now, Cai Dongfan holds more weight in Zhou Cheng's heart than Luo Yun.

The real kindness of knowing you, the first person who gave him money, the first person who said he would weave for him!

At that time, Zhou Cheng was really nothing.

The icing on the cake, you can smile with a smile.

Those who send charcoal in the snow must be friends of life and death.

Teacher Cai, these three words will be fixed in this life.

"Well, let's finish this month. At the beginning of next month, you still have to clean up. Running programs and so on is enough trouble for you." Cai Dongfan grinned, looking like he was watching a joke.

But in fact, my heart is really a little empty, as if someone took a knife and gouged out a piece, there is nothing I can do!

With limited ability, Zhou Cheng couldn't be tied by his side, but if he, Cai Dongfan, was a professor and could give Zhou Cheng the same platform as the Affiliated Hospital of Shonan University, he would lock Zhou Cheng, and he couldn't go there!

No!

To stay is to cut off one's future.

Cutting off people's wealth is like killing their parents...

When Zhou Cheng was chatting with Cai Dongfan, he vaguely noticed that Yang Yifeng seemed to be walking towards Ding Changle, and Ding Changle was still wiping the corners of his eyes. The two walked into the small room next to the rostrum in.

This scene made Zhou Cheng's heart inexplicably twisted.

Could it be that Ding Changle was reluctant to part with knowing that he was going to Shanghai?Only then did today's release come out?

If Ding Changle is like this, what about the little eye next to him?

Chapter 195 Beautiful gift!

The subsequent meeting process is going on normally, and nothing has changed.

Cai Dongfan listened for a while, then called Luo Yun and asked Luo Yun what his plans were, and Luo Yun replied that he had nothing to do.Then Cai Dongfan quickly took Zhou Chengxian to yo-yo.

The main reason is that the eyes of the people next to him are too hot, they always come to find out the news, or they are surprised by Zhou Cheng's previous operation and focus their eyes on this side.

Cai Dongfan had a thick skin, but he couldn't stand such fiery gazes: "Zhang Zhengquan, Yan Jun, you guys take a taxi back later, I'm going out first, I have something to do."

"Okay!" Du Yanjun and Zhang Zhengquan both nodded.

I even felt that once Zhou Cheng and Cai Dongfan left, the pressure on them was reduced a lot. Before, they had been wandering around non-stop, which put a lot of pressure on the two of them, and they were very uncomfortable.

"Brother Quan, Brother Zhou Cheng is really awesome today." Du Yanjun breathed a sigh of relief.

Zhang Zhengquan also nodded: "Yeah, Brother Zhou Cheng is really awesome. Everyone around here is looking at him with fiery eyes, even worse than seeing a doctor from the Affiliated Hospital of Shonan University."

When Du Yanjun heard what Zhang Zhengquan said, he seemed to think it made sense.

It seems that the appearance of Zhou Cheng broke the theory of academic supremacy at least on a personal level!

……

Originally, Cai Dongfan planned to take Zhou Cheng to eat, preferably the kind where he could find a place to have a drink, chat, and talk alone.

But as soon as he got in the car, he saw that the phone rang, and Zeng Yi actually called.

Cai Dongfan didn't answer the first time, but Zeng Yi called again.

Cai Dongfan hesitated a little, and after taking it, he listened for a while before saying, "Director Zeng, are we still at the venue? It will take a certain amount of time to come to the operating room now."

Zeng Yi said, "Cai Dongfan, can you do me a favor and rush to the hospital? Dean Zhang is in the operating room right now, and Director Huang of the vascular surgery department is also here."

"Okay!" Although he said, Zeng Yi's phone call disrupted Cai Dongfan's arrangement.

But, as a member of the department, as a doctor, you can never imagine when the emergency department will come, and in what strange way it will come!

After hanging up the phone, Cai Dongfan said to Zhou Cheng: "The Department of Orthopedics came to the emergency department and needed amputation. It is an acquaintance of Director Zhang. Director Zeng called us to help."

"This wine seems to be undrinkable." Cai Dongfan said helplessly.

Hearing this, Zhou Cheng moved his heart and said, "Teacher Cai, we originally made an appointment with Teacher Luo Yun and Professor Liu to have dinner together, and then send them back to Shanghai. If we don't have time, why don't we call them in advance?"

The arrival of the emergency department will disrupt many plans, but doctors still have to focus on patients, although they don't have to go.

But if you hear the call, if you have time and ability, you still have to be there.

Cai Dongfan hurriedly said: "Oh, yes, you come to drive, I have to make a few calls, I have several appointments tonight!"

Cai Dongfan has a lot of friends, and he likes to make friends, so today he has a lot of appointments, and it just happens to be dealt with together now.

Originally, the weekend annual meeting was a time to learn and build relationships...

But for work.

……

Zhou Cheng took his driver's license and drove to the downstairs of the No. [-] Hospital. Then Cai Dongfan also pushed all the bureaus, and the two ran directly into the operating room together.

And because of Zhou Cheng and Cai Dongfan's sudden disappearance, Luo Yun drank two glasses of wine, four or two, and was fined. In the end, Liu Yiping really couldn't find anyone to send Luo Yun home, so he directly called Luo Yun's address book The person who made the most calls, because they had to catch a plane, they couldn't deliver it in person...

When Zhou Cheng and Cai Dongfan went to the operating room, they saw it.

The instruments from the femoral artery in the vascular surgery department had not been removed before, and there were still many traces of black thrombus in the form of cords on the operating table. Zhou Cheng estimated that the person in the vascular surgery department might have removed the thrombus from the femoral artery or It was taken from the popliteal artery, the branches of the popliteal artery, and the proximal ends of the anterior tibial and posterior tibial arteries were also connected.

Obviously, after the vascular surgeon has completed the thrombectomy of a relatively large blood vessel, he has no way to go further.

One is that the distance from the femoral artery to the lower part of the knee joint is too far, and most of the space for manipulation has been lost, and without any imaging aids, they can't blindly guess where the artery should go next. go!

Seeing this, Zhou Cheng immediately exited the operating room, and then washed his hands as quickly as possible.

This patient is special, so the itinerant nurse assigned three directly. Even the dean Zhang Hongsheng was doing hemostasis on the surface of the liver on the operating table. Therefore, the itinerant nurse didn't even ask Zhou Cheng which department he was in, and just put it on for him. clothing.

……

After Zhou Cheng put on his clothes and gloves, he immediately came to the opening in Huangshi Nan.

In fact, the most suitable thrombectomy for this patient is incision and thrombectomy from the artery in the popliteal fossa. However, the patient also has an abdominal injury, and the popliteal fossa is behind, so he can only take the supine position!

Thrombosis will only harm the legs, and if the damage in the abdomen is not treated, it will also kill!

Therefore, Huang Shinan had no choice but to perform ultra-long-distance arterial balloon dilatation and thrombectomy from the femoral artery.

He also specially introduced to Zhou Cheng: "Xiao Zhou, last time you said that the equipment for thrombectomy is not good, we introduced this set of equipment."

"Yeah!" Zhou Cheng nodded hurriedly and said, "Director Huang, with equipment available, taking out the thrombus is less traumatic than incision and easier to take out, right?"

Zhang Hongsheng glanced at Zhou Cheng who was operating, but didn't say much, but chose to continue working on his abdomen with the general gastrointestinal surgeon.

After Zhou Cheng took Huang Shinan's position, he immediately extended the balloon down, and then followed the femoral artery to the popliteal artery.

Zhou Cheng turned a little bit in one direction, and then went straight into the anterior tibial artery!

The anterior tibial artery is somewhat simpler, unlike the branch of the posterior tibial artery that divides into the posterior tibial and peroneal arteries.

And the role of the anterior tibial artery is important, it can supply blood to the dorsalis pedis artery!

However, even taking out the thrombus in the anterior tibial artery is still useless, because there is still a thrombus in the dorsalis pedis artery, so Zhou Cheng has to do at least two accurate thrombus removal operations before he can truly let his lower limbs recover. Restore blood supply.

At this moment, Zhou Cheng's spiritual power was highly concentrated throughout the process.

Vascular endovascular catheterization has similarities with orthopedic arthroscopic surgery, but there are more differences. The catheter has been extended from the femoral artery to the anterior tibial artery. This is already a super long tube, no less than the catheter from The blood vessels in the neck extend into the blood vessels of the brain!

Moreover, this operation was performed without the assistance of angiography, so there cannot be a slight difference.

Otherwise, if the blood vessel is punctured, or the inner wall of the blood vessel is scraped, the intima of the artery will be torn again, and the patient cannot stand such a toss.

Finally, the front end of Zhou Cheng's catheter was about to touch the front end of the thrombus, and it became a little difficult for Zhou Cheng to move on.

The catheter is soft, but the thrombus is not soft, and it cannot penetrate violently. At this moment, the branch artery is almost only a little bigger than the catheter!

If it is larger, the balloon catheter will not be effective and will only push the thrombus further forward.

After Zhou Cheng felt the thrombus with his hands, with a little force, the catheter passed through the thrombus. When he got inside, he hadn’t gone halfway through, but when he pushed forward again, the anterior tibial artery was already pushed forward. The distal thrombus was pushed farther.

Zhou Cheng tried again, but the catheter still could not pass through again, so he could only inflate the balloon, and then began to pull back the thrombus that had passed through.

But not fast, if you pull too fast, it will damage the blood vessel, and it will easily cause the thrombus to separate from the bifurcation of the anterior and posterior tibial artery into other blood vessel cavities. In addition, it may push the blood vessel into the anterior recurrent artery of the knee joint go.

The recurrent artery of the knee joint and the anterior tibial artery are a bifurcation!

So this process must be careful, Zhou Cheng carefully controlled the direction of the proximal end of the thrombus in the blood vessel, and then slowly adjusted it, and then, finally!

Zhou Cheng brought the thrombus out of the common artery before the branches of the anterior tibial artery and the anterior recurrent artery of the knee joint.Then use the same principle to bring the thrombus back to the popliteal artery!

At this time, Zhou Cheng breathed a sigh of relief. Perhaps in the eyes of others, Zhou Cheng was entering and recovering the intravascular balloon catheter like an apprentice, so his movements were very slow.

But didn't they know that Zhou Cheng's balloon was carrying a heavy thrombus at the moment!

Moreover, when it is in a large blood vessel, pay attention to continuing to expand the balloon a little bit, otherwise, the lumen of the large blood vessel may be larger than the sum of the diameter of the thrombus and the expanded balloon in the small blood vessel, and then the thrombus will fall into the Unknown place!

Zhou Cheng dragged back slowly, and then took out the first thrombus!

"Itinerant teacher, can you get me another balloon catheter with the smallest size?" Zhou Cheng asked the itinerant nurse.

The itinerant nurse immediately agreed, without any hesitation, and quickly opened a thinner catheter and came to the stage.

Seeing Zhou Cheng take out the thrombus, Zhang Hongsheng and the other people who performed abdominal surgery didn't think much of it. Before Huang Shinan went out, he said that the patient had a lot of thrombus and it was widely distributed. It's not very big either.

That's why, when Zhou Cheng was operating here, even though he looked young, the patient's lower limbs were likely to be amputated, so there would be nothing wrong with letting Zhou Cheng practice his hands!

Zhou Cheng changed to a thin catheter, and when he felt it in his hand, he frowned fiercely.

The smaller the thing, the more uncomfortable the force in the longitudinal direction. The catheter must be wound at least several times from the femoral artery to the anterior tibial artery and even the farther dorsalis pedis artery and metatarsal artery!

In this way, it will be more difficult to bear longitudinal force and break through the thrombus, which requires more precise force control!

……

When Huang Shinan stood next to Zhou Cheng, he interrupted Zhou Cheng: "Xiao Zhou, where did you get this blood clot from?"

The catheter Zhou Cheng operated was very thin and long, so Huang Shinan estimated that it was at least taken out from the anterior tibial artery or the posterior tibial artery, and it was also taken from the distal end of the artery, because only the diameter there could be so thin. .Usually, Huang Yuanwu takes thrombus strips from the popliteal fossa, and can also take them into the anterior and posterior tibial arteries!

However, from the femoral artery, it is indeed a bit difficult to cross so many forks!

"Director Huang, this is the dorsalis pedis artery. The thrombus in the artery of this leg has basically been taken out, and there may be a thrombus in the dorsal metatarsal artery, but it can be ignored for the time being. The communicating branches of the foot are well developed." Zhou Cheng said with some regret, and gave up his seat: "Director Huang, it's up to you to verify whether there are blood clots in the inner and outer plantar arteries!"

Without arteriography, the specific location of the thrombus cannot be found, so Zhou Cheng said conservatively, and if the proximal thrombus is blocked, it cannot be visualized even with angiography, and a diagnostic thrombectomy is still required, integrating diagnosis and treatment change.

"Where? Where?" Huang Shinan thought he had heard it wrong.

The dorsalis pedis artery, as the name suggests, is the dorsum of the foot.