medical simulator

And Zhou Cheng's idea of ​​embolizing the limbs before also sent away the orthopedic surgeon Fu Youhan who was invited to evaluate whether to perform amputation.

Now he honestly looks like a younger brother on stage, not like an associate professor of orthopedics at all.

The equivalent is to say.

Anesthesiology, general surgery, vascular surgery, and orthopedics, Zhou Cheng basically 'worked' four at once.

okay.Still not satisfied yet, Zhou Cheng finally started working on neurosurgery again.

Fang Jingsheng dared not speak. Although he is a vascular surgeon, the blood vessels in the brain have always been treated by neurosurgery!

Even today, when there is an interventional department dealing with intracranial hematoma, it is the professor of neurosurgery who performs the surgery himself.The interventional department dare not operate intracranial hematoma alone.

Du Li's scalp has already been peeled off, but the time is too short and he hasn't had time to open the window. He suddenly raised his eyes when he heard this, "You mean interventional embolization + conventional craniotomy to remove the hematoma?"

Originally, Du Li also had to perform craniotomy to remove the hematoma + craniotomy to stop the bleeding, and it was also very urgent.

Because of intracranial hemorrhage, the patient's death is generally not caused by insufficient blood flow!

But the blood that comes out exists in the brain, which is a very terrible thing in itself.If a brain herniation is formed, how fast can he die? He can die faster than you.

How fragile is the brain?

This is where everyone is most vulnerable.

Zhou Cheng's suggestion is theoretically feasible, but patients with ruptured aneurysms are all relatively large aneurysms. Under monitoring conditions, embolization can be done to prevent further bleeding, and then released. Detachable spring coil.

Now this?

There are several bleeding points, can you put them in?

Zhou Cheng said: "There is MRA here, as well as conventional MRI. We can actually try a minimally invasive method to release a few hematomas inside."

Du Li thought of me right then!

If you fucking wanted to say it earlier, why should I open such a big scalp flap?

"I can prepare a mirror, but are you sure you can get rid of the bleeding? This kind of multiple bleeding spots, even after the hematoma is removed with an endoscope, there is a great possibility of bleeding again."

"Endoscopic treatment is actually not suitable for this type of disease." Du Li felt that he still had to tell the pros and cons of the matter first.

The operating room has indications.

Sometimes, it doesn't mean that the more minimally invasive, the faster the surgery, the better!

It depends on the situation that can be handled and the postoperative recovery.

The time spent, this operation, the fastest optimal solution!

It is to open the window for drainage, or even open the skull to stop the bleeding.To stop the bleeding and clean up the hematoma, it was done directly with a trip to the water.

And even if you want to use an endoscope, you have to open a bone flap!

It's just that the opening method may not be consistent with the current one.The head needs to be shaved in advance and then positioned.

Zhou Cheng shook his head and said, "What I mean is that after the hole is drilled, a guide wire is used to add a hose, and after the hose is sent to the center of the hematoma, the hematoma is directly sucked."

When Du Li heard this, he suddenly felt like a good guy.

Are you brave or cowardly?

If you are brave, why are you in such a hurry?

Slowly put the endoscope in and stop the bleeding slowly, if you are timid.

This young man's guts cannot be small.

Du Li looked at Zhou Cheng seriously, then pursed his lips, and asked, "Can you do operations?"

If you say you can't, I'll beat you right now!

Du Li can't do it himself. If you push me to such a point, and you don't come up to do it yourself, and then ask me to try, then you are really going to be beaten, young man, I want to tell you in advance clear.

Therefore, Du Li's words were not polite, even a little threatening.

"I can try." Zhou Cheng narrowed his eyes.

Neurosurgery is a department very close to orthopedic spine surgery, so Zhou Cheng accidentally acquired some corresponding skills and understanding during the simulation.

Especially for important structural injuries in the brain, the final manifestations are all classified as orthopedic activities, and Zhou Cheng's understanding is more in-depth.

Chapter 4 Killing without a knife!

Surgery is not a joke, each surgery has its corresponding indications.

It's not a surgery, as long as it sounds better, high-end, and capable enough, it can be performed directly.

Needle hematoma evacuation under CT monitoring.

Naturally, it is the least traumatic, but it is only suitable for a single hematoma, especially if the patient suffers from a single and relatively large hematoma.

The problem can be solved quickly.

However, there are many hematomas like Lu Ganzhou today, but not very large, it may be safer to remove the craniotomy, or to do it slowly under the endoscope!

This is Du Li's idea, and it is also a relatively conventional idea.

However, Lu Ganzhou's condition is different now. According to the conventional perspective and thinking, then just wait for death.

Therefore, from the very beginning, Zhou Cheng's thoughts did not take the usual path!

The reason why medicine needs to develop is that the current level of inheritance and knowledge will never be able to analyze all existing diseases, no matter which medicine is the same.

You know, under normal circumstances, who would embolize the arteries of the limbs?

The idea of ​​this operation is already in progress, so what can't be done with the thinking of interventional hemostasis and clearing the intracranial hematoma with a puncture needle?It's just that the premise is that you can do it yourself.

Zhou Cheng nodded and said, "I can do it!"

At this time, Zhou Chengcheng was no longer polite or modest. Now that time is urgent, if he is humble a few times, the people of Lu Ganzhou will disappear.

In fact, Zhou Cheng wanted to get started directly from the very beginning, but he couldn't.

If this was at the Affiliated Hospital of Shonan University, Zhou Cheng would have the home field advantage. With people behind him, Zhou Cheng would not even have to create opportunities by himself, but would directly tell Ding Changle and Cai Dongfan.

He can start the main operation immediately.Even in the Ninth Academy, Zhou Cheng can directly say that I want to go on stage, instead of asking a few professors for their opinions, and I can only go on stage after getting permission.

There is a teacher named Zeng Diwei in the Ninth Academy.

This is Huashan Hospital. This operating room is only open to doctors in Huashan Hospital!

Even if Zeng Diwei came to have an operation, he still had to go through procedures.

Of course, the procedure they have to follow is very simple.

And if Zhou Cheng was not a little-known doctor but a very well-known associate professor in the industry, Zhou Cheng wouldn't have to make all kinds of suggestions in such a humble way, and just get started, let's say, this It's my specialty, please feel free to leave it to me.

But Zhou Cheng is not!

Even everyone in Huashan Hospital knew Zhou Cheng.

Zhou Cheng himself is a little confident about his current technical level, but others don't know!

It is impossible for everyone to know, this is still a lack of experience and resume.

And according to the most conventional way of thinking, Du Li and Professor Ni did not scold his mother or even kick him out when Zhou Cheng opened his mouth to disturb their own surgical design ideas.

After all, there are not many people like Zhou Cheng who have professors to speak and support him.

Then Zhou Chengcheng said: "Teacher on tour, can you push the computer for reading the images over for me? I want to see the specific location of the bleeding point. I'm going to put gel to stop the bleeding in the skull now, thank you!"

When Zhou Cheng said this, Du Li immediately said: "Xuan Xun, quickly push the computer over and transfer the MRA video to him."

Immediately afterwards, Du Li also took charge of his own work: "Xiao Zhou, I will do the needle drilling, and you only need to be responsible for stopping the bleeding!"

There are some dangers that should be taken when necessary. We can't let a young man fight alone here to be a hero.

Du Li is also a well-known neurosurgery professor at Huashan Hospital, and it's not like he doesn't know how to evacuate a hematoma guided by a puncture!

But, he wasn't absolutely sure.

The first reaction of every doctor is that they must not leave any mistakes in the operation process to cause trouble for others, and choose the optimal solution under the most standard operation suitability for everything!

However, seeing Zhou Cheng's strength, it was almost a case of humbly begging for their opinions and trying all kinds of extreme methods before.

He didn't intend to keep his own strength anymore, he was always thinking about self-protection, he decided that since Zhou Cheng wanted to save people with all his strength, then he would take a risk to cooperate with him and save him time.

"The hematoma removal operation?" Zhou Cheng still asked one more question, mainly because the hematoma might be fatal, Zhou Cheng didn't want him to save his legs and hands and lose his body when he performed the thrombus removal operation on limbs.

"Don't worry, I can definitely do this!" Du Li replied very calmly.

Zhou Cheng nodded at that time, and after a slight turn in his mind, he suddenly understood, and said to himself, Brother Zhou Cheng, you better not be too careless!

You are now in Huashan Hospital. This is not a place where you can be unscrupulous. There are more professors and experts here than you can see.

Let's put it this way, in fact, the current professors in major teaching hospitals may be able to carry out surgeries that are much wider than the scope of real surgeries, and they also have a lot of thoughts in their hearts and minds.

However, in most cases, because of the current medical environment, these professors are unwilling to touch or try many things.

I firmly frame my actions under the so-called expert consensus and so-called guidelines, because only in this way can I be exempted from responsibility and attribute all accidents to the limitations of medical technology.

Do what can be done, what should be done, what should not be done, there is no need to take risks.

In this way, even if there is a lawsuit, it is strictly within the guidelines, and operations outside the guidelines are illegal operations!

Very skillful, three points are enough to eat, six points are hidden for self-protection, and one point depends on God's will.Isn't this life delicious?

Because, if you don’t hide six points of your skills and ideas, one out of a hundred patients will have an accident and go to court. It’s nothing to say, you didn’t act according to medical principles, and you didn’t follow the guidelines for treatment!

Full responsibility, losing money, apologizing, demotion, affecting promotion, and even being a doctor may not be possible anymore.

Why bother?

Therefore, under such circumstances, Zhou Cheng was a little touched that Du Li was able to say such words.

"Thank you, Professor Du."

Du Li didn't say much, and immediately began to change the operation method, and then began to draw a positioning line comparing the position of the intracranial hematoma.

An assistant next to Du Li seemed to be a little frightened by Du Li's action, and said, "Mr. Du, the diameter of this hematoma is not very easy to operate, isn't it? Actually."

"Shave your hair!" Du Li just replied.

He could only shave his hair.

Then, at this time, a lot of people suddenly gathered at the door of the operating room, but these people just surrounded the door of the operating room and looked inside curiously, but none of them really stepped on the door of the operating room. The door of the room is afraid of affecting the rescue operation!

One of the itinerant nurses saw this scene and thought there was something wrong, so he went to the door and opened the door to ask about the basic situation.

For this operation, because the director personally spoke, there is no upper limit for the staff of itinerant nurses and handwashing nurses. If she needs ten, she will call ten people to the operating room!If there is a real shortage of people, she can fill in by herself.

……

Surgery continues.

Zhou Cheng's hemostasis was also very fast. Basically, he treated several intracranial bleeding points within two to three minutes.

At this time, the general surgery personnel opened the abdomen.

This speed is not slow anymore. After all, it has only been more than 6 minutes since Zhou Cheng made his decision.

After 6 minutes, sterilize the towel, stick a sterile film on the incision site, and cut the skin and subcutaneous tissue.Cut a small opening in the anterior sheath of the rectus abdominis first, and then use scissors to cut the anterior sheath upwards and downwards.

Along the direction of the muscle fiber, the rectus abdominis bundle is first separated with a vascular forceps and then with a knife handle or fingers.

Stretch the rectus abdominis to both sides, clamp the posterior sheath of the rectus abdominis and the peritoneum, and clamp the peritoneum with toothed forceps, and the assistant clamps another one centimeter away from the place where the surgeon clamped with the assistant. , and then the surgeon loosens the clamped peritoneum, and then clamps another place, repeats the same procedure, and cuts it open with a knife.

These steps are indispensable, plus the process of hemostasis, this speed is considered the limit speed, okay?

It's just that the speed at which Zhou Cheng was doing the hemostasis of the splenic artery and the intracranial artery was a little too fast!

After doing this, Professor Fang Jingsheng embolized all the blood vessels in the limbs.Zhou Cheng breathed a sigh of relief.

In this way, the most deadly places are all solved first.

If the intracranial hemorrhage does not continue to expand, there is no big problem.If the rupture of the spleen is serious, just cut it off. The contusion and laceration of the liver is not particularly serious. For the professor of general surgery, it is just a piece of cake.

At this time, Professor Yan from the Department of Thoracic Surgery also sent good news, saying: "There is not a lot of bleeding in this chest, and the drainage on my side is not too much."

The anesthesiologist, Professor Chu, also took a long breath and said: "CVP has finally stabilized. The blood transfusion is still taking place here, so it should be more stable. For the time being, we are out of the period of possible shock at any time."

Good news came from all sides.

The only bad news is that the lower extremities that were embolized before have already started to embolize.

After all, the flow of blood in the blood vessels is completely dependent on the pump circulation of the heart. After the flow stops, it will stagnate.The blood does not move in the body, but there are other traumas, which will stimulate the activation of the endogenous and exogenous coagulation system, and then cause blood coagulation.