on Monday.
Ling Ran brought his thesis and came to Yunhua Hospital full of energy.
The hospital at five o'clock in the morning is slowly waking up. Dozens of breakfast carts occupy several pedestrian passages in Yunyi. On the way to the parking lot, the security guards also started charging. The most active ones are the scalpers, who sell well-known expert numbers, whether it is the director number or the deputy director number, they are all based on fame and fairness, so that doctors occasionally joke at this price.
There was also a long queue in front of the fee counter for outpatient clinics. Specialist clinics with RMB 13 or RMB 17 were their first choice. Only after the number of specialists had been registered would someone choose general clinics with RMB 5 or RMB 7.
The scalpers who have been involved in it can raise the price of the 17-yuan expert number to 60 yuan, and sell it for 80 yuan, or even 180 yuan.
In the month when Pan Hua came back with the "Japanese expert", the expert account was sold for up to 500 yuan, which is rare in Yunhua Hospital.
Compared with scalping tickets for celebrity concerts, scalping tickets for hospitals is even more lucrative. The experts visit clinics every week, so there is no need to worry about selling, the supply is very stable, and the transactions are mainly in cash...
On the contrary, the emergency room is more peaceful.
The patients in the evening were settled, but the patients in the daytime had not yet come, and the nurses in the reception area were a little drowsy.
"I brought you some fruits." Ling Ran put a bag of fruits from home on the waiting table.
The two nurses said in surprise, "Doctor Ling is very polite."
"It should be." Ling Ran's understanding of courteous reciprocity is quite deep. Now he often receives gifts from nurses, doctors, patients, family members, elder sisters and others, and he always wants to return one or two. Fortunately, Ling Ran's mother, Tao Ping, had been preparing gifts for Ling Ran, and there were plenty of supplies.
"Wow, the grapes are so fresh..."
"And apples, I like apples the most..."
Regardless of whether it was true or not, the two nurses expressed their affection for Ling Ran's gift.
"Grapes and apples are grown by relatives and friends in the neighborhood. My family orders some in advance every year, and they can be delivered to our home at any time during the picking season." Ling Ran specifically explained, and added: "Although chemical fertilizers and pesticides are still used, but It was all within the standard and cleaned up very well.”
The two nurses nodded excitedly and said in unison: "Doctor Ling is the best."
Ling Ran entered with a smile, put the written paper on Huo Congjun's desk, changed into a white coat, and headed to the operating area.
In the operation area, I changed my hand clothes again, entered the room and passed the lounge, and unsurprisingly, I smelled the smell of stewed meat.
Ling Ran entered with a smile, and suddenly found a flat plate with more than a dozen pig's trotters piled up. There was also a small sign on the lower right with a QR code hanging on it. There was an explanation beside it: In order to balance income and expenditure, each pig's trotter is 19.9 USD, please pay by yourself.
Looking up again, I saw Lu Wenbin standing beside the table with a smile on his face. The white coat looked more and more like that of a cook.
"Are you ready for the surgery?" Ling Ran's focus was always on the operating room, pig's trotters... Of course it's delicious and useful.
While speaking, Ling Ran took out his mobile phone and scanned a pig's trotter.
Lu Wenbin fished a big one from the bottom, handed it to Ling Ran with both hands, and said with a smile: "The operating room is all ready. The anesthetist is Su Jiafu, and the MRI scans are also put in there. The 38-year-old air conditioner, When installing the air conditioner, the hand got stuck, and the index finger was rotated and avulsed, the skin defect was serious, and the tendons and blood vessels were pulled out."
Rotational avulsions are much more severe than cuts.
For doctors, the survival rate of replantation is also lower.
Ling Ran nodded slowly, and asked: "What are the expectations of the patient and family members for the operation? They know that the possibility of a complete recovery is close to zero."
"The family members understand." Lu Wenbin said: "I told them that skin grafting and blood vessel transplantation will be done, and shortening of fingers is inevitable. The family members said they can accept it. However, the patient hopes to restore hand function as well as possible, and to recover as quickly as possible. Some, can go back to work sooner.”
Lu Wenbin paused while speaking, and then said: "The patient's family conditions are not very good, and he is more concerned about medical expenses."
Ling Ran nodded slightly. For the replantation of severed fingers, these are the requirements within the normal range.
The most frequently encountered patients in replantation of amputated fingers are industrial workers. Industrial workers care less about their appearance, and pay more attention to survivability and medical burden.
"Go inside." Ling Ran threw away the pig's trotter bone, then wiped his mouth and hands, and entered the operating room. With the help of the nurse, I put on the surgical gown covering the whole body.
At this time, the operating room is in a nearly sterile state.
However, in the operating room of the emergency department, the aseptic standard has never been high, and the same is true for hand surgery. After all, every time a patient enters, it is impossible to clean it thoroughly.
The operating room of neurosurgery can do craniocerebral surgery, and the operating room of cardiothoracic surgery can also prevent foreign pollutants. The emergency department does not have such conditions, nor does hand surgery.
There will also be no high-cleanliness operating room, including general surgery. When a bag of shit is sprayed on the roof, any high-cleanliness operating room will be blinded.
Ling Ran took the MRI first as usual. Lu Wenbin and Ma Yanlin unwrapped the towel wrapped around the patient's hand together, and tried to clean up the oil on the patient's non-operative position.
After Ling Ran finished reading the film and came back, he continued to perform debridement.
I saw that his waist and neck were kept straight, his legs were separated, his elbows and wrists were firmly supported, and his spirit was highly concentrated...
Both Lu Wenbin and Ma Yanlin learned by watching.
Among surgeons, the one who pays the most attention to the surgical posture (surgical posture) is microsurgery. Because microsurgery is a typical physical surgery, it requires long-term concentration, and the burden on the body is extremely serious.
Without a good surgical posture, microsurgery doctors should be on the operating table before they become famous and successful.
"Lower the light." Ling Ran ordered, and the itinerant nurse immediately came over and pressed down the light on the first floor of the affected hand.
The main function of the lamp is to maintain temperature.
One of the key points in the replantation of severed fingers is the temperature of the hand. Once the blood temperature drops too much, it will be very difficult for the replanted severed finger to survive.
At the same time, the anesthesiologist Su Jiafu also gathered his spirits, watching the monitor at all times, and was always ready to deal with the problems of vascular spasm and blood coagulation.
In the operating room, in addition to heparin, doctors can also use a few poppyrines. The latter has a more prominent anticoagulant effect and is a super effective special drug. It will probably not be eliminated for a long time.
"Use the retrograde method today." Ling Ran made a decision after finishing the debridement.
Anterograde and retrograde are relative to the order of suturing.
The so-called antegrade is to fix the bone joint first, then suture the extensor tendon, then suture the dorsal tendon of the finger, the skin of the dorsum of the finger, then suture the flexor tendon, artery and nerve, and finally suture the skin of the palm. It can be seen as easy first and then difficult.
Retrograde is basically the reverse, the most difficult arteries, nerves and flexor tendons are sewed up, and then joints and extensor tendons are made.
Newcomers generally go forward in surgery, they can complete more steps step by step, and build confidence step by step. Retrograde is a relatively high-end operation, and only a few doctors will use it.
If Ling Ran was just a master-level severed finger replantation, perhaps he would only master the direct method, which is the current perfect level, so that he can use the retrograde method proficiently.
There is not much difference in the results between forward and retrograde. The difference is mainly in the habit of the doctor, the state of the patient, and the ability to control risks.
As far as avulsion wounds are concerned, bone and joint fixation is relatively easy, and arterial and tendon replantation is the top priority.
Ling Ran and Ma Yanlin were on one side of the binocular microscope, while Lu Wenbin used a high-power microscope to cut the patient's own blood vessels from the upper reaches of the right arm for transplantation.
Arteries need to be transplanted, veins need to be transplanted, and skin flaps need to be transplanted on a large scale.
For this one finger, the three of them worked for 2 hours before finishing the hardest part.
"Put another 10-0." Ling Ran was a little tired, but his eyes did not leave the microscope, for fear of losing his vision.
laugh.
The door of the operating room was opened, and Nurse Liu entered with a smile: "Remember to get your eggs when you come out. Each person has a box of native eggs, a box of salted duck eggs, and a box of 4 potatoes for the deputy director and above."
After a pause, Nurse Liu said again: "Doctor Ling, Director Huo asked you to take his portion."
"Oh." Ling Ran still didn't look up.
The same is true for Lu Wenbin and Ma Yanlin.
Nurse Liu got used to it a long time ago, so she went to the operating room next door to inform her with a smile.