Zheng Ren and Lin Ge came to the cardiothoracic surgery department. In the office, Zhao Yunlong was standing in front of the film reader, frowning as he watched the film.
Because it's already off work and the second-tier professors from other departments haven't arrived yet, it's normal to arrive a little later at this time.
"Old Zhao, who is the patient?" Zheng Ren asked.
"Mr. Zheng, come and take a look." Zhao Yunlong saw Zheng Ren and Ling Ge coming in together. Without saying hello to Ling Ge, Zhao Yunlong directly pulled Zheng Ren over to watch the movie.
Zheng Ren glanced at it and his heart sank.
The patient's mediastinum was covered in white, and the infection was severe and had invaded the visceral pleura and aorta.
"The patient is 62 years old. He ate mandarin fish at home two weeks ago and got a fish bone stuck in it. Later, he took some vinegar and ate steamed buns and wanted to choke," Zhao Yunlong said.
It turns out that's the case. No wonder Big Pig Hotter calls this a murder caused by a steamed bun.
Zheng Ren nodded, hugged his arms and started watching the movie.
"There were no strong symptoms at the time. Coughing and sputum began to appear three days later. One week later, it was difficult to breathe and the sputum was yellow-green. One day ago, the sputum turned black and yellow. The local hospital doctor recommended coming to the Imperial Capital for diagnosis and treatment." Zhao Yunlong introduced .
"The mediastinal abscess is very serious. We must seize the time for surgery." Zheng Ren said.
"Well, I think the aorta has been violated and an aortic stent needs to be removed." Zhao Yunlong said: "If possible, artificial blood vessel anastomosis is not needed. Try not to use it."
"Well, if you do that, the operation will be too big. And the infection is too serious, and there is a possibility of bacteremia and sepsis... there will basically be complications." Zheng Ren immediately understood what Zhao Yunlong meant.
"I also want to see who will come to the interventional department for consultation. If it's a problem, I'll call Su Yun." Zhao Yunlong said in a low voice with a smile.
"Who will perform the surgery?" Zheng Ren asked.
"I'll go to the second tier, but Professor Zhang is not good enough." Zhao Yunlong said straightforwardly as they were all from his own team.
This is the case in clinical practice. The level of professors may not necessarily be higher than that of residents, nor may nationally renowned professors be of higher level than others.
Generally speaking, the level of nationally renowned professors is not necessarily that high. Many people give up clinical practice when they are in their forties, when their hand speed, eyesight, and energy begin to decline from their peak, and start running and giving lectures across the country.
In this case, the reputation across the country will increase, but the level of surgery will also decrease accordingly.
Some things are difficult to have both ways. People who are really good at surgery squat in the hospital and perform surgeries in obscurity, and rarely have the opportunity to let everyone know.
Even if someone knows about it, it's just a matter of fame within a small circle.
"Professor Zhang..." Zheng Ren said, turned around and looked around, and saw that only Lin Ge was sitting on the chair and reporting on the matter on his mobile phone, so he whispered: "Can aortic arch replacement be done?"
"It can be done, but the mortality rate is extremely high." Zhao Yunlong said.
Zheng Ren knew it well.
He did not continue to ask. The quality of other people's surgeries had nothing to do with him.
Continuing to watch the movie with his arms folded, Zheng Ren was like a stone sculpture, unmoving despite the wind and rain.
More than ten minutes later, the second-line on-duty professors from relevant departments came in one after another. Anyone who knows Zheng Ren, please say hello. Zheng Ren didn't recognize most of them, so they just passed by.
"Is this the patient's film?" a voice came from behind.
"Professor Zhang, it's a film about emergency patients." Zhao Yunlong responded in a deep voice.
Zheng Ren turned his head and saw a doctor in his fifties with gray hair standing behind him.
His hair is meticulously styled, and his snow-white clothes are like a swordsman in white, which can fly in the wind. The whole person looks very energetic, with a sense of elegance.
"Hello, Professor Zhang." Zheng Ren greeted politely.
"Boss Zheng, do you also have research on our cardiothoracic surgery?" Professor Zhang greeted calmly.
"This is not about thinking that if surgery is performed, the risk of installing an aortic stent will be much smaller." Zheng Ren said with a smile: "The stent is easy to remove, but it is still difficult to peel off the abscess."
"This operation is impossible to do." Professor Zhang heard Zheng Ren talk about the operation and directly denied it.
Zheng Ren said nothing and just smiled. The muscles on Zhao Yunlong's face trembled a few times, but he refrained from speaking.
"Everyone is here, Mr. Zhao, please introduce the patient's condition." Lin Ge sat in the middle and began to preside over the meeting on behalf of the medical office.
Zhao Yunlong reported the medical history, which was much more detailed than when he described it to Zheng Ren.
The patient had been experiencing a high fever, a sign of a serious infection. Bacterial culture, mainly Pseudomonas aeruginosa, there are other drug-resistant bacteria.
The films clearly show that the diagnoses of pneumomediastinum and mediastinal abscess are particularly numerous and complex.
But when it comes to treatment, it’s even harder.
"Let me tell you my opinion." Professor Zhang stood in front of the reader and said calmly.
His gray hair seemed to speak of his rich clinical experience. The whole person looks clean and calm, and a bookish air rushes towards him, making people unconsciously trust him.
"The patient needs surgical treatment, I don't deny this. But after reviewing the films, we can see that due to the long delay in the lower-level hospital, some layers of the aortic adventitia have been damaged." Professor Zhang's voice is pleasant. There is a slight hoarseness in the thickness.
"In this case, there is no chance to peel off the abscess. If the operation is forced, the chance of the patient dying on the operating table is greater than 95%." Professor Zhang said loudly: "If the patient's family insists on surgery, I recommend at least a chest surgery. Let’s talk about it after 3D reconstruction of 64-slice CT.”
Zheng Ren shook his head inwardly.
The 64-slice CT three-dimensional reconstruction of the chest... He should be talking about the three-dimensional reconstruction of the blood vessel CTA and the mediastinum.
This kind of chronic diagnosis examination, even if the medical office comes forward, will not be able to do it until at least tomorrow. According to the normal procedure, it would be early to get the results the day after tomorrow.
What he said was clear, and the underlying meaning was clear. Surgery can't be done, at least not tonight.
Because Professor Zhang is in the second-tier class today. If something happens, he needs to take responsibility.
Even if we do it, we have to do it tomorrow and the day after tomorrow.
When he is not on duty, he can just sit and watch the operation. Success or failure will have nothing to do with him.
However, Professor Zhang spoke more tactfully and first emphasized the seriousness of the condition. For such a serious disease, it is necessary and necessary to perform three-dimensional reconstruction to understand the condition before surgery.
What a slick Tai Chi master, Zheng Ren thought.
Seeing that everyone was silent, Professor Zhang picked up the medical records and started talking nonstop.
Starting from the laboratory examination of white blood cells, neutrophils, and C-reactive protein, all the way to pathophysiological changes, the explanation is clear and logical.
The lecture was really good, Zheng Ren thought to himself.
"Do you have any opinions?" Linge paused and asked.
"Let me say a few words." Zheng Ren stood up, smiled gently, and said.
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