"Brother Yun, look at what you said. This is a normal complication. We didn't do it on purpose. We all hope that the patient will be well. Who could deliberately knock the Kirschner needle out of the bone." Mr. Zhou listened to Su Yun When he said this, his face turned pale with fright and he kept explaining.
"If you have the ability, go out and explain to the patient's family." Su Yun refused.
"Boss Zheng, do you think Mr. Zhou will come now or later?" Mr. Wang came to smooth things over.
I have been coming to Haicheng for a while and have had many interactions with orthopedics. I know that Mr. Zhou is honest and a bit of a girl.
This kind of person would be bullied to death by Brother Yun in a one-on-one fight. The one-sided crushing finally made Mr. Zhou cry.
He didn't care about Mr. Zhou's life or death, but if he wanted to die, he would have to undergo surgery first and then die.
"Hmm..." Zheng Ren pondered for a moment, "In a few minutes, the pericardial fibrous tissue will be peeled off. Could you please Mr. Zhou to come and take out the K-wire?"
Only then did Mr. Zhou realize that the patient’s Kirschner needle was still there…
Yes, if he wasn't there, it wouldn't be such a big deal.
Generally, before surgery, the K-wire will be removed after half a year. Even if he did it himself, Mr. Zheng estimated that it had been three years since the operation, and the patient did not come for the second-stage surgery. This should be discussed.
After calming down for a while, Mr. Zhou finally figured out the problem.
I was so panicked that Mr. Zhou mentally scolded himself.
While they were chatting, Zheng Ren had already cut the pericardium in the left ventricle, as far back and lateral as possible, choosing an area without calcification.
There were layers underneath the incision, and the pericardial effusion had been sucked out.
The delamination is found outside the epicardium and blunt dissection is performed along the delamination and gradually widens.
Blunt dissection is a unique skill that Zheng Ren is good at. At this time, it is also easy to separate the adhesions between the epicardium and the fiber plate.
"Mr. Zheng, why are you back?" Mr. Zhou looked at Zheng Ren operating and suddenly remembered that Mr. Zheng had gone to the imperial capital? Without thinking, he asked in shock.
As soon as these words came out, Mr. Zhou immediately realized that something was wrong and lowered his head directly to avoid having to face Su Yun's disdainful gaze.
But it’s okay to lower your head and pretend to watch the surgery, but you can’t deliberately plug your ears.
"Mr. Zhou, did you travel through time, or did you open the door and see The Truman World? A Kirschner needle dissociated and you were so scared?" Su Yun's voice was full of infinite contempt.
"It's just a Kirschner needle. If a hospital in our city were to perform cervical spine surgery, would you be unable to sleep all night long?"
"I'm homesick, come back and have a look." Zheng Ren said in a serious tone, "Mr. Zhou, please go wash your hands."
"Huh?" Mr. Zhou was distracted and let out a confused ah.
"The operation is almost finished. Come up and take out the Kirschner needles, and we will close the chest again." Zheng Ren glanced around and had to accept the fact that he would stay and close the chest.
It is still convenient to call 912. After the operation, you can walk away without having to worry about closing your chest or abdomen.
Unconsciously, Zheng Ren's thinking has changed into that of a professor and director.
Close the chest, close the abdomen? Whether the little doctor's job is good or not has nothing to do with me.
Zheng Ren peeled off the pericardium in order.
Try to remove it in pieces. If myocardial rupture occurs, the stripped pericardium can be used to repair and stop bleeding.
Of course, this was just a precautionary measure. Zheng Ren only did it subconsciously, never thinking that such a problem would arise with his master-level cardiothoracic surgery skills.
The right pericardial slice was separated to the left atrioventricular groove, and its upper limit was to the lower part of the thymus. The upper border of the left pericardial slice was separated from the main pulmonary trunk, and its constricted ring was cut off to avoid causing severe postoperative right ventricular hypertension.
The lower boundary completely frees or removes the thickened pericardium beyond the diaphragm key; the posterior boundary completely frees the pericardium manifested by the left ventricle as much as possible.
When separating the interventricular sulcus, Zheng Ren's hand speed was a little slower, and he was extra careful not to damage the coronary artery branches.
But it was just the fist-sized heart that was separated bluntly step by step in sequence, and the separation was completed in an instant.
After the operation, Zheng Ren asked for warm saline gauze to cover the incision.
It is best to leave the opening in the chest open.
Otherwise, if the heroic operation of the orthopedics department was really performed blindly, Zheng Ren was afraid that Mr. Zhou would puncture the patient's aorta in one fell swoop.
After changing the incision and paying attention to the sterile area, Zheng Ren took a look at the ECG monitor.
The patient's vital signs are stable, and this difficulty should be over.
"Boss Zheng, you said this heart problem, how could the first symptom be in the abdomen?" Mr. Wang recalled the patient's medical history. Although he didn't know everything in detail, if he had seen the patient himself, he might not have thought of chest disease.
Asking Boss Zheng for his ideas can be a reference in the future.
"Didn't you see how the left phrenic artery was squeezed during the operation?" Su Yundao said: "Patients have gradually become accustomed to long-term chronic injuries, so they just say they have chest tightness. But abdominal peptic tract ulcers and bleeding can cause Nausea and vomiting are relatively typical symptoms, so it’s really easy to be missed.”
"Boss Zheng, Brother Yun, how did you two find out?" Mr. Wang said with admiration.
"The patient complained of chest tightness and shortness of breath. It is normal to auscultate the breath sounds." Zheng Ren said casually: "Mr. Wang, a normal physical examination is required. Some simple major items still have to be done. Don't be careless."
Mr. Wang was startled for a moment, then smiled bitterly.
According to regulations, a physical examination is mandatory, and it is a complete one.
But clinical matters are not that simple.
It takes less than half an hour to complete a set of inspections. The emergency department is so busy, how can I have time for detailed examination
Besides, the situation is definitely not that simple.
A female patient came in and was diagnosed with appendicitis. She insisted on doing a chest and vulva physical examination. Isn't that a hooligan? !
Many doctors who have just entered clinical practice fall into this trap.
Mr. Wang could only smile bitterly in response to Zheng Ren's statement. However, the patient complained of chest tightness, so he should be able to auscultate, and he should be able to.
Mr. Zhou took the front-line orthopedics doctors to disinfect, lay out the sheets, and start the operation.
Removing Kirschner wires is one of the smallest orthopedic surgeries, and it should not be difficult for Mr. Zhou.
But today's surgery was extremely awkward.
He was cautious and almost did not dare to use violence.
But the Kirschner needle was deeply buried in the callus and could not be removed without violence.
In the past, when the scope of orthopedic diagnosis and treatment did not include the cervical and lumbar spine, people were called "carpenters."
Adze, chisel, axe, saw, all available.
The surgery was performed with great courage, and it was over with a series of blows and blows.
Seeing that Mr. Zhou couldn't let go, Zheng Ren also sighed.
I had no choice but to provide adequate protection for Mr. Zhou in his chest, using a layer of large gauze pad to protect him, and then using an iron sheet with a large curved retractor to block the Kirschner needle. In this case, even if the K-wire is moved violently, it will not cause too much damage.