"Why don't we just leave it like this and observe it for two days, maybe it will grow out." Fang Lin had no choice but to suggest in a low voice when Boss Zheng didn't speak.
"You still have the nerve to say that you are a thoracic surgeon? As a resident general, one year is not enough. It will take at least three years. Just squat in the department and perform operations every day." Su Yun said coldly.
"Brother Yun, let's talk it over carefully, and you won't let me do the hospital job again. This year, I feel sick all over." Fang Lin said with a sad face.
For him, nothing would be more distressing than being hospitalized again.
If it was like what Su Yun said, Fang Lin would rather not be a leading professor than just resign and go to a private hospital.
Fang Lin is quite resistant. Many doctors will resign without hesitation when they hear that they want to be the chief resident.
"What does the guide say?" Su Yun looked at Fang Lin with disdain, "Primary spontaneous pneumothorax continues to leak after 7 days of intercostal drainage; secondary pneumothorax continues to leak after 14 days of intercostal drainage. Pneumothorax; essentially a persistent bronchopleural fistula."
"Brother Yun..."
"The 2015 European Respiratory Society Statement on the Diagnosis and Treatment of Spontaneous Pneumothorax states: For patients whose drainage time is longer than 3-5 days and who still have persistent air leakage, further treatment should be taken." Su Yun looked at Fang Lin and seemed to feel the stethoscope on his shoulder. It was too dazzling, so he turned around and said to Lin Yuan: "Xiao Linzi, tell him what other guides say."
"Oh, okay." Lin Yuan said while watching the film with Zheng Ren: "The 2010 British Thoracic Society Management Guidelines for Spontaneous Pneumothorax pointed out: In spontaneous pneumothorax, conservative drainage for 48 hours should be considered if air leakage persists. Surgical intervention.”
Fang Lin looked at the monsters in Boss Zheng's medical team with a frown.
Everyone knows these things, but who would memorize so many details? Memorizing treatment guidelines is only useful when talking about it during consultations with the whole hospital. Will it have even the slightest effect on the patient in front of me
It's simply impossible. Fang Lin sighed inwardly. He looked at the image on the reader sadly and was about to speak, but was interrupted by his train of thought.
Because the topic about the guide is not over yet.
"The 2018 German Spontaneous Pneumothorax Management Guidelines propose that whether it is a spontaneous or secondary pneumothorax, if there is still air leakage after 48 hours of drainage, a change in treatment plan should be considered." Lin Yuan continued.
"Stop!" Fang Lin saw that she wanted to say more, so he immediately apologized, "Surgery? I have to ask the director for instructions. Even if this patient is asked for emergency treatment, the anesthesiologist will not dare to anesthetize him."
"Boss, what can you do?" Su Yun approached Zheng Ren and asked softly.
Zheng Ren didn't speak. He tried interventional treatment under bronchoscopy in the system operating room.
Generally speaking, there are several treatments for pneumothorax.
The first is the most common thoracotomy surgery ten years ago. The benefits of this surgery are just like what Su Yun said, the surgery is bright and bold. The disadvantage is that the trauma is huge and the patient's postoperative recovery is slow.
If the old patient in front of him who had become "scumbag" underwent this kind of surgery, Zheng Ren was not sure whether he would be able to step down. After all, relevant surgical training has been done in the system operating room, and the completion degree of the operation is not high at all.
The low degree of completion of the operation meant that there were many postoperative problems, which was ruled out by Zheng Ren.
Secondly, there is minimally invasive thoracoscopic surgery, which is now the preferred method for thoracic surgery in major hospitals. Not only general chest surgery, but also high-spirited cardiothoracic doctors like Zhao Yunlong are beginning to prepare to perform endoscopic surgery for type 1 aortic arch dissection.
Major guidelines recommend it as the first choice treatment for refractory pneumothorax. However, the patient in front of me is not suitable. He has poor basic physical condition, poor cardiopulmonary function, and extensive lung lesions. The completion rate of thoracoscopic surgery is still very low.
Besides, the patient had severe thoracic adhesions, and the field of view of the thoracoscope was quite limited, so he had to perform dissection first. If a blood vessel breaks accidentally, the bleeding must be stopped first. There is no surgery to make a ball in the surgical field, and this is also ruled out.
Next came the pleurodesis performed at the local hospital.
Although it is said to be a technique, it is actually a very simple operation.
The principle is to rub the pleura with chemicals or surgery to form uniform aseptic pleural inflammation and completely seal the pleural cavity. This is the procedure where the patient undergoes a chest injection of 50ml of 50% high sugar in the local hospital.
Both talc and tetracycline can be used as the first choice drugs, and other commonly used drugs include autologous blood, elemene, hypertonic glucose, iodophor, etc. (Note 1)
Then there is argon plasma coagulation. Some doctors attribute this treatment to internal medicine, but Zheng Ren disagrees.
But this technology is also not suitable for the patient in front of me.
The last one, which was the only solution Zheng Ren could think of, was interventional treatment under bronchoscopy.
Use bronchial plugs, stents, one-way valves, autologous blood, bioprotein glue, and gelatin sponge to block the airway to achieve the purpose of treatment.
Among them, autologous blood and biological protein glue can be absorbed by themselves, but they are easy to cough up. Currently, major guidelines do not recommend them as the first choice.
Zheng Ren tried a full 20 times before he found a feasible solution.
No matter how big or small the illness is, once it becomes serious, it will be very difficult. Boss Zheng, who is at the pinnacle of interventional surgery, the pinnacle of general surgery, and the top level of cardiothoracic surgery master, faced a small pneumothorax and actually performed more than 30 surgical trainings.
In this regard, Zheng Ren expressed his helplessness.
"You can try interventional treatment." Zheng Ren said, "For anesthesia... let's go to Lao He."
"Using bronchoscopy for interventional surgery? The risk is very high." Su Yun reminded.
"But there is no other good way." Zheng Ren said, "Use a laryngeal mask for general anesthesia, and I will use a bronchoscope to seal it."
Su Yun hesitated for a long time and asked: "Boss, if the stimulation is too intense, there may be problems."
Zheng Ren nodded, "There's nothing we can do about it. I'll try to do it as gently as possible. Fang Lin, what do you think about it?"
In fact, Fang Lin didn't have any considerations. He didn't dare to perform any invasive treatment on the patient in front of him.
If nothing else, the severe COPD of old patients is enough to scare away 99% of doctors. Of the remaining 1%, 99% are stupid, bold, and ignorant people who are fearless.
That is to say, Zheng Ren relied on the system space to cheat, kept trying, and finally figured out the correct method before he dared to operate on him.
Higher-level hospitals have the same difficulties as higher-level hospitals, otherwise Fang Lin wouldn't ask Boss Zheng to solve this matter.
…
…
Note 1: In 2011, Professor Didu performed a lung cancer operation, and the patient still had pneumothorax 2 weeks after the operation. On the second day of the Lunar New Year, I gave the patient a high-sugar injection and he was fine. This is a very common method with many shortcomings, but it is also very useful.
As for elemene, I really have a love-hate relationship with it. The specifics are another story, which will be detailed later.