My medical skills can add experience points Chapter 126 Consequences of Nerve Recurrent Branch Damage, Thumb Reconstruction
For severed limbs, surgery within six hours generally has a good survival rate. The storage environment is okay, if the temperature is low, there is still hope within eight hours.
Even more than 12 hours, there are still cases of successful recovery.
More than 24 hours after the replantation, the man's four fingers are still pale and wrinkled, which is a very bad sign.
Only dead fingers look like this.
Doctor Shan examined the patient carefully, and then asked about some postoperative symptoms.
For example, do your fingers hurt?
Did you take care to keep it warm?
Did you follow the doctor's advice after the operation, and so on.
Zhou Can just stood at the end of the bed and listened.
When doctors make ward rounds, the order of entry and standing are all particular.
The right side of the patient is generally reserved for the director and attending physician, and the left side is reserved for the resident physician. During the director's ward rounds, there are usually multiple residents, and at this time it is necessary to determine the priority according to their seniority.
Those with high seniority stand in front and those with low seniority stand behind.
The head nurse usually stands in front of the bed, so that he can 'care and take care' of the patient at any time.
The remaining position at the end of the bed is reserved for unimportant people.
Such as training students, interns, graduate students, advanced students and the like. All these are only for standing at the end of the bed.
After Dr. Shan finished examining the patient, his face was quite solemn.
Others felt the oppressive atmosphere, too.
The failure of the operation is a bad result for the patient and his family, as well as all the doctors and nurses.
"Can you show me your medical records?"
Zhou Can didn't want to get the limelight, but remembered a situation that the teacher said.
He wanted to confirm the basic condition of the patient before making further analysis.
The tube bed doctor is a somewhat greasy young doctor, about thirty years old. It may be due to excessive puberty, leaving dark marks on the face after the acne has healed.
He just glanced at Zhou Can indifferently, without any response.
I'm afraid I'm still thinking in my heart, this stupid B-regulation Pearson, didn't he see that this is the attending rounds? Who do you think you are?
"Bring me the medical records!"
Seeing that the greasy man didn't respond, Doctor Shan's tone was extraordinarily cold.
Many doctors actually hate bureaucracy and bureaucracy.
Because patients can't afford to wait, can't procrastinate, and can't be perfunctory about their illness.
Doctors and nurses normally flatter leaders at all levels and superior doctors, and everyone can understand it. They all want to be in the top position, and want to get more support and resources.
But absolutely no doctor likes bureaucracy.
Because it means high death rate, high accident rate.
The greasy male doctor shivered in fright, he didn't understand why Doctor Shan was so angry?
He handed over the medical records with respectful hands.
"Please check it out!"
After Dr. Shan took it, he handed it directly to Zhou Can.
"If Dr. Zhou wants to know anything, if there is no record in the medical record, you can ask questions at any time."
By doing this, she was almost tantamount to publicly supporting Zhou Can.
"Thanks!"
Zhou Can took the medical records and carefully
The patient cut off four of his fingers when he was operating the wedge with his co-workers because the co-workers did not operate properly.
After the accident, he was sent to the local social hospital immediately.
The doctor simply bandaged the injured wound and provided the patient with an ice pack to cool down the severed finger. It is recommended that they immediately go to a large hospital for replantation of severed fingers.
So I drove to Tuya Hospital.
After receiving the diagnosis, Director Shen led a team to replant the severed finger of the patient.
At that time, in order to shorten the operation time, Dr. Shan and Director Shen replanted the severed finger of the patient at the same time. One person took two severed fingers. The bones of the four fingers were all done by Director Shen.
She mainly performed tendon anastomosis, vascular anastomosis and nerve anastomosis, as well as cortical suture for the patient's two fingers.
The whole operation went very smoothly.
At that time, the blood supply of the four fingers was tested to be unobstructed.
After reading the medical records, Zhou Can walked to the hospital bed and carefully examined the patient's palms and backs.
I saw many bruises on the back of his hand near the wrist and near the tiger's mouth.
"When you communicated with Doctor Shan just now, you mentioned the numbness of your thumb, right?"
"That's right! When I was first injured, I thought I was in so much pain that I couldn't feel it. After the operation, I thought I would be fine after waking up from the anesthesia. As a result, my thumb still feels numb."
The patient described exactly how he felt.
Zhou Can nodded, and took a straw from the iron cabinet next to the bed. Touch the patient's index finger near the palm.
"Do you feel it?"
"A little bit, but it seems to be separated by a layer of clothes."
The patient's education level is limited, and the description is not so specific.
The analogy is quite vivid.
Zhou Can tried his other three fingers in turn, and they were almost the same.
It feels very dull and extremely insensitive to the touch.
At this point, Zhou Can basically had a bottom line in his mind.
He picked up the film taken by the patient and watched it carefully.
Doctor Shan waited patiently, and the other doctors had to be patient even though they felt a little dissatisfied with Zhou Can.
"Doctor Shan, do you see that the injured part of the patient's hand is the recurrent branch of the median nerve?"
"Yes! The reverse branch of the median nerve is approximately at this position."
She nods.
Then, the eyes became brighter little by little.
There was also a hint of enlightenment on his face.
"You mean, the median nerve is damaged, so the blood supply is affected?"
Dr. Shan's expression at the moment does not have the cold and serious demeanor of attending a doctor.
He is clearly a happy kid who found the answer.
The solemn expression before has long been wiped away.
"I didn't say it, you said it." Zhou Can blinked.
"Hehe, at least you have a lot of credit for being able to find out the reason for the poor blood flow of the severed finger."
Doctor Shan generally seldom smiles.
At this moment, Zhou Can is sensible, save face for her, and give her all the credit. It made her happy and useful.
"Mr. Gao, now we suspect that this part of you is injured, probably a nerve. Nerve cells are the only cells that cannot regenerate. Therefore, if the nerve damage is serious, we may not be able to do anything. Now I will prescribe two tests for you, Focus on checking whether the nerve pathway is interrupted, and the hematoma in this area."
"After we find out, we will formulate a new treatment plan for you, and try our best to keep the fingers and hand functions of your hand."
She communicates with patients, leaving room everywhere.
And let patients make their own choices.
Among them, Zhou Can secretly learned and absorbed the communication skills.
In addition to doctors' efforts to improve the level of diagnosis and treatment, communication with patients is also a compulsory course.
"Doctor Shan, please tell me, is there any relationship between the nerve damage and the poor blood supply of the replanted severed finger?"
The medical level of the greasy male doctor should not be very high.
Didn't know the relationship between the two.
The relationship between the two is rarely recorded in books. It is the valuable experience summed up by doctors in practice.
Zhou Can just clicked, and Doctor Shan knew the reason.
She is clearly aware of the connection between nerves and blood supply.
This also shows that it is too important to have a director-level teacher.
You can avoid many detours.
"You can ask Dr. Zhou for advice!"
She should have taken this opportunity to teach the greasy male doctor a lesson about his arrogance towards Zhou Can.
The greasy male doctor looked at Zhou Can with embarrassment.
Asking him, a senior resident doctor, to ask a regular trainee for advice, is somewhat embarrassing.
What's more, not long ago he pretended to be an uncle in front of Zhou Can.
How embarrassing it is to ask others for advice now!
It will only be more embarrassing if you don't ask for advice.
Everyone knew what was going on and was sure to secretly laugh at him.
"Doctor Zhou, can you give me some pointers?"
The greasy man had no choice but to say this to Zhou Can cheekily.
"Nerve damage may affect blood flow. Didn't your teacher teach you?" Zhou Can asked back.
"Ahem... Maybe I taught it, maybe I forgot."
The teacher of the greasy male doctor is the attending level if he is exhausted.
If the teaching teacher doesn't like his behavior, it is likely that he is going through the motions as a routine.
Therefore, the difference in level still has to find the reason from yourself.
"Doctor He, remember to follow up with the patient in this bed. After he finishes the examination, he can show me the results, or find Director Shen. His severed finger has been replanted for more than a day, so it must not be delayed."
Dr. Shan handed over the matter to Dr. He for follow-up.
She led several people to continue rounds.
There are more than 100 beds to be checked, and even if it takes an average of one minute for each bed, it will take nearly two hours.
Therefore, ward rounds are basically to check key patients.
The patients who have just finished the operation, may be life-threatening, and the director mainly explained that these patients need to be carefully checked to understand the patient's condition. The remaining ordinary patients can only be left to the residents, trainees, and interns to investigate slowly.
After about half an hour, they checked all the open beds,
Dr. Shan led them into the two wards of this group to continue rounds.
Patients who need to be admitted to the ward generally need special care or have high requirements for the environment.
Nurses and doctors also pay special attention to the patients in the ward.
Everyone is afraid that something will happen.
Zhou Can saw the male patient who was transferred from bed 120 at a glance.
"Doctor Zhou, hello!"
When the male patient saw Zhou Can, he immediately greeted him warmly.
If Zhou Can hadn't been scolded by the superior doctor two days ago, he would have to reflect his problem.
Whether he can keep this leg is hard to say.
The male patient didn't say anything, but he kept his gratitude in his heart.
Seeing Zhou Can at this moment, he was very excited and happy.
"Hello! Are you here?"
Zhou Can walked up to talk with a smile.
The male patient's wife also knew good and bad, and knew that the young doctor was a benefactor. Handed Zhou Can a bottle of eight-treasure porridge prepared for the patient's breakfast.
"I have to thank you last time. We country people don't have any good things. Please drink a bottle of porridge. Don't be disgusted."
"Thank you, but our hospital has a rule that we cannot accept any gifts from patients and their families. Let's save this bottle of porridge for uncle!"
Zhou Can felt very relieved and very happy.
Every time a patient's illness is cured, or the patient's life is saved, they will be grateful from the bottom of their hearts.
For example, Mr. Cui, and that Mr. Wu's child, or this simple middle-aged couple in front of us. The gratitude behavior of these people made Zhou Can feel very happy.
"Is your leg better now?"
"After another operation, it's much better. My legs are no longer painful."
The middle-aged uncle said with a smile.
It seems that the spirit of the middle-aged uncle is much better than that day.
Zhou Can took advantage of the opportunity and lifted the quilt to check the middle-aged man's feet.
The edema has disappeared, and the subcutaneous purpura is also gone. The complexion of the feet looks good. The skin on the feet is still a little wrinkled though. it `s just normal.
It is necessary to wait until the patient can walk on the ground before doing some rehabilitation exercises on this foot.
At that time, it will naturally return to normal.
"After his first operation, a thrombus formed in the blood vessel, which may be related to the injury of that blood vessel. Later, Director Shen cut off a piece of vein for him and replaced it, and this was completely resolved."
Doctor Shan explained later.
Maybe she also wanted to tell Zhou Can that the thrombus was not because she didn't sew it properly. Instead, the patient's blood vessels are damaged.
In fact, in the final analysis, I still lack experience and technology.
If Dr. Xu performed the vascular anastomosis in this operation, this kind of thing would definitely not happen.
Soon, they checked all the beds in the two wards.
The patients living here all have problems of one kind or another and need careful care or intensive monitoring. And many of them have undergone major surgery.
For example, Zhou Can was lucky enough to see the sternotomy patient that Director Shen presided over yesterday in the inpatient ward.
The ultimate goal of this operation is generally to remove the scapular gland tumor.
It is a major thoracotomy.
The level is at least level three, and the risk factor is extremely high.
Sometimes the orthopedic department cannot complete such an operation alone, and it needs to be performed jointly with doctors from the cardiothoracic surgery department.
If there is a subdivided scapular surgery department in our hospital, it is also possible to directly invite doctors from this department to perform joint operations.
Today, as medicine is becoming more and more subdivided, it is really awesome to make a certain subdivision to the extreme.
When it comes to this, we have to mention the Japanese craftsmanship.
Their craftsman spirit of pursuing only one thing in their lives is actually worth learning from.
Even when making a piece of sushi, some people do it to the extreme.
Who would have thought that someone could become a master with such a simple task as making sushi. Moreover, after continuous improvement in making sushi, several genres have been separated.
Belongs to subdivision again.
With micro-knowledge.
It is not without reason that Japan can make achievements in many fields.
"Let's go to the operating room! You three newcomers, after getting off work every day, you need to understand all the surgical patients in this group. The patient's information and surgical arrangements can be viewed through the intranet. In addition, you are also required to understand the new income of this group. Surgical patients, as well as patients who have not been discharged from the hospital after the operation, are kept in a timely manner."
Doctor Shan taught the three of them how to log in to the intranet.
First, you need to verify your login identity. After receiving the verification request, the hospital information center will contact the department where Gui Peisheng works. After obtaining the permission of the department director, release the corresponding viewing authority.
This is actually quite convenient.
Zhou Candeng went to check it out. The surgical patients in this group were divided into three categories: unoperated, about to be operated, and postoperative.
The patient who is about to be operated on, when, in which operating room, and who will perform the operation are clearly written.
That's not the case in the emergency department.
Basically, we treat whatever patients come here. If the operation cannot be performed on the same day, the emergency department must be transferred to a specialist.
It's past eight o'clock in the morning, and there will definitely be no more time for them to check the data of this group of patients.
Doctor Shan led them directly into the operating room.
What I entered today was actually a level 100 operating room. It seems that this is preparing to participate in a major operation.
After entering, a strange male doctor had already arrived ahead of schedule with two residents.
The male doctor may be about thirty-seven or eighteen years old, tall and burly, and exudes a strong aura. He is studying a dozen films displayed on the light curtain.
"Good morning, Doctor Chi! As expected of the strongest attending doctor in our group, he came here early to study the patient's film."
Doctor Shan greeted each other with a smile.
"Stop complimenting me! If you hadn't taken care of the ward rounds, would I have been able to go to the operating room to read the documents in such a leisurely manner?"
After Dr. Chi responded, he continued to concentrate on checking the patient's film.
Being able to become the strongest attending doctor in this group really has his strengths.
Not to mention anything else, this kind of focus alone is not something ordinary people can have.
Doctor Shan also walked over to watch the film.
The film is not complicated, and it shows an X-ray image of a patient's right hand.
The bone defect of the patient's thumb can be clearly seen.
At the root, the entire thumb is absent.
I don't know whether it was a congenital deformity or an accident that caused the disability the day after tomorrow.
What kind of surgery is this for?
Zhou Can was secretly curious.
His status is extremely low, so he can only stand behind Dr. Tang and Dr. He and watch the film from a distance.
Not long after, Director Shen walked into the operating room quickly.
One director, two excellent attending physicians, plus several residents and regular trainees. There are also three operating nurses.
Just by looking at this battle, you can tell that this is a major operation.
Finger replantation is only a secondary surgery.
There is no need for so many doctors to be dispatched together.
"They're all here! Not bad, they have a positive attitude towards work."
When Director Shen looked at Dr. Shan and Dr. Chi, it was as if he was looking at the two most important generals under his command. UU reading www.uukanshu.com
Zhou Can has only been in orthopedic surgery for a few days, how many groups are there in total?
I don't know who the doctors in this group are.
Director Shen is the team leader, and Dr. Shan and Dr. Chi are attending. There are also four residents including Dr. Tang and Dr. He.
These are the people he knows so far.
"What is displayed on the screen is the patient's incomplete right hand. It is a congenital deformity. The thumb controls more than 50% of the functions of the hand. It is very important! The patient is now a 21-year-old boy who earns a little money by working. At that time, he happened to hang up my number. He said that the missing right thumb has brought him a lot of trouble these years.”
"It's inconvenient to write, it's inconvenient to hold things, and you can only use your left hand to wipe your buttocks. When looking for a partner, the girl saw that his hand is disabled, so she ran away. He wants to ask our doctor to think of a way. Can you help me?" He made a thumb."
Director Shen briefly introduced the patient's situation.
In addition to sympathizing with such a disabled patient who is constantly striving for self-improvement, the doctor is also deeply moved.
Willing to do everything possible to help them.
Another thumb?
How is this made?
Nowadays, medical science and technology are more and more developed. I have heard of artificial hip joints and artificial blood vessels, but I have never heard of artificial thumbs.
A low leg amputation allows a prosthetic to restore most of the patient's motor function to the leg.
But what about the thumb on the hand?
Director Shen smiled and swiped across the display screen of the light curtain.
"Look, this is an X-ray picture of the patient's foot."
Zhou Can took a closer look and found that the bones of the patient's right foot were clear and complete. +Bookmark+