The road to the rise of great doctors

Chapter 78 Maintenance of Sewers

"The elevator is here, Teacher Wang"

"Come on, come on, wait for me."

I saw Wang Lin walking over quickly with a probe, urinary catheters of different sizes and a bladder puncture and fistula bag.

Liu Dong took the urinary catheter and the ostomy device, then looked at Wang Lin and asked, "Teacher Wang, why do you have so many urinary catheters? Just use one!"

Wang Lin said with a smile, "You are still young and don't understand the benefits of multiple models!"

By the time the two arrived at the emergency surgery department, the injured middle-aged man had just returned from a CT scan, and the orthopedic surgeon who followed him was already writing consultation opinions.

Although the images have not yet been uploaded to the computer, the orthopedic surgeon followed and saw the examination results in real time on the computerized tomography monitor. After the examination was completed, he asked the imaging technician to help pull it out and read it carefully.So, now the medical record is written.

When he saw Wang Lin arriving, he waved hello and said, "Doctor Wang, are you on duty today? This man has a fractured pelvis, but the outline of his bladder is still OK. It shouldn't be a big problem. You can check again later." Just one glance. But when I first did the physical examination, I asked the patient that he wanted to urinate but did not urinate, and there was still some blood at the urethral opening. Go and see how to deal with it. "

"Hello, I'm going to take a look."

Wang Lin and Liu Dong walked to the rescue room. The injured man was lying on one of the beds with his eyes closed.

Liu Dong took a look and found that this man's face was worse than before, and his energy level was not as good as before.But seeing that the intravenous access has been established and the fluids are being infused in the hands and feet, this shows that the anti-shock part is done well.

The biggest short-term problem with pelvic fractures is the issue of first aid and rescue. The patient's life must be saved. Only when the patient's life is saved, that is to say, the blood pressure, heart rate, breathing and other vital signs can be stabilized, can we continue to treat the disease and save the patient's life. The cause is resolved.

If your blood pressure has been very low, this is a very dangerous time.

Wang Lin went over to say hello to the patient, looked at his condition, frowned slightly, and said, "Hello, I am a doctor from the Department of Urology, and I am here for consultation. Let me tell you first, your pelvis is injured. Afterwards, in order to facilitate nursing, a urinary catheter needs to be left. But there is a problem. The pelvic fracture is likely to be accompanied by urethral injury. If the urinary catheter is left smoothly, then congratulations, there is a high possibility that there will be no damage. Even if there is damage, it can It is also a good thing to put a urinary catheter in and leave it on for a while to allow the urethra to repair; if a urethral catheter can be put in, even if the urethra becomes narrow in the future, it will be easier to deal with than if the urethra cannot be put in."

When he saw the patient, he nodded slightly, and then continued, "If the urinary catheter cannot be inserted and the computed tomography scan comes out and confirms that there is no bladder rupture, then a cystostomy will be needed until you are almost recovered from the surgery of pelvic fracture. At that time, urethral stricture can be treated with surgery at the urology department.”

"The biggest problem with urethral injury in the long run is that after the injury, it is easy to become stricture in the future. It may be scarring or organized inflammation. If the urethra is stricture, it may require multiple surgeries or operations. Follow-up may need to be done regularly. Urethral dilation. Of course, the first priority now is to put a urethral catheter in your urethra to first solve your current peeing problem."

Wang Lin put on a mask and hat, then opened the outer dressing of the catheter bag and put on sterile gloves. He picked up the dressing bowl and handed it to Liu Dong.Liu Dong picked up the iodophor and poured it in.

After routine disinfection and draping, Wang Lin lifted it up to clearly expose the urethral opening.Then the urinary catheter was lubricated and inserted into the urethra. It was inserted about halfway and should be in the posterior urethra, but it could not be crossed despite repeated attempts.At this time, I saw that Wang Lin's technique was gentle and not rash, but it still did not have the desired effect.
"Don't use any more force, otherwise a 'false channel' will easily form. Xiao Liu, please bring that thin urine tube up to the table."

Liu Dong quickly picked up the thinnest urinary catheter on the side. This is usually used in children. However, if the injury is relatively short, a urinary catheter can be put in, even if it is thin, it will have a great impact on future recovery. role.

"Bring up a pack of paraffin oil. This is a silicone urine catheter. The lubrication effect with water is relatively poor, so you have to use paraffin oil to lubricate it." Wang Lin took the silicone thin urine catheter lubricated with paraffin oil and followed the catheterization technique again. Perform operations.Based on his five years of experience as a urological surgeon, he felt that he could still get over it, but there was still a slight bend in the front.

"Xiao Liu, put the guide wire up, then put on sterile gloves and be my assistant."

Liu Dong put the sterilized "guide wire" on the table, then put on sterile gloves, and saw Wang Lin put the guide wire along the urinary catheter, which improved the hardness of the urinary catheter.

Then he lifted it up and pressed it down, and then Liu Dong pulled the guide wire while Wang Lin pushed it forward with all his strength.

"Okay, pull the guide wire out. It's a bit laborious, but if you pull it, I still need to keep it fixed."

Following Dr. Wang Lin's instructions, Liu Dong withdrew the guide wire forcefully, while Wang Lin firmly fixed the urinary catheter, trying not to let the urinary catheter go out with the guide wire.

After withdrawing the guide wire, I saw some red urine flowing out along the urethra.

Wang Lin picked up the syringe, followed the label on the urinary catheter, and injected some water into the balloon of the urinary catheter. This could prevent the urinary catheter from slipping out of the urethra.Then Liu Dong handed over the urine bag and connected it to the urine tube.

I took off my gloves, glued the patch I asked the emergency department nurse to on the side of my thigh, and fixed the urinary catheter on the patch.

Looking again at this time, the color inside the urine bag is red, but the color inside the urine tube is somewhat clear, and there are only red marks around the urine tube.

"Okay, it's done. Let's go watch the movie again. If nothing unexpected happens, our work will be over."

Wang Lin said to Liu Dong, "You can have a good rest at night."

Pelvic fracture combined with urethral injury. If the urethra is broken and completely displaced, what can be done is to make a cystostomy first to allow urine to come out of the fistula tube first.Generally, if there is no accompanying rectal or bladder injury, open surgery to reset the urethra is not recommended in emergency situations.This is contrary to the traditional belief that delayed surgery three to six months after trauma is more appropriate, as it will promote healing and stabilize the inflammatory response.

Of course, this is a complete break.

If it is a partial break, or a minor urethral injury, a urethral catheter can be placed, or an anastomosis can be achieved in one stage, which will be very helpful for the recovery of the urethra or for not having to worry about repeated urethral stricture in the future. .

Wang Lin and Liu Dong went to watch the film and found that there were indeed no new problems.I wrote the consultation opinions and then left.

Accessing all sewers is a routine skill in their department.

(End of this chapter)