The road to the rise of great doctors

Cooperative combat
Walking into the emergency room, Liu Dong felt that it was obviously much quieter than outside. Except for the voices of the patients, everyone else was busy quietly.

"Many medical operations are difficult for patients' family members to understand without training. During the rescue, we are not allowed to allocate time to introduce them one by one. Therefore, only the necessary people are left here, and the treatment will be significantly more efficient." Zhu Guoliang introduced road.

They walked to the patient and first looked at the monitoring equipment and the patient's general condition. They saw that the patient was breathing rapidly and was groggy as if he was sleeping. His blood pressure was around 90/60mmHg while being infused with fluids. From time to time, the monitor would alarm. Ring a few times.
I picked up the emergency medical record and looked at the records in the emergency department. This patient was sent here by 120 because of injuries in a car accident. He was still conscious when he first came here, with obvious abdominal pain, low back pain, and abdominal distension.

"What are we doing now?" Liu Dong asked Zhu Guoliang quietly.He thinks that the normal process is to ask about the medical history + physical examination, but the patient is now lethargic, and the family members have just gone out to get the imaging report.
"Let's check the lower body first, and after the CT comes out, we will read the film and then write the consultation opinion." Zhu Guoliang responded, and then said: "Your luck. This patient didn't urinate after the injury, but I just checked the opening of the urethra, and it seems a little Blood stains may indicate damage to the urinary system. Of course, in most cases, even if there is damage, there may not be a problem with the urethral opening.”

Zhu Guoliang continued: "Based on the patient's impact location, history of trauma, symptoms of abdominal pain and distension, and a slight drop in blood pressure, the possibility of spleen damage is relatively high; but if there is any problem with the kidneys, we will check the enhanced CT later. As a result, plain CT scan is generally difficult to identify.”

"Well, you're right. I went to the emergency department and asked for an emergency consultation from the general surgery department. They will probably be there in a while." Liu Dong replied.

"What else do you think needs to be done?" Zhu Guoliang suddenly stared at Liu Dong and asked in a school examination style.

This kind of sudden question is really a characteristic of teaching hospitals.Zhu Guoliang has now finally changed from the person being questioned to the "examiner".

Without thinking, Liu Dong said: "The patient is comatose after trauma and cannot get out of bed. The blood pressure is low and the circulating blood volume may be insufficient. The results of blood routine and blood biochemistry must be paid attention to at all times."

He paused briefly and then said: "On the one hand, the diagnosis must be further clarified. Only when the diagnosis is clear can the treatment plan be formulated appropriately; on the other hand, a urinary catheter should be left in place to monitor the patient's urine output and record the input and output."

After answering, Liu Dong looked at Zhu Guoliang with a slightly uneasy expression.

Zhu Guoliang's face sank and he said: "Get ready quickly. You have been in the urology department for two weeks and have had a urinary catheter before. When you are ready, you can do it. If you don't know where the things are, just ask the nurse."

After listening to this, Liu Dong quickly left the rescue room and went to prepare things.

It is impossible to say that there is no tension.

Although he obtained "subcutaneous suturing" through the system and had catheterization on the operating table, the emergency room was an unfamiliar environment, and the patient may need more than just catheterization and sutures.

Liu Dong and the nurse briefly explained the situation and asked about the specific locations of these items.

He went directly to get a set of catheterization kits and 2 pairs of sterile gloves, and put on a hat and mask.

Pull the operating cart containing the items back to the rescue room, skillfully open the first layer of sterile dressing, then put on sterile gloves and open the other layers.After disinfection, a urinary catheter was successfully inserted into the bladder, and only a small amount of red urine was drawn out.

After Zhu Guoliang saw it, he said: "The kidney may be damaged. Whether or not to operate depends on whether other departments perform conservative treatment or surgery, and the degree of kidney damage."

"Well, yes, the kidneys are wrapped by fascia and are also in the retroperitoneal cavity. Relatively speaking, if a hematoma is formed after trauma, the pressure will continue to bleed. But the abdominal cavity and pelvic cavity are too large. If bleeding continues, it will be too easy for the patient. Hemorrhagic shock." Liu Dong responded.

Zhu Guoliang nodded after hearing this. This boy has done his homework and has a future.The enhanced CT came out soon, and other laboratory results were also received.

Under the auspices of the emergency physician, Li Rong from the general surgery department, Zhu Guoliang from the urology department, and Zhao Jun from the critical care medicine department gathered together to have a small discussion around the condition.

It was initially determined that there was damage to the spleen and kidney on the same side, and the brain and lungs were generally normal.

Seeing this situation, Dr. Li Rong scratched his head and said with a heavy face: "The patient's spleen is damaged. The spleen has a rich blood supply and is prone to bleeding. Emergency surgery must be performed immediately. But there is also a problem with the kidneys, and the brothers from the urology department must work together." Come to the stage and deal with it. In addition, since the patient is so serious, post-operative infection prevention, anti-shock and other treatments must also be kept up. Can he be admitted directly to the intensive care unit and then transferred to our general ward when his condition is stable? "

As soon as he finished speaking, Zhu Guoliang continued: "I agree with Dr. Li's opinion. From the perspective of diseases in our department, renal laceration can be treated conservatively according to the treatment principles. However, if exploratory surgery is performed in an emergency, the peritoneum may be opened, then we Treating the kidney damage at the same time on the stage is more effective than conservative treatment. However, the patient needs to be absolutely bedridden after the operation to avoid further kidney damage."

All parties reached an agreement that the general surgery department and the urology department each called their own teams to come to the operation. According to the priority, the general surgery department continued to explore and deal with the spleen injury first, and then the urology department came on stage to confirm and deal with the kidney injury.The patient is directly admitted to the Department of Critical Care Medicine, and goes directly after surgery. After his condition stabilizes, he is transferred to the General Surgery Department.

Liu Dong followed Zhu Guodong to the operating room.

This kind of exploratory surgery, unlike the previous perineal surgery, requires general anesthesia.

After anesthesia, the general surgeon took the stage first.

Liu Dong observed carefully, as if he was repairing Ultraman seriously.

Even if you look at it, it is just an action of disinfecting and spreading towels. What laymen don’t understand is not something you can do just by watching the video.

Moreover, this step is the step where intern doctors are most likely to find faults and follow the rules.The internship of medical students is used to supplement this.

For different surgeries, the choice of incision is very particular.Different surgical methods and different organ surgeries require different incision selections.

When teaching in schools, they mostly focus on theory rather than practice.When it comes to disinfection and draping, the anterior midline incision is a typical example.Updates on other surgical incisions and surgical methods are mentioned directly in one go.

However, when a patient is injured, they don’t follow the textbook.

Complex surgeries, such as this kind of combined organ damage, require different departments to perform simultaneous investigations, which is very demanding.

If it can be done with one incision, there will be no need to add another incision.But for those that are far away, you may need to do one first, and then do the other after closing.

After communication between the general surgery department and the urology department, an incision was chosen that was acceptable to both parties.

(End of this chapter)