Sleepless Doctor

　　 The 6th and 7th intercostal space on the left side, the position of the mid-clavicular line, Wu Mian marked and disinfected.

　　 Chu Zhixi had already prepared the anesthetic, and Wu Mian used a 5ml syringe to draw the anesthetic, and then he was infiltrated and anesthetized locally.

A skin knife made an incision of about 1.5 cm, and Wu Mian used a hemostatic forceps to perform a blunt separation. Close the pliers one by one and separate Cheng Linhai's intercostal muscles a few times.

　　 "Doctor Wu, your hand is very light and it doesn't hurt at all." Cheng Linhai wanted to comfort Wu Mian as much as possible, he smiled and said relaxedly.

　　 "Big man, why did you say this wildfire started again?" Wu Mian asked.

　　 Chu Zhixi prepared the chest tube, cut two side openings, clamped it with hemostatic forceps, and handed it to Wu Mian.

　　 County hospitals use fewer chest tubes and chest bottles, and at most they will have a closed drainage. Thoracic surgery is a little more advanced than brain surgery to some extent. At least county hospitals can perform neurosurgery drilling and drainage operations.

　　 The chest tube is still the oldest, not the one with a steel core. But to Wu Mian, everything is the same. Holding the pliers in one hand, he leaned into the incision, with a chest tube in his palm, ready to go.

"Isn't this afforestation? The old forests drop leaves year after year, and there are places in the mountains where the leaves are too thick to go." Cheng Linhai said, "Sometimes there is an open flame, which ignites the forest. All kinds of things are okay. But thunder and fire... Our captain said that a dew can refract the sun's light, and by coincidence, it can be... Ah!"

　　 was talking, Cheng Linhai yelled suddenly.

　　 "Okay, it's okay." Wu Mian had already put the chest tube in while he was engrossed in talking about the mountain fire.

　　 Cheng Linhai is in good health, and his whole body is tense, and his pleura is very hard. It is almost impossible to complete the operation unknowingly. Wu Mian used a hemostatic forceps to penetrate the pleura and instantly opened the jaws, and the other hemostatic forceps directly sent the chest tube in cleanly.

　　 Chu Zhixi connected the chest bottle, and the dark brown pleural fluid gushed out.

　　 Stitched, fixed, corner stitched No. 7 thread, Wu Mian's hand didn't seem to move, a beautiful knot appeared, firmly fixing the chest tube to the chest wall.

　　 Wu Mian didn't let Cheng Linhai get up, he squatted in front of the disposal bed, carefully watching the fluctuation of the chest bottle.

　　 The amount of pleural effusion is very large. There is 500ml of normal saline underneath. The saline is mixed with dark brown pleural effusion, and the water surface moves upward along the scale.

　　 When it reached 1000ml, Wu Mian stuck the chest tube with hemostatic forceps.

　　 "Prepare the methylene blue solution."

　　 After speaking, Chu Zhixi handed Methylene Blue to Cheng Linhai.

　　 "Would you like to drink?" Cheng Linhai frowned as he looked at the blue barking cup.

　　 "Well, drink." Wu Mian said positively.

　　 Cheng Linhai didn't murmur, he believed in Wu Mian, even if Wu Mian "lied" him with a small trick just now.

　　 Like drinking, Cheng Linhai is quite heroic, and regardless of whether the Methylene Blue is good or not, he simply pours it down in one sip.

　　 "When you drink slowly, take a sip..." Before Chu Zhixi finished speaking, he saw that the cup in Cheng Linhai's hand was empty.

　　 This execution power is too strong! Wu Mian was not ridiculous, sighed, and said, "It's okay, wait for me to see."

　　 Under normal circumstances, the doctor will ask the patient to slowly drink the methylene blue solution. If there is a rupture in the esophagus, the blue solution will enter the chest cavity along the esophagus and then be drawn out along the chest tube.

　　 This is a logical and self-consistent diagnostic method, commonly used clinically. The only regret is that Chu Zhixi was a bit slow in speaking, and Cheng Linhai was a bit strong in execution.

　　 About 10 seconds later, Wu Mian opened the clamped chest tube.

　　 The color of the liquid introduced this time changed from dark brown to a strange color, and the dark brown pleural fluid was even more color, mixed with extremely dark blue.

　　 The diagnosis is clear, and it is indeed a broken esophagus.

　　 Director Lu has been standing behind Wu Mian, watching the color of the liquid drawn from the breast bottle with all his attention.

　　 Seeing the weird colored pleural fluid draw out, he sighed deeply, knowing that the young doctor's judgment was correct.

　　 "Doctor Wu, how do you judge it?" Director Lu asked.

"Boerhaave'ssyndrome..." Wu Mian said naturally in English, and then paused, "Spontaneous esophageal rupture is not very common, but there is no other reason for a large amount of pleural effusion in a short period of time. It can only be considered as spontaneous esophageal rupture. "

　　 "How do you know it is a short time?" Director Lu continued to ask.

　　 "Because you had a diagnosis." Wu Mian said.

　　 "Me?" Director Lu was dumbfounded. He looked at Wu Mian in a puzzled manner, completely not understanding what Wu Mian meant.

"You are the old director of the Respiratory Department of the county hospital. You have done simple bronchoscopes. How can you not listen to the auscultation? My judgment is that you did not have so much fluid during the physical examination. The left breath sounds clear and slightly weak. , There is no wheezing, so you can judge it’s okay."

　　 What Director Lu wanted to say was finished by Wu Mian, and he could only remain silent.

"When I listened, the patient's left lower lung breath sound was extremely weak. At this time, the patient did not show signs of cyanosis, plus I said you shouldn't have auscultation, so I judged it was a ruptured esophagus. It is probably a big one. You drank a lot of water after the examination, which caused a pleural effusion. UU Reading www.uukanshu.com"

　　 It turns out that I have become a part of the patient's disease judgment. Director Lu carefully tasted it, and increasingly felt that the young man in front of him was not easy.

　　 "Dean Zhou, can you sign." Wu Mian asked, turning around.

　　 "What to sign?"

　　 "The esophagus is ruptured and requires thoracotomy and surgical sutures." Wu Mian said.

　　 "..." Dean Zhou was taken aback, then bit his head and said, "Yes!"

　　 If it weren't for nothing, he didn't want to make this trouble for himself. If the esophagus is ruptured and sutured, it is the esophagus, not the prostate!

　　 The prostate is picked at will, even if there is a secondary injury, how big it can be. The tension of the esophagus is very high, the blood supply after suture is very critical, and the possibility of esophageal fistula after surgery is quite high.

　　 But this is a firefighter who is fighting a bushfire. He needs emergency surgery and his family members are not around. Moreover, the front line is urgent, and the command staff and Captain Li are not there, and this character can only be signed by the dean.

　　 "Big guy, you have to have an operation." Wu Mian said.

　　 Cheng Linhai has been listening, he asked suspiciously, "Doctor Wu, why did you say my esophagus broke? Nothing else."

　　 "I consider that when the flame rises, you conditioned your breath to hold your breath reflexively, the abdominal muscles reflexively contracted, and the abdominal pressure increased, while the cricopharyngeal muscle spasm, and the pressure in the esophageal cavity increased rapidly.

　　 At the same time, you suddenly stop breathing during the inhalation process, and the negative pressure in the pleural cavity increases, causing the esophagus to rupture. "

　　 "..." Cheng Linhai regretted asking the sentence just now, but Wu Mian didn't understand a word of explanation.

"Actually, it doesn't matter how it breaks. The important thing is that I will sew the hole for you. The chest tube is removed 2 days after the operation, you can go home in 1 week, and the stitches are removed in 2 weeks, and you are just like someone who has nothing to do." Wu Mian said with a smile.