Doctor Peerless

Chapter 633
When Zhou Sheng was about to perform a thoracentesis.

He Congshuang on the side stopped him and said, "Wait, what is an intern doing in such a hurry? Let me talk about the taboos of thoracentesis first. Let's see how good your theory is."

Zhou Sheng looked helpless.

Brother is a man who got 100 points in the practical exam, and he has to ask questions after a thoracentesis.

Zhou Sheng just wanted to complain.

Seeing that He Congshuang's cherry red lips were about to open again, I was afraid that she would lose points again.

Hey, I'm under the fence, let's answer honestly...

"First of all, the chest need to be anesthetized, and those who have a history of allergies to anesthesia cannot be punctured."

"Patients suspected of having pleural hydatid disease, puncture may cause the spread of infection, so puncture is not suitable."

"No infection at or near the puncture site."

"Coagulation dysfunction, severe bleeding tendency, not suitable for puncture."

"..."

Zhou Sheng was eloquent.

He Congshuang finally said: "Okay, okay, the answer is good, let's start the operation."

Monday was born.

Start surgery immediately.

Piercing is the same as all surgeries.

After the disinfection is completed, it is the selection of the surgical site.

The puncture point of pneumothorax, the second intercostal space on the mid-clavicular line, and the upper edge of the next rib.

After confirming the location, lay a hole towel, which is a piece of cotton cloth with a hole in the middle, which can facilitate the operator to determine the location of the operation.

This is followed by anesthesia injections.

Minor surgery, but there is no professional anesthetist to serve.

Mondays are hands-on.

For local anesthesia, 2% lidocaine was used to infiltrate local anesthesia along the upper edge of the next rib at the puncture point.

Infiltrative local anesthesia means that anesthesia is applied directly to the surgical site or around the site of surgical resection.

But it's numb.

It is still a little different from the debridement one.

First, a skin pit is made on the local skin, and then the needle is inserted vertically to anesthetize the pleural layer in layers.One thing to note here is that when pushing the anesthetic, you have to withdraw the needle.

Zhou Sheng has mastered this kind of small operation in the emergency center.

After the anesthesia is over, press for a while.

While waiting for the anesthesia to take effect, Zhou Yisheng was bored and chatted with the patient a few words.

"Where are you from?" Zhou Sheng asked.

"Qin Zhong."

"Do you have a girlfriend?"

"Doctor, you still ask these questions when you see a doctor."

"Didn't I just let you relieve stress?"

"Oh Nope."

"Is the anesthesia uncomfortable?" Zhou Sheng finally got to the point.

"No."

Even though this is a virtual world, it is not at the same level as those silly NPCs in virtual games in reality. When Zhou Sheng faced professional questions and small talk, he always answered them in a decent way.

It made Zhou Sheng not feel that he was in a virtual world at all.

At the end of the inquiry, it can be regarded as a small evaluation of local anesthesia.

The anesthetic also started to work at this time.

The next step is the official operation.

Zhou Sheng picked up the puncture needle and checked whether the needle was sharp.

Wait for the puncture, it all depends on this stuff.

As the saying goes, if a worker wants to do a good job, he must first sharpen his tools.

Make sure the needle is correct, and then check whether the rubber tube connected to the lancet is normal and airtight.

Everything is fine.

Zhou Sheng clamped the rubber tube on the puncture needle and wrapped the rubber tube with sterile gauze.

Everything is in place, Zhou Sheng fixes the skin at the puncture point with his left index finger and middle finger, and slowly punctures the puncture needle along the anesthesia site with his right hand.

At this time, Zhou Sheng could clearly feel the resistance of the patient's body tissue to the needle, and Zhou Sheng exerted a slight force on his hand.

At this time, it is necessary to check the equipment.

If by chance a faulty needle is encountered, the patient has paid for it.

The needle entered bit by bit, when Zhou Sheng felt the resistance of the needle disappear in an instant.

Prove that the puncture has been successful and the needle has entered the body.

The next step is to connect the syringe to the other end of the rubber tube, open the clamp, and start pumping out the accumulated gas.

……

The piercing is complete.

Because the trauma is very small, smaller than those minimally invasive.

Therefore, povidone iodine can be used to disinfect the wound and just bandage it.

Zhou Sheng completed the operation.

Waiting for He Congshuang to check.

This is also nothing to check.

Zhou Sheng made a 100-point practical demonstration.

The screen turns.

Zhou Sheng went straight back to the consulting room.

Regarding Zhou Sheng's performance just now, He Congshuang didn't have any after-the-fact comments.

Copy continues.

Since it is a copy of cardiothoracic surgery.

It can't just be a project of thoracic surgery.

Cardiac surgery is also indispensable.

No, the second patient is a patient with a heart problem.

The patient, male, suffered from palpitations, chest pain and malaise for 5 days.

He Congshuang was still the same, after a physical examination, he asked Zhou Sheng to give the inspection items.

patients with chest pain.Electrocardiogram examination is indispensable.

Zhou Sheng was of course the first to ask the patient to check the electrocardiogram.

The ECG came out and the ECG showed sinus tachycardia 119 BPM, mild ST segment elevation and T wave inversion.

This chest pain has nothing to do with the outside of the chest.Definitely a heart problem.

In order to confirm the diagnosis, continue to check the heart.

Without the help of the system, there is no shortage of inspections that can be done.

Biochemical, photographic, and functional tests are all given.

Open the door, close the door.

All kinds of inspection data came in one after another.

Myocardial enzymes were negative, CT angiography showed a large pericardial effusion, ruling out pulmonary embolism, and echocardiography showed a large pericardial effusion, right ventricular diastolic collapse with signs of cardiac tamponade.

Ok, that's it.

It was almost certainly a pericardial effusion.

In severe cases of pericardial effusion, pericardiocentesis is required.

In principle, it is similar to a thoracentesis.

But it is much more difficult than thoracentesis.

Thoracentesis can be performed casually in a county hospital, but pericardiocentesis may not be possible.

Is it a mistake that this operation suddenly appeared in the intern dungeon?

Actually not.

Because this is a first-level extracardiac surgery.

It can be seen how terrifying the heart is.Any first-level surgery is difficult.

Same process.

Before surgery begins.

He Congshuang first tested Zhou Sheng's theory.

But this time He Congshuang no longer asked Zhou Sheng about the taboos of pericardiocentesis.Ask him about the indications instead.

Theory is not difficult at all for a good student like Zhou Zhousheng.

Zhou Sheng talked about it.

"If a large amount of pericardial effusion has symptoms of cardiac tamponade, puncture and aspirate fluid to relieve the symptoms of compression."

"Extract pericardial effusion to assist diagnosis and determine the cause."

"Intrapericardial Therapy."

Although it is also puncture, it also has two functions, treatment and diagnosis.

But pericardiocentesis is the daddy of thoracentesis.

Anyone who can do pericardiocentesis must be a puncture master.

In an emergency center, there is little chance of doing a pericardiocentesis.

If the pericardial puncture is not done well, if the puncture penetrates the heart, it will cause massive bleeding, which will directly endanger life.

Therefore, the emergency department usually provides an electrocardiogram, and as soon as the CT film comes out, it will be directly consulted.

If further puncture diagnosis or treatment is required, it is also a matter of cardiac surgery.

After all, the heart is not as dangerous as the chest.

Without two brushes, it would be fatal.

Take Cao Xin from Xinwai, who has been to Xinwai for more than a year, and has never had this pericardiocentesis.

……

(End of this chapter)