White armor

Chapter 421: What Happened Because of Being Thin

Chen Yan's heart was in turmoil and he began to feel uneasy.

What did Luo Hao mean by that? !

It was normal to gossip about something when meeting someone. But Chen Yan felt that something was wrong with Luo Hao today. Was there something wrong with his surgery?
Is Ronaldinho trying to seduce himself? There is no reason.

Chen Yan frowned and thought for a long time, but couldn't think of any mistakes.

After sending the patient out, Chen Yan briefed the patient's family, did his best to please them, changed his clothes, and returned to the office.

He sat cross-legged on the chair, twisting his heart hair with his hands and began to read the medical records.

Chen Yan's sixth sense told him that Luo Hao had said a lot more today, and it must be about something!
He knew Luo Hao, that guy was a bad guy.

In addition to the high level of surgery and the even higher level of diagnosis, these few words cannot be ignored.

But what could possibly happen to the patient? Chen Yan pulled at the heart hair, pondering it bit by bit.

A 60-year-old male presented with acute epigastric colic for 2 days, accompanied by radiating pain in the back, moderate nausea, and intermittent fever. His temperature was 37.8℃ without chills when he visited the doctor.

The patient had experienced mild attacks of similar symptoms in the past, and coronary CT scan at another hospital showed mild myocardial ischemia, which was treated with low-dose oral aspirin.

Preoperative examination, blood routine: white blood cell 17.8x109/L, bilirubin, liver enzyme, lipid levels are normal. Serum lactate dehydrogenase (LDH) 820U/L, myocardial enzymes are normal. Abdominal B-ultrasound showed gallstones, bile duct was not visualized.

Everything is normal, don't be normal, just a patient with a very common cholecystitis.

What about surgery?
The intraperitoneal CO2 pressure was set at 12 mmHg. The operation was smooth, the hemodynamics were stable, and the end-tidal CO2 partial pressure was maintained at 35 mmHg.

Intraoperative exploration revealed a normal gastrointestinal tract and gallbladder inflammation, and no obvious abnormalities were found in intraoperative cholangiography.

No problem, Chen Yan is sure.

Although he had thought about everything he needed to think about, Chen Yan was still careful.

Three hours after the operation, he went to the ward to see the patient.

Sure enough, if nothing unexpected happened, the accident really happened.

It is normal for patients to feel pain in the incision after surgery, but Chen Yan knows it won’t be too painful.

but!

The patient complained of severe pain.

His problem was abdominal pain, with obvious tenderness in the middle abdomen, accompanied by rebound pain, and Chen Yan could even feel a little bit of muscle tension.

When seeing this scene, Chen Yan's beard and heart hair stood up.

[When establishing pneumoperitoneum, the pressure was too high. In fact, it was based on normal delivery, but the patient's condition was limited. In other words, the boss was unlucky and encountered a landmine. ]

The words that Luo Hao said during the "chat" appeared in Chen Yan's ears, and he never forgot a single word.

What a bad mouth, Chen Yan sighed in his heart. Although he thought so, Chen Yan still picked up the phone and called Luo Hao.

"Ronaldo!"

"Hello, Director Chen."

"The patient suffered abdominal pain after surgery. What do you think?" Chen Yan asked straight to the point.

"If the surgical procedure is confirmed, it is possible that the ischemia was caused by the creation of pneumoperitoneum and compression of the mesenteric artery and vein."

"!!!"

Chen Yan's hair exploded.

This kind of thing is extremely rare, especially when I determined by myself that the intraoperative abdominal CO2 pressure was 12 mmHg, and confirmed it repeatedly with the anesthesiologist and the resident manager.

Can mesenteric arteriovenous ischemia occur when the intraperitoneal CO2 pressure is 12 mmHg?

Just kidding.

"Xiao Luo." Although he thought so in his heart, Chen Yan still asked cautiously, "What do you think we should do?"

"Let's do an angiography and take a look at the situation. If it's really ischemia, interventional surgery may be a solution."

Chen Yan was silent.

This was the first time he encountered such a situation. It was very unfamiliar, quite unfamiliar.

However, Chen Yan had seen similar cases in papers and case reports. Although he had never eaten pork, he had seen pigs run.

But this time the pig came too suddenly, and Chen Yan was caught off guard, and he almost fell over.

"Xiao Luo, is it true?" Chen Yan asked tremblingly.

"I do not know."

"Damn!" Chen Yan blurted out.

"It's true, Director Chen. I didn't see the patient. But according to your description, there is no reason for abdominal pain after surgery. There is also postoperative angiography, right?"

Chen Yan sighed, indeed.

I was so cautious and treading on thin ice, but I didn't expect there would be problems.

"It's okay, Director Chen. If nothing goes wrong, it means you don't perform enough surgeries. It would be the same if you performed more surgeries. Everyone would have accidents." Luo Hao comforted him.

"Then I'll consult Shen Zizai." Chen Yan said.

"Row."

"Xiao Luo, if anything happens, you have to come back for surgery." Chen Yan begged, "Although Shen Zizai's surgery went well, you are here. Can you spare some time?"

"Yes, I'll drive back right after I finish making the arrangements here. As for the preoperative instructions... you should explain everything to the patient's family. Please go talk to Lao Meng about our department."

"it is good."

After the matter was settled, Chen Yan breathed a sigh of relief.

Regardless of whether it is true or not, it is always better to be careful. If a gallbladder removal surgery requires a second visit to the abdomen and the removal of a section of intestine, things will develop in an uncontrollable direction.

It's always better to be careful. Chen Yan first called Shen Zizai, then went for another physical examination, and then explained the situation to the patient's family.

Chen Yan was not confident in letting his professors or hospital managers do this kind of thing, so he called the patient's family to his office, explained the whole story in detail and made clear "his" guesses.

Soon, Shen Zizai came for consultation.

He wanted to say something else, but when he heard that it was Xiao Luo's suggestion, Shen Zizai said nothing and directly called the interventional catheterization room to prepare for the operation.

The directors pushed it hard, there was no lag at all, and the ping value was good.

By the time the patient was pushed into the operating room, Meng Liangren had already completed the preoperative instructions. He took the instructions to the operating room and put them in the empty medical record.

Chen Yan's old face turned red with shame. He had already completed the emergency surgery and the patient had been admitted to the hospital for the second time, but the medical record was still empty.

Every time I look at Xiao Luo's medical records, they are all impeccable. This is really incomparable.

This was really too much. Chen Yan directed his anger towards his own young doctor and planned to emphasize the writing of medical records after this matter was over.

It's impossible to wait until every patient is discharged from the hospital before hastily pasting their medical records.

If it doesn't work, ask Xiao Luo to bring the robot panda to educate them again.

The robot panda is good, but it's too cute. It doesn't look as majestic and powerful as the robot dog.

Chen Yan's mind began to wander with all sorts of random thoughts, and he tried hard to calm himself down.

"Director Chen, have you ever encountered a similar situation?" Shen Zizai was a little confused and asked Chen Yan before going on stage.

"I haven't encountered it before." Chen Yan shook his head. "But there is a description in the case report of the paper. It is an isolated case... How isolated is it? You see, I have performed thousands of similar operations, and this is the first time I have encountered it."

"This is so rare. I just checked the patient and he did have abdominal pain. You are quite alert to notice this. I thought you would just give him a painkiller injection if he had such a mild case."

Shen Zizai praised.

For similar patients, misdiagnosis is a high probability scenario.

Postoperative pain is normal.

If there is abdominal pain, it is considered to be traction pain, and the problem of mesenteric artery and venous blood flow will not be considered.

For such a minor operation, Chen Yan actually went to check the patient’s condition in person after the operation and was able to find any problems. It must be said that Chen Yan is very alert.

Chen Yan felt ashamed when he heard this.

If I hadn't met Xiao Luo when I was leaving the operating room, and he hadn't said some inexplicable words, I would definitely not have taken it seriously.

Still going to the physical examination in person? It is good not to scold the patient for being "pretentious".

"What if we find out there's a vascular problem?" Shen Zizai asked.

"How would I know? This is your business." Chen Yan began to pass the blame.

Shen Zizai was very dissatisfied, but then he thought, "Xiao Luo said he would come?"

"Well, he'll come over when he finishes his work over there."

"Did he catch the bamboo?" Shen Zizai felt a warm feeling in his heart.

"Chen Yong went to get the bamboo, and Xiao Luo went to Gongda to use 3D printing to make a lower beak for a red-crowned crane with a broken lower beak, and prepared to have it replaced by surgery."

"..."

Shen Ziyi was stunned.

What Xiao Luo did was really high-end. He 3D printed the lower beak of a red-crowned crane? What does this mean?
After it was installed, the red-crowned crane became arrogant and domineering like the Blade Runner.

However, Shen Zizai knew that time was running out, so he would do the examination first. If Xiao Luo was right, intestinal necrosis might occur later.

He didn't chat, but turned around to wash his hands, go on stage, and take pictures.

Ten minutes later, the angiography appeared in front of everyone.

Sure enough, there was incomplete occlusion of the mesenteric artery at the duodenal level.

After seeing this, Shen Zizai concentrated and thought about it, then turned his head and saw Luo Hao already standing in the operating room.

My originally somewhat uneasy heart suddenly calmed down.

Although this was the first time Shen Zizai encountered this situation, he had a rough idea of ​​it and knew how to treat it.

But when it comes to taking the lead, Shen Zizai is so cunning that there is no problem with ordinary operations, but he will definitely not take the blame for others if he can.

After decades of clinical experience, I have learned to avoid cleaning up other people's messes as much as possible, and this has become a fixed mindset.

If Luo Hao wasn't there, Shen Zizai would have been forced to do it.

But now?

Without waiting to talk to Luo Hao, Shen Zizai turned around, tore off the disposable sterile suit and threw it into the medical waste bin, kicked open the airtight lead door, and strode out.

"Xiao Luo, there is really a problem."

"Well, adult men, or elderly men, weighing less than 50kg and women weighing less than 45kg, should be aware of the risk of mesenteric artery occlusion."

"what?!"

Shen Zizai and Chen Yan were both stunned.

“Because I was too thin and had little body fat, there was no cushion in the thoracic and lumbar spine.

Although the pressure given by Director Chen was not high, it was still pressure. When the pneumoperitoneum was established, the mesenteric artery near the horizontal section of the duodenum was pressed against the spine, causing blood to be cut off. "

"!!!"

"!!!"

"Similar cases have not yet been discussed maturely, but Director Qian has explored hundreds of related medical records from all over the country and found a common point - the patients are too thin."

Gan!
This works too!!

Shen Zizai was a little confused.

Before and after the lockdown, some people said that they should gain some weight. Fat people going to the ICU are risking their fat, while thin people going to the ICU are risking their lives.

Just because of this sentence, Shen Zi deliberately gained 10 kilograms of weight during that period of time, in preparation for any emergency so that he could handle it with his body of fat.

This is a bit too much, but now it seems to make sense. Being too thin is not good, isn't that a problem?

"Okay, then I'll do it." Seeing that Shen Zizai had already taken off his clothes, Luo Hao knew what he meant, so he went to wash his hands without any hesitation.

"Director Shen, you..." Chen Yan twisted his heart hair and glanced at Shen Zizai.

"I haven't done it, but Xiao Luo will definitely have no problem." Shen Zizai answered frankly without any shame.

After so many years of experience, Shen Zizai will definitely not be shy like young people. His skin is thicker than a city wall.

As for the reason, it’s already there. At most, you can just admit defeat and send Ronaldinho to take action.

"Director Chen, thin patients are more likely to have this condition, don't you know?" Shen Zizai asked back immediately.

Chen Yan's hand trembled and he felt a pain in his chest.

Damn, I pulled too hard and broke a heart-protecting hair.

Chen Yan shook his head, a little confused.

I do perform a lot of surgeries a year, but not as much as Peking Union Medical College, not to mention that Peking Union Medical College’s alumni are spread all over the country.

If all this energy is taken into account, the number of surgeries is an astonishing astronomical figure.

But no one in the group had ever talked about anything like this. Even though Chen Yan could vaguely understand the reason, he would not pay special attention to it before the operation.

Ugh.

Even Chen Yan felt a little discouraged.

It seems that there is no difference between himself and Union Medical College, but Luo Hao, a PhD graduate from an eight-year undergraduate, master's and doctoral program, is so awesome.

Tsk tsk.

On the screen, Luo Hao has already started the operation.

While he was talking, the guide wire had already entered the incomplete obstruction segment, and one end was inserted into the newly formed thrombus.

Because the blood clot had just formed less than 3 hours ago, the catheter was able to penetrate it effortlessly.

Luo Hao then inserted the thrombolytic catheter.

As urokinase flushes out, small blood clots are dissolved.

However, Luo Hao did not perform angiography again directly. Instead, he switched to slow intravenous injection of papaverine to dilate the blood vessels.

He withdraws the medication very slowly and is very patient.

In less than 20 minutes, angiography was performed again, showing that the partially obstructed mesenteric artery in front of the duodenal horizontal segment had been completely opened.

Luo Hao pulled out the guide wire and catheter, and turned sideways to make a finishing gesture.

"Professor Luo's skills are really high. He performed the operation very skillfully." Technician No. 66 exclaimed.

He didn't notice at all that his words might be a veiled criticism.

It’s no wonder that Technician No. 66 is not likable. This person’s emotional intelligence is indeed not enough. Meng Liangren sighed as he stood behind.

When he saw that the operation was finished, he went to the catheterization room and "by the way" pretended to be tripped by the chair of technician No. 66 and kicked the chair.

Meng Liangren kicked open the airtight lead door, put on sterile gloves and began to press to stop the bleeding. Zhuang Yan followed behind Luo Hao and took over the lead coat and skirt.

"It's done, Director." Luo Hao came out and reported to Shen Zizai obediently.

"This operation...why does it look so familiar?" Shen Zizai was still pondering.

"Femoral head necrosis, the principle is similar." Luo Hao said.

"!!!"

"The principle is the same as the recanalization surgery for femoral head necrosis, but this patient had a small blood clot, so I added a thrombolysis process in the middle."

"I understand!" Shen Zizai was a little excited.

If Luo Hao used a bunch of technical terms, Shen Zizai would be able to communicate, but it would definitely not be as clear as it is now.

Chen Yan saw this scene and sighed.

The intervention of Professor Koro turned against Tiangang. Now he looks like the director, and Shen Zizai looks like the resident manager under Luo Hao.

That’s good too. Shen Zizai is really lucky to have such a powerful helper falling from the sky. Chen Yan immediately began to envy him.

If Xiao Luo had been parachuted into his department at that time, it would be him who is so awesome now, not Shen Zizai.

"Director Chen, the patient will be fine after two days of low-molecular-weight heparin after the operation." Luo Hao and Chen Yan explained the post-operative treatment.

"it is good."

"Everything else is fine. I'm going to perform surgery on the red-crowned crane."

"!!!"

"!!!"

"Xiao Luo, are you confident in performing the surgery on the red-crowned crane?" Shen Zizai asked.

"Orthopedics is all carpentry work, and I know a little bit about it."

"Hahaha." Shen Zizai now especially likes to hear Luo Hao say this.

But what Luo Hao did was not like what a doctor would do, including those few words that made Chen Yan cautious after just one look in the operating room.

Shen Zizai didn't know what the specific sentence was, but he had already guessed in his heart that this monkey Chen Yan would definitely not be so cautious just because of a laparoscopic cholecystectomy, and finally found that he had escaped a disaster.

It must be that Xiao Luo saw something was wrong and reminded him casually.

Unexpectedly, just one sentence saved a section of the patient's intestine and prevented a medical accident.

The more he looked at Luo Hao, the more he liked him. Shen Zizai patted Luo Hao on the shoulder and said, "Go and do your work. After the operation on the red-crowned crane, show me its beak."

"Okay, Director." Luo Hao responded simply and left.

Shen Zizai puffed out his chest and was full of pride.

"Director Chen, I think there is someone to take over our interventional department."

￥#@&*￥#
Chen Yan cursed in his heart but smiled gently on his face.

Shen Zijia's ancestral tomb was really on fire. He was sitting in the department peacefully when Luo Hao suddenly appeared out of nowhere.

Why don’t I have this kind of luck?

Chen Yan sighed deeply in his heart.

"Go tell the patient's family that it's nothing, go quickly." Shen Zizai pushed Chen Yan, "Don't leave tonight, I'll treat you to dinner."

"What?"

"It's been a while since we last sat together and had a meal. You managed to avoid such a big disaster. Old Chen, your luck is getting better and better." Shen Zizai praised loudly.

These words touched Chen Yan's heart.

It was indeed good luck, especially after Chen Yan thought of an incident that happened recently in the hospital next door, he became more and more certain of it.

"Okay, I'll come find you later." Chen Yan put the heart protector into the isolation suit and walked out of the interventional catheter room with a social step.

Just from his steps, one could tell that Chen Yan's mood had changed from nervousness, anxiety, and uneasiness to pride.

"Director, that's awesome." Meng Liangren gave a thumbs up and praised softly.

"Tell the truth." Shen Zizai glanced at Meng Liangren, "Old Meng."

"Director." Meng Liangren shuddered and quickly bent down, "Please don't scare me."

"Well, it's just a name. What's wrong with calling you Lao Meng? I'll call you that, and you just need to respond. It won't cost you anything. Let's go eat together later, and call Zhuang Yan."

Meng Liangren hesitated for a moment, looking embarrassed.

"Director, how about you and Director Chen go together?"

"Huh?" Shen Ziyi was stunned.

When the director goes out to eat and asks his junior doctors to come with him, he may not feel lucky, but at the very least he has to be fawning and carry their bags in front and behind.

How could there be someone like Meng Liangren?

Normally, Lao Meng can flatter Luo Hao very smoothly, so why is it that when it comes to himself, he can't do it at all?
But although Shen Zizai thought so, he did not turn his face away from Meng Liangren, and smiled slightly, "What's the matter, Old Meng."

"Director, wasn't I transferred from the infectious disease hospital?"

Shen Zizai suddenly remembered something and looked embarrassed.

The current director of the Infectious Disease Hospital was criticized in recent days.

Because they went out to eat at noon, three people were reported and eventually criticized.

If there are more than 3 people, it is considered a dinner party and you need to ask your superior for permission.

Who would ask for instructions on such a trivial matter? Who should I ask for instructions from?
Shen Zizai complained in his heart, but he couldn't say anything else. He could only say that Meng Liangren was cautious.

Don't cause trouble when you are in the middle of a storm.

Come to think of it, it seems to be for my own good.

"Okay, then you guys eat it by yourselves." Shen Zizai patted Meng Liangren's shoulder, remembering how cautious he was when he gave him a gift at the beginning of the year.

Time flies. In less than a year, Meng Liangren actually has the aura of a great professor.

Even his dog-like temperament is a bit similar to Luo Hao.

When Chen Yan came to find him, Shen Zizai told him what Meng Liangren meant, and then drove away everyone around Chen Yan. Only he and Chen Yan went to have dinner together.

It was a bit deserted and Chen Yan was not used to it.

When eating, especially when dining out, it is better to drink and chat with friends.

There were only two of them, and it was a bit quiet, but Chen Yan knew that this was the general trend. He was not much older than Maluo, so there was no point in saying strange things.

When they arrived at the restaurant, they ordered three dishes and opened the beer. Chen Yan didn't hesitate and drank one directly.

"Old Chen, what are you doing?"

"Oh, don't mention it. I've been in a trance these past few days. I always feel like something big is going to happen." Chen Yan wiped his mouth with his hand, and the beer stained his beard, making it shiny.

Shen Zizai laughed, "Why, you took Xiao Chen as your master?"

"Young man from the Chen family? Someone asked me recently and said he's quite impressive. It's really hard to connect him with the second boss of Professor Luo's medical team."

"He's doing pretty well. He's got himself a publication channel in the New England Journal. He's going to publish a paper on urology soon, and Xiao Chen will be the corresponding author."

Chen Yan was stunned. This was the first time he heard of this. Corresponding author?

He was silent for a moment and gave a thumbs up.

"Old Chen, tell me what's going on."

"That's right. The day before yesterday, my student, a doctoral student, did not stay after graduation and returned to his hometown. He is the director of general surgery at a Class 3A hospital in a county-level city, which is not bad."

Shen Zizai listened quietly.

"He called me in the middle of the night the day before yesterday, and he was completely shocked. It was an appendectomy, and the patient had no money, so he performed a major surgery, a 5cm incision."

"Separate them layer by layer. My student is also good at using a big knife, and he has never given it up."

What Chen Yan said was a mess.

But here he paused.

"Guess what you see after opening the peritoneum?"

"Hahaha, Lao Chen, are you telling me a ghost story? What did you see? You can even see a ghost doll."

"Yes!" Chen Yan slapped the table, "I saw a 10cm fetus that had already fibrosized."

(End of this chapter)