Come on, Dr. Wu

Chapter 421 Two months, more than 30
How did Wu Xiaofu calculate it to be so precise?
How can it be controlled so perfectly? The amount of medicine required for the hematoma is controlled so accurately that the medicine is consumed just when the hematoma disappears.

“Is there a formula for this?”

Such a question popped up in Zhao Xin's mind, and he asked it directly without hiding it. He came to this operation for the purpose of learning, but in a short while, he only saw Wu Xiaofu showing off his skills. Wu Xiaofu did it so easily, how could he learn it?

There's no trick at all to be found.

However, as long as he learned this formula, Zhao Xin felt that he had gained a lot.

"Formula? What formula?"

"There is no formula. How can you calculate it so exactly?"

"The medicine you used the first time was definitely not enough. Then you can give an appropriate amount of medicine the second time based on the amount of medicine that ablated the hematoma the first time. You don't have to calculate it. You just need to have a rough idea.

In fact, it is not that accurate. There are still some hematomas, but they are not visible. These small hematomas should be absorbed quickly by the patient's liver. "

Is this human language?
Zhao Xin really wanted to cry. This was not human language at all. He probably had an idea, but he suddenly felt that he was so stupid that he couldn't even form two concepts.

In fact, it’s not Zhao Xin’s fault. It’s just because Wu Xiaofu’s brain is so strong that he can think of all these things in his mind with just a little effort.

There's really no need to use a formula.

At this point in the operation, it is actually half done, and the other half is dealing with the bleeding area.

The bleeding area was indeed wrapped in the hematoma, which was two blood vessels of the liver.

Because interventional packing and other methods cannot be used, we can only rely on medication to make the bleeding area heal as quickly as possible.

In fact, drugs that promote blood clotting can do the job, but they must be taken in appropriate amounts.

Otherwise, not only will the blood vessels heal, but blood clots will also form, which will be even more troublesome if they fall off.

After all, it is intravascular administration, so you still need to be extra careful.

It’s just that Wu Xiaofu had already left such a magical impression on them before, so even though the later part was difficult, they didn’t actually worry too much.

Sure enough, the balloon was removed, replaced and reinserted, medication was given, and the bleeding gradually decreased until there was no bleeding, then the balloon was removed again and the operation was over.

Well, it really is over.

Everyone felt as if they were in a dream, and when they looked at the time, only ten minutes had passed. Normally, it would take more than this time just to take the image. Sure enough, it was still that familiar taste and familiar feeling.

The medical staff in the interventional room and the doctors in the department looked at Wu Xiaofu and thought about the operation just now. They couldn't help but sigh in their hearts.

This is undoubtedly a world-class operation, enough to shock the world's interventional field and make them rush to learn it. Of course, the patients and their families certainly don't know this.

All they knew was that the operation was successful and the patient's life was saved.

The engagement was completed, but the wedding date has not yet been set. It is only tentatively scheduled for next year. Therefore, Wu Xiaofu, who returned to work, quickly immersed himself in his busy work.

With so many things mixed together, including surgeries, house calls, ward work, research projects, and the treatment guidelines that he had previously advocated, Wu Xiaofu almost wished he could split himself into several parts.

Even though Wu Xiaofu was very efficient, he still felt very tired.

However, the sense of accomplishment brought by the work made Wu Xiaofu enjoy it and he couldn't stop.

Two months passed in the blink of an eye. The north should be covered with snow at this time, but the weather in the East China Sea is just a little damp and cold.

Two months later, Wu Xiaofu devoted himself to his work completely. The clinical work in Area F has been completely put on the right track. Some parts that were originally imperfect have now been completed.

There is basically no big difference between the current area F and the older areas A and B.

"Two months, more than 30!"

This was the weekly morning meeting, attended by all the practitioners, and a case was put on the table by Wu Xiaofu.

His eyes looked around and finally stopped on Yuna's face. Yes, this patient was Yuna's, and the surgery was also performed by Yuna.

At this moment, Yuna met Wu Xiaofu's gaze, her face full of self-blame, and she slowly lowered her head.

It can be seen that Yuna now looks much more haggard than she was two months ago.

The reason lies in this case. The fault is definitely Yuna's, but it is not reasonable to attribute the fault entirely to Yuna. After all, most doctors would be in a bad situation if they encountered such a case.

Two months ago, a 68-year-old male patient was sent here.

I went to the emergency room first. I had been having pain in my upper right abdomen for 6 days and my overall condition was very bad.

According to the patient and his family, the patient had persistent dull pain in the right upper abdomen 6 days ago without any obvious cause. The pain worsened in paroxysmal ways and was quite severe, but the patient was the type who could endure it and just endured it without saying anything.

The pain was accompanied by fever, but it was a low-grade fever. After consulting the community, the patient's family members took physical measures to reduce the temperature on their own, and the temperature was basically reduced to normal.

But the condition became more and more serious later on, and I began to feel nausea and vomiting. The vomit was the contents of the stomach, and the pain did not subside after vomiting.

At that time, the patient first went to the community hospital, and the color ultrasound examination showed: gallstones with cholecystitis.

The community did not have the conditions for surgery and the patient requested conservative treatment, so we simply gave him anti-inflammatory treatment, but the effect was not good.

Seeing that the condition was getting worse, the patient and his family knew that they could not delay any longer, so they rushed to the emergency department of the First Affiliated Hospital.

When I came to the emergency department, I had a color ultrasound recheck, which also showed gallstones with cholecystitis.

It happened to be Yuna's shift that day, so she went for a consultation. Due to her busy schedule, she was admitted directly after a simple physical examination.

After receiving the patient, Yuna conducted routine tests on the patient's blood, four coagulation tests, liver and kidney function, blood lipids and blood sugar, blood amylase, troponin, etc. Because she had other things on hand, she temporarily gave the patient analgesic treatment and prepared to wait for the results.

After the examination, there was no obvious abnormality.

After the effect of the painkillers wore off, the patient was sent for emergency surgery. Yuna had a good talent for surgery.

Now, most of the routine surgeries can be performed very quickly, such as this gallbladder stone surgery, which Yuna can basically complete in an hour. That is, she came from the emergency room, otherwise, she would have done it directly in the day ward.

The operation went smoothly and was completed in an hour. However, during the operation, Yuna discovered that the patient's gallbladder condition was not serious and should not cause the patient to suffer such a serious condition.

However, this also depends on the specific situation. It is normal for some people to be intolerant to pain and be sensitive.

But Yuna never expected that she would accidentally start her own nightmare mode.

After the operation, at about 15:30 in the afternoon, the patient experienced abdominal pain. Yuna gave the patient an intramuscular injection of tramadol. After the analgesia, she went home after a busy period.

In fact, tramadol is not that effective for the patient, but the patient could endure it and did not say anything. He just endured it until the pain was so severe at night that he could not sleep at all, and then he spoke to the nurse.

Feng Lingling was on the night shift. When she heard that the patient who had undergone surgery during the day was in pain, she gave him another dose of morphine by subcutaneous injection. Only then did the patient's pain improve.

In fact, it is very common. There is no patient who does not feel pain after surgery. Even with the addition of a pump, it cannot be avoided. It is a routine operation to give analgesics for one to three days after surgery.

Because they are used frequently, the department now has a large stock of painkillers. Basically, they are given to patients directly after the doctor's order is given, and there is no need to go to get the medicine.

After finishing the work, save up the orders for the day, and then pick them up together the next day to replenish the inventory.

The patient finally felt much better. The pain of the day was finally relieved, and the patient fell into a deep sleep.

However, the patient's good dream did not last long. After just one hour of sleep, the pain came again. It was already late at night. After the patient told the nurse, the nurse did not even ask the doctor and directly gave him another injection of morphine.

This is also routine treatment. As for pain, the basic treatment is analgesia. There is no other good way. Even if you tell the doctor, it's still the same. It's not easy for the doctor on duty to get some sleep. Most of the people in the ward are postoperative patients. This situation happens at least a dozen times a night.

If we ask the doctor, I'm afraid the doctor can only do sit-ups for one night, so the nurses habitually give painkillers and then ask the doctor to give additional instructions the next day.

The doctor was also happy about this, so even though it was a bit against the rules, they tacitly agreed not to mention it to anyone, and the situation continued like this.

But the patient's condition tonight seems to be different. In addition to pain, the patient now has some other symptoms, such as fever, nausea, and vomiting, but the most important thing is still pain, so the patient chooses not to talk about it, thinking that this may also be a normal symptom after surgery.

drop by drop...

In the early morning of the next day, an urgent alarm sounded throughout the nurses' station. The nurses, who were extremely sleepy and had not yet changed their shift, became somewhat alert and hurried to the ward without any doubt.

It was Lao Wang who had undergone surgery yesterday. His blood pressure dropped to a critical level, his heart rate exceeded the critical level, and his electrocardiogram also showed changes.

When the nurse saw this situation, she did not dare to be careless and hurried to report it to the doctor.

Feng Lingling rushed to the ward and intervened immediately, using a series of medications, which helped to keep the patient's indicators stable.

But the most important thing now is to know why the patient has this condition.

A series of tests including electrocardiogram, urine analysis, troponin, blood and urine amylase, liver and kidney function, etc. were quickly ordered.

There are many reasons for the patient's critical condition, including but not limited to uncontrollable hypertension, septic shock, acute renal failure, deep vein thrombosis of the lower limbs, electrolyte imbalance, bilateral pleural effusion, hypoproteinemia, persistent high fever, abnormal coagulation function, moderate anemia, intestinal fistula, bile fistula, incision infection, fungal infection, new coronavirus infection and other complications.

All of these may cause sudden disturbances in the patient's indicators.

After the examination, the results came back quickly, showing no abnormalities in liver and kidney function. Blood amylase was 287U/L.

Amylase increased? This increase is nearly doubled. From a surgical point of view, this height is acceptable, but considering the patient's current condition, this may be a signal.

Is there something wrong with your digestive system?

Without hesitation, I went for a check-up, including a CT scan and a gastrointestinal endoscopy.

Duodenal ulcer!

And it was already very bad, it had already perforated, the cause had undoubtedly been found, the sudden changes in the patient were obviously caused by the duodenal ulcer.

Because the patient was Yuna's, Yuna rushed over quickly. After checking the patient's condition and the examination, Yuna immediately broke out in a cold sweat. With her current professional ability, she could figure out what was going on after thinking about it carefully.

The reason why this patient was in pain upon admission to the hospital might be duodenal ulcer. At that time, the patient only had an ulcer but no perforation, so it was not easy to detect during examination.

It just so happened that the patient had a history of gallstones and chronic appendicitis, and the color ultrasound results were perfectly consistent. You should know that it is basically impossible to see duodenal ulcers on color ultrasound.

Yuna actually treated it subjectively as gallstones and cholecystitis.

Thinking of this, Yuna regretted even more. During the operation, she discovered that something was not right and her gallbladder condition did not seem to be that serious.

But she was too lazy at the time and didn't think much about it, so she just continued. If she had paid more attention and examined it more carefully, she might have discovered the duodenal ulcer.

Regret.

Regret for my carelessness.
There is actually a difference between the pain caused by gallstones and the pain caused by duodenal ulcers. When you find that the symptoms and signs are not completely consistent with gallstones and cholecystitis, you should be cautious. Doing a gastroscopy or upper gastrointestinal tract angiography before surgery may reveal the problem.

However, who would perform gastroscopy and upper gastrointestinal tract radiography on someone just because of this doubt? If the results are good, it's fine. But if they are not, isn't this over-medicalization?

Therefore, encountering such a case is really a pity. Yuna's mouth was bitter. Things have already happened. It is not important to think about those things. The most important thing is how to make up for it.

In fact, the process of doctors diagnosing and treating diseases is really complicated and complex, just like this case. It was obviously very simple to come for a diagnosis, but one made mistakes step by step. Only after making mistakes can one find and solve the problem.

This time it is considered lucky that the patient survived, which is not easy as the patient had many underlying diseases.

He has a history of hypertension, coronary heart disease, diabetes, and old cerebral infarction.

Although blood pressure and blood sugar can be well controlled, when the disease breaks out, these become factors that aggravate the condition.

"It cost more than 30 yuan to be hospitalized in two hospitals! Can patients still spend this much money?"

Wu Xiaofu looked at everyone and asked, the patient had a duodenal ulcer, which had already been perforated when it was discovered, and it would not be so easy to perform surgery on him.

Because the perforation was severe and the inflammation and infection were even more serious, the only option was to remove the duodenum and perform a gastrojejunostomy. This operation was much more complex than a cholecystectomy.

(End of this chapter)