2283 Guide book
“Why don’t we just leave it like this for now and observe it for two days? who knows if it might grow.” There was nothing Fang Lin could do about it. He suggested softly when he noticed that boss Zheng did not speak for a long time.
“You still have the cheek to say that you’re from the cardiothoracic Department? You’ll need at least three years to become a chief resident. You can just stay in the Department and perform surgeries every day. ” Su Yun coldly said.
“Big brother Yun, let’s talk this out. Don’t make me the chief resident again. In just one year, I’ve been disgusted. ” Fang Lin said with a long face.
For him, there was nothing more vexing than being a chief resident again.
If it was as Su Yun had said, Fang Lin would rather resign and go to a private hospital than be a leading professor.
Fang Lin was considered quite resistant. Many doctors would choose to resign without the slightest hesitation when they heard that they were going to be chief residents.
“What did the guide say?” Su Yun looked at Fang Lin in disdain.”The patient still continues to leak air after ribcage drainage for seven days.”[A patient who still continues to leak air after 14 days of secondary pneumothorax being driven through the rib.] In essence, it’s a persistent bronchi fistulas. “
“Brother Yun …”
“The 2015 European Respiratory Society’s spontaneous pneumothorax diagnosis and treatment statement States: For patients whose drainage time is longer than three to five days and whose air is still leaking, further treatment should be taken. ” Su Yun looked at Fang Lin as if she felt that the stethoscope on his shoulder was too glaring. She turned her head and said to Lin Yuan,””Wang Lin, tell him what the other guides say.”
“Oh, okay.” Lin Yuan looked at the film with Zheng Ren and said,””The 2010 United Kingdom thoracic society’s spontaneous pneumothorax Management Guide states that: Surgical intervention should be considered if there is a continuous air leak after a conservative drainage of spontaneous pneumothorax for 48 hours. “
Fang Lin looked at the monster in boss Zheng’s medical team with a long face.
Everyone knew about this, but who would memorize so many details? Memorizing the treatment Guide would only be useful when he spoke with confidence during the hospital consultation, but would it be of any use to the patient in front of him?
‘It’s impossible. ‘Fang Lin heaved a sigh in his heart. He looked at the image on the film reader in distress. He was about to speak when his train of thought was interrupted.
This was because the topic of the guidebook was not over yet.
“The 2018 Germany spontaneous pneumothorax Management Guide States: Whether it’s spontaneous or secondary pneumothorax, if there’s still a leak after 48 hours of drainage, we’ll have to consider changing the treatment plan. ” Lin Yuan continued.
“Stop!” Seeing that she was about to continue, Fang Lin immediately begged for mercy,”surgery? I’ll have to ask the Department Director. Even if this patient were to request for an emergency diagnosis, the anesthetist would not dare to administer anesthesia. “
“Boss, can you do it?” Su Yun whispered to Zheng Ren.
Zheng Ren did not say anything. He tried to perform an interventional therapy under a tracheostomy tube in the system operating theater.
In general, there were several treatments for pneumothorax.
The first was thoracotomy, which was the most common surgery ten years ago. The advantage of this surgery was just as Su Yun had said. The surgical field was bright, and it was decisive. Its disadvantage was that the trauma was huge, and the patient’s postoperative recovery was slow.
Zheng Ren was not sure if the old patient in front of him, who had already “lost some of his body parts”, would be able to step down from the stage if he were to undergo such a surgery. After all, he had already done relevant surgery training in the system operating theater, and the surgery completion rate was not high at all.
A low surgery completion rate meant that there would be a lot of postoperative problems. This was ruled out by Zheng Ren.
Secondly, it was the minimally invasive thoracoscopy surgery, which was now the top choice for chest surgery in major hospitals. It was not just common-breasted cardiologists. Even a proud cardiologist like Zhao Yunlong had begun preparing to perform the type 1 aortic dissection surgery using a endoscope.
Various major guidelines recommended the first treatment method for difficult-to-treat pneumothorax. However, the patient in front of him was not suitable. His basic physical condition was poor, his heart and lungs were weak, and he had a wide range of lesions in his lungs. The completion rate of thoracoscopy was still very low.
Besides, the adhesion of the patient’s thoracic cavity was severe, and the field of view via thoracoscopy was quite limited, so they had to strip it off first. If a blood vessel burst, he would have to stop the bleeding first. A surgery without a surgical field was also ruled out.
The next step was pleura fixation, which was performed by the local hospital.
It was called a surgical method, but it was actually a very simple operation.
The principle was to rub the pleura with chemicals or surgery to form a uniform sterile pleura inflammation and completely lock the pleura cavity. The patient was injected with 50 ml of high sugar in the local hospital’s thoracic cavity, which was this type of surgery.
Chalk and tcroline could be used as the primary medicine. Other commonly used medicines included autologous blood, metitanine, perosucoid glucose, iodophor, and so on. (Note 1)
There was also the use of argon plasma coagulation. Some doctors attributed this treatment to Internal Medicine, but Zheng Ren did not agree.
However, this technique was not suitable for the patient in front of him.
The last option was the only solution Zheng Ren could think of, which was tracheostomy via tracheostomy.
The airway was blocked with a tracheal stopper, a stent, a one-way valve, autologous blood, biological protein gel, and gelatin sponge to achieve the purpose of treatment.
Among them, autologous blood and bio-protein gel could be absorbed by themselves, but they were easy to cough out. At present, the major guidelines were not the first recommendations.
Zheng Ren tried 20 times before he found a feasible solution.
Regardless of whether it was a serious illness or not, it would be very troublesome if it got serious. Boss Zheng, who was at the peak of interventional surgery, general surgery, and cardiothoracic surgery, had actually done more than 30 surgical training when facing a small pneumothorax.
Zheng Ren was helpless about this.
“We can try interventional therapy,” Zheng Ren said,”for anesthesia … Let’s go to old he.”
“An interventional surgery with a tracheostomy tube? It’s very risky. ” Su Yun reminded.
“But there’s no other good way.” Zheng Ren said,”use the laryngeal mask for general anesthesia. I’ll block it with a tracheostomy tube.”
“Boss,” Su Yun said after hesitating for a long time,”a little more stimulation might cause problems.”
Zheng Ren nodded.”I can’t help it. I’ll try to be gentle.” Fang Lin, what do you think?”
In reality, Fang Lin did not have any other considerations. He did not have the courage to perform any treatment on the patient before him that was too traumatic.
Forget everything else, just the old patient’s serious chronic pulmonary obstruction was enough to scare off 99% of doctors, and 99% of the remaining 1% were foolish, bold, and fearless.
It was only because Zheng Ren had relied on the system space’s cheat code to continuously try and figure out the correct method that he dared to perform the surgery on him.
Superior hospitals had their own difficulties. Otherwise, Fang Lin would not have sought boss Zheng’s help to solve this matter.
……
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[Note 1: before 2011, a professor from Beijing was asked to perform a lung cancer surgery. The patient suffered from pneumothorax two weeks after the surgery.] On the second day of the new year, I injected high sugar into the patient’s body and she recovered. This was a very common method. It had many flaws, but it was very useful.
As for the Elementium, it was a mixture of love and hate. It’s another story that will be explained in detail later.