Chapter 425 The beginning of complicated surgery!

The next morning, when Lu Cheng rushed to the department with breakfast, he found that Fang Nixin was already in the doctor's office in the department.

The time now is only 7:25, which is quite early before the shift handover time.

"Sister Fang, why are you here so early? Did something happen last night?" Lu Cheng asked.

Logically speaking, today's emergency class is not in the fifth ward of the Department of Orthopedics, but only in the general inpatient department in the third ward. Now there is an emergency class every six days in the general inpatient department, so there is no need for Fang Nixin to come so early.

"At two o'clock in the morning, one of Professor Wu's post-operative patients had a sharp drop in blood oxygen level and developed a pulmonary embolism. He was transferred to the ICU. Later, another patient had an electrolyte imbalance and has been dealing with it. Now

The blood potassium level finally returned to normal."

"I didn't go back to rest." Fang Nixin replied a little tiredly, and then her eyes were still staring at all the test results of a patient from admission to the present.

It should be the patient with electrolyte imbalance.

"Low potassium or high potassium?" Lu Cheng pushed breakfast in front of Fang Nixin, two steamed buns and a cup of soy milk. He had already eaten his own breakfast.

The current fifth ward of the Department of Orthopedics is not the same department where we stayed at the end of the quarter, so there is no so-called breakfast support group.

"Low potassium. The patient had mild diarrhea. It should be that the digestive tract and exudate caused fluid loss at the same time, leading to hypokalemia. Later, after potassium supplementation, it became high potassium. I looked at the previous doctor's orders.

"There's nothing wrong with potassium supplementation. I don't know what's going on." Fang Nixin was still clicking on the computer with the mouse in her right hand, but her left hand naturally accepted the breakfast given by Lu Cheng.

Then after flipping it up and down for a while, he said, "I'll take it away first and go wash my face."

Fang Nixin stood up and said that although she is currently in the hospital, she still needs to apply basic things such as lotion and lotion when washing her face in the morning during a certain period of time. Otherwise, the skin will also suffer

You can't afford to bother, unless you really don't have time, then there is nothing you can do.

"Oh, okay." Lu Cheng nodded and moved his chair slightly to make room for Fang Nixin.

Then Lu Chengcheng took a look at the examination results of several patients who were preparing for surgery today, and checked again to avoid any mishaps before surgery.

Not long after watching, Cao Xiaohe came with breakfast in his hand, including three portions.

After seeing Lu Cheng, he said: "Lu Cheng, I brought breakfast, have you eaten it?"

While talking, he opened his own bowl of rice noodles, started to open the outer packaging bag of rice noodles, and then tapped the disposable chopstick head.

"I've already eaten, thank you, senior brother. Why are you here so early?" Lu Cheng said, and then continued to look at the test results.

"Well, I'm going to see the patients who are going to have surgery tomorrow in advance and catch up on the test results."

"But if I had known you were in the department, I wouldn't have had to bother myself." Cao Xiaohe said very naturally.

It does not require so many people to check the results of preoperative examinations. Lu Cheng will definitely do these things if he is here. But now, getting up early every day to check on the patients in his group is a habit he developed in Kyoto, and the biological clock

I woke him up around six o'clock and he still hasn't adjusted yet.

Lu Cheng smiled slightly, changed the subject and asked, "Senior Brother Cao, when you were studying in Kyoto, did you come into contact with similar patients?"

"Senior Sister Fang and I came into contact with Professor Cao Mengda. Most of the patients we came into contact with were sports medicine patients. We rarely encounter such complicated patients."

Yesterday, when Professor Qu Hongsheng called Lu Cheng and the others to discuss the condition and surgical arrangements, Lu Chengcheng noticed that Cao Xiaohe didn't talk much and seemed to not feel unfamiliar or complicated about the situation in the department.

Cao Xiaohe sighed and said, "Actually, I don't know what to say."

"Where I went to study, although some patients also need simple joint replacement surgery, Kyoto is relatively advanced in the development of joint replacement, and even second-level hospitals can perform simple joint replacement very well.

.”

"So the patients we usually encounter are mostly troublesome patients that cannot be solved in various places across the country. These patients in our department can be regarded as one of the routines there."

"Speaking of which, my teaching teachers are all envious of where I am now. Most of the patients' conditions are simple and not particularly complicated. Complex ones can also be transferred to Magic City and Kyoto. It's good, and you don't have to worry about the number of patients."

"Although there are many patients in Kyoto, the quality is not very good."

Lu Cheng nodded. Lu Cheng had never encountered this problem before from Professor Cao Mengda. This is mainly because the subspecialty of sports medicine has a higher incidence rate in cities with a larger number of people, especially now that many people

They all like fitness.

Enthusiasts and practitioners of gymnastics, fitness, basketball, runners, mountain climbers, etc. are all reserve patients for sports medicine.

Therefore, when I was in Shanghai, the sports medicine patients I met were not particularly complicated.

"So, Senior Brother Cao, do you have any opinions on the patients who will be operated on today?"

"If it were in Kyoto, how would the operations and treatment of these patients be arranged?" Lu Cheng was a little curious.

Life is filled with countless multiple-choice questions. If Lu Cheng went to the Magic City, he would not be able to go to other places at the same time and see different scenery.

Cao Xiaohe smiled bitterly and said: "How can it be as amazing as you think? In fact, in clinical medicine, there are just a lot of principles. Surgery is surgery and medication, but the process and details of the surgery are slightly different."

"For example, joint infection is better treated in Kyoto and Shanghai, but the other one is Xinjiang Province. There are many infected patients there, and the reimbursement ratio is also very high. Patients hardly spend any money."

"But no matter what, it still comes down to complete debridement. It's hard to say. If the debridement surgery is done well, the number of surgeries can be reduced."

"If the dosage and variety of antibiotics used are well selected, the duration of anti-infective treatment can be reduced. But these are issues that professors should consider. We junior doctors can only slowly rely on experience to figure it out."

"I was fortunate enough to perform one operation in Kyoto, and it was the only one that performed simple debridement on a patient with infected arthritis. But the operation process was not very pleasant."

"In the end, the patient's curative effect after debridement was average." Cao Xiaohe did not brag about himself, but rather laughed at himself.

Lu Cheng took a look at Cao Xiaohe and found that Cao Xiaohe had become much calmer since his trip to Kyoto. Although he still had a few funny attributes and was still a bit competitive, he was better than before.

It was much better then.

It should be that my knowledge has increased a lot and my temperament has become smoother.

"Then do you think Professor Qu can handle it?" Lu Cheng continued to ask.

"Not necessarily. The Department of Orthopedics, Joint Surgery and Traumatology are three different sub-specialty departments. I can't say that Professor Qu can't perform surgery. I can only say that he is definitely not as good as the professors of professional joint surgery and trauma surgery.

Be professional.”

"Of course, Professor Qu must have encountered joint infections when he was clinical in the Department of Orthopedics, and he solved them himself. There is no doubt about his strength." Cao Xiaohe analyzed it more objectively.

Lu Cheng nodded.

…

Because he checked all the patients in detail yesterday and had a general understanding of the basic situation, the ward rounds ended quickly today, and Qu Hongsheng led his team to the operating room early.

The operating room this time was the operating room in the surgical building. Lu Cheng had been there before, so he was familiar with it.

After going in and quickly changing clothes, the anesthesiologist was still anesthetizing the patient, and it would take a while before the operation could officially begin. Xie Jian and Pang Lin watched in the operating room.

Qu Hongsheng, Lu Cheng and other 'senior doctors' all went to the lounge to rest.

It was not until 8:42, after Pang Lin and Xie Jian had disinfected and spread drapes on the three beds of patients, that they called Lu Cheng and others up.

The patient who underwent sinus resection on bed 3 had a lot of exudate from the wound every day after returning to the ward after the last operation. The amount of exudation did not decrease, so we decided to arrange it as the first one today.

Qu Hongsheng and others washed their hands, changed into sterile surgical gowns, and each wore two pairs of gloves, and then the formal surgery began.

Qu Hongsheng stood at the chief surgeon's position, with Lu Cheng as the first assistant, Fang Nixin as the second assistant, Pang Lin as the third assistant, and Xie Jian as the fourth assistant.

There were enough people on the operating table, so Cao Xiaohe did not go on the operating table. Instead, he went to the bedside anesthesiologist's best viewing position and began to check.

Before disinfection, the gauze and other materials on the patient's wound were removed. The patient's wound was a surgical incision of no more than 3-4cm, and there was a drainage tube wound below the surgical wound. But now, whether it is a surgical incision or a drainage tube opening,

, there is a small amount of light pink turbid liquid leaking out.

At first glance, it was clear that it was filled with pus.

The patient had undergone surgery elsewhere before, and after developing sinus tracts about half a year after the operation, he came to Attachment 2 for treatment.

Qu Hongsheng said: "For this patient, the sinus tract was connected to the right hip joint before. The last operation was a total hip replacement. During the last operation, although the sinus tract was connected to the right hip joint, there was no trace inside the hip joint.

Since there was no accumulation of pus, I did not remove the joint prosthesis."

"But I estimate that this time, the prosthesis may have to be removed together and the joint cavity must be debrided together. But in this case, the original joint replacement surgical incision must be reopened."

The location of the patient's sinus tract is on the inner side of the thigh. The total hip replacement uses a posterolateral approach, which is in two different directions. After coming to the hospital, the sinus tract was cleaned and resected. Naturally, the sinus tract mouth was used, because the MRI before

The displayed result is that the sinus tract is a semi-blind sinus tract.

Today's total hip prostheses, even the metal cup and metal handle, are made of inert metal and can be used for magnetic resonance imaging.

Before the operation, Qu Hongsheng discussed with Lu Cheng and others whether to open the original joint replacement incision. After all, the sinus opening was too far away from the original surgical incision.

The result of everyone's discussion was to open it and take a thorough look at the situation inside the joint cavity.

However, after Qu Hongsheng said this, Lu Chengcheng suggested: "Teacher Qu, how about we clean up the inside a little first. Otherwise, wait until the joint cavity and the wound on the inside are connected, and then treat the wound here.

When I was pregnant, there was a lot of fluid accumulation."

"Okay! That's okay." Qu Hongsheng thought for a while and felt that it is also advisable to deal with the inner side first. Although the last step still has to be on the inner side, sometimes the extra steps are also necessary. Otherwise, dealing with the inner side last will probably

If pus pours back into the treated opening on the outside, it will be troublesome.

The outer side is still a blind end, and can pass through the original sinus opening to form a certain degree of drainage.

Qu Hongsheng then saw that Lu Cheng was planning to change positions with him, and said: "Don't bother, Xiao Lu, just do it at your position. When it comes to treating the inner side, you will be the surgeon. I will handle the outer side later.

It’s very troublesome to walk around.”

Lu Cheng took only half a step back. When he heard what Qu Hongsheng said, he nodded politely.

In fact, he was also very curious about what was so difficult to deal with this level 81 monster. This was the first time Lu Cheng encountered it, an epic monster made up of purely orthopedic diseases.

Infection after right hip replacement lv72*Epic monster: sinus tract formation, infection after sinus tract resection, extensive muscle space infection, muscle necrosis, prosthesis loosening, osteoporosis, muscle atrophy. Characteristics: probability of disability
To be continued...