Two Hundred and Sixteenth Abacus

"Hang up the thread with the small round needle, and let the thread lengthen when you turn back, and the vital signs of Secretary Ren and that patient will be handed over to you.

Dr. Chen, extend the anesthesia time!

Dr. Wang, please negotiate with the patient's family, we have to prepare both ways.

Once the preservation of the spleen fails, a splenectomy operation must be performed, and the patient's family must be clearly explained to the patient's family about the danger of the operation. "

"it is good!"

"yes!"

Ren Li agreed, and Dr. Wang immediately agreed after hearing what Zhang Fan said, and left the operating room with a thick stack of consent forms for the operation.

The instrument nurse hung the absorbable thread on the smallest round needle with great difficulty.

Needles, all kinds of skin needles, round needles, and special absorbable thread with needles, there are many types in medical treatment.

The round needles are actually the needles of my own sewing clothes that are bent into a round moon shape, just like a round moon scimitar.

The shape of the leather needle is actually exactly the same as the round needle, the difference lies in the needle head.

The head of the round needle is pointed, while the head of the skin needle is like a triangular thorn.

Skin needles are used to suture skin and cartilage, and round needles are used to suture soft tissues and organs under the skin.

Because of the different needles, if the skin needle sutures the soft tissue under the skin, the result is that the tissue is split.

Regardless of the small needles, they are classified into three or six grades in the hospital. For example, the round needles that come with the absorbable thread in a certain country are quite easy to use.

Sharp, as if the material has its own smooth oil, when inserted into the tissue, it does not bring a little bit of dryness.

Moreover, the most amazing thing is that its material is very good for skin needles, and doctors with good skills can use it to penetrate flat bones, such as ribs.

But the price is also good, one thread, one needle, more than 400! This is still the price of the hospital. If it is in a beauty salon, it will cost several thousand.

In order to prevent repeated use in the hospital, there is no threading hole at the end of the needle, and it is considered a complete disposable product.

To be honest, if it is not a matter of price, doctors like to use this kind of foreign needles and threads.

It is estimated that small needles do not make money,

Domestic manufacturers did not put their heart into it. Then the domestic needles are really not very good.

Especially for doctors with poorer skills, when suturing relatively tough tissues, if a little force is not appropriate, the needle will be bent first.

Nurses complained, anesthesiologists urged, superior doctors criticized, really, young doctors could cry because of needle bullying.

Although Zhang Fan has no requirements for needles, he also likes to use this kind of needle which is not dry at all. When inserted, it is very slippery, just like a popsicle, very smooth.

After receiving the needle, Zhang Fan looked up at the anesthetist, who nodded slightly to Zhang Fan, "The Zhang Institute can start."

"it is good!"

Abdominal tissue, including gastrointestinal tract, liver, pancreas, spleen, and kidneys. These abdominal organs have a lot of autonomy, and they don't pee the brain very much.

For example, intestinal peristalsis, which is managed by the intestinal tract itself. If you eat too much, eat irritating food, or use something to tease it from the back door, people will speed up the peristalsis.

But for other stimuli, they are also lazy, and they don't give much feedback to the brain about what happens.

For example, if the intestinal tract is perforated, only after the intestinal fluid flows out will people roll around in pain.

What is the intestinal juice? This thing is a strong alkali. Even so, the pain point in the abdomen is not very clear.

The abdominal organs are not very sensitive to temperature, cutting, and acupuncture.

However, the abdominal viscera are the most sensitive to pulling force. This is also why the second brother of the grassland will kill any prey he sees.

Once you bite the head of the cecum in one bite, and then pull it back, no matter you are a two-ton rhinoceros or a big lion with sharp teeth, you can lie on the ground in pain and call Dad.

Therefore, when performing abdominal surgery, when the old doctor leads the young doctor, he will definitely say, "Slow down, slow down, be gentle, don't pull!"

If the stretch is frequent, even if the patient is under anesthesia, it will cause restlessness or even painful shock in the patient.

And when there is pain in the abdomen, you must not take painkillers at home, such as ibuprofen and diclofenac sodium sustained-release tablets.

Don't eat it, this thing doesn't pee the brain very much, once you take painkillers, it will cover up your illness.

Seeing the anesthetist nodding his head, Zhang Fan stabilized his emotions and collected himself.

"start!"

Old Zhao held the tweezers in one hand, and gently fixed the spleen in his hand with the other, and then steadily showed Zhang Fan the surgical field clearly.

Suture, in the organ, the stomach is the best suture, with three or four layers of structure, and the texture is tight, just like a pocket.

The spleen is the most difficult to suture, how to say this thing, like a crisp water radish, or a green apple rich in water.

If you sew up a green apple with a needle, you will know the difficulty of this operation.

Once this thing is split, it is quite difficult to handle, the angle of entry of the needle is a little bit off, not to mention sewing, it can continue to split a few petals for you.

This kind of acupuncture, each needle is a gamble, you don't know if your needle will split the spleen tissue.

Moreover, when the suture opening becomes smaller and smaller, it is more difficult to suture, because the closer to the edge, the greater the chance of it cracking.

Just like a piece of ceramic, this thing breaks not only at one point, sometimes, because of the torque problem, this thing can open the whole spleen for you.

Therefore, the older the doctor, the less he dared to do the spleen, because if one is not careful, it will be a waste of all previous efforts.

However, precision and stability are no problem for Zhang Fan.

Zhang Fan took a long breath, and saw the moon-like needle piercing the spleen wound at a 90-degree angle.

On the edge of the spleen tissue where the wound was like a petal, the needle holder in Zhang Fan's hand held the round needle and stabbed it firmly into the tissue.

Wrist strength must be used to suture cartilage or even penetrate flat bone or fascia.

And this kind of brittle tissue must use the strength of the fingers, which must not only have a clean penetrating power, but also have an unbiased stability.

Human body sewing is not sewing clothes. You can do whatever you want with a needle in your hand.

For human body suture, the needle holder is used to hold the round needle, so the strength is transmitted to the needle through the needle holder.

Just like you use pliers to hold a nail and stuff it into the wood. Once the force is not appropriate, the clamped nail will be like a person who is not used to wearing high heels, walking crookedly.

If this happens after this time, don't even think about it, the spleen will definitely turn into a splenomega, so we have to cut it off.

As Zhang Fan inserted with his breath closed, every time he inserted, Zhang Fan would insert at the most stable moment with his breathing, and then seized the time to send out.

This thing doesn't use reckless force, anyway, the spleen is where it is, I inserted it desperately, and I can get in no matter what.

Not to mention Zhang Fan, even Zhao Quanping, the director of general surgery who was the first assistant, held his breath involuntarily every time he was inserted.

It was as if he was deeply afraid that his breathing would affect Zhang Fan's insertion.

One stitch, two stitches. The distance between the pins is neatly arranged as if measured with a ruler.

The profession of surgery is slightly the same as that of chefs. In the profession of chefs, the best performers are men, while the best performers in surgery are also men.

Don't talk about being tall, just talk about the stitching.

When Zhang Fan and the others were teaching surgery in college, the teacher anesthetized the students, and tied the rabbits with skins to the operating table.

Then have students practice sewing.

At that time, to be honest, everyone was the first brother and the first sister, who had done this job before.

The overall result of sewing is that boys sew better than girls.

The crisp apple-like spleen slowly oozes traces of blood with the stitches. Old Zhao glanced at Zhang Fan, and he didn't even dare to wipe the blood.

Zhang Fan sewed not only steadily, but also quickly. Seeing the dense sweat dripping from Zhang Fan's forehead, the itinerant nurse didn't dare to go forward to wipe it.

At this time, the back is too critical, the wound on the spleen slowly closes and closes slowly like the mouth of a crying child.

Stability is the foundation of this kind of stitching, and speed is the key. In trauma medicine, there is a golden hour.

For example, the spleen, which is full of tissues made up of various small bubbles, can hold and eat, but there are very few blood vessels.

Once it leads to ischemia for a long time, even if it is sutured, it will also cause ischemic necrosis.

Zhang Fan sewed up quickly, like a see-through eye, every time the needle goes down, it will avoid the blood vessels in the spleen.

There is only a light layer of superficial bleeding on the surface of the spleen, and there is absolutely no bleeding like a blood flower.

Doctors, although most doctors have the same education, but during the operation, the skills displayed by doctors vary widely.

For some doctors, performing surgery is like killing a pig, overflowing with blood.

And he rushed forward with his head bowed like a lonely knight in the blood, cut an appendix, and then the patient had to have a blood transfusion.

On the operating table, for such a crappy doctor, the only weapon of resistance for a patient under anesthesia is bleeding.

Therefore, an excellent surgeon is not only good at stopping bleeding, but also good at avoiding bleeding in advance.

On the operating table, it can be said that 1g of bleeding requires 10g of treatment.

"Boost!" After Zhang Fan sewed up the last stitch, he gently let go of the curved forceps with his left hand that was held on the spleen door. This kind of looseness is not a complete loosening.

Rather, the mouth of the curved forceps has just left the vessel, but it can clamp the vessel again immediately if necessary.

Hold the left hand, and gently press the right hand on the sutured wound of the spleen.

This particularly fragile tissue, sometimes, contractures the body due to sutures, and then the body will be cracked after reperfusion.

Therefore, the suturing of this kind of tissue is too weird. Sometimes after failure, even the doctor can't find out what went wrong.

Zhang Fan is confident in his skills, but just in case.

Therefore, before the blood fills the spleen, you must not be careless.

At this time, the general idea is a human life.

Ren Li administered the medicine herself, and little by little the booster medicine entered the medicine pot. Slowly, the discolored spleen gradually became darker and darker.

There was also significantly more bleeding from the sutured stitches.

"What's your blood pressure?"

"High pressure 120 mm Hg, low pressure 90 mm Hg!"

Zhang Fan pressed on the upper hand of the spleen, and at this moment he also began to feel the swelling of the spleen slightly.

Just like a cat probing, first licked lightly, then deeply, and finally put his tongue directly on Zhang Fan's hand.

Swelling is inevitable, let alone this kind of injury, even if you slap someone across the face, your face will swell, let alone this kind of injury.

When the blood pressure rose to normal blood pressure and the spleen was lying there firmly, I heard Old Zhao let out a long breath.

"Hurry up, wipe Zhang Yuan's sweat, and wipe me too, I'm almost dizzy!"

Can you not be nervous? It's like a ticking time bomb, which can be blown up at any time!

"Close the abdomen, go out alone, and inform the patient's family that the patient's spleen is covered!"

As soon as the head nurse heard this, she ran out quickly, and the little doctor beside her didn't react yet.

"Don't cry, it's okay, it's okay, wipe away the tears, the patient has been rescued, and the spleen has been preserved!"

Pulling off the mask, the head nurse who showed her face stood at the door and informed the family members of the patient's situation.

After speaking, the head nurse proudly turned her head and entered the operating room.

The high head and straight chest seem so arrogant, she likes this feeling, likes being surrounded by grateful and adoring eyes.

Before the operation, the doctor told the patient that he was critically ill and might die on the operating table. The hearts of the family members were as if they had been crushed by a steamroller, and there was black mist in front of them.

During the operation, the doctor came out of the operation and told that the spleen might be cut. Although one organ needs to be cut off, as long as the person can be saved, the family members are willing to do whatever it takes.

When the patient's family members had only a little hope left, that is, as long as the patient was rescued, the beautiful and plump nurse proudly told them that the patient was alive.

The family members were really pulled from the abyss to the peak at once. This sense of gratitude is really exciting.

The gray-haired old man was holding his little granddaughter and crying so heartily.

One month after the operation, I heard that the female owner of the hardware store sold the shop and gave the money to the female owner of the optical shop, and then got the understanding of the optical shop owner.

This was something Zhang Fan occasionally heard when the nurses in the hospital were gossiping.

After the beginning of spring, the annual medical practitioner examination began to register again.

The hospital's technology is now at the forefront of tea, but Ouyang still feels that it is not enough. Not only must the technology be at the forefront, but it must also be at the forefront of the exam.

Na Duo, Xu Xian, and Xue Xiaoqiao, who all scored more than 500 in the exam, as well as the directors of various subjects, were pulled by Ouyang to set up an exam tutoring class.

Of course, Ouyang certainly did not let Zhang Fan go, Zhang Fan is the main person in charge of the tutoring class.

Ouyang's current governing philosophy is to think that what happens is what happens. When arguing with the government, she will send Lao Gao first.

The internal affairs of the hospital were almost all on the heads of Zhang Fan and Ren Li.

Ren Li is willing to work hard, Zhang Fan can't afford to be lazy now and then, and Ouyang is getting more and more thieves.

As soon as Zhang Fan opened his mouth, she said that she had been working for her whole life, and she had either a backache or a headache, or a headache or annoyance, and now she couldn't even support the prickly pear, so Zhang Fan must be considerate to her.

Zhang Fan couldn't say anything!

Anyway, just one sentence, if the old lady doesn't work, you can figure it out yourself.

For the young doctors who are taking the exam to practice medicine this year, even though they are tutored by top academics like Zhang Fan, the bad news makes them terrified.

Ouyang has already announced that those who have passed 500 points in the test will receive half a year's bonus and performance, while doctors who have not reached 500 but pass the exam will be given an extra month's bonus and performance.

For doctors who did not pass the first exam, all performances will be stopped from the day the results come out, and only a living allowance of 600 yuan per month will be given. Those who fail the second exam will be directly terminated from the labor contract.

As soon as the hospital's red-headed documents came out, there was a lot of wailing. With the continuous improvement of the reputation of the Municipal People's Hospital, now I want to enter this unit. To be honest, some undergraduates have spent a lot of thought. How does Su still live, how does Su Su get along in the medical circle.

On the day when the auxiliary class started, not only the candidates from the Municipal People's Hospital, but also young doctors from other hospitals came to sit in on the candidates who had to take the exam.

The deputy director of the medical department originally wanted to drive out these doctors from other hospitals. Isn't this taking advantage of our hospital!

The result was stopped by the director of the medical department. Chen Sheng understood Ouyang so well, as expected, when Ouyang found the strange doctors all over the auditorium, the wrinkles on his face burst into smiles.

How famous the hospital is, isn't it because of the support from peers, isn't it because of the envy and jealousy of peers!

If these doctors were really kicked out, Ouyang would definitely be furious.

Besides, if he can find a few good seedlings in the study class, Ouyang is absolutely confident in poaching them. The old lady's plan is very smart.

Zhang Fan was the first teacher in the remedial class to come to the podium.

When Zhang Fan stepped onto the podium, there was an instant buzz from below.