"If you don't, just observe it for two days, maybe in case you grow up." Fang Lin couldn't help it. Seeing Boss Zheng hesitating, he whispered a suggestion.
"You still have the face to say that you are a thoracic surgeon? As long as you are hospitalized, one year is not enough, at least three years will be enough. Squat in Corey and have surgery every day." Su Yun said coldly.
"Brother Yun, let's say it well, without taking me to the hospital again. This year, the whole person was disgusted." Fang Lin said sadly.
For him, there is nothing more distressing than doing another hospitalization.
If, as Su Yun said, Fang Linning is not a professor, it would be better to resign and go to a private hospital.
Fang Lin was relatively resistant, and many doctors resigned without hesitation when they heard that they were going to be hospitalized.
"What did you say in the guide?" Su Yun looked at Fang Lin with disdain. "Primary spontaneous pneumothorax drainage continued to leak after 7 days; secondary pneumothorax drainage continued to drain after 14 days. Pneumothorax; essentially a persistent bronchopleural fistula. "
"Brother Yun ..."
"The 2015 European Respiratory Society's spontaneous pneumothorax diagnosis and treatment statement states: For patients who have a drainage time greater than 3-5 days and still have a leak, further treatment should be taken." Su Yun looked at Fang Lin and seemed to feel the stethoscope on his shoulder. Too dazzling, turning his head and Lin Yuan said, "Xiao Linzi, tell him what other guides say."
"Oh, okay." While watching the film with Zheng Ren, Lin Yuan said: "The 2010 British Thoracic Society Spontaneous Pneumothorax Management Guide states: Spontaneous pneumothorax conservative drainage for 48 hours and continuous air leakage should be considered whether Surgical intervention. "
Fang Lin looked sadly at the monsters in Boss Zheng's medical team.
These things, we all know, but who will memorize so many details. It is useful to memorize the treatment guidelines in addition to talking about the whole hospital. Can it have any effect on the patients in front of them?
It was impossible, Fang Lin sighed, he looked sadly at the image on the reader and just wanted to speak, but was interrupted directly.
Because there is no end to the topic of the guide.
"The 2018 German Spontaneous Pneumothorax Management Guideline proposes: Regardless of whether it is spontaneous or secondary pneumothorax, after 48 hours of drainage, it is necessary to consider changing the treatment plan." Lin Yuan continued.
"Stop!" Fang Lin immediately told Rao when she saw that she had to say, "Surgery? I can ask the director. Even if this patient is in the emergency department, the anesthesiologist will not dare to anesthetize."
"Boss, can you do it?" Su Yun whispered beside Zheng Ren.
Zheng Ren did not speak, and he tried bronchoscopy for interventional treatment in the system operating room.
In general, there are several treatments for pneumothorax.
The first is the most common thoracotomy 10 years ago. The benefits of this method are like Su Yun said. The disadvantage is that the trauma is huge and the patient recovers slowly after surgery.
If this old patient who is already "slagging off" is performing this operation, Zheng Ren is not sure if he can step down. After all, relevant surgical training has been done in the system operating room, and the completion of the surgery is not high at all.
The low completion of the surgery meant that there were many problems after the operation, which was ruled out by Zheng Ren.
Secondly, it is minimally invasive thoracoscopy surgery, which is the first choice of thoracic surgery in major hospitals. Not only general chests, but even heart-hearted doctors such as Zhao Yunlong who were preparing to do type 1 aortic arch dissections were done with laparoscopy.
The major guidelines recommend the preferred treatment for refractory pneumothorax. However, the patient in front of him is not suitable. He has poor general body conditions, poor cardiopulmonary function, and extensive lung lesions. The completion degree of the operation performed by thoracoscopy is still very low.
Besides, the patient's chest adhesion was so severe that the thoracoscopy had a very limited field of vision and had to be stripped first. One accidentally stopped bleeding when a blood vessel broke. There was no surgery in the field for a ball operation, which was also ruled out.
The next step is pleural fixation at the local hospital.
Said to be a technique, it is actually a very simple operation.
The principle is to rub the pleura through chemical drugs or surgery to form a uniform and consistent sterile pleural inflammation, and to completely close the pleural cavity. The patient injected 50% high-sugar 50ml into the chest of the local hospital.
Both talc and tetracycline can be used as preferred drugs. Other commonly used drugs include autologous blood, elemene, hypertonic glucose, and iodophor. (Note 1)
Then there is argon ion coagulation. Some doctors attribute this treatment to medical treatment, and Zheng Ren disagrees.
But this technique is also not suitable for patients in front of them.
The last, and the only treatment that Zheng Ren can think of, is bronchoscopic interventional therapy.
The bronchial plug, stent, one-way valve, autologous blood, bioprotein gel, and gelatin sponge are used to block the airway to achieve the purpose of treatment.
Among them, autologous blood and bioprotein glue can be absorbed by themselves, but easy to cough. At present, the major guidelines are not recommended as the first choice.
Zheng Ren tried it 20 times before he found a feasible solution.
Regardless of major illness or minor illness, as long as it gets worse, it is very tricky. Boss Zheng, who is at the top of the peak of intervention, the peak of general surgery, and the top master of cardiothoracic surgery, faced a little pneumothorax, and even had more than 30 surgical training.
In this regard, Zheng Ren said he was helpless.
"You can try interventional treatment." Zheng Rendao, "Anesthesia ... Let's find Lao He."
"Bronchoscopy for interventional surgery? The risk is high," Su Yun reminded.
"But there is no other good way." Zheng Rendao, "the laryngeal mask for general anesthesia for anesthesia, I under the bronchoscope to block."
Su Yun hesitated for a long time and asked, "Boss, a little stimulation may cause problems."
Zheng Ren nodded, "This is no way, I try to lightly. Fang Lin, what do you think?"
In fact, where did Fang Lin have any consideration, he did not dare to do any traumatic treatment to the patients in front of him.
Not to mention anything else, the severe COPD of old patients alone is enough to scare 99% of doctors, and 99% of the remaining 1% are silly and bold, the ignorant are fearless.
That is, Zheng Ren drew on the system space, kept trying, and finally figured out the right way, before he dared to perform surgery.
The superior hospital has the difficulty of the superior hospital, otherwise Fang Lin would not ask Boss Zheng to solve this matter.
...
...
Note 1: Before 2011, Professor Didu was invited to have a lung cancer operation. Patients still had pneumothorax 2 weeks after surgery. On the second day of the new year, I filled the patient with high sugar, and it was just fine. This is a very common method. It has many disadvantages, but it is also very easy to use.
As for elemene, it really loves and hates. The specific is another story, which will be detailed later.
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"If you don't, just observe it for two days, maybe in case you grow up." Fang Lin couldn't help it. Seeing Boss Zheng hesitating, he whispered a suggestion.
"You still have the face to say that you are a thoracic surgeon? As long as you are hospitalized, one year is not enough, at least three years will be enough. Squat in Corey and have surgery every day." Su Yun said coldly.
"Brother Yun, let's say it well, without taking me to the hospital again. This year, the whole person was disgusted." Fang Lin said sadly.
For him, there is nothing more distressing than doing another hospitalization.
If, as Su Yun said, Fang Linning is not a professor, it would be better to resign and go to a private hospital.
Fang Lin was relatively resistant, and many doctors resigned without hesitation when they heard that they were going to be hospitalized.
"What did you say in the guide?" Su Yun looked at Fang Lin with disdain. "Primary spontaneous pneumothorax drainage continued to leak after 7 days; secondary pneumothorax drainage continued to drain after 14 days. Pneumothorax; essentially a persistent bronchopleural fistula. "
"Brother Yun ..."
"The 2015 European Respiratory Society's spontaneous pneumothorax diagnosis and treatment statement states: For patients who have a drainage time greater than 3-5 days and still have a leak, further treatment should be taken." Su Yun looked at Fang Lin and seemed to feel the stethoscope on his shoulder. Too dazzling, turning his head and Lin Yuan said, "Xiao Linzi, tell him what other guides say."
"Oh, okay." While watching the film with Zheng Ren, Lin Yuan said: "The 2010 British Thoracic Society Spontaneous Pneumothorax Management Guide states: Spontaneous pneumothorax conservative drainage for 48 hours and continuous air leakage should be considered whether Surgical intervention. "
Fang Lin looked sadly at the monsters in Boss Zheng's medical team.
These things, we all know, but who will memorize so many details. It is useful to memorize the treatment guidelines in addition to talking about the whole hospital. Can it have any effect on the patients in front of them?
It was impossible, Fang Lin sighed, he looked sadly at the image on the reader and just wanted to speak, but was interrupted directly.
Because there is no end to the topic of the guide.
"The 2018 German Spontaneous Pneumothorax Management Guideline proposes: Regardless of whether it is spontaneous or secondary pneumothorax, after 48 hours of drainage, it is necessary to consider changing the treatment plan." Lin Yuan continued.
"Stop!" Fang Lin immediately told Rao when she saw that she had to say, "Surgery? I can ask the director. Even if this patient is in the emergency department, the anesthesiologist will not dare to anesthetize."
"Boss, can you do it?" Su Yun whispered beside Zheng Ren.
Zheng Ren did not speak, and he tried bronchoscopy for interventional treatment in the system operating room.
In general, there are several treatments for pneumothorax.
The first is the most common thoracotomy 10 years ago. The benefits of this method are like Su Yun said. The disadvantage is that the trauma is huge and the patient recovers slowly after surgery.
If this old patient who is already "slagging off" is performing this operation, Zheng Ren is not sure if he can step down. After all, relevant surgical training has been done in the system operating room, and the completion of the surgery is not high at all.
The low completion of the surgery meant that there were many problems after the operation, which was ruled out by Zheng Ren.
Secondly, it is minimally invasive thoracoscopy surgery, which is the first choice of thoracic surgery in major hospitals. Not only general chests, but even heart-hearted doctors such as Zhao Yunlong who were preparing to do type 1 aortic arch dissections were done with laparoscopy.
The major guidelines recommend the preferred treatment for refractory pneumothorax. However, the patient in front of him is not suitable. He has poor general body conditions, poor cardiopulmonary function, and extensive lung lesions. The completion degree of the operation performed by thoracoscopy is still very low.
Besides, the patient's chest adhesion was so severe that the thoracoscopy had a very limited field of vision and had to be stripped first. One accidentally stopped bleeding when a blood vessel broke. There was no surgery in the field for a ball operation, which was also ruled out.
The next step is pleural fixation at the local hospital.
Said to be a technique, it is actually a very simple operation.
The principle is to rub the pleura through chemical drugs or surgery to form a uniform and consistent sterile pleural inflammation, and to completely close the pleural cavity. The patient injected 50% high-sugar 50ml into the chest of the local hospital.
Both talc and tetracycline can be used as preferred drugs. Other commonly used drugs include autologous blood, elemene, hypertonic glucose, and iodophor. (Note 1)
Then there is argon ion coagulation. Some doctors attribute this treatment to medical treatment, and Zheng Ren disagrees.
But this technique is also not suitable for patients in front of them.
The last, and the only treatment that Zheng Ren can think of, is bronchoscopic interventional therapy.
The bronchial plug, stent, one-way valve, autologous blood, bioprotein gel, and gelatin sponge are used to block the airway to achieve the purpose of treatment.
Among them, autologous blood and bioprotein glue can be absorbed by themselves, but easy to cough. At present, the major guidelines are not recommended as the first choice.
Zheng Ren tried it 20 times before he found a feasible solution.
Regardless of major illness or minor illness, as long as it is regained ~ www.novelhall.com ~ is very difficult. Boss Zheng, who is at the top of the peak of intervention, the peak of general surgery, and the top master of cardiothoracic surgery, faced a little pneumothorax, and even had more than 30 surgical training.
In this regard, Zheng Ren said he was helpless.
"You can try interventional treatment." Zheng Rendao, "Anesthesia ... Let's find Lao He."
"Bronchoscopy for interventional surgery? The risk is high," Su Yun reminded.
"But there is no other good way." Zheng Rendao, "the laryngeal mask for general anesthesia for anesthesia, I under the bronchoscope to block."
Su Yun hesitated for a long time and asked, "Boss, a little stimulation may cause problems."
Zheng Ren nodded, "This is no way, I try to lightly. Fang Lin, what do you think?"
In fact, where did Fang Lin have any consideration, he did not dare to do any traumatic treatment to the patients in front of him.
Not to mention anything else, the severe COPD of old patients alone is enough to scare 99% of doctors, and 99% of the remaining 1% are silly and bold, the ignorant are fearless.
That is, Zheng Ren drew on the system space, kept trying, and finally figured out the right way, before he dared to perform surgery.
The superior hospital has the difficulty of the superior hospital, otherwise Fang Lin would not ask Boss Zheng to solve this matter.
...
...
Note 1: Before 2011, Professor Didu was invited to have a lung cancer operation. Patients still had pneumothorax 2 weeks after surgery. On the second day of the new year, I filled the patient with high sugar, and it was just fine. This is a very common method. It has many disadvantages, but it is also very easy to use.
As for elemene, it really loves and hates. The specific is another story, which will be detailed later.
Tips: press [Enter] to return to the directory, press (left key on the keyboard ←) to return to the previous chapter and press (right key on the keyboard →) to enter the next chapte
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