Chapter 413: The relationship between thrombectomy and debridement, suspicion is the most terrifying

Author: Jiangbian Yuweng

Chapter 413: The relationship between thrombectomy and debridement, suspicion is the most terrifying

"Teacher, I just went to the ward for rounds."

"Oh, that's alright."

"The gangrene patient who had just undergone debridement surgery reported a symptom to me. He said that his right leg would experience dissociated swelling and pain from time to time after the injury. According to his description and when he was debrided today,

Based on the blood supply condition of the right leg, I suspect that arterial embolism may have occurred. And it is likely that local arterial embolism caused gangrene in the leg wound."

Zhou Can stated all his inferences and evidence.

After listening to his report, Dr. Xu was silent for nearly half a minute, and then said, "If there is really a local arterial thrombosis in the right leg, the thrombus must be removed overnight. Let's do a color ultrasound first. If necessary, I will contact the interventional room."

The patient undergoes angiography."

As an experienced doctor with extensive surgical experience, he naturally understands the dangers involved.

The biggest risk of arterial thrombosis is that the thrombus breaks free and enters the heart and brain, which can directly cause life-threatening consequences.

I believe many people have been frightened by their parents since childhood, saying that embroidery needles should not be thrown around. If they accidentally get stuck in a blood vessel, they will follow the blood vessels and enter the heart or head, killing the person.

This risk does exist, but the probability of it actually happening is extremely small.

Adults are mainly afraid that children will throw embroidery needles around, especially if they are thrown on the bed or fabric sofa, and they are particularly easy to get hurt when people sit down.

After getting Dr. Xu's permission, Zhou Can immediately went to the emergency room, borrowed the doctor's computer, logged into his account, and ordered a color ultrasound examination for the patient in bed No. 22.

Many inspections cannot be done at night.

One advantage of emergency care is that even at one o'clock in the morning, some emergency examinations can be done.

The medical technology departments of specialized outpatient clinics usually only work during the day. Some special examination rooms are even open only one day a week.

The test results came out quickly.

The patient did have suspected vascular embolism in his leg.

Zhou Can was about to call Dr. Xu, but Dr. Xu rushed back by taking a taxi.

"It would be better to perform an interventional surgery to remove the thrombus. If you do an interventional surgery, endoscopic surgery is very powerful. Are you confident that you can do the thrombectomy?"

He asked Zhou Can.

"I'm 70 to 80 percent sure!"

Zhou Can didn't dare to speak too fully.

"I called a doctor from the interventional room to open the door, and the blood clot had to be removed overnight. A blood clot occurred at this site. No wonder the patient's wound was difficult to heal! Fortunately, the hidden cause was found in time, otherwise his leg would definitely not be saved."

Dr. Xu was also filled with emotion.

It is possible to encounter any kind of disease. Even he, an old doctor with decades of surgical experience, did not find the real cause of the patient's wound gangrene. At that time, everyone's first reaction was to debridement in a small clinic.

The suturing technique was poor and the patient was not sutured properly. In addition, the patient recuperated at home in order to save money, which led to the infection.

Who would have thought that the culprit would be arterial thrombosis.

If the artery is completely blocked, it will definitely be discovered in time. Because limb ischemia will directly lead to necrosis.

It just so happens that this thrombus did not completely block the blood vessel, but blocked more than 90% of it.

This means that the artery can still supply blood, but the blood supply is very poor, with only 10% of the blood supply capacity left. With such a poor blood supply, it would be a miracle that the wound can heal.

There is a blood supply, which can maintain the basic survival of the lower limbs, which also makes it difficult for doctors to detect the existence of this blood clot.

Don't even think about it at all.

In the interventional room, Zhou Can relied on his superb operating skills to successfully remove the real culprit who had tortured the patient for many days. This was a blood clot about one centimeter long.

Visual inspection suggests it is caused by blood clotting.

It doesn't look like a fat plug.

There are many reasons for the formation of this kind of clot, mainly caused by trauma. Some nurses may even cause blood clots if they use the indwelling needle for a second time and operate it improperly.

Experienced nurses, before using the indwelling needle for infusion for the second time, will usually use a syringe of about 10ml to draw back the infusion until redness is seen before starting the infusion.

A common mistake made by reckless novice nurses is direct infusion.

Then I discovered that the indwelling needle I had just inserted yesterday seemed to be blocked.

Then, the lazy nurse flushed the tube directly with liquid water.

They didn't know that the indwelling needle they had just inserted yesterday was blocked. It was probably because blood flowed back into the needle when the needle was sealed. Overnight, a blood clot formed.

In this case, forcibly flushing the tube with saline can easily flush the blood clot into the patient's veins.

If the indwelling needle is blocked, in addition to the possibility of thrombus, it is also possible that the residual infusion may form crystals in the needle. This is more dangerous.

No matter which one, as long as it is forcibly sent into the patient's veins, it may cause serious consequences of death.

If the indwelling needle is blocked, there are three correct methods of operation.

After determining the cause, you can use a 10ml empty syringe to gently withdraw the clot from the tube.

Or if the patient's condition permits, 10ml of 0.9% sodium chloride injection containing sodium heparin (25u/ml) or urokinase (100,000U/ml) can be used to dilute the clamp for 5 minutes, and then use an empty syringe to return it.

Pump. If there is no blood return, repeat again. If there is still no blood return after two operations, the needle should be removed immediately.

In this case, the indwelling needle should be replaced with a new one and re-tied.

After Zhou Can successfully removed the patient's blood clot, he felt a sense of fear. If the blood clot had not been discovered in time, the patient's leg wound would definitely continue to worsen. It is estimated that by tomorrow, he would most likely have to make a ruthless decision to amputate the leg to save his life.

It may be a devastating blow to the family.

After amputation, the patient will lose the ability to work. His wife may be in trouble due to family finances, and the husband will become disabled. He cannot accept this result. Intense family conflicts will occur, and he will finally choose to divorce.

Her husband may also give up on himself.

It was the little boy who suffered in the end.

Only a little bit bigger.

And I heard from them that there is an eldest daughter in the family who is in junior high school.

Who will take care of the two minor children?

[Pathological diagnosis experience value +1, reward experience value +100.]

[Debridement experience +1, reward experience +1000.]

[Special medical skills, loving heart experience value +1, reward experience value +100.]

Zhou Can didn't expect that just by helping a patient remove a blood clot, he would be able to gain so many medical experience points.

In particular, it is extremely difficult to obtain experience points for the medical skill of Benevolence.

He was rewarded with 100 experience points at a time, and he was as happy as winning the lottery. This special medical skill has not yet been upgraded.

Its function has always been a mystery.

According to Zhou Can's experience, the more difficult it is to improve medical skills, the greater the effect.

For example, if pathological diagnosis and pharmacological syndrome differentiation are upgraded to Level 4, then he will be at the level of attending internal medicine. If he is raised to Level 5, he will be the deputy director level.

Currently, both of his medical skills are at Level 5, a proper deputy director level.

This is also the reason why he was often better than the deputy director of the department in the later training. Especially after the training in gastroenterology, this advantage became particularly dazzling.

Often the attending physician of the department or even the chief physician invites him for consultation.

To put it nicely, it’s a joint consultation. To put it more bluntly, isn’t it just asking him to come over and help?

After pharmacological syndrome differentiation reaches level five, it is directly reflected in the ability to prescribe medical advice.

Whether it is temporary medical orders, emergency medical orders, hospital admission orders, postoperative medical orders, etc., Zhou Can can gain the trust of superior doctors and has the right to act first and report later.

What does it mean?

When encountering a situation where a doctor's order needs to be issued, he can first issue a medical order to save the patient, and then ask the superior doctor to add his signature.

"How come the experience value of debridement is increased even though it's just a blood clot? And it's also an unprecedented bonus of one thousand."

The pathological diagnosis experience value awarded him 100, which is understandable.

After all, it was he who discovered the highly concealed arterial thrombosis based on some clues. Neither the clinic where the patient was first diagnosed, nor the doctors at the Provincial People's Hospital, nor the doctors at the Tuyap Surgery Department or the Emergency Department were able to discover this hidden secret.

The presence of lesions.

Zhou Can's ability to discover it is a major breakthrough in diagnosis and an accumulation of diagnostic experience.

Debridement and thrombectomy seem to be two different things!

After pondering for a moment, Zhou Can had a glimmer of understanding. It seemed that thrombus removal had nothing to do with debridement, but if the arterial thrombus was not removed, it would be useless no matter how well he did the patient's wound debridement.

This is a bit similar to the metaphor often used by entrepreneurs: physical health is 1, and the money earned is the zero after 1.

If you lose your health, it will be useless no matter how many zeros you earn.

This arterial thrombosis is directly related to the healing of the wound.
To be continued...