MTL - Doctor’s Life Simulator-Chapter 330 Shocked Professor Yang and new reward: ECG diagnosis
Qin Lang made a careful diagnosis. Under the master-level ventricular correction surgery series, ideas appeared in his mind one by one, and soon a preliminary formula appeared:
Patient: Xia Dongpeng, male, 53 years old
Symptoms: Double outlet right ventricle (DORV) with complete atrioventricular septal defect (AVSD)...
Treatment plan: Use the optimized and improved bi-ventricular orthopedic surgery in the simulated world to perform surgery on patients.
It's just that some details still need to be adaptable during the operation.
[Ding, new task: innovate a new operation in front of senior expert Professor Yang, and successfully operate on the patient. Mission reward: 1.1 life simulation points. 2. Electrocardiographic diagnostic techniques: entry-level]
Looking at this reward, Qin Lang was also quite happy. ECG diagnosis is a very useful diagnostic tool, especially in cardiovascular diseases. With this, he will become more and more versatile.
When Qin Lang constructed a new biventricular correction operation in his mind, Professor Yang's cell phone suddenly rang.
Professor Yang took out his mobile phone and saw that it was his attending physician. Generally speaking, the attending physician would not call him unless there were any special circumstances.
Professor Yang and Director Huang said hello, and then took the mobile phone and walked to the corridor outside the ward.
As soon as the phone was connected, he heard the doctor in charge anxiously asking for advice:
"Professor Yang, just now the department sent a somewhat complicated patient, which belongs to a very rare corrective transposition of the great arteries. We had a preliminary consultation with Director Ling just now. After we discussed this disease, we couldn't come up with a solution. The perfect plan, the single ventricle correction surgery is initially scheduled, but the single ventricle correction surgery is difficult to operate, and even if the surgery is completed, because the patient loses the right ventricle that supports the pulmonary circulation, the pattern of the circulatory system is similar. The circulation characteristics of the inferior reptile arteries, the postoperative short-term and long-term complications are unpredictable, and the cardiac function and quality of life are not satisfactory. Therefore, we would like to seek your opinion, whether it is surgery or simply Adhere to conservative treatment."
After Professor Yang listened to it, he took a deep breath. He was relatively experienced in this kind of case. After thinking about it, Professor Yang replied:
"Single ventricle correction surgery, although difficult and unpredictable late complications, relatively speaking, the average life expectancy and quality of life of patients after surgery are still higher than those of conservative treatment."
"So, I suggest using single ventricle correction. Director Ling will be the main surgeon, and he can handle it at his level. What about Director Ling?"
"Oh, Director Ling said that I should contact you first. He is going to post a post on the medical forum to ask for advice. At the same time, he also searches to see if there are similar cases and how his colleagues deal with it."
The attending physician honestly reported that under the Internet, there are still a lot of dry goods in medical forums, especially among the younger generation of physicians, and it is very common to share rare cases like this.
Of course, old experts like Professor Yang are relatively more traditional. In addition, he is already a Taishan Beidou in the field. Less than 1% of those who are more powerful and experienced than him on the forum will not waste it. Time to watch the little dolls mess around.
"Okay, then you can pass on my opinion and have the surgery as soon as possible. Look at the mess on the forum."
After listening to Professor Yang's words, the attending physician on the opposite side agreed: "Okay, Professor Yang, then I'll go and pass on your opinion to Director Ling now."
After Professor Yang switched off the phone, he walked into the ward and continued to wait for Qin Lang's diagnosis.
"How is it, Doctor Qin, can you complete the operation?"
Director Huang asked expectantly that the patient's daughter and son also stretched their necks and looked at Qin Lang anxiously.
"no problem."
Qin Lang directly gave a positive reply, but just as he was about to say that he had a better plan, he was interrupted by Director Huang.
"Professor Yang, since Qin Lang is able to perform the operation, then we will go to the consultation room. You will explain the details and attention points of the operation to Dr. Qin, and we will start the operation as soon as possible."
Director Huang led the way directly, Professor Yang thought about it and followed.
As he walked, he asked, "Doctor Qin, how many cases have you done body-lung shunt surgery before?"
Wang Xiaoying is also very curious to see that a young doctor who is not much older than her can have such a deep accumulation, body-lung shunt is not an ordinary operation.
"No."
Qin Lang was thinking about how to put forward his biventricular correction surgery plan concisely and concisely, so he answered casually and fell into his own thoughts.
Seeing Qin Lang's perfunctory attitude and not answering, Professor Yang was shocked.
I even felt a little incomprehensible. It's fine for young people to be ignorant. Why did Director Huang and Deputy Director Qian accompany him to make a fool of himself.
Moreover, Qin Lang's attitude made him a little angry. Even if a young man is a little bit special, he shouldn't be so arrogant and rude.
However, since it was in someone else's hospital after all, Professor Yang controlled his dissatisfaction, but his tone was a little cold:
"Director Huang, are you kidding me? You have never done a body-lung shunt, so you dare to let him go to the operating table?"
Hearing that Qin Lang said that he had never done it, Director Huang and Deputy Director Qian were used to it. Director Huang explained directly:
"Professor Yang, you may not know that Physician Qin's surgical talent is very amazing. For ordinary operations, he only needs to watch it once. Moreover, in the short few operations in our department, Physician Qin is only an original technique. A lot of formulas have been completed. Therefore, it cannot be viewed with common sense.”
Professor Yang looked at Director Huang again, and the latter gave him a positive nod. Professor Yang was almost autistic.
When will the operation not need repeated practice and accumulation, just watch it once?
Wang Xiaoying also looked at Qin Lang suspiciously, but the latter still looked like he was immersed in his own world.
Could it be that this is a genius way of doing things that is different from ordinary people?
At a time like this, shouldn't you listen to Professor Yang's question with all your attention, and then respond like walking on thin ice?
In Wang Xiaoying's opinion, it is a once-in-a-lifetime opportunity to get the guidance of a senior expert from the 301 People's Liberation Army Hospital like Professor Yang. I don't know how many young doctors can't ask for such an opportunity.
Could it be that you think you are an old expert with decades of skill?
After all, Professor Yang was a guest. He held back his anger and entered the consultation room. Then he began to design his own surgery and repeat it carefully:
"The whole operation adopts tracheal intubation and intravenous anesthesia, and the operation is performed through the median sternum incision at room temperature. Due to the development of the pulmonary arteries on both sides of the patient, I recommend the modified Waterson operation, that is, artificial blood vessels are used to separate the subclavian artery and the pulmonary artery. End-to-side anastomosis between the aorta and pulmonary artery..."
Although Professor Yang has some doubts about Qin Lang's attitude and level, it does not hinder his professional analysis. After all, he is very rigorous and responsible for surgery.
"Due to the patient's age, body weight and pulmonary vascular development, I recommend choosing an artificial shunt with a diameter of less than 4 mm. When the intraoperative oxygenation is poor, the extracorporeal circulation should be established in time, and at the same time, the pulmonary artery and its branches should be observed during the operation. Developmental status..."
While Professor Yang was doing serious analysis, Qin Lang also picked up a piece of paper on the side and began to deduce and construct a schematic diagram of his biventricular correction surgery.
With his full attention, it was not that Qin Lang deliberately did not give face to Professor Yang, but was completely immersed in the design of the technique, drawing diagrams stroke by stroke, and smiling with satisfaction from time to time.
Because Professor Yang was separated by a long conference table, he didn't see the contents of Qin Lang's paintings, and thought he was taking notes seriously, which finally comforted him a little, but it was not hopeless.
However, the results of the operation are still not very convinced.
Professor Yang explained carefully, especially the details that he thinks young doctors may overlook.
Director Huang and Deputy Director Qian also listened carefully, corroborating each other with their own experience and nodding their heads. I have to say that Professor Yang is indeed an authoritative expert in this field and has made great efforts.
Wang Xiaoying listened with admiration, holding a notebook to record, looking at the other side, also thinking hard, constantly taking notes, occasionally Qin Lang, who was in a state of enlightenment, was very proud, and now he knew what Professor Yang said. Great!
Professor Yang is also very satisfied with the serious listening attitude of several people:
"Because the patient's shunt diameter is <4mm, high blood cell volume, extracorporeal circulation surgery and postoperative platelet application, it is very easy to cause tube embolism after surgery, which should be especially noted..."
"In addition, based on my personal clinical experience, special attention should be paid to the change of blood oxygen saturation after surgery. Once the blood oxygen saturation is found to have dropped significantly, the continuous murmur on the right or left second intercostal space disappears after auscultation, and artificial blood vessel occlusion should be considered first. Or twisted, the artificial blood vessel needs to be replaced immediately. For anticoagulation after shunt, my experience is that early treatment with low molecular weight heparin or aspirin can not only reduce the complications of postoperative bleeding, but also effectively prevent early thrombosis.”
"Yes, Professor Yang said it well."
Director Huang couldn't help but admired it, and then looked at Qin Lang: "Qin Lang, do you remember?"
And Qin Lang, who just finished the last stroke, satisfactorily flattened his technique diagram, raised his head, and responded in a dazed tone, "Yes."
Professor Yang also finished his sharing, then looked at Qin Lang, and instructed again:
"My personal experience has basically been shared. As long as the difficulty I mentioned just now is solved in the operation, the operation will be 90% successful. If it cannot be done, I suggest giving up the operation. It is still too late. Dr. Qin, Do you have anything else to ask?"
Qin Lang was excited about the research and development of the new technique. Now he wanted to go to the operating room to practice. He couldn't wait to get up and replied directly:
"Okay, I'm ready, Director Huang, we'll start the preoperative preparation right away."
Seeing that Qin Lang got up so impatiently and was about to prepare for surgery, Director Huang smiled awkwardly at Professor Yang: "Young people are like this, full of energy."
Director Huang stopped Qin Lang seriously: "Qin Lang, you can deduce it carefully. If there is anything you don't understand about the whole operation, please bring it up now."
"No, I've already thought it through."
Qin Lang walked out of the consultation room directly, with a very confident tone, even a little sharp.
Looking at Qin Lang's back, Professor Yang opened his mouth slightly and shook his head. Young people nowadays really don't understand the rules.
"Then let's get ready and go to the operating room, shall we?"
Professor Yang would also like to see what such an arrogant young man can do with this operation.
Wang Xiaoying also looked at Qin Lang's back, her face was a little puffed up. When was Professor Yang despised by such a young doctor.
"Let's see, why can't we treat it with common sense!"
Under the special instructions of Qin Lang, the cooperating staff of all parties began to prepare for the operation in an orderly manner.
Twenty minutes later, Qin Lang, Director Huang, Professor Yang, and Deputy Director Qian entered the operating room simultaneously.
Director Huang was very accustomed to helping Qin Lang.
"General anesthesia...hypothermia...establish cardiopulmonary bypass...a help with cannulation of the ascending aorta, superior and inferior vena cava to establish cardiopulmonary bypass..."
After hearing Qin Lang's order, not only Director Huang, but also Professor Yang was stunned. He quickly reacted, and Professor Yang directly reprimanded:
"Doctor Qin, what are you doing? Who asked you to perform cardiopulmonary bypass at low temperature? Did you listen to my previous surgical plan?"
Regarding Professor Yang's doubts, Qin Lang's heart is clear under the aura of the talented master knife. In the operating room at this moment, everything is under his leadership, and he said calmly:
"I don't want to follow your surgical plan. Pulmonary artery shunt is not the best solution. There are many defects. What I am going to do is my own modified biventricular correction."
"What did you say, biventricular correction surgery?"
Professor Yang was immediately fascinated. This young doctor was really not joking. He co-authored and explained it for a long time. He didn't listen to anything, and now he has changed the surgical plan without authorization?
Qin Lang ignored Professor Yang. After all, he had experienced decades of struggle in the simulated world. In this operation, he was the only authority!
The patient's condition does not wait for anyone!
Qin Lang immediately started the next step.
"Medical Polyester Sheets...Scissors..."
Under Qin Lang's instructions, the equipment nurse followed up obediently. After Qin Lang took it, he started trimming the patches.
In the confusion of Director Huang, Professor Yang, and other doctors, the patch was trimmed into a "comma shape".
While operating, Qin Lang explained the principles and principles of his operation, and explained to the crowd:
"I now use the "two-piece method" to repair the AVSD, and the ventricular septal defect (VSD) is repaired with a medical polyester sheet, which is cut into a "comma" of the corresponding size, and repaired through the right atrium and right ventricle incision; part of the VSD is separated from the pulmonary valve Closer, the entire funnel septum needs to be resected posteriorly and upwardly.”
Qin Lang said, and performed the operation quickly. Under the perfect level of incision and suture, the operation was extremely smooth.
Even though Professor Yang is still in a state of anger, he has to obey Qin Lang's operation.
This... is really amazing!
"One help me to repair atrial septal defect (ASD) with autologous pericardium..."
Qin Lang's instructions were very clear. Seeing Qin Lang's calmness, Director Huang chose 100% trust and cooperated very quickly.
"sutures...needle pliers...microscope..."
Qin Lang proceeded to the next step, and directly sutured the upper edge of the VSD patch, the common atrioventricular valve, and the lower edge of the atrial septal defect patch, and the coronary sinus was separated from the right atrium when repairing the ASD.
Seeing Qin Lang's textbook-level suturing technique and neat and clean suturing speed, Professor Yang had forgotten Qin Lang's rudeness and nonsense before, and watched his surgical procedures with his eyes closed.
After all, Professor Yang is a senior expert of the 301 People's Liberation Army Hospital. Seeing that he has begun to deduce the entire operation of Qin Lang at a rapid rate, he quickly understands Qin Lang's intention and unconsciously sighs:
"So it is... such a clever idea, such a bold attempt!"
"Director Huang, always pay attention to the water injection of the left atrioventricular valve..."
"okay!"
Director Huang immediately began to monitor his patient's vital signs and water injection.
Under Director Huang's precise report, Qin Lang quickly determined the formation of the left atrioventricular valve and issued the next order:
"Routine suturing of the mitral valve fissure is performed, and the right atrioventricular valve is correspondingly shaped."
"clear!"
After all, Director Huang was a veteran who had been in the cardiovascular department for decades. He understood Qin Lang's orders and cooperated very tacitly.
During the advancement of the operation, Qin Lang's thinking gradually became clear, and several elders also saw the mystery, and the operation became more and more smooth.
"Scalpel..."
With Director Huang's perfect cooperation, the operation was quicker than Qin Lang had expected. He was indeed the chief physician of the First Affiliated Hospital of Zijingang University!
Such a help is really comfortable!
Qin Lang began to treat the patient's right ventricular outflow tract due to pulmonary stenosis.
Professor Yang on the side has also figured out the principle of Qin Lang's operation at this moment, and he is also very nervous and excited and muttered to himself:
"The next step is to remove the abnormally thickened muscle bundles in the right ventricle, and then use an autologous pericardium to widen the right ventricular outflow tract."
Sure enough, the next step, Qin Lang's operation is exactly the same as what Professor Yang said. Of course, Qin Lang's completion and completion speed are more perfect and faster than Professor Yang imagined.
"Genius, genius!"
Professor Yang has completely forgotten his previous doubts and dissatisfaction with Qin Lang. Now I just want to applaud Qin Lang's operation!
Such a genius, young and frivolous, arrogant and arrogant, what's wrong?
Seeing Professor Yang's reaction, Deputy Director Qian also smiled slightly, looking at Qin Lang on the operating table, his eyes were full of surprises.
At this moment, he also understood that during the previous consultation, Qin Lang was absent-minded and had been thinking about his surgical plan.
It's just that this stinky boy, after reading the patient's information, and taking advantage of Professor Yang's consultation, he designed such a complex modified surgery?
Deputy Director Qian suddenly felt that most of his life had really been in vain.
At this moment, Professor Yang, watching Qin Lang's operation on the operating table, was more nervous than his own operation. While watching, he said:
"By expanding the ventricular communication, building a smooth left ventricular outflow tract with a "comma-shaped" patch, and accurately reconstructing the left and right atrioventricular valves, the right ventricular outflow tract is guaranteed to be unobstructed, while avoiding damage to the conduction bundle, which is really genius idea!"
Professor Yang has not seen a new technique that excites him for a long time.
"This is an excellent improvement! A huge leap in the treatment of double outlet right ventricle (DORV) combined with complete atrioventricular septal defect (AVSD), Director Huang, Dr. Qin in your department is amazing, amazing."
Professor Yang watched that the operation had come to an end under Qin Lang's frantic operation, and only took time to talk to Director Huang.
"Professor Yang, it's too much. I want to temporarily change the technique for Qin Lang. I didn't communicate with you, like you apologized, but I didn't expect it. Fortunately, the operation went well. Qin Lang has this problem. Once he thinks of a new technique I will be immersed in it, and I will often make assertions, even I can do nothing. I just didn't mean to ignore your explanation, and if I offend you, I ask you to forgive the young man for being ignorant. "
When Director Huang saw Professor Yang in a good mood at the moment, he apologized for Qin Lang's reckless operation before. After all, the college will have to cooperate deeply with Professor Yang later, so there can be no future troubles.
"Wherever you speak, where you speak. Physician Qin's professionalism is worth learning from me. When I was his age, how could I dare to calm down and come up with my own improvement plan when my senior proposed an operation plan. ."
Professor Yang looked at the talented Qin Lang again.
"Director Huang, to be honest, I envy you for having such a talented doctor in your department."
Professor Yang looked at Qin Lang who was doing the finishing touches and praised.
Wang Xiaoying, who was on the side, suddenly became sour for some reason. Looking at Qin Lang, her whole face collapsed.
She has been with Professor Yang for so many years, and the praise she has heard is not as much as that of Qin Lang's operation.
Ten minutes later, the operation was completed perfectly.
"It's really not enough! Director Huang~www.novelbuddy.com~ Dr. Qin's operation video can I take it back later, so that the colleagues of *** can learn from it."
Professor Yang naturally knew that the significance of this operation, whether it was the groundbreaking biventricular correction surgery or Qin Lang's own operation techniques, were all excellent.
"certainly."
The operation was completed soon.
…
…
When Professor Yang and Director Huang just walked out of the operating room, Professor Yang's cell phone rang, and when they took it out, they turned out to be his attending physician again.
Professor Yang's face changed. Could it be that there was an accident in that operation?
Immediately connected to the phone, he asked, "The operation didn't go well?"
"Oh, no, Professor Yang, I called because Director Ling decided not to use single ventricle correction surgery, but to use the latest domestic "one and a half" ventricle correction surgery."
"A semi-ventricular correction?"
Professor Yang was obviously stunned, what kind of new technique is this:
"Director Ling, which expert did you learn from? Why haven't I heard of it?"
PS: Two-in-one, oops, what a surprise. For the random danger, the boss has a good waist and a good kidney!
