On this day, it was Zhang Lin's turn to work the night shift.
"In the evening, we work night shift. Come here early to have a rest. We're afraid there will be more emergency rooms at night." Zhang Lin said with a concerned tone.
Take over at 5:30 pm.
Yang Ping came over at four o'clock and ate a bowl of Lanzhou Ramen with beef and fried eggs. He was full and brought a bucket of instant noodles over for later use.
It was about nine o'clock when nothing happened, so Zhang Lin took Yang Ping to inspect the rooms.
"Doctor Zhang, you are bringing a new intern." The nurse on duty greeted him. The guy was lying on the marble table of the nurse's station, flirting with the nurse.
Yang Ping looks a bit young. He has been working for several years and is always considered a freshly graduated intern.
"Where, where, Dr. Yang is new and is not familiar with the environment. For the time being, we will be on duty together." Zhang Lin emphasized that we would be on duty together. How could he dare to admit that he was taking care of Yang Ping?
"My treat! I'm on duty today!" The nurse smiled.
"Hi tea? How many cups?" Zhang Lin was happier today.
"There are four of us, two on duty and two practice nurses." The nurse counted the number of people.
Sometimes when on duty, the doctor on duty would ask the nurses to drink some drinks and ask them to ring the bell to wake you up if the patient sneezes. This is also considered on-duty culture.
"Dr. Yang, what kind of food do you like?" Zhang Lin said flatteringly.
Yang Ping was a newcomer and felt that he should treat the guests himself: "Doctor Zhang, I'd rather treat everyone to a meal. You can order whatever you want."
"No, no! How can I let you spend money? I'll choose for you." Zhang Lin took out his mobile phone and started ordering takeout from Meituan.
"Dr. Zhang, you are very generous today." The nurse laughed at him. She has never seen him so generous and cheerful. Every time he laughed at him, it was either because he didn't have enough change on WeChat or next time. In fact, it was his girlfriend who had strict discipline and had no room to pay in order to save money.
It is inevitable to make a down payment and save money on food and clothing.
The hi tea was delivered, and everyone sat down to rest, drink hi tea, and chat.
"Tonight is definitely Christmas Eve!" A trainee nurse smiled while drinking tea.
"Pi Pi Pi, crow's mouth!" Zhang Lin stamped his feet anxiously and pretended to spit on the ground.
There is a rule among doctors, that is, you cannot make false claims. For example: none of the operations I performed were infected; I will definitely not admit a single patient on duty today; the patients in my care will not cause disputes--
Legend, if you say so. No? Then I will show you one right away.
This kind of talk is taboo. Anyone who dares to talk like this is either a newcomer or has no idea.
"Why did the teacher teach me that he didn't even teach the basic rules?" Zhang Lin squinted his eyes and glared at the senior nurse.
The senior nurse immediately said: "Okay, okay, I'll give you some severed fingers and replant them today. Is that okay?"
The replantation surgery of severed fingers takes a long time and is very laborious. Most doctors on duty are afraid to accept such patients.
After drinking the tea, they were safe for the time being. Zhang Lin and Yang Ping chatted at the nurse station. Zhang Lin knew all the gossip about the hospital.
We were chatting vigorously when the phone at the nurse's station rang. Everyone, look at me and I look at you. It can't be so magical. The senior nurse picked up the phone and said, "Hello, I'm from the orthopedics department. I'm here for emergency consultation. What kind of patient is this? He has a broken finger."
?”
Damn it! Zhang Lin’s eyes are spitting fire.
The nurse gently put down the phone: "No way, did you hear? Emergency department, consultation, broken finger!"
Zhang Lin suppressed the roaring anger, stood up, and gently patted the little nurse on the shoulder: "I've convinced you."
Then he said to Yang Ping: "I'll go down and take a look. Wait for the news. Maybe it's an open phalanx fracture, which means it's a severed finger."
This kind of broken finger is divided into complete separation and incomplete separation. Complete separation means that it is broken into two or more sections, and each section is completely separated without any connection.
Incomplete disconnection, usually more than three-quarters of the fracture is severed. If the blood vessels are not anastomosed, the finger cannot survive.
Sometimes the emergency department may misjudge incomplete finger separation in the rush, which is also possible.
Many fingers are broken, but the main blood supply blood vessels are still there, and if the blood vessels are not anastomotic, the fingers can survive. This is generally classified as an "open phalangeal fracture."
Zhang Lin straightened his hair and got into the emergency elevator.
Ten minutes later, Zhang Lin's call came.
"A real broken finger, right thumb, broken by a cutting machine, broken into three sections, ready for emergency surgery."
Dr. Guo, the chief resident physician, was still busy with a major surgery on the stage and could not get off the stage for a few hours. Besides, Dr. Guo basically passed the test when replanting his severed finger, and his skills were not very good.
Chief resident is not a professional title, but a doctor's position. Generally, residents must serve as chief resident for one year before being promoted to attending physician. The purpose is to bear a larger workload before being promoted to attending physician, so as to be trained under high-intensity work pressure.
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Therefore, this position is the most difficult position in the inpatient ward. It is available year-round, 24 hours a day in the ward or near the hospital, and is available on call.
There were three people who did the best job of replanting Corey's severed finger, Director Han, Director Tian, and Song Zimo. Others who knew how to do it were not as good as them. Director Han and Song Zimo all went to the meeting, and only Director Tian was left.
Director Tian is on the second line, but there is something urgent at home. He has to go to the city and report to Director Han. He will go to the general shift office to file a record and ask Lao Jin to help with the second line. Lao Jin is on the operating table and asks Zhang Lin to debridement first. Director Tian is very happy.
You'll be back soon.
Zhang Lin called Director Tian again, and Director Tian said that it would be best to wait for him to come back to do this kind of three-section work. He was on the way and put the severed finger in the refrigerator. It would not be a big problem if he waited for a while.
The little nurse burst into tears, her innocent eyes seeming to say: "It's not my fault!"
Yang Ping hung up the phone, and another photo came on WeChat. The thumb was cut into three sections, which was too horrible to look at. The two free sections were spread one by one on the white gauze, which looked particularly dazzling.
"I just called Director Tian. He said to arrange the operation first. He is on his way over." Zhang Lin said, "Dr. Yang, please go directly to the operating room. Blood draws, electrocardiogram, and preoperative examinations have been done in the emergency department.
I am just talking and signing, and will go to the operating room immediately."
This kind of emergency surgery can generally be done through the green channel, and there is no need to be hospitalized before the surgery. In order to save time, pre-operative preparations are done in the emergency department, the conversation and signing are completed, and then sent directly to the operating room for the surgery, and then admitted to the ward after the surgery.
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Yang Ping asked a medical examiner to look at the ward, and then went to the ward to check on a few seriously ill patients to make sure they were not in danger. He took the emergency elevator and went directly to the operating room, where he changed into slippers, hand-washing clothes, and put on a mask and hat.
The operating room was brightly lit, and Lao Jin and Mr. Guo were busy doing caesarean sections in the obstetrics and gynecology department, appendicitis in the general surgery department, hemopneumothorax in the thoracic surgery department, and craniotomy in the neurosurgery department.
The automatic door opened, but the patient hadn't arrived yet. Yang Ping was waiting in the operating room, and the circulating nurse was already preparing surgical instruments.
About ten minutes later, the nurse pushed the patient in, and Zhang Lin also changed his clothes and came in.
The small refrigerator where the severed finger was kept was placed on an equipment cart. Yang Ping opened it and saw that the broken finger was not even.
"Where's Director Tian, hasn't he come yet?" the circulating nurse asked Zhang Lin a little anxiously, her voice a little unfriendly.
Zhang Lin felt that it was embarrassing for the nurse to talk to him like this, so he said angrily: "Rinse first!"
The superior doctor is not on the first-line shift, but only on the second-line shift. If there is an emergency operation, the doctor below will first disinfect the sheets and then slowly lay the groundwork. This is a routine process.
The brachial plexus block anesthesia went smoothly. Yang Ping helped lift his hand. Zhang Lin put on gloves and began to rinse the wound on his hand and the severed finger. Normal saline, hydrogen peroxide, normal saline, and type III amriodine were rinsed for two days in this order.
all over.
"Doctor Yang? I raise my hand, you go and wash your hands?" Zhang Lin asked Yang Ping to wash his hands. This is a courtesy.
Yang Ping had just arrived and was not very familiar with the operating room: "I raise my hand, you can go ahead, it's okay."
The instrument nurse has washed her hands and dressed. The sterile instrument table has been laid out. The instruments are placed on the table one by one. A pair of dexterous hands are constantly playing with them. Soon, the instruments are divided into several areas, and the commonly used ones are placed in the most convenient areas.
place.
After Zhang Lin washed and disinfected his hands, he laid out the sheets with the instrument nurse, disinfected his hands again, put on surgical gown, and asked Yang Ping to wash his hands as well and come on stage to help.
The two of them had prepared everything. They put on surgical gowns and sat face to face. Director Tian hadn't come yet.
Debridement, let’s debridement first.
Zhang Lin's expression was a little unnatural, and the confidence he pretended at the beginning was compromised.
Rinse - debridement - rinse again!
One point zero Kirschner wire, electric drill!
With the rustling sound of a micro electric drill, the two broken ends of the bones were fixed with crossed Kirschner wires.
The microscope was brought in and adjusted. With eyes facing the eyepiece, adjustments were started. The focal length and interpupillary distance were adjusted. After adjusting, the field of view was finally clear.
Fix the patient's hand to prevent it from moving around and affecting the surgical operation. The preparations are complete, and the only remaining step is to find the blood vessels and anastomose them.
Zhang Lin could only do a simple microscopic operation, kissing the blood vessels, but that didn't work. So he didn't dare to continue. The three-legged cat's microscopic skills could not open the blood even if he barely connected the blood vessels.
After waiting for a while, Zhang Lin couldn't wait like this. He picked up the microscope tweezers and scissors and tried to find blood vessels. His hands were shaking a little.
"Brother, are you okay?" Yang Ping asked gently.
I originally wanted to show off, but I didn't know that my hands were not in control. I immediately put down the microscope tweezers and scissors and said, "Let's wait for Director Tian."
"It's been almost half an hour, why hasn't it come yet?" the traveling nurse whispered in Zhang Lin's ear.
"Urge!" Zhang Lin also lowered his voice.
The anesthesia is a brachial plexus block, not a general anesthesia. Only one arm is anesthetized. The patient cannot be heard when talking or making phone calls, lest he become worried or anxious.
The circulating nurse ran out to make a phone call again. A few minutes later, she came in dejectedly, shook her head and whispered: "There is a traffic jam in the city. Even if the traffic is opened immediately, it will take several hours."
"What should we do?" the circulating nurse asked.
"Wait, just wait on the stage, it should be soon! If it can't be done, call Lao Jin over." Zhang Lin also wanted to think of countermeasures.
But he was afraid that the patient would be anxious after hearing it, so he asked the anesthesiologist to put the patient to sleep.
Yang Ping tried to say: "If you wait any longer, you are afraid of delaying your condition, can I do it?"
"Have you had your severed finger replanted?"
Yang Ping said calmly: I did!
"Is it much?"
"Not many, maybe a few hundred!"
There are hundreds of units. I and I didn’t even look at hundreds of units. You made a few hundred units. Isn’t that much?
"You try it!" It doesn't hurt to give it a try, Zhang Lin agreed.
Under the microscope, the adventitia of a blood vessel has been trimmed and is being anastomotic. The operation is very skillful.
