The diagnosis of coronary artery stenosis or occlusion in Kawasaki disease relies on coronary angiography. The information obtained by cardiac auscultation is very limited, but physical examination is a must and cannot be missing in any case.
Because only medical history and physical examination allow doctors to directly contact patients and obtain information directly from patients, it has an irreplaceable status. Sometimes it can discover information that cannot be discovered by various instruments and equipment.
The child had been a little noisy just now, and the mother had been holding it in her arms to comfort her. Now the doctor came over for a physical examination. She reluctantly put the child on the bed, then untied the child's clothes and auscultated Yang Ping's heart.
The little guy immediately stopped crying, blinked at Yang Ping, and then smiled at Yang Ping. The child's father, who had wanted to say something, immediately gave up his thoughts and was infected by this invisible atmosphere.
Yang Ping not only auscultated the heart, but also conducted some other detailed physical examinations. During the physical examination, it was inevitable that the baby would be turned around and put into various postures to facilitate the physical examination. The doctors onlookers were silent and kept staring.
Follow every detail of Yang Ping's physical examination.
Maybe the master's physical examination is different from others, everyone thinks so.
Sure enough, the great master's physical examination was different. Several doctors present had examined the little guy. When they did the physical examination, the little guy cried loudly and kicked his limbs everywhere.
During a doctor's physical examination, the little boy filled his diaper with stool in order to express strong protest. The smell hit his face, and the doctor had to give up the physical examination.
However, no matter how Professor Yang manipulated the little guy during the physical examination, he lay motionless on the bed and cooperated to the best of his ability. Not only did he not cry, he also kept smiling at Professor Yang, and his smile was so sweet.
The baby's parents were also very surprised. Today was really strange. Not to mention these intern doctors, even Professor Wen came to listen to the heart. This little guy was also crying and fussy, with no intention of cooperating. He was so well-behaved today. This intern doctor
What kind of magic was cast?
The baby's parents couldn't help but feel a little better about this "fake professor".
"Thank you for your cooperation!"
After Yang Ping finished the examination, he made a face at the baby. The little one giggled with joy. Yang Ping put away the stethoscope, neatly put on the little one's clothes, then picked him up and handed it to his mother.
Then Yang Ping asked some medical history. After asking, Yang Ping said to Dr. Chu:
"Let's go to the doctor's office."
The baby's parents were still immersed in their child's joy. Suddenly the physical examination ended. They were still a little uncomfortable. All the doctors had evacuated the ward. The baby was still giggling in their arms. They were a little confused. This professor had just examined him.
They observed from the sidelines that the professor was pretending to be presentable and had more aura than the real professor. The couple also laughed unconsciously. Today's students are top notch in pretentiousness.
But I also understand that doctors always have a process of growth. If no one is willing to cooperate with teaching, how can these young doctors go from novices to experienced doctors.
The baby's mother said: "In the past few times, whether it was Professor Wen or the intern doctor who came for a physical examination, my son was crying and fussing. Today, when the intern doctor came to listen to his heart, he actually didn't cry or fuss, and even smiled at the doctor."
"This intern doctor is interesting. He's pretending to be something like that. If his appearance hadn't revealed some flaws, I would have thought he was a great professor. If you don't know his aura, you'd think he was some world-class professor."
The baby's father said with a smile that under the aura of the "fake professor" just now, he just stayed silent and did not dare to express any dissatisfaction, which meant that he was also infected.
The baby's mother held the baby in her arms and said, "Look, my son is still smiling. It's interesting. This doctor has magic power. He can do whatever he wants, but the little guy doesn't have any objection at all, and he still giggles."
Back in the doctor's office, Dr. Chu pulled up the child's coronary angiography pictures. Everyone gathered around the computer to study the child's condition. Song Yun handed Yang Ping a pencil. He knew it would be better if the professor had a pencil in his hand.
The opening of the left anterior descending coronary artery has been completely occluded, and the blood supply to the heart is maintained by the collateral vessels of the other two coronary arteries. The diameter of the collateral circulation is also very narrow. This is extremely dangerous, and sudden death may occur at any time due to cardiac ischemia asystole.
Therefore, coronary artery bypass grafting is the only option.
Nowadays, medical science is advanced. If we put it in the past, this kind of case would be hopeless, and the child would die suddenly due to acute myocardial infarction soon.
"Modu Children's Medical Center is the best one in China that does coronary artery bypass grafting. However, they only have experience in more than ten cases. The youngest age recorded is 14 months. They also lack experience in coronary artery bypass grafting at one month old.
The caliber is too thin and the technical requirements for non-stop vascular anastomosis are too high. The difficulty lies not in theory but in surgical operation."
This is Dr. Chu's patient, and Dr. Chu is naturally very familiar with it.
"The biggest difference between children's heart bypass grafting and adults' is that the diameter of blood vessels is too small. For a one-month-old baby, it is only about 1 millimeter."
Song Yun said from the side.
Then the doctors around me also became active. Everyone said something to me and actively participated in the discussion.
''If you are too young, you should use non-stop beating technology. In this case, it will be more difficult to anastomose such a thin blood vessel to the beating heart."
''That's why Director Wen asked Yang Ping to perform the surgery together. He knew that Professor Yang had a very deep foundation in microsurgery."
“What is used to bypass blood vessels?”
"Internal mammary artery, right?"
"The heart is beating all the time, so how can we anastomose the blood vessels?"
"This requires professional training, just like shooting with a moving target. Your muzzle must follow the moving target, and you must be able to accurately predict the advance."
Any surgical operation is composed of countless basic skills. The single technique of vascular anastomosis can be used in many operations, such as organ transplantation, coronary artery bypass grafting, etc. These operations all require vascular anastomosis technology.
While everyone was still discussing the case, Director Wen came back from the operating room in a hurry. He didn't even change his washing clothes. He was wearing a white coat and a pair of slippers.
His surgery had been scheduled until after ten o'clock in the evening. When he heard that Yang Ping was coming to the department to see the 12-bed patient, he took advantage of the time between the two surgeries to come down and say hello.
"Professor Yang, I have a lot of surgeries today, so I'm sorry that I didn't accompany you." Director Wen shook hands with Yang Ping.
We are all doctors, how could we care about this? Yang Ping said: "Director Wen, why don't you come down in person? Go and do your work quickly. Don't worry about mine. I'll just come over and take a look myself."
"Xiao Chu, I have some tea in my office. Let me make tea for Professor Yang to drink."
Director Wen took out the key and handed it to Dr. Chu, then sat down and pointed at the picture on the electronic reader.
"You see, the opening of the left anterior descending artery has been completely occluded. We can only rely on the collateral vessels of the other two coronary arteries to barely maintain the blood supply to the heart. If we don't perform surgery quickly, we may die suddenly at any time. I originally asked my colleagues in Shanghai to help, but they didn't do it.
My experience in this regard is that the child was born prematurely and I don’t know if the blood vessels are 1 mm long. I met Professor Liang a few days ago and when talking about this case, Professor Liang said, you should ask Yang Ping, our distinguished professor of orthopedics, he can anastomose the blood vessels.
The technology is top-notch. It doesn’t matter whether you have coronary artery disease or not. Just go to him. Director Zuo said that Academician Wang from Fuwai is very familiar with you. You have also done a lot of coronary artery bypass grafting in 301. This greatly increased my confidence. It was just right.
It is fate that you are in Xiehe these days."
"Professor Yang, I quite believe in medical fate."
Director Wen is eloquent and very eloquent.
"Yes, the sooner the surgery, the better. Arrange the surgery as soon as possible. I can help you at any time these days." Yang Ping said.
Director Wen turned to Dr. Chu, who had just gotten the tea leaves and was making tea.
"Xiao Chu, the preoperative examination must be completed today and tomorrow. Is there any problem with the surgery the day after tomorrow?"
Dr. Chu said while making tea: "No problem."
Director Wen didn't know Yang Ping's surgery schedule these days, so inviting him to operate so suddenly might disrupt their department's surgery schedule.
"You won't have many surgeries the day after tomorrow, right?" Director Wen asked with concern.
Song Yun took over: "About a dozen."
More than a dozen? Then how do you have time to help with our surgeries? Director Wen immediately frowned, thinking that this completely disrupted Professor Yang's plan. He has more than a dozen surgeries.
"Oh, what should we do? How about putting this operation at night?" Director Wen said helplessly.
Yang Ping knew Director Wen's worries and reassured him: "It's okay. Your surgery won't take up much of my time. It's just a few bridges. It only takes a few minutes. You don't have to wait until night."
I'll go! You can talk about this kind of bridge building for a few minutes, and it will be as easy as a child playing house.
Director Wen took a cup of tea from Dr. Chu and just took a sip. Hearing Yang Ping's words, he almost burst out: "Xiao Chu, why is your tea so hot? Is it boiling water?"
Dr. Chu was confused. Could it be that tea should be made with warm water instead of boiling water? Director Wen reached out and flicked a few tiny water droplets on his pants and handed the cup to Dr. Chu.
Other doctors were also frightened by Yang Ping's words and looked at each other, hoping that someone could give an explanation. Is this a boast or true?
Even for an adult's coronary artery bypass grafting, it can't take several minutes if there are several bridges. For this kind of infant's coronary artery bypass grafting, you can actually say it only takes a few minutes.
"Professor Yang? How many minutes can it take you to complete this kind of bridge building?" Director Wen asked based on the principle of seeking truth from facts.
Yang Ping answered matter-of-factly: "Yes, it won't waste much time, it will only take a few minutes."
Yang Ping answered this to reassure Director Wen that the operation could be arranged as he pleased without considering the time limit. However, after hearing this, Director Wen gulped. The young man was so domineering. He wanted to see how the operation could be completed in just a few minutes.
, a few minutes, that’s too exaggerated.
Originally, I wanted to chat with Yang Ping for a few more words, but the operating room called Director Wen to remind him that the operation had already started and the surgeon was waiting for him to come on stage.
"Xiao Chu, please communicate with the anesthesiology department in advance about the 12-bed bed that will be the first one the day after tomorrow, and ask them to try their best to come and see the patient today."
Director Wen hurriedly explained a few words, then shook hands with Yang Ping and said goodbye.
How many minutes?
This question is still buzzing in the minds of many doctors. This is Concorde. Master, are these few minutes of yours real? Are your timing standards the same as ours?
Men always exaggerate when announcing certain numbers, but they always report them to higher places. This reporting method is obviously not in line with the mainstream.
Until the crowd dispersed, everyone was still thinking about this simple and complex problem.
In the evening, in order to test how good he was at peeling lobsters with chopsticks, Song Yun took Yang Ping to eat lobsters with everyone.
Of course it was Lu Xiaobao's treat, because the shop owner has become Lu Xiaobao's prospective father-in-law.
When the owner of the lobster shop saw that the doctor from Union Medical College was here again, he was very happy. Especially Dr. Lu Xiaobao, who was in the team and had not learned the skill of peeling lobsters, actually fell in love with the boss's daughter.
The boss has always wanted to find a son-in-law from Xiehe. It seems that this matter has been settled. The boss’s daughter is a graduate student at Capital Medical University. She is currently in the second year of graduate school. She will come to the store to help when she has time, so these doctors from Xiehe all know each other.
.
Lu Xiaobao had already made an agreement with the shop owner in advance, and the shop owner had already reserved the best table.
"Lu Xiaobao, why don't you go help? Your father-in-law and mother-in-law are so busy."
As soon as everyone sat down, Song Yun made fun of Lu Xiaobao.
Lu Xiaobao really rolled up his sleeves and was about to help, but his "father-in-law" stopped him: "Go and eat with the staff. Remember to bring something back before you leave."
My father-in-law prepared good things to replenish my health. Despite the hard work of being a doctor, my father-in-law was still very considerate.
There are several waiters in the store, and my father-in-law only walks around. If the waiters are too busy, he will help himself. My mother-in-law stands at the service desk and is responsible for paying the bill.
When I heard that Yang Shenjia had arrived, Lu Xiaobao's girlfriend, the shop owner's daughter, must rush over from school to meet the legendary CNS Emperor.
Lu Xiaobao patted his chest and said, "That's not easy. Yang Shen is my brother and my good buddy. I will take him directly to the store to eat lobster."
My girlfriend thought Lu Xiaobao was joking, but she didn't expect it to be true.
She came over as a waiter to help with ordering. Lu Xiaobao shrank his head shyly, and Song Yun said: "Why don't you do this? I'm afraid of being like this. What will I do in the future?"
"Yes, my ancestors in the Lu family are henpecked." Lu Xiaobao defended, which made the eldest girl's face turn red instantly.
After the girl left, Kong Weiquan said: "Lu Xiaobao, I suspect you are pursuing her because you want to eat lobster for free?"
Soon, the lobsters and various side dishes were served, and everyone found that the waiters serving the dishes were all girls, and except for Lu Xiaobao's girlfriend, the others were all unskilled. It was their first day on the job.
"These waiters are all my classmates, which one is Yang Shen?"
The girlfriend pulled Lu Xiaobao aside.
No way, you don’t know who the idol you admire is? Lu Xiaobao secretly pointed at Yang Ping, and his girlfriend nodded: "I guess so, tell him later, we want to take a photo with him and post it on WeChat Moments."
