Only answers from such pragmatic medical students can make seniors feel the dangers coming from behind. Sometimes, it only takes a few years to be surpassed by juniors.
Dr. Cheng Yuchen looked serious and asked her: "Have you ever had chest closed drainage surgery?"
Thoracic closed drainage is a secondary surgery, a minor surgery that can be performed by daily residents. It can be said to be difficult or simple. In clinical practice, there are usually two methods for this surgery.
One method is a very traditional one, which requires local anesthesia and a scalpel to cut the skin and muscles between the ribs. Finally, a hole is made in the patient's chest with curved forceps, and the drainage tube is inserted and sutured to fix it.
Another method is to use a trocar to directly penetrate the drainage tube through the skin without incision.
Last year, when she was participating in the emergency rescue of car accident patients as a trainee, she had a chance to perform a thoracentesis to help decompress patients with tension pneumothorax. When she arrived at the Department of Respiratory Medicine, she assisted Teacher Xin in performing a pleural effusion puncture. In fact, she did it
Puncture and then connecting a drainage bottle is almost the second method of thoracentesis and drainage just mentioned.
In addition to this, Xie Wanying has performed many other clinical puncture procedures, including subclavian vein puncture.
The focus of various clinical puncture surgeries is to master the accurate anatomy and keep the operating procedures in mind, which is far less complicated than surgery. However, since puncture surgery is classified as a second-level surgery and not the simplest first-level surgery, in order to fully explain its risks.
If the puncture is performed incorrectly, serious complications such as massive bleeding may occur.
Dr. Cheng Yuchen asked her if she had done it, and her tone was quite questioning. Apparently she thought that she, a medical student who might not have done such an operation before, might be talking on paper.
You know that there are two puncture methods, so do you know which puncture method is suitable for this patient?
The first method, which used to be called thoracostomy, involves making an opening. It is very similar to the situation where a tube is left at the end during a thoracotomy. The tube is very thick. The advantage of a thick drainage tube is that it is not easy for drainage to block the tube, which is very
It is suitable for patients with complex conditions such as empyema and hemopneumothorax.
The shortcomings are also obvious. To open the patient's chest, the length of the cut is up to two to three centimeters, and the patient will always be in pain. This will bring a relatively traumatic operation to the patient, and the patient will not like it.
For the second method, the puncture needle usually used clinically is a central venous catheter needle. The needle is small, and the drainage tube introduced is thinner and softer, which brings extraordinary comfort to the patient. In comparison, the tube is thin and soft and is easy to be drained.
Blockage, not suitable for patients with complex drainage.
Also, there is a difference between simple puncture and leaving a tube for drainage, otherwise there would be no choice between puncture or leaving a tube.
Applying it to specific clinical cases, let’s summarize it in simpler terms: The reason for leaving a tube is because simple puncture cannot allow lung recruitment. For example, the young man who was rescued last time went back to the hospital and had to be drained again.
The visceral membrane tear always exists, and pneumothorax will soon occur again, causing difficulty in breathing.
The patient in the Department of Respiratory Medicine is no longer a patient. He has encapsulated pleural effusion. The purpose of clinical extraction of pleural effusion is to confirm the diagnosis of infection. The degree of difficulty in breathing does not need to require long-term tube retention. More importantly, it is to deal with the source of infection.
It can be seen that the clinical treatment measures are very subdivided, and it is not like the laymen think that the surgeries are almost the same.