Zhou Congwen was on the road to consultation.

He strided heavily, holding his cell phone while talking.

"Director Deng, if the boss wants to do it, then do it. I have confidence in the boss." Zhou Congwen said seriously.

"Xiao Zhou, the boss has just simulated the new technique and has not actually operated it yet." Deng Ming emphasized.

"What's the matter? One or two tests in 912 were also surgery. I went to the Didu Cardiovascular Hospital and had surgery, and there were more people watching the surgery."

"..." Deng Ming really wanted to carry Zhou Congwen's head through the phone and yelled at his ears - what if the boss fails the operation!

The boss doesn’t care, shouldn’t the students in front of him care?

"It's okay if the surgery fails. We are doctors in cardiac surgery." Zhou Congwen seemed to hear Deng Ming's "scream", and then said, "If the new surgical attempt fails, then use the classic Crush technology to solve the problem. If the heart ruptures, then open the chest and suture it directly."

“We are cardiac surgeons, and the range of options is always a little larger.”

"What should I do if my boss's reputation!" Deng Ming almost roared.

"The boss doesn't care." Zhou Congwen said, "Director Deng, what do you mean by the boss?"

Deng Ming's mouth was bitter, "You can take your time with the new technique."

"The boss is old. After this improved crush surgery, you can go on stage without wearing lead clothes. Speaking of this, I want to criticize you Director Deng." Zhou Congwen said lightly.

Deng Ming had countless misunderstandings about the similarities between his junior brother and his boss.

Criticize yourself?

From what angle does Zhou Congwen criticize himself?

"The boss is so old, and you have to wear lead clothes for surgery. You should have taken it over long ago." Zhou Congwen's voice floated over, "But what age is this? It's our fault for making an eighty-year-old man wear lead clothes for surgery. "

"My...level..." Deng Ming concluded.

Although Zhou Congwen's words were a little bit unreasonable, Deng Ming sounded a different sound.

Compared with Zhou Congwen, he looks like a junior brother, and he is the eldest brother.

"Don't worry, Director Deng." Zhou Congwen said, "With me here, what you are worried about will not happen."

“…”

"I will have eighteen laparoscopic surgery tomorrow or the next day. After that, I will fly to the imperial capital." Zhou Congwen said, "Let's meet and talk."

"Okay, I'll pick you up then." Deng Ming no longer insisted.

Although he saw the boss give a simple and simple demonstration and understood the principle of the new technique founded by the boss, he was just worried.

But both the boss and Zhou Congwen insisted, and they seemed to not care that they would be embarrassed when they failed the operation... Alas, Deng Ming sighed deeply when he thought of this.

One is that the old horse knows the way, and the other is that the newborn calf is not afraid of tigers, I hope it can do it.

After hanging up the phone, Zhou Congwen quickly came to the circulation department.

"Xiao Zhou, you are here." Teng Fei was a little happy when she saw Zhou Congwen strode in.

"What patient, Director Fuji." Zhou Congwen got to the point directly.

"A patient who was involved in interventional surgery had all had the coronary artery activate, but the patient's vital signs were unstable and there was also precordial pain."

"I'll look at the medical records." Zhou Congwendao.

Zhang You stood aside with his big teeth bared. Seeing Zhou Congwen coming, he felt a little unhappy, but he still smiled, "Now our hospital is getting more and more people. I'll go to the surgery to check for the missing and make up for the leaks. Xiao Zhou, you are the chief surgery, and I'll be your assistant."

This is nothing wrong with saying it, but the subtle sarcasm made Tengfei very unhappy.

Zhang You is like this. Although he always comes to consult him and does surgery, he always grasps the problem of interventional surgery from time to time and makes people feel sarcastic, which makes people very unhappy.

Zhou Congwen glanced at Zhang You and gave him a smile.

Are you talking about trash? Zhang You’s level is far inferior to himself.

In his previous life, he emerged from Jianghai City Third Hospital to the second year of medical school to 912. Mayo and Cleveland were slandering their opponents all the way.

However, when he came back from rebirth, Zhou Congwen felt that he was much more stable and he was very satisfied.

While he looked at the test form in the medical record, Teng Fei introduced the patient's condition.

The patient was 79 years old. He was admitted to the hospital for 2 years due to repeated chest tightness and palpitations, which was aggravated for 1 week. He had a history of hypertension for 3 years and denied his history of diabetes.

Coronary angiography was performed on the 9th day after admission, and the 6F sheath was inserted through the right femoral artery and sent to the J14 angiography catheter from the guide wire. The patient was severely distorted inside the iliac and the abdominal aorta, and the angiography catheter was not allowed to go up with the guide wire when it was sent to the descending aorta.

So, Johnson & Johnson's 25cm arterial sheath was used instead, and the guide wire was first sent to the R3.5 angiography catheter for right coronary angiography, and then sent to the angiography catheter for left coronary angiography.

When the angiography catheter bounces into the left coronary artery opening, the pressure is measured at 120/70mmHg.

The position of the C-arm metroscopic tube of digital subtraction angiography was adjusted. After injection of contrast agent, the proximal end of the anterior descending branch was completely blocked. The patient complained of chest pain. He was observed to have pale complexion, sweat profusely, expression was indifferent, and reaction was slow.

At that time, the electrocardiogram showed that the heart rate was 90/min, atrial fibrillation, and the ST segment of lead V1~V6 was elevated in the arch-shaped shape, indicating acute anterior wall myocardial infarction.

Immediately injected dopamine and epinephrine. After 5 minutes, the intraarterial pressure was measured at 170/90mmHg and the heart rate was 150/min. It was still atrial fibrillation. Nitroglycerin was injected into the coronary artery, nifedipine was taken sublingually, and nitroglycerin was injected intravenously.

The patient's symptoms were relieved in 10 minutes, and the intra-arterial blood pressure was measured at 140/80mmHg and the heart rate was 110/min. The sinus rhythm was not restored.

Coronary angiography showed that the coronary artery with proximal occlusion in the anterior descending branch had completely expanded and TIMI blood flow level 3. He was sent back to the ward and his vital signs were stable. 4.5 hours later, the patient complained of chest tightness, palpitations, sweating profusely, and pain in the right middle abdomen.

After Teng Fei reported her medical history, Zhou Congwen also read the medical record.

Although there were some troubles during the operation, it was not a big deal. The coronary artery was opened, TIMI blood flow level 3, and the operation was successful.

"What do you say about the U.S.A.?" Zhou Congwen asked.

"Considered is pancreatitis."

"No." Zhou Congwen said with certainty, "Hemoglobin progressively decreases, combined with the intraoperative situation, I consider pancreatitis and appendicitis that are not caused by surgical stress."

“That’s…”

"It must be that there is a problem with coronary artery opening. The pain in the precordial area of ​​the patient said everything." Zhang You interrupted, "I suggest conservative first. If it doesn't work, tell the patient's family to prepare to open the chest."

As he said that, he glanced at Tengfei.

"This is how interventional surgery is, it is activated during the operation and then blocked. It's better to have bypass surgery at the beginning."

Tengfei's mentality is a bit broken.

The patient's surgery is extremely difficult, at least for Tengfei. She performed well and took the surgery down, and the intraoperative test effect was quite good.

But the pre-heart pain in the patient's pre-heart area after the operation, how could Tengfei have a good mentality?

At this time, Zhang You always said that interventional surgery is not as good as heart-bypass, like a mosquito, buzzing around in his ears, which is really upset.

It would be great if I could still cooperate with Chen Houkun. Tengfei missed the past.

"Director Zhang, you're out of sight." Zhou Congwen said lightly, "There should be no problem with the blood supply of the heart. I highly suspect that it is a ruptured renal artery."

"..." Tengfei was stunned.

"..." Zhang You was also stunned.

Renal artery, how big a blood vessel is that! Although the continuous decline in hemoglobin may be caused by bleeding, it should not be from the renal artery.

Although he doubted it, Zhang You dared not question Zhou Congwen casually. He had been beaten for a long time, and Zhang You was not cheap.

Let’s wait and see. If Zhou Congwen’s diagnosis is wrong, he will be scolded at that time, and Zhang You will sneer in his heart.

"If you have a CT scan of the abdominal area, if you have a retroperitoneal hematoma, it will prove that my judgment is fine." Zhou Congwen said.

Tengfei scratched her head a little.

She originally thought that the patient might have a stubborn myocardial infarction, or she had some unknown disease that caused the patient to still have symptoms of myocardial infarction after the coronary blood vessels were opened.

But Zhou Congwen said that it has nothing to do with myocardial infarction, it is a renal artery rupture and retroperitoneal hematoma.

Is there any problem with the operation of your own surgery?

There are some complications, but Tengfei has never encountered them.

What is written in the book, what is listened to by your ears and experience it yourself are definitely two different concepts.

Tengfei hesitated for a moment, and at this time Zhou Congwen said, "Give a doctor's advice, let's take the patient to check for CT, bring the rescue medicine with you, check it before leaving, and don't lose myrrh in the hands of the CT patient with problems."

"Xiao Zhou, it shouldn't be possible that you thought." Tengfei said hesitantly.

"Look at it, the relevant examinations need to be done. If not, let's consider it from another perspective." Zhou Congwen did not insist and said a very ambiguous, professional doctoral words.

"Xiao Zhou, have you seen a similar situation? Patients still have corresponding symptoms after coronary vascular opening?" Zhang You asked.

"See." Zhou Congwen said, "But the patient in front of him is not."

“…”

"In renal artery stenosis percutaneous angioplasty, the incidence of iatrogenic perrenal injury is between 6.5% and 22.8%, and the most common reason is the perforation of renal artery at the distal end of the guidewire. I considered that during the operation, the renal artery was too tortuous, and the guidewire penetrated the blood vessels and a hematoma appeared."

Without objective auxiliary examination, everything is guessed. Tengfei had no choice but to take the patient to do the examination.

Just like Zhou Congwen's "guessment", the patient found a hematoma in the peritoneum afterwards.

The patient's blood pressure decreased after the operation and the cause of persistent chest pain was found - the renal artery was pierced.

Looking at CT, Tengfei was helpless.

I was already very careful in my operation, but there was still a problem in the end.
To be continued...