Zheng Ren and Lin Ge arrived at the cardiothoracic department. In the office, Zhao Yunlong was standing in front of the radiographic film viewer, frowning as he looked at the radiographic films.
Because it was already after work and the second-string professors of the other departments had not arrived yet, it was normal for them to arrive a little late.
"Old Zhao, what patient is it?" Zheng Ren asked.
"Chief Zheng, come and take a look." When Zhao Yunlong saw Zheng Ren and Lin Ge come in together, he did not greet Lin Ge and directly pulled Zheng Ren over to look at the radiographic films.
Zheng Ren glanced at them and his heart sank.
The patient's mediastinum was white. The infection was serious and had already invaded the visceral pleura and aorta.
"The patient is 62 years old. Two weeks ago, he ate mandarin fish at home and got stuck with a fish bone. Later, he ate a steamed bun with vinegar and wanted to swallow it, "Zhao Yunlong said.
So that was the case. No wonder the System called this a murder case caused by a steamed bun.
Zheng Ren nodded and began to look at the radiographic films with his arms crossed.
"At that time, there were no strong symptoms. Three days later, he began to cough and spit. A week later, he had difficulty breathing and the spit he coughed up was yellow-green. A day ago, the spit he coughed up turned black and yellow. The local hospital doctor suggested that he come to the Imperial Capital for treatment, "Zhao Yunlong explained.
"The mediastinal abscess is very serious. We need to hurry up and operate," Zheng Ren said.
"Yes, I think the aorta has been invaded and I need to remove the aortic shelf," Zhao Yunlong said. "If we can avoid artificial blood vessel anastomosis, try not to."
"Well, if we do that, the surgery will be too big. Moreover, the infection is too serious. There is a possibility of bacteremia and sepsis … There will definitely be complications. "Zheng Ren immediately understood what Zhao Yunlong meant.
"I still want to see who will come to the interventional department for consultation later. If their skills are high, I'll call Su Yun," Zhao Yunlong said softly with a smile.
"Who's going to perform the surgery?" Zheng Ren asked.
"I'll do it. The second-string Professor Zhang's skill level is not good," Zhao Yunlong said straightforwardly.
Clinical practice was like this. Not necessarily the level of a professor was higher than the chief resident, and not necessarily the level of a nationally famous professor was higher than others.
Generally speaking, the level of a nationally famous professor was not necessarily high. Many people in their forties gave up clinical practice when their hand speed, eyesight, and energy began to decline from their peak. They began to travel the country and give lectures.
In that case, his reputation in the country would go up, but his surgical skills would go down correspondingly.
Some things were difficult to satisfy both sides. Those who were really good at performing surgeries would quietly squat in the hospital and rarely had the chance to let everyone know about them.
Even if someone knew about it, it would only be in a small circle.
"Professor Zhang …" Zheng Ren said and looked around. Seeing that only Lin Ge was sitting in a chair and reporting on the matter on his phone, he whispered, "Can the aortic arch replacement be done?"
"It can be done, but the mortality rate is extremely high," Zhao Yunlong said.
Zheng Ren knew what to do.
He did not continue to ask. The quality of other people's surgeries had nothing to do with him.
He continued to look at the radiographic films with his arms crossed. Zheng Ren was like a stone sculpture. No matter how the wind and the rain hit him, he did not move.
Ten minutes later, second-string professors from the relevant departments came in one after another. If anyone knew Zheng Ren, they would greet them. Zheng Ren did not know most of them, so he just passed by.
"Is this the patient's scan?" A voice came from behind.
"Professor Zhang, these are the scans of an emergency patient," Zhao Yunlong answered in a deep voice.
Zheng Ren turned his head and saw a doctor in his fifties with white hair standing behind him.
His hair was meticulously combed, and his snow-white clothes fluttered in the wind like a swordsman in white. He looked especially spirited and had a scholarly air about him.
"Hello, Professor Zhang," Zheng Ren greeted politely.
"Boss Zheng, do you also study our cardiothoracic surgery?" Professor Zhang greeted him indifferently.
"I'm just thinking that if it's surgery, the risk would be much lower with an aortic stent." Zheng Ren smiled and said, "The stent is easy, but it's still difficult to remove the abscess."
"This surgery can't be done at all." When Professor Zhang heard Zheng Ren mention surgery, he immediately denied it.
Zheng Ren did not say anything and just smiled. The muscles on Zhao Yunlong's face twitched a few times, but he held back and did not say anything.
"Everyone is here. Chief Zhao, introduce the patient's situation." Lin Ge sat in the middle. He represented the medical administration division and began to preside over the meeting.
Zhao Yunlong reported the medical history. It was much more detailed than when he recounted it to Zheng Ren.
The patient had been running a high fever, which was a sign of a serious infection. Pseudomonas aeruginosa was the main bacterial culture, but there were also other drug-resistant bacteria.
The radiographic films were very obvious. There were many diagnoses of mediastinal effusion and mediastinal abscess, and they were complicated.
However, when it came to treatment, it was even more difficult.
"Let me tell you my opinion," Professor Zhang stood in front of the radiographic film viewer and said calmly.
His gray hair seemed to be narrating his rich clinical experience. He looked clean and calm, with a scholarly aura that made people unconsciously trust him.
"I don't deny that the patient needs surgery. However, after reading the radiographic films, we can see that because of the long delay in the lower-level hospital, part of the aortic epithelium has been damaged. "Professor Zhang's voice was very pleasant, with a slight hoarseness in it.
"Under such circumstances, there is no chance to remove the abscess. If the surgery is forced, the probability of the patient dying on the operating table is more than 95%, "Professor Zhang said loudly. "If the patient's family insists on surgery, I suggest at least a 64-slice CT scan with 3D-image reconstruction of the thoracic cavity."
Zheng Ren shook his head in his heart.
64-slice CT scan with 3D-image reconstruction of the thoracic cavity … He should be talking about vascular CTA and 3D-image reconstruction of the mediastinum.
Even if the medical administration division came forward for this kind of slow diagnosis, it would at least be done tomorrow. According to the normal procedure, the results would be out the day after tomorrow.
His words were very clear, and the underlying meaning was also very clear. The surgery could not be done, at least not tonight.
That was because Professor Zhang was in the second-string class today. If something happened, he would have to bear the responsibility.
Even if it was done, it would be tomorrow or the day after.
When the time came, he would not be on duty. He could sit anywhere and watch the surgery. The success or failure would have nothing to do with him.
However, Professor Zhang was more tactful. First, he emphasized the seriousness of the condition. It was necessary and necessary to do 3D-image reconstruction before the surgery to understand the condition of such a serious disease.
'What a slippery Tai Chi expert,' Zheng Ren thought.
Seeing that everyone was silent, Professor Zhang picked up the medical record and began to talk non-stop.
From the test to the white blood cells, neutrophils, C-reactive protein, to the pathophysiological changes, everything was clear and logical.
The class was really good, Zheng Ren thought to himself.
"Does anyone have any objections?" Lin Ge asked after a pause.
"I'll say a few words." Zheng Ren stood up and said with a gentle smile.
…
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