Only this kind of practical medical student's answer can make seniors feel the danger coming from behind. Sometimes, it only takes a few years to be surpassed by younger generations.
Dr. Cheng Yuchen looked serious and asked her, "Have you ever had chest closed drainage surgery?"
Chest closed drainage is a secondary surgery. It is a minor surgery that can be performed by daily residents. It can be said to be difficult or simple. Clinically, there are usually two approaches to this surgery.
One method is a very traditional one, which requires local anesthesia and a scalpel to cut through the skin and muscles between the ribs. Finally, a hole was made in the patient's chest with curved forceps, and the drainage tube was inserted and sutured to fix it.
Another method is to use a trocar to directly guide the drainage tube through the skin without incision.
Last year, when she was participating in the emergency rescue of a car accident as a trainee, she had a chance to perform a thoracentesis to decompress a patient with tension pneumothorax. When I arrived at the Department of Respiratory Medicine, I assisted Teacher Xin in performing pleural effusion puncture. In fact, the puncture and drainage bottle she performed was almost the second method of thoracentesis and drainage just mentioned.
In addition to this, Xie Wanying has performed many other clinical punctures, including subclavian vein punctures.
For various clinical puncture procedures, the focus is on mastering the accurate anatomy and keeping the operating procedures in mind, which is far less complicated than surgery. However, since puncture is classified as a secondary surgery and not the simplest primary surgery, in order to fully explain its risks. If the puncture is performed incorrectly, serious complications such as massive bleeding may occur.
Doctor Cheng Yuchen asked her if she had done it, and his tone was quite questioning. Apparently thinking that she, a medical student who might not have done anything like this before, might be just 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, which 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 suitable for patients with complex and serious conditions such as empyema, hemopneumothorax.
The shortcomings are also obvious. The length of the cut to open the patient's chest is two to three centimeters, and the patient always suffers from pain. This will bring a relatively traumatic operation to the patient, and the patient will not like it.
In 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 can easily be blocked by drainage, so it is not suitable for patients with complicated 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 use a simpler summary: the reason why the tube is left in is because simple puncture cannot allow lung recruitment. For example, the young man who was rescued by her last time had to go back to the hospital to undergo drainage and leave a tube. If the tube was not left in place, the rupture of his visceral membrane would always exist, and he would soon develop pneumothorax again, causing difficulty in breathing.
The patient in the Department of Respiratory Medicine is no longer the patient. He has encapsulated pleural effusion. The purpose of clinically extracting 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 segmented, and it is not like the laymen think that the surgeries are almost the same.
