Chapter 1613: 1561 Full Physical Examination (Alliance Leader Lin Yuan He Xian Yu Bonus Chapter 1)

"Yun Ge'er, look at what you're saying, this is a normal complication, not something we did on purpose. Everyone hopes the patient gets better; who would deliberately knock the Kocher needle out of the bone?" Manager Zhou, hearing Su Yun say this, turned pale and kept explaining.

"If you're capable, go explain it to the patient's family outside." Su Yun refused to let up.

"Boss Zheng, do you think Manager Zhou should go up now or later?" Manager Wang came to smooth things over.

I've been in Hai Cheng for a while, and I've had plenty of exchanges with Orthopedics; I know Manager Zhou is honest and a bit effeminate.

Someone like that, in a one-on-one, would be bullied to death by Yun Ge'er—complete domination, enough to make Manager Zhou break down in tears.

He doesn't really care whether Manager Zhou lives or dies, but if he's going to die, the surgery must be done first.

"Hmm..." Zheng Ren pondered for a moment, "A few minutes, once the pericardial fibrous tissue is peeled off, please have Manager Zhou remove the Kocher needle."

Only then did Manager Zhou realize the patient's Kocher needle was still in place…

That's right; if it weren't there, it wouldn't be such a big deal.

Normally before surgery, they'd arrange to remove the Kocher needle six months later. Even if he did it himself, Chief Zheng estimates it's been at least three years post-op; the patient never came back for the second-stage surgery, so this could be discussed.

After the fright subsided, Manager Zhou finally figured out the crux of the problem.

He was really too flustered; Manager Zhou blamed himself a couple of times in his heart.

While they were chatting, Zheng Ren had already opened the pericardium at the left ventricular area, positioning the incision as far posterior-lateral as possible, choosing a non-calcified area.

Beneath the incision, layers were visible; the pericardial effusion had been completely suctioned away.

Outside the epicardium, a plane was found; blunt dissection was carried out along it, gradually expanding the range.

Blunt dissection is Zheng Ren's specialty; at this moment, separating the adhesions between the heart's outer membrane and the fibrous plate was also easy for him.

"Chief Zheng, how come you're back?" Manager Zhou watched Zheng Ren in surgery, suddenly recalling that Chief Zheng wasn't supposed to have gone to the capital, and without thinking, he asked in surprise.

As soon as he said that, Manager Zhou immediately realized it was wrong, and lowered his head to avoid facing Su Yun's contemptuous gaze.

But lowering his head to pretend to watch the surgery is fine; he certainly couldn't deliberately plug his ears.

"Manager Zhou, are you time-traveling, or did you push open a door and see the world of Chu Men? Just a distal Kocher needle coming loose, and you're scared like this?" Su Yun's voice was full of endless contempt.

"It's just a Kocher needle; if our City First Hospital were to launch cervical spine surgery, you wouldn't be able to sleep night after night."

"I'm homesick, coming back to take a look." Zheng Ren said solemnly, spouting nonsense, "Manager Zhou, please go scrub up."

"Huh?" Manager Zhou, who was spacing out, let out a dazed "ah."

"The surgery is almost done; come up and take out the Kocher needle, then we'll close the chest." Zheng Ren glanced around and had to accept the fact that he'd have to stay to close the chest.

"Still, the 912 is convenient—after the surgery, I can just shake my hands and leave, with no need to worry about closing the chest or abdomen."

Unconsciously, Zheng Ren's thinking had become that of a professor and department head.

"Closing the chest or abdomen? That's grunt work for junior doctors, what does it have to do with me?"

Zheng Ren peeled off the pericardium in order.

He tried to remove it in large sheets; if myocardial rupture occurred, he could use the already detached pericardium to patch and stop bleeding.

Of course, this is just a preventive measure; Zheng Ren did it subconsciously, never imagining that his master-level cardiothoracic surgical skills would encounter such a problem.

The right pericardial flap was dissected to the left atrioventricular groove, its upper boundary reaching below the thymus. The left pericardial flap's upper boundary was dissected to the main pulmonary artery trunk, which was then narrowed and circumferentially cut to avoid severe postoperative elevation of right ventricular pressure.

The lower boundary completely freed or excised the thickened pericardium beyond the diaphragm's attachment; posteriorly, he endeavored to completely free the pericardium overlying the left ventricle as much as possible.

While dissecting the interventricular groove area, Zheng Ren's hand speed slowed a bit, and he paid extra attention here to avoid damaging the coronary artery branches.

But it's just a fist-sized heart; following the sequence, step-by-step blunt dissection was completed in an instant.

After the surgery, Zheng Ren requested warm saline gauze to cover the incision.

Leaving the thoracotomy opening is best.

Otherwise, with Orthopedics' bold approach, if done blindly, Zheng Ren feared Manager Zhou might instantly puncture the patient's aorta.

He changed the incision, paying attention to the sterile field, and Zheng Ren glanced at the ECG monitor.

The patient's vital signs were stable; this crisis should have been overcome.

"Boss Zheng, you said this heart condition—how could its initial symptoms appear in the abdomen?" Manager Wang recalled the patient's history; although he didn't know it in detail, if he were the one seeing the patient, he probably wouldn't think of a chest disease.

Asking Boss Zheng's approach would also serve as a reference for the future.

"Didn't you see how the left phrenic artery got compressed during the surgery just now?" Su Yun said: "Long-term chronic injury, the patient has gradually become accustomed to it, so he only mentions chest tightness. But gastrointestinal ulcers and bleeding in the abdomen cause nausea and vomiting, which are fairly typical symptoms, making them especially easy to miss."

"Boss Zheng, Yun Ge'er, how did you two discover this?" Manager Wang said admiringly.

"The patient complained of chest tightness and shortness of breath; listening to breath sounds is quite normal." Zheng Ren said offhandedly: "Manager Wang, a normal physical exam must still include some basic items; you can't be careless."

Manager Wang stared for a moment, then gave a wry smile.

According to regulations, a physical exam must be performed, and it must be a full one.

But clinical matters aren't that simple.

Doing a full set of checks takes less than half an hour is not enough. The Emergency Department is so busy—where would they find time for a detailed examination?

Moreover, the situation is absolutely not that simple.

A female patient came in diagnosed with appendicitis, insisting on having a chest and genital exam— isn't that just hooliganism?!

Many doctors just entering clinical practice fall into this pit.

Manager Wang could only respond to Zheng Ren's remark with a wry smile. However, since the patient's chief complaint is chest tightness, he should auscultate, right? He should.

Manager Zhou led the frontline Orthopedics doctors in disinfecting and laying out the drapes, then began the surgery.

Removing the Kocher needle is one of the smallest procedures in Orthopedics; for Manager Zhou, it should originally have posed no difficulty at all.

But today's surgery was performed extremely awkwardly.

He was extremely careful, almost afraid to use force.

But the Kocher needle is deeply buried in the callus; without force, it simply cannot be extracted.

Previously, when Orthopedics' scope did not yet include cervical and lumbar spine, people called them "carpenters."

Adzes, chisels, axes, saws— they had them all.

The surgery was also performed boldly, with a series of bangs and thuds, and it was over.

Zheng Ren saw Manager Zhou unable to relax his hands and feet, and also sighed.

Had no choice but to provide sufficient protection for Manager Zhou in the chest cavity, using a layer of large gauze pad for protection, then using the iron plate of the large curved retractor to block the Kocher needle. In this way, even if the Kocher needle moves position under violence, it will not cause excessive damage.