Only the answers of such pragmatic medical students can make the seniors feel the danger of the coming waves. Sometimes, being surpassed by the younger generation is just a matter of a few years.
Dr. Cheng Yuchen looked serious and asked her, "Have you ever had a closed chest drainage procedure?"
Closed chest drainage is a secondary operation, a minor operation that can be performed by residents on a daily basis. It is neither difficult nor simple. In clinical practice, this operation is usually performed in two ways.
One method is a very traditional one, which requires injecting local anesthetics, using a scalpel to cut the skin and muscles between the ribs, and finally using curved forceps to make an incision in the patient's chest cavity, inserting the drainage tube, and suturing it in place.
Another method is to use a trocar to directly puncture the drainage tube through the skin without surgery.
Last year, when she was an intern and escorted patients to a car accident, she had a chance to perform a thoracentesis to help relieve the pressure of a patient with tension pneumothorax. When she arrived at the Department of Respiratory Medicine, she assisted Teacher Xin in performing a thoracentesis for pleural effusion. In fact, the thoracentesis she performed and then connected a drainage bottle was almost the second method of thoracentesis and drainage mentioned above.
In addition to this, Xie Wanying has performed many other clinical punctures including subclavian vein puncture.
The key to clinical puncture is to master the accurate anatomy and remember the operation procedures. It is far less complicated than surgery. However, since puncture is classified as a secondary operation rather than the simplest primary operation, it fully explains its risks. If the puncture is wrong, it will cause serious complications such as heavy bleeding.
Dr. Cheng Yuchen asked her if she had done it before, with a questioning tone in his voice. It was obvious that he thought that she, a medical student who may not have done such an operation, might be just talking about it on paper.
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You know there are two puncture methods, but do you know which puncture method is suitable for this patient?
The first method was previously called thoracostomy, which is to make an opening, much like the tube left in a thoracotomy, and the tube is very thick. The advantage of a thick drainage tube is that it is not easy for the drainage to block the tube, which is very suitable for patients with complex and serious conditions such as empyema and hemothorax.
The disadvantages are also obvious. The incision made to open the patient's chest is two or three centimeters long, which makes the patient feel 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 in clinical practice is a central venous catheter needle, which has a small needle tip and a thinner and softer drainage tube, which brings extraordinary comfort to the patient. In contrast, the thin and soft tube is easily blocked by the drainage material, and is not suitable for patients with complex drainage materials.
Also, there is a difference between simple puncture and catheter drainage, otherwise there would not be two options: puncture or catheter drainage.
Applying to clinical cases, and summarizing it in simpler terms: leaving the tube in is because simple puncture cannot re-expand the lungs. For example, the young man she rescued last time had to go back to the hospital for drainage and tube retention. If the tube is not left in, the rupture of the visceral membrane will always exist, and pneumothorax will soon recur, causing difficulty in breathing.
The patient in the respiratory department is not like that. He has a pleural effusion. The purpose of clinical extraction of pleural effusion is to confirm the diagnosis of infection. The degree of dyspnea does not need to be so severe that a long-term tube is required. What is more important is to deal with the source of infection.
It can be seen that clinical treatment measures are very subdivided, and are not at all like what laymen think that similar operations are all similar.
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