BXBX NOVEL Chapter 2306: 【2306】The importance of segmentation
Dr. Cheng Yuchen looked serious and asked her, "Have you ever had closed chest drainage?"
Closed thoracic drainage is a secondary surgery, a minor surgery that can be performed by a daily resident physician. Clinically, there are usually two approaches to this surgery.
One method is a very traditional method, which requires local anesthesia and a scalpel to cut the skin and muscle between the ribs. Finally, use curved forceps to open an opening in the patient's chest cavity and then insert the drainage tube for suture fixation.
Another method is to use a trocar to guide the insertion of the drainage tube without surgery.
Last year, when the trainee participated in the emergency **** of patients in a car accident, she had a chance to perform thoracentesis to help decompress patients with tension pneumothorax. When I arrived at the Department of Respiratory Medicine, I assisted Mr. Xin in puncturing the pleural effusion. In fact, the puncture she had done followed by a drainage bottle was almost the second method of thoracocentesis and drainage.
In addition to this, Xie Wanying has done many other clinical punctures including subclavian vein puncture.
Clinical various puncture procedures, focusing on mastering the accurate operating anatomy and keeping in mind the operating procedures, are far less complicated than surgery. It's just that since puncture is classified as a secondary surgery, it is not the simplest primary surgery, in order to fully explain its risk. If the puncture is wrong, it can cause serious complications such as massive bleeding.
Dr. Cheng Yuchen asked her if she had done it, with a questioning tone. Apparently thinking that she, a medical student who may not have done such an operation, may be talking on paper.
You know that there are two puncture methods, so do you know which puncture method is suitable for this patient?
Like the first method, which was called thoracotomy in the past, it is to make an incision, which is very similar to the condition of the tube left in the end of thoracotomy. 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 complicated and severe conditions such as empyema, hemopneumothorax.
The shortcomings of are also obvious. The length of the cut to open the patient's chest is two or three centimeters, and the patient is always in pain. This will bring a relatively traumatic operation to the patient, and the patient will not like it.
In the second way, the puncture needle usually used clinically is a central venous catheter needle. The needle is small and the drainage tube brought in is thinner and softer, which brings extraordinary comfort to the patient. In contrast, the tube is soft and easy to be blocked by the drainage material, which is not suitable for patients with complicated drainage material.
Also, there is a difference between simple puncture and catheter drainage, otherwise it would not be a choice of puncturing or catheter retention.
Applies to specific clinical cases, and then uses a simple word: if the tube is left, it is because the lung can not be recruited by simple puncture. For example, the young man who was rescued last time had to go back to the hospital for drainage and keep the tube. If the tube was not left, because the rupture of his own visceral membrane always existed, he would soon have a pneumothorax again, which would lead to difficulty in breathing.
The patient in the Department of Respiratory Medicine is no longer, because of encapsulated pleural effusion. The purpose of clinical extraction of pleural effusion is to confirm the diagnosis of infection. The degree of difficulty in breathing does not need to be long enough to stay in the tube. More importantly, it is to deal with the source of infection.
It can be seen that the clinical treatment measures are very subdivided, and it is not at all similar to the same surgery as the layman thinks.
(end of this chapter)