My Medical Skills Give Me Experience Points

Chapter 1047: Chapter 413: The Connection Between Thrombectomy and Debridement, and the Dangers of Paranoia

"Teacher, I just checked on the patient in the ward."

"Hmm, that’s good."

"The patient who just underwent debridement surgery for gangrene reported a symptom to me. He said his right leg has been experiencing intermittent, diffuse pain since the injury. Based on his description and the condition of the blood circulation in his right leg during today’s debridement, I suspect an arterial embolism might have occurred. It’s quite likely that a localized arterial embolism caused gangrene at the leg wound."

Zhou Can shared all his deductions and evidence.

After hearing his report, Dr. Xu remained silent for nearly half a minute before saying, "If it’s indeed a localized arterial thrombus in the right leg, thrombectomy must be performed overnight. Let’s do a color Doppler ultrasound first; if necessary, I’ll contact the intervention room to perform angiography for the patient."

Being an old doctor with extremely rich surgical experience, the dangers were naturally understood.

The greatest risk with arterial thrombosis is that once the thrombus becomes detached, it can enter the heart or brain, directly resulting in life-threatening conditions.

I believe many people were frightened by their parents from a young age, being told that embroidery needles shouldn’t be thrown carelessly. They warned that if the needle accidentally pierces a blood vessel, it could travel through the vessel into the heart or head and kill someone.

This risk indeed exists, though the actual chance of occurrence is extremely small.

Adults mainly fear children throwing embroidery needles carelessly, especially tossing them on beds or fabric sofas, where people can easily get pricked when sitting down.

With Dr. Xu’s permission, Zhou Can immediately went to the emergency duty room, borrowed the on-duty doctor’s computer, logged into his own account, and ordered a color Doppler ultrasound for the patient in bed 22.

Many tests cannot be done at night.

An advantage in emergency is that even at one in the morning, some urgent test items can be performed.

Specialty outpatient medical labs usually operate during daytime only. Some special examination rooms even open just one day a week.

The test results came out quickly.

Suspicious vascular embolism indeed existed in the patient’s leg.

Zhou Can was about to call Dr. Xu when Dr. Xu, having taken a taxi, returned.

"It would be better to do the thrombectomy via an interventional procedure. You’re proficient with intervention and endoscopy surgery; are you confident doing the thrombectomy?"

He inquired of Zhou Can.

"I’m about seventy to eighty percent confident!"

Zhou Can didn’t dare speak too confidently.

"I’ll call a doctor from the intervention room to open the door; we must remove the thrombus overnight. No wonder the patient’s wound has difficulty healing with a thrombosis at this location! Luckily, we identified the hidden cause in time, or he would definitely lose that leg."

Dr. Xu was quite emotional as well.

You could encounter all kinds of medical conditions. Even for an old doctor with decades of surgical experience like him, he hadn’t identified the true cause of the patient’s gangrenous wound. The initial reaction was everyone thinking that the debridement and suturing technique at the small clinic was poor, not properly suturing the patient. Added to the cost-saving mindset of the patient recovering at home, it led to an infection.

Who could have imagined the real culprit turned out to be an arterial thrombus?

If that artery had been completely blocked, it would have definitely been detected timely. Because limb ischemia leads directly to necrosis.

Coincidentally, this thrombus hadn’t completely blocked the vessel but rather about 90%.

This caused the artery to still be able to supply blood, yet the circulation was very poor, with only about 10% capability remaining. With such poor blood supply, healing the wound would really be miraculous.

With some blood supply able to maintain the basic survival of the lower limb, it also made it very difficult for doctors to detect the presence of this thrombus.

They wouldn’t even consider this possibility at all.

In the intervention room, Zhou Can, relying on his superb technical skills, successfully removed the real culprit that had tormented the patient for many days. It was a thrombus approximately one centimeter long.

Judging visually, it seemed to be caused by blood coagulation.

It didn’t look like a fat embolism.

The formation of this blood clot had various causes, mainly due to trauma. It’s possible that a nurse, while inserting an indwelling needle, reused it incorrectly, also causing the coagulation thrombus.

An experienced nurse generally uses a 10ml syringe to gently draw back before reinfusing with an indwelling needle to ensure a blood return before starting the infusion.

A common mistake by a reckless novice nurse is directly infusing.

Then realizing the indwelling needle inserted just yesterday seemed to be clogged.

Next, a lazy nurse would directly flush the line with fluid.

They didn’t realize the needle tube had possibly been blocked due to blood backflow into the needle tip when sealing it yesterday. Overnight, a blood clot formed.

In this situation, forcibly flushing the line with saline can easily push the clot forcibly into the patient’s venous blood vessel.

If the indwelling needle tube is clogged, aside from a possible thrombus, leftover infusion in the needle tube might crystallize. This is even more dangerous.

Regardless of which cause it is, if forcibly sent into the patient’s venous blood vessel, it can lead to deadly serious consequences.

Faced with a clogged indwelling needle tube, there are three correct operational methods.

Upon identifying the cause, a 10ml empty syringe can be used to gently draw back, extracting the clot from the tube.

Or if the patient’s condition allows, a 10ml 0.9% sodium chloride injection containing heparin sodium (25u/ml) or urokinase (100,000U/ml) can be used to dilute and clamp the tube for 5 minutes, then use an empty syringe to draw back again. If no blood return occurs, repeat once more. If after two operations there’s still no blood return, the needle should be removed immediately.

In such situations, a new indwelling needle should be inserted anew.