My Medical Skills Give Me Experience Points

Chapter 1415 - 564: Calming the Situation, A False Alarm

Zhou Can carefully examined the patient, hoping to find a way to save this man’s life.

To be honest, once the lungs are seriously damaged, even using extracorporeal membrane oxygenation may not necessarily save the patient. ECMO is by no means omnipotent; its role is only to temporarily replace the work of the heart and lungs, helping the patient complete respiration and circulation.

It cannot take over heart–lung function for a long time.

Let alone ECMO: even something as simple as putting a patient on a ventilator cannot be done for too long. Otherwise, the body can easily become dependent, and the risk of infection will increase dramatically.

For a patient who has undergone a unilateral pneumonectomy, postoperative lung function is suddenly reduced by 50%, and both the respiratory and circulatory systems have to bear enormous pressure. It’s like two people originally lifting a 100-kilo load together, and one suddenly bails; the one left will be worked to death.

So the mortality and complication rates after a unilateral pneumonectomy are both extremely high.

By comparison, removing only part of a lung lobe carries much less risk.

In addition, the quality of life of a patient after unilateral pneumonectomy will also be greatly affected. Previously he could easily walk up to the third floor; now he might be panting and exhausted after just half a flight.

If the patient is relatively young, he may even no longer be able to lead a normal married life.

When he initially formulated the surgical plan for this patient, Zhou Can had thought it over very carefully. There really was no other option; only then did he choose to remove the left lung to save the patient’s life.

The patient underwent surgery two days ago; today is the third day.

At present, his facial complexion and lips are cyanotic, and even his fingernails have an abnormal bluish-purple tinge—this is a clear sign of hypoxia.

The patient is in respiratory distress, with a large amount of pink, frothy sputum, and his heart rate is obviously far above normal, reaching 150 beats per minute.

His blood oxygen saturation has dropped to rock bottom, long since below the minimum warning line.

When blood oxygen saturation is below 95%, patients will usually have obvious discomfort, which also alerts doctors. The patient’s current oxygen saturation has already fallen below 80%, and that’s after all kinds of resuscitative measures.

Zhou Can’s face was like still water, while the attending chief physicians in the ICU all watched him with grave expressions. They genuinely had no other ideas and could only pin their hopes on him, to see whether he could come up with a way to save the patient.

"Sister Yan, let me borrow your stethoscope for a moment!"

Zhou Can said to Director Xue Yan.

The reflex hammer and stethoscope are basically standard gear for Cardiothoracic Surgery doctors, things they carry with them all the time, because they might need them at any moment.

But this is an aseptic management area; items from outside cannot be brought in casually.

Director Xue Yan’s stethoscope should be one kept here in the ICU.

Although every breath the patient took looked like it might be his last—his appearance was terrifying—Zhou Can remained as steady as Mount Tai. Holding the stethoscope, he placed it on the patient’s chest over the lung area and auscultated.

"The lungs are full of moist rales and bubbling sounds. Combined with the patient’s current various symptoms and signs, this has to be pulmonary edema, no doubt. He was still okay on the first postoperative day, which shows the deterioration in his lungs occurred yesterday, or possibly even this morning. Let me see the IV and medication charts."

Zhou Can’s pharmacological differentiation has now risen to Level 6. When treating critically ill patients like this, he is already capable of approaching the problem from multiple angles.

Including pharmacology, pathology, clinical manifestations, and so on.

In the past, when it came to orders and medication—especially for patients with complex regimens—he always felt out of his depth and could hardly get involved.

Between an associate chief physician and a chief physician, it may look like only half a rank on paper, but the gap in ability is like night and day.

Especially in pharmacology and pathology, those two core domains, the difference is even more pronounced.

Before Zhou Can’s pharmacological differentiation leveled up, he was in fact inferior to Nurse Jiang Wei in several drug-use domains.

Director Xue Yan’s theoretical level has always been outstanding; her pharmacological differentiation reached Level 6 long ago. Even now, Zhou Can is still slightly inferior to her.

At most you could say that Zhou Can now has the qualifications to "discuss the Dao" with her.

Roughly speaking, they’re now at the same tier; she’s just a bit stronger.

Although Xue Yan and Vice Director Hee and the others had already gone through the patient’s IV and medication orders, Zhou Can still wanted to review them again. Even if he didn’t find any problems, he could gain a clearer understanding of the treatment and drug use so far.

Which drugs were used, in what doses, and what effects they had—these could all give Zhou Can very useful feedback.

After he finished reading, the frown on his face actually relaxed quite a bit.

"The main resuscitation measures implemented so far are oxygen via face mask and intramuscular injection of sedatives."

Perhaps with differing diagnostic opinions, no one dared to use stronger drugs rashly.

"Zhou Can, judging by that look on your face, you’ve already found the cause of the patient’s pulmonary edema, haven’t you?"

Having worked with him for a long time, Director Xue Yan had a deep understanding of some of his habits.

Seeing the furrow in Zhou Can’s brow smooth out, she felt her own heart lighten considerably.

This was trust built up through long-term cooperation.

In emergency care, Zhou Can only shows that expression when he feels he has a relatively high chance of success.

"More or less."

Zhou Can nodded.

"Actually, after our discussion just now, we also felt the patient was very likely suffering from pulmonary edema. But once we saw the pink sputum and couldn’t clarify the underlying pathophysiology, we didn’t dare act rashly. So our resuscitation approach has been rather conservative."

There was a hint of saving face in what Vice Director Hee said.

After all, in the Thoracic Surgery field, he counts as an old hand in the department.

For a long time after Director Hu Kan passed away, he had regarded himself as the top dog in Thoracic Surgery.