top student at medical school

Chapter 392 The Power of a Superior (Please Subscribe)

The nurse's voice was surprisingly powerful, coming from a distance down the corridor and echoing throughout the ward.

Fang Ziye hesitated for only a second before squatting down and placing the box in his hand in a corner of the corridor. Then he stood up and hurried toward the source of the sound.

Fang Ziye is currently the chief resident. If something happens in the ward, no matter what Fang Ziye is doing, he is the first person responsible. In the current situation, Fang Ziye happens to be in the department, which is what Fang Ziye feels most at ease with.

The inpatient general office was a short distance from the doctors' offices. Before Fang Ziye could even reach the doctors' offices, the on-duty doctors Guo Ruodun and Lan Tianluo, both in white coats, hurriedly rushed out of the doctors' offices.

Lan Tianlu, with considerable experience, instructed: "Guo Ruodun, hurry up and find the tracheotomy kit and push the dressing cart to the bedside. It would be best to find iodine chelate as soon as possible, but if you can't find it, then forget it."

Lan Tianluo's voice was hurried as he ran, taking out his phone to call Fang Ziye.

"Dad, the doctor lost the box..." Little Pear looked at her father with some unease after seeing Fang Ziye's actions.

However, his wheelchair was slightly blocking the passage, so his father quickly moved it to the side against the wall.

After making way for Fang Ziye, Lan Tianluo, and the others, he watched Fang Ziye hurriedly running alongside Lan Tianluo, and then turned Xiaolizi's wheelchair around again: "Xiaolizi, the doctor brother has gone to work."

"He might be rescuing someone's mother, someone else's child, or maybe another child's father. Now that we've delivered the goods, let's go..."

"Is that so?" Little Pear was quite young.

He had no idea what suffocation meant; his only understanding was that Fang Ziye had thrown away the gift he had given Fang Ziye.

“That’s right! Let’s not bother your Dr. Fang brother anymore. After you are discharged from the hospital, and after your mother is discharged, we will come and thank him together, okay?” The man explained sensibly, and then pushed the child away.

As people grow older, they need to learn to have empathy...

"Senior brother, I was just about to call you when a nurse said that the patient in bed 34 is having difficulty breathing..." Lan Tianluo explained briefly after seeing Fang Ziye catch up with him.

Fang Ziye nodded, inwardly giving Lan Tianluo a thumbs up: "Let's go over and assess the situation first!"

Lan Tianlu did not believe the nurse's descriptive diagnosis of suffocation.

Asphyxiation is a pathological state in which the human body's breathing process is obstructed or abnormal for some reason, resulting in hypoxia and carbon dioxide retention in various organs and tissues throughout the body, leading to metabolic disorders, functional disorders, and morphological damage to tissue cells.

"Okay, senior brother." When Lan Tianluo saw Fang Ziye behind him, his tightly furrowed brows relaxed by about 70-80%.

As Fang Ziye ran quickly, a thought suddenly struck him: "You handle this, I'll watch from the side."

Lan Tianluo's legs, which had been running, buckled slightly, and he asked incredulously, "Senior brother, me?"

“You’re almost finished with your first year of master’s degree. If we count your year of residency training, you’ve been in the department for almost two years.”

"The worst-case scenario for suffocation caused by airway obstruction is a tracheotomy."

"We're here. Go in and get things done!" Fang Ziye said.

Asphyxiation caused by airway obstruction has a certain rescue time, which can be summarized as the golden five minutes.

However, Fang Ziye was confident that he could complete the tracheotomy in thirty seconds!
Under these circumstances, Fang Ziye handed over the primary responsibility for treating patients to Lan Tianluo.

Young doctors always need to grow, and if Lan Tianluo doesn't handle something properly, Fang Ziye can take over immediately.

As soon as the two entered, they saw the patients' families and the families of the patients in the next bed huddled together in a panic, some patting their chests and others helping to support their backs.

The patient was a middle-aged man in his forties. At this moment, his eyes were wide open, his eyeballs were bulging out, his mouth was wide open, and his chest was heaving violently.

"Doctor! Please come quickly, my husband has suddenly become like this~" Upon seeing the doctor in the white coat, the middle-aged woman pleaded with tears in her eyes and her voice cracking.

Lan Tianluo quickly approached, scanning something.

After Fang Ziye approached, he continued to conduct a visual examination.

The patient's forehead was covered in fine sweat, the sternocleidomastoid muscle was prominent and taut, and the lips were relatively dark, which should be signs of impending hypoxia.

Looking at the patient's chest breathing amplitude, it is seen that the respiratory muscles are contracting violently and heaving rapidly, but even during this heaving, breathing is still not smooth.

The patient's throat made an unpleasant "uh, uh" sound.

"What did he just eat? Betel nut or fruit, or did he eat both together?" Lan Tianluo immediately noticed something was wrong when he approached to perform the physical examination.

"Yes!" The patient's wife nodded, crying as she said, "He said he wanted to eat it, so I bought it for him. I never expected it to turn out like this..."

Fang Ziye promptly reminded him, "Use a stethoscope to listen to see if you can hear any turbulent sounds in the throat."

"If the betel nut isn't too deep, see if you can use tweezers to remove it," Fang Ziye said quickly.

But Lan Tianluo reacted quickly, grabbing his ever-present stethoscope and applying it: "Senior brother, the turbulence sound is quite low."

When the airway is partially blocked, the airflow hitting the trachea and obstruction will produce a localized wheezing sound.

"Tch!" Fang Ziye gave the order without hesitation.

When he is present, he must issue the orders himself to make them convincing.

"Senior brother, the tracheotomy kit is here."

"The iodine complex has been opened." Guo Ruodun quickly pushed over the dressing cart, on which lay a sealed tracheostomy bag.

Seeing that Guo Ruodun didn't have much experience, Fang Ziye took the initiative to help. After tearing open the tracheostomy kit, he rotated it to turn the contents back upside down.

At the same time, after the disinfection tray was exposed, Fang Ziye opened the complexed iodine and poured it into the tray: "After putting on gloves, quickly rotate to disinfect, and select the center tangent line."

Lan Tianluo started putting on gloves as soon as Fang Ziye opened the tracheotomy kit.

Just as they were mostly dressed, Lan Tianluo picked up the iodine-soaked cotton balls from the tray, quickly instructed the patient's family to help secure the head and chest, and then said, "Guo Ruodun, call the ICU and the anesthesiology department for consultation, and call the ENT department for consultation."

"Urgent consultation!"

"Senior brother!" Lan Tianluo was about to ask Fang Ziye to help open the box of marijuana when...

Fang Ziye had already opened the separately prepared lidocaine and saline solution and mixed them together!
"Draw, local anesthesia, begin!" Fang Ziye practically handed all the procedures to Lan Tianluo.

Because this is Lan Tianluo, Fang Ziye knows that Lan Tianluo's current incision technique is absolutely capable of performing a tracheotomy.

Without further hesitation, Lan Tianluo quickly applied a dermal wheal and then performed the standard three-step local anesthesia procedure of needle insertion, aspiration, and drug administration.

In just twenty seconds, Lan Tianluo completed the local anesthesia.

Then, he turned to the side, holding the needle and connecting it to the blade of the scalpel. He held the toothed forceps upside down in his left hand, selected the midline of the neck as the incision line, and quickly cut a straight line directly to the concave part of the manubrium of the sternum.

Next, Lan Tianluo used hemostats to separate the sternohyoid and sternothyroid muscles along the midline, exposing the isthmus of the thyroid gland!
At this moment, Fang Ziye also put on his assistant gloves, took the hemostat, and became Lan Tianluo's assistant.

"Give me the little hook, and I'll expose the canyon for you." Fang Ziye's voice was decisive and calm.

"Okay, senior brother." Lan Tianluo's panic was finally tempered with a sense of calm.

Fang Ziye has become an assistant and can take over as the surgeon at any time. Lan Tianluo can rest assured.

"The 2-4, 1-2 principle! Okay." Fang Ziye continued to instruct.

Upon hearing this, Lan Tianluo no longer hesitated. Along the 2nd to 4th tracheal rings, he used a sharp blade to make an arc-shaped cut from bottom to top on the anterior wall of 1 to 2 tracheal rings to form an anterior tracheal wall flap.

As soon as the anterior wall of the trachea ruptures, the patient's breathing immediately eases.

A whooshing sound of turbulent air emanated from the throat.

At the same time, his tense expression gradually calmed down, and he lay flat on the bed like someone who had just died, as if the whole world was completely silent.

The relief a suffocating patient experiences upon sudden ventilation is no less than that of a shiver, and perhaps even a hundred times more so...

"I see, half of the betel nut is here. Let's pry it open and see if we can take it out. If we can, then take it out."

"It's really stuck." Fang Ziye continued to give instructions.

Lan Tianluo simply used tweezers to gently pick out the betel nut residue without damaging it. After examining it for a while, he said, "Luckily it's betel nut residue. If it were chewing gum stuck together, it would be quite troublesome."

"Let's temporarily insert a tracheostomy tube and wait for the senior doctors from the ICU and anesthesiology department to come and handle the follow-up!"

After Fang Ziye finished speaking, he looked at the patient's family member and said coldly, "Come with me. We'll sign a document to fill in the missing information. Then, I'll give you a proper education about hospitalization."

“In our department, I remember being told from the moment you were admitted that chewing betel nut is prohibited during hospitalization, especially when you have difficulty moving around after surgery. Didn’t anyone tell you that?”

Fang Ziye was genuinely angry!

If the patient's symptoms are a heart attack or other symptoms, then spending time and effort to save them is quite rewarding.

TM was just making trouble out of nothing. He choked on betel nut, then had a tracheotomy performed, and once the betel nut was removed, the rescue was over. It was a completely unnecessary and self-inflicted injury.

Furthermore, in such cases, if rescue is not timely, Fang Ziye's total hospital stay could potentially be prolonged.

Because the hospital has regulations that, regardless of the reason, if a death occurs in a ward during elective surgery, the ward director will be held responsible for negligence, regardless of whether it is the director's fault.

Excluding emergency room deaths.

If the emergency room examination is not thorough enough, and a blood vessel suddenly ruptures, it won't put pressure on the resident physician.

"Doctor, as I've said before, the main problem is that my husband can't control his eating; he just has to eat it," the middle-aged woman continued to argue.

"If he insists on eating it, should you just give it to him?"

"Is he a child or are you a child?"

"Whether betel nut is healthy is beyond the scope of my explanation. The main reason for this sudden suffocation is that you accidentally swallowed betel nut into your trachea. Such an accident is extremely dangerous."

"What if, I mean, what if, your husband doesn't make it?" Fang Ziye was also furious. After venting for a while, he said this.

Then his voice softened a bit, and after looking at the 14 knowledge points that had floated up, he said, "Well, alright, things are already like this. A tracheotomy is necessary. You come and sign this..."

"You don't need me to explain these things anymore, right?"

The middle-aged woman nodded vigorously: "Don't worry, Dr. Fang, if my husband tries to eat it again this time, I'll slap him a few times..."

The middle-aged woman then turned her head to look at the tube inserted into her husband's throat, feeling both heartache and helplessness...

Fang Ziye actually knew that the relationship between this couple must be excellent.

Otherwise, most men wouldn't be able to ask their wives to help them buy betel nuts.

After Guo Ruodun completed the signing in front of the patient, the chief resident of the anesthesiology department and the ICU rushed over.

The ICU ward director stood by the bedside for a while, and seeing that everything seemed alright, said, "The symptoms have subsided for now. Continue with postoperative education. Now that the airway is clear and the patient's muscle tissue is still okay, we can simply seal the tube and remove it..."

About half an hour later, Fang Ziye said to Ning Shan, who stayed behind to treat the tracheotomy wound, "Thank you, President Ning. We really don't have any experience in treating this tracheotomy incision."

"I've been in this department for many years, and this is the first time I've encountered a tracheotomy."

Ning Shan, the chief resident of the ICU, took off her gloves and pressed a hand sanitizer as she heard this: "So you surgeons are really bold. You've never encountered this before, yet you dare to let the resident do it."

"This is unimaginable in our ICU."

Ning Shan is not tall, about 1.6 meters, and has a very thin figure. She has a neat ponytail and is rubbing her slender fingers together.

"Well, my junior brother is pretty good. I figured the operation wouldn't be too difficult, so I let him do it," Fang Ziye explained with a smile as he walked towards the ward entrance to see Ning Shan off.

"Hmm, it's not bad. You guys do a lot of surgeries, so performing a tracheotomy like this should be a piece of cake for you."

"Mr. Fang, can we add each other on WeChat? It'll be easier to communicate privately in the future. In case our team has an emergency orthopedic consultation, I can call you right away." Ning Shan's voice was crisp and soft, with a childlike quality.

Fang Ziye added frankly: "Fang Ziye, Trauma Surgery. Mr. Ning, please remember to save this note."

Ning Shan narrowed her eyes. She looked petite, but she was quite bold: "Don't worry, girls like us make very detailed notes when we meet handsome guys."

Fang Ziye did not pick up on the topic: "Then I'll have to trouble you, President Ning. I have surgery to perform and I need to take care of this patient's follow-up when I get back."

After saying goodbye to Ning Shan, Lan Tianluo very sensibly jogged forward.

"Senior brother, just now, would you say I performed a tracheotomy all by myself?" Lan Tianluo asked excitedly.

Tracheotomy is a small, standalone surgery. Although it is simple to perform, it is of extraordinary significance; it is a truly life-saving surgical procedure.

Lan Tianluo had been at Zhongnan Hospital for two years before finally getting this opportunity.

“Yes…it is…a doctor from Lanzhou University.” Fang Ziye deliberately dragged out his words.

"Hehehe, you can't call me that. I'm still far inferior to you, senior brother."

"But being able to cut an octahedral pyramid in the training room really puts this basic skill to good use!" Lan Tianluo said.

The ability to cut out an octahedral pyramid using the incision technique is a high-level skill that represents a significant advancement in a particular age group, a test of proficiency in the master's and doctoral programs.

Fang Ziye said, "The level of skill you possess won't have much impact on you, Tianluo, since you won't be making a living through surgery anyway."

Lan Tianluo said very seriously, "No, senior brother, the more skills you have to make a living, the more options you have, and the more free you are."

"For example, right now, if I want to quit being a doctor, I can quit being a doctor; if I want to quit mathematics, I can quit mathematics; if I want to quit computer science research, I can quit algorithm research; if I want to quit clinical practice..."

Lan Tianluo turned her head as she thought about it, and when she opened her eyes again, she found that Fang Ziye had already walked far away. She quickly chased after him and said, "Senior brother, I'm not pretending anymore."

"Today, Senior Brother Jie came up with a really good idea. He asked me to keep an eye on when you step down, and as soon as you step down, he'll come to the department to report to you..."

(End of this chapter)