I, Tomoya Aki, am not a bootlicker

Chapter 434: Nighttime Sudden Incident

I got a general idea of ​​the situation of the three trainee doctors in the department through the director of the logistics department, Sasaki Ichiru.

Strictly speaking, Professor Yano's man is Tomoya Aki, and Majima enjoys preferential treatment because of his father.

As for Nishikino Maki, that is another matter. She was sent here by the dean and will go back to inherit the family business sooner or later.

Regarding the three of them, Sasaki Ichiru listened to Director Monobe's words and decided that they didn't need to think about anything else at this stage. While they were residents, they would enter the cardiac surgery department for training and just do whatever was necessary.

Therefore, Sasaki Ichiru did not change the arrangement for the three people. After two months on the adult side, in July, he asked the doctor in charge of the pediatric side to serve as their supervising doctor.

The process is the same as in university hospitals.

However, university hospitals have more of a teaching nature, and there are lecturers in every department.

Even though a private hospital like Kanto General Hospital is a large and powerful hospital, there are very few people who nominally retain positions above lecturer in the university.

But it doesn’t mean that other people can’t supervise trainee doctors. It’s just that people in private hospitals are not as skilled as those in university hospitals.

Every year, the majority of medical students enter university hospitals for postgraduate medical training.

In July, Tomoya Aki and his colleagues got a new supervising doctor arranged by Ichiru Sasaki.

Dr. Senju, who was in charge of pediatrics, became their new supervising physician.

During the two months they followed Dr. Nakagawa, they became generally familiar with the work content of cardiac surgery, and had a clear understanding of the patient's medical history, condition description, and why that treatment plan was used.

In my free time, I read books and various materials, which is still a learning process.

In mid-July, it was the turn of Tomoya Aki and Maki Nishikino to be on duty at night. Besides the two of them, the only people in the department at night were Dr. Yoshida and another doctor who specialized in large blood vessels.

"Ami-kun, we are going to spend another wonderful night together."

"Dr. Yoshida, you are making it difficult for me."

It has been two and a half months since they entered the cardiac surgery department, and Tomoya Aki and his colleagues have gradually become familiar with the doctors in the department.

In the entire department, the most humble person is probably Dr. Yoshida.

But to say that he is not arrogant is more like a person who is usually free and easy, but very serious at critical moments.

"How did you handle that?"

"If you are talking about that ungrateful person who wants to sue me, I can clearly answer you that I will never lose this lawsuit, and justice will be on my side."

He was sued after all.

I guess they didn't follow the plan given by the director of affairs and the hospital's lawyer at all.

After two months of getting along, he could see that Dr. Yoshida was a man of strong personality and a very proud person.

When faced with a medical dispute, even if there is no medical fault, he will never compromise simply because of his attitude.

"Dr. Moriyama, please go to room 1112."

The night shift is not easy, at least not as easy as the first day Aki Tomoya arrived at the hospital, when he had a peaceful night.

Just after twelve o'clock, Mori San, who specialized in large blood vessels, was called away, and there were only three people left in the duty room.

Shortly after Moriyama left, Dr. Yoshida was also called away, taking a resident with him.

In less than ten minutes, Tomoya Aki was the only one left in the department.

Just when Tomoya Aki had to stay at home to look after the family, the phone in the department suddenly rang. The emergency room called, asking the person on duty in the cardiac surgery department to come over.

After receiving the news, Tomoya Aki took out the internal contact phone provided by the hospital and contacted Dr. Yoshida to inform him of the matter. Then he hurried out and took the elevator to the emergency room to see what the situation was.

"I'm An Yi from the Department of Cardiac Surgery. Where is the patient?"

When Tomoya Aki walked into the emergency room, the first thing he noticed was a boy about five years old and two adults who looked anxious.

He knew the little boy. He had been a patient of their cardiac surgery department and had undergone a catheterization surgery on him by their supervising doctor, Dr. Aihara.

Before coming here, after receiving the news from the emergency room, An Yilun brought the boy's medical records here.

"The previous VSD..."

Amaki Tomoya murmured as he walked up to the boy and, while flipping through his medical records, he noticed that the boy's left leg's pants were rolled up and his lower limbs were swollen.

The boy had previously undergone a transcatheter interventional occlusion surgery in the cardiac surgery department for a congenital heart disease called ventricular septal defect.

After the operation, it was observed that the occluder was in a good position with no residual shunt, and the patient was discharged from the hospital after recovery.

But now it seems that a new problem has arisen. If something goes wrong with the operation, someone will be in trouble.

"He was discharged from the hospital two days ago..."

Aki Tomoya murmured to himself, and then asked for details.

According to the boy's parents, he was discharged from the hospital two days ago and experienced pain in his left lower limb at night. By this evening, it was swollen and could not be straightened, so he was unable to walk.

"Pain in the left lower limb, unable to straighten...obvious swelling, normal arterial pulse...no obvious difference in skin temperature, no obvious change in color..."

After a preliminary examination, Akitomo pulled up the boy's clothes and looked at the location of the puncture point.

"There is no redness, swelling or suppuration at the puncture site..."

There was no problem with the surgical site. Akitomo narrowed his eyes, then asked the nurse to hold the boy and take him for examination.

"Both blood coagulation and platelets are within normal range..."

Looking at the chest X-ray again, there was no obvious abnormality.

Next is a cardiac ultrasound to check the location of the blockage.

"Normal, no residual shunt, and normal valve activity..."

Aki Tomoya checked each item one by one and had a rough idea in his mind. He was just waiting for the final examination to confirm his idea.

Finally, he found abnormalities on bilateral arteriovenous ultrasound that were similar to what he had imagined.

"thrombus?"

Akitomo pinched his fingers. It was a low-echo mass in the left deep femoral vein. The first word that came to his mind was thrombosis.

Just as he was coming up with a plan, he heard footsteps behind him.

At the same time, Dr. Yoshida, who had finished handling the matter, came over.

"How's it going?"

He patted Aki Tomoya's shoulder and asked seriously.

"I suspect it's post-operative thrombosis."

"what happened?"

Then, Akitomo explained the boy's medical history and the catheter intervention surgery he had undergone before.

After a series of examinations, Aki Tomoya believed that he had postoperative thrombosis.

Chapter 435: Pretty Capable

"This is Dr. Sagara's patient. He was just discharged from the hospital two days ago."

Sagara is the current supervising doctor of Aki Tomoya and his colleagues, and they are currently rotating over to the pediatric department.

The boy in question was a former patient of Dr. Sagara, and had undergone surgery on him.

However, the surgery was not a thoracotomy, but a catheter-interventional occlusion procedure.

He was admitted to the hospital on July 10th, discharged on the 14th, and then in the early morning of the 16th, an emergency occurred.

"This is his previous medical record. During the examination, it was found that he had a congenital heart disease, ventricular septal defect."

The medical records all stated that the tricuspid valve tissue was attached to the perimembranous part of the right ventricular surface, the shunt was diffuse, and there was a more obvious shunt opening from left to right.

"The surgical site has recovered to normal, D-dimer is 630g/L, four coagulation tests and platelets are also within normal range, chest X-ray shows no abnormalities, and after cardiac ultrasound reexamination, the occlusion position is also very good, there is no residual shunt, the valve activity is normal, and there are no vegetation around. Only here, this small low-echo mass may be thrombosis."

Aki Tomoya repeated to Yoshida Aoba the results of his previous examinations and analyses.

"You are right, it is a blood clot, but this complication is really rare."

Yoshida Aoba nodded, and his words confirmed that Aki Tomoya's judgment was correct.

"Then you can inject low molecular weight heparin sodium first? And take aspirin effervescent tablets orally."

After the operation, Dr. Xiangliang also gave such medical instructions, injecting low molecular weight heparin sodium 24 hours after the operation, twice a day, every twelve hours, and taking aspirin effervescent tablets orally to prevent thrombosis.

However, what was unexpected was that two days after the patient returned, blood clots still formed in his veins.

The reason why the little boy's lower limbs were swollen, he was unable to walk and had pain was because of the blood clot.

"Quite capable."

Yoshida Aoba did not have any objection or anything to add. In his opinion, this response was sufficient. After injecting sodium heparin and having the boy take effervescent aspirin tablets, he was hospitalized for follow-up observation.

Although he arranged a bed for her and took care of her, he still couldn't let his guard down. In one night, Akitomo visited her no less than ten times.

"Ami-kun, is your side difficult?"

After spending a long time explaining the boy's condition to his parents and arranging the current key matters, Akitomo followed Yoshida Aoba back to the department.

"You've been working on that for quite a while, is it okay?"

As soon as he returned to his seat and sat down, Akitomo heard Nishikino's question next to him.

He checked the time and then noticed that he had been out for a long time.

"Well, there shouldn't be any major problems for now. He was Dr. Sagara's patient before. You remember the boy who had the VSD catheter intervention surgery?"

It was hard for Akitomo to say that he was 100% assured.

Although Yoshida Aoba said that it was okay, he still considered many situations.

"What happened to Dr. Sagara's patient?"

"I was discharged from the hospital two days after surgery and developed a blood clot. I am now hospitalized. I will report to Dr. Sagara when he arrives in the morning."

It was obvious that Nishikino still remembered the little boy.

They also learned the previous VSD catheter intervention surgery in the observation room nearby.

"There was clearly nothing wrong with him when he was discharged from the hospital, but now he has developed a blood clot?"

"Yes, I was shocked when I saw him. I thought something went wrong with the operation."

At this time, Tomoya Aki couldn't help but sigh.

When he saw the little boy, he was really a little scared.

If something went wrong during the operation, it would be a big deal for their department.

"In Aki-kun's opinion, it's not because of the surgery?"

"Well... I can't say that there are no such factors at all, but as far as the ventricular septal defect closure surgery is concerned, it was successful. The recheck showed that there was no problem with the closure position, but complications still occurred."

It is impossible to say that it has nothing to do with the surgery.

"Doctor Sagara performed a femoral vein puncture, and the thrombus was also found in the deep femoral vein of the left lower limb. It may be due to damage to the vascular endothelium at the puncture site, or it may be due to the prohibition of eating and drinking before the operation, the blood is concentrated and in a hypercoagulable state, and there are also factors such as slow blood flow. Even if there are no problems in the hospital, we cannot completely guarantee that there will be no problems after you leave the hospital..."

Aki Tomoya shrugged as he spoke.

He also thought about the possible causes of thrombosis and decided to talk to Nishikino about it.

Before and after discharge, doctors have no way of guaranteeing that the patient will be completely fine after leaving the hospital. It’s hard to say as there are too many uncertainties.

"Doctor Xiangliang also gave medical advice after the operation, including injection of low molecular weight heparin sodium and oral aspirin, which can be used as anticoagulants to prevent platelet aggregation. However, the boy still developed deep femoral vein thrombosis two days after being discharged from the hospital. I guess when Doctor Xiangliang arrives at the hospital during the day and learns about this, he will be very helpless."

This is something no one expected.

During the operation, heparin was injected for anticoagulation, and low molecular weight heparin sodium was injected and aspirin effervescent tablets were taken orally after the operation to prevent the formation of blood clots.

This is why Yoshida Aoba said it was uncommon before.

But the fact is that I still developed a blood clot, so it really feels like there is no way to prevent it.

There is really nothing in this world that is completely certain, especially in medicine which is full of uncertainty.

Rigorousness is one aspect, but there are also countless unstable factors.

"Fortunately it didn't fall off, otherwise it would be a big trouble..."

As he spoke, Aki Tomoya smacked his lower lips.

During femoral vein catheter intervention, thrombosis is uncommon, but once it forms and falls off, the thrombus will enter the anus with the blood flow and then cause blockage.