"The patient, a 25-year-old male, was admitted to the hospital due to head bleeding in a car accident and vomiting for two hours."

"Forehead scalp laceration accompanied by local skull depression, muscle strength and muscle tone of the limbs were normal, and emergency scalp debridement and suturing was performed. The patient was conscious, fluent in speech, and his pupils were equal in size and round, 3 mm in diameter, sensitive to light, and opened his eyes automatically.

Answer the questions correctly and follow the instructions, and you will get 15 points on the GCS."

Reading the results of her evaluation, Zhang Lu handed the film on her hand to Tian Lu: "According to the results of the CT examination, it indicates a depressed fracture of the forehead and skull."

Tian Lu took the film and nodded after watching it for a while: "Acute open craniocerebral injury, open depressed skull fracture, and pneumocephalus. I think we should prepare for surgery."

Zhang Lu nodded and agreed with Tian Lu's judgment. For acute open craniocerebral injuries, the key to preventing complications is immediate and thorough debridement. Although the patient's condition is not bad, it is better to have surgery earlier.

Before the operation, there were still a series of necessary examinations to be done, and the anesthesiology department had to be asked to do a risk assessment. There was a lot to do, so Zhang Lu sat down and got busy.

"Huh?"

Watching Zhang Lu open the order, Tian Lu found out very sensitively that his movements would often stop suddenly. Often when he was halfway through writing a word, Zhang Lu's hand would stop for a moment before he could continue writing.

How is this going?

Tian Lu's brows frowned deeply.

As a neurosurgeon, the importance of a steady hand goes without saying, but looking at Zhang Lu's performance at this time, it seems that her body is in an abnormal state!

Because it was related to the next operation, since he discovered that something was wrong with Zhang Lu tonight, Tian Lu asked without hesitation: "Teacher Zhang, are you feeling a little uncomfortable?"

"ah?"

Zhang Lu was startled when she heard this. She quickly raised her head and said with a forced smile: "Oh, it's okay. I'm just a little tired today and may not be in good spirits. Haha, I'm older and I can't compare to you young people."

"Then you'd better not participate in the upcoming surgery. Go back to the duty room and take a rest." Tian Lu immediately said with concern.

Zhang Lu waved her hands and said: "No, I will be your assistant later, it should be fine!"

"This is not okay!"

Tian Lu shook his head and persuaded: "Teacher Zhang, even if you can persist, we still have to be responsible for the patient. I think you should go back and rest first. I will ask Zhang Qianqian and the two of them to come and help. This surgery

It’s relatively simple and no problem.”

After hesitating for a moment, seeing that Tian Lu's expression was very determined, Zhang Lu finally nodded in agreement.

Lin Jun and Zhang Qianqian rushed over after hearing the news. When they heard that they had the opportunity to be Tian Lu's assistant for surgery, the two students were very excited. Such an opportunity was relatively rare for them.

Everything went on in an orderly manner. Soon, the patient was pushed into the operating room, and Tian Lu and two students were standing in front of the operating table.

"Activate the clinical operations support system!"

Silently, Tian Lu issued instructions in his heart.

For a not-so-complex surgery, there would be no problem without activating the operation support system, but Tian Lu has long been accustomed to performing operations with the help of the operation support system. Moreover, the future Practicing Physician Law also stipulates that surgeons perform operations

The system must be turned on when operating, even if it has been performed thousands of times!

Being able to add a layer of guarantee to a 100% sure operation is something that every qualified doctor should do.

The patient's hair had been shaved. Tian Lu drew a line on the patient's head. After glancing at the two students, he found that Lin Jun and Zhang Qianqian were obviously a little nervous while they were excited. Four eyes were fixed on Tian Lu's face.

, for fear of missing any instruction.

"Haha, you two, don't be so nervous."

Tian Lu smiled and said: "This is not a complicated operation, and the patient's condition is pretty good. Don't worry. Your job is to be an assistant. Just follow my instructions."

Perhaps infected by Tian Lu's indifferent expression, after a few words, Lin Jun and Zhang Qianqian's expressions relaxed slightly. Indeed, the depressed skull fracture surgery is only a second-level surgery in the surgical classification of Shenwai, and it is not difficult, and

The danger was not great. However, the two of them still stared closely at Tian Lu's movements, as if they were afraid of missing something.

While comforting the two students, Tian Lu's movements with his hands were not slow at all. He drew a marking line on the patient's head almost without thinking, and then directed the two of them to place the patient in a supine position.

After routine disinfection and draping, Tian Lu began to inject lidocaine subcutaneously into the patient.

"Who can tell me what is the purpose of injecting lidocaine?" Tian Lu asked softly while operating.

Zhang Qianqian wrinkled her nose and was still thinking, but Lin Jun replied from the side: "It avoids stimulation of blood pressure during the skin incision process, and it also has a certain hemostatic effect."

"very good!"

Tian Lu nodded with satisfaction. Since both of them called him Teacher Tian, ​​he naturally couldn't do the surgery on his own. In addition, the surgery was not very complicated, so he could enjoy the addiction of being a teacher again.

After incising the skin and subcutaneous tissue, he directed the two students to use scalp clamps and bipolar electrocoagulation to stop bleeding. Tian Lu's hands were like mechanical arms, performing a series of operations without a trace of tremor: subgaleal separation

The scalp was turned forward and the skin flap was turned forward to expose the partially depressed skull.

"So fast!"

While helping Tian Lu fix the skin flap, Lin Jun and Zhang Qianqian's eyes lit up, and they suddenly exclaimed. Although they have never been assistants on the operating table, they have both seen neurosurgery, and it seems that they have never seen anything like this before.

No doctor can move as fast and as steadily as Tian Lu!

"I'm afraid even Director Leng can't do what Teacher Tian is like, right?"

After thinking back and comparing the cold surgery, Zhang Qianqian got an answer that surprised her.

As the next step of the operation was carried out, Tian Lu asked: "Zhang Qianqian, what is the purpose of putting gauze under the skin flap?"

Zhang Qianqian, who was named by Tian Lu, was startled, and shook her head in a panic, saying that she didn't know clearly. However, Lin Jun saw her shaking her head and said softly: "Prevent the occlusion of blood vessels in the scalp."

Zhang Qianqian’s little face turned red!

She didn't know the answer to the two questions in a row. Instead, Lin Jun, a boring gourd, answered it right away. This made her suddenly feel extremely ashamed. If she hadn't been standing on the operating table, she would have wanted to find a crack to get in right away.

.

Ignoring the change in the assistant's expression, Tian Lu, who was very satisfied with Lin Jun's answer, continued the operation at hand.

"Zhang Qianqian flushes the surgical site with hydrogen peroxide and saline, and Lin Jun operates the suction device!"

While instructing the two of them, Tian Lu cleaned up the foreign objects in the surgical field, then incised the periosteum and used a periosteal screwdriver to separate the periosteum, exposing the patient's skull.

"oh!"

This was the first time for the two students to see a real skull at such a close distance. When they saw the dented and partially shattered skull, they couldn't help but let out a low exclamation.

The next operation is one of the most difficult parts of the operation: drilling.

It seems very simple, but it does take a certain amount of experience to master the strength of the hand and judge the depth of drilling. Following the system prompts, Tian Lu quickly drilled both ends of the depression without any hesitation.

Two holes.

Next, use a dural stripper to separate the dura mater under the inner skull plate, use a milling cutter to mill the bone flap around the depressed fracture, use gelatin sponge to separate the dura mater under the bone flap, drill holes on the edge of the bone plate, and suspend the dura mater.

.

While doing the above series of operations, Tian Lu did not forget to give a lecture to the students: "Using gelatin sponge under the bone flap for separation can avoid dural rupture and bleeding, and suspending the dura mater can reduce postoperative dural stripping.

and hard

The occurrence of extrameningeal hematoma. You must remember that a good surgeon must master many things. Not only must the operation be performed quickly and cleanly, but he must also consider postoperative treatment and try his best to prevent complications.

"

After separating the bone flap and exposing the somewhat broken dura mater, Tian Lu began to cut the titanium steel plate according to the size of the bone flap.

"Teacher Tian, ​​can't the removed skull be reset?" Zhang Qianqian asked curiously.

Tian Lu shook his head and said: "The fracture is obviously shattered and it is difficult to reset."

Watching Tian Lu cutting the titanium steel plate, Zhang Qianqian shuddered when she thought that there was no skull on top of her head, but a piece of titanium steel plate with many holes. She couldn't help but shudder.

Because there was a break in the dura mater, after cutting the titanium steel plate, Tian told Zhang Qianqian to rinse it with saline, then carefully cut the dura mater along the break, and began to clean the bone fragments embedded in the brain. This was because it was necessary to minimize the impact on the brain.

It was exciting, so this step required special caution. In addition to following the system's prompts, Tian Lu also opened his eyes wide and operated carefully.

After the cleaning was completed, there was no obvious bleeding or brain contusion under the dura mater. Tian Lu covered the brain surface with hemostatic material and tightly sutured the dura mater. After doing this, Tian Lu concentrated his attention again.

Next, there is another difficulty in the surgery: covering and fixing the titanium plate.

After covering the epidural with hemostatic material, Tian Lu carefully took out the titanium steel plate and fixed it on the outer plate of the skull with screws. While fixing, he had to constantly shape the titanium steel plate to conform to the original skull shape as much as possible and avoid the titanium steel plate.

The periphery is warped. This work is quite tedious, and even with the help of the system, it still took Tian Lu a lot of time.

However, after completing this step, the operation was almost completed. Tian Lu breathed a sigh of relief, and the following operations suddenly sped up.

The drainage tube was placed, the galea was sutured in layers, the subcutaneous sutures were sutured, and the scalp was sutured. Tian Lu's hands were like two dexterous butterflies, flying up and down with great dexterity. Zhang Qianqian and Lin Jun completed the rest at a speed that stunned Zhang Qianqian and Lin Jun.

operate!

"Wow, awesome!"

The moment she finished the last stitch, Zhang Qianqian finally couldn't suppress the excitement in her heart and cried out in a low voice: "Teacher Tian, ​​how did you practice? Could it be said that you have performed this operation thousands of times?

?”

Lin Jun also had an incredible look on his face, staring at Tian Lu in a daze. When he first met Tian Lu, the boy was quite unconvinced, especially when he learned that he had returned to China after completing his residency training.

, and even felt that Tian Lu came back because he could no longer survive there.

Now, Lin Jun has finally completely put aside this idea in his heart!

"Okay, let's send him to the postoperative anesthesia recovery room!"

The surgery did not consume much energy from Tian Lu. He ignored the surprise of the two students and changed the subject with a smile: "But before that, I want to ask one last question!"

Zhang Qianqian's spirit immediately became highly tense. She failed to answer the first two questions, which made her feel extremely embarrassed. The last question could no longer let Lin Jun steal the spotlight.
To be continued...