No one taught him; it was purely a matter of personal workplace survival skills.
"You did very well. When a patient develops a hemopneumothorax, this is exactly how it should be handled. For the treatment of such patients, as long as effective drainage is performed, and the lung re-expands to press the bleeding site, it can basically heal on its own. If continuous bleeding occurs, then timely thoracotomy for hemostasis must be considered. When you hand over your shift, you must explain clearly to the doctor taking over and observe closely."
Zhou Can really wasn’t putting on airs.
Even when an attending doctor spoke to him, it was generally with this kind of consultative demeanor.
He used to try to speak with them very politely. Then he found that it made the other party feel flattered, and the conversation was particularly hard.
Always being long-winded and polite, Zhou Can really didn’t have time to waste on that.
Also, he’s quite straightforward and doesn’t like hypocritical politeness. Later, he decided to just go with the flow.
"Okay, I will make sure to hand it over clearly."
Dr. Pu carefully noted it down in his notebook.
"Dr. Zhou, may I ask about the causes of bleeding in such patients? There’s quite a discrepancy between practice and what’s in the books, and I just want to learn more about this kind of practical experience."
He explained with a smile.
"The main causes of hemothorax are the tearing of adhesions between the visceral and parietal pleura. Most bleeding is due to the rupture or severing of small arteries at the ends of the chest wall adhesions. So after the lung expands, pressing the bleeding site can have a hemostatic effect. Most cases of hemopneumothorax can recover without surgery. You did very well by promptly transfusing blood and using hemostatic drugs intravenously."
While imparting some clinical practical experience, Zhou Can also did not hold back from praising Dr. Pu.
"Clinically, hemopneumothorax is more mon in young male patients, and it occurs more in the left chest than the right. The onset of this disease is often quite insidious, making it difficult to detect, and diagnosis is easily delayed. That’s why when I gave medical orders, I specifically instructed you to closely observe the patient’s bleeding situation."
After performing a closed thoracic drainage on the patient yesterday, Zhou Can gave some verbal medical orders.
He just didn’t explain how to handle the occurrence of hemopneumothorax in the patient.
Because he believed that the doctor in charge of the bed and the nurses would definitely report to the senior doctor in time.
If he hadn’t been in a rush to go to the operating room for two other major surgeries at the time, Zhou Can might have directly discovered the patient’s hemopneumothorax by observing a bit longer.
Judging from the patient’s drainage situation last night, the bleeding was still quite severe.
Hopefully, thoracotomy for hemostasis won’t be needed.
But sometimes, illness doesn’t follow the doctor’s wishes. Nor does it show softness just because the patient’s family is pitiful.
Illness is merciless and often extremely brutal to patients.
Therefore, this patient still needs to be observed closely to prevent any accidents.
"May I ask, how long after implementing closed thoracic drainage in such patients can we determine whether further surgical treatment is needed?"
Dr. Pu carefully noted the points that Zhou Can mentioned in his notebook.
A good memory is not as reliable as a flawed pen.
Doctors have too much to learn, and taking more notes is definitely a good thing.
"Basically, if drainage continues for more than twenty-four hours without a cessation of air leaks, further measures should be considered. However, for most patients, continuous gas discharge in the water seal bottle may take three or four days to slowly weaken and eventually disappear. Only a very small number of patients will still have gas discharge for as long as a week, which might mean the rupture is too large, and closed thoracic drainage is difficult to cure. Thoracotomy surgery for repair would be necessary."
For newers or veterans alike, Zhou Can is essentially not withholding information, patiently teaching.
This mendable teaching quality was also passed on to him by Director Hu Kan, Dr. Xu, Director Shen, and others.
The mentoring teachers Zhou Can encountered, no matter how reclusive or aloof, generally took the time to teach him patiently if they believed he was genuinely learning when he asked insightful questions.
At least so far, Zhou Can has never encountered a senior doctor who didn’t teach him.
Including Director Feng from the Anesthesiology Department, such an aloof doctor even took the initiative to ask Zhou Can to follow and learn.
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