My Medical Skills Give Me Experience Points Chapter 1209: 478: Closed Thoracic Drainage and the Urge to

Capítulo 1209: Chapter 478: Closed Thoracic Drainage and the Urge to Teach

Pneumothorax can be divided into two main categories based on its cause: primary and secondary.

This patient experienced pneumothorax for the first ti after a bout of rage, which classifies as primary pneumothorax. This condition is more common in males than females, with a ratio of about 6 to 1.

The main reason for pneumothorax in males is the rupture of subpleural bullae.

In particular, tall and thin individuals are more prone to spontaneous pneumothorax.

After diagnosis, Zhou Can has determined that this patient has left-sided spontaneous tension pneumothorax.

He earlier used an 18-gauge thick needle to puncture the left midclavicular line of the second intercostal space to aspirate air from the chest cavity. Currently, the patient is still experiencing severe symptoms of pneumothorax despite the treatnt.

What was initially thought to be a simple case quickly resolved, ended up with complications.

Holding the patient’s X-ray chest film, he quickly pondered possible solutions.

“Performing a left-sided closed thoracic drainage to release the gas might be an appropriate treatnt thod.”

After careful consideration, he decides to adopt this procedure for the patient’s treatnt.

There are two major indications for closed thoracic drainage: first, lung compression exceeding 30%, and second, tension pneumothorax. This patient ets both criteria, so the procedure is justified.

There are two thods to insert a drainage tube for closed thoracic drainage: the cannula thod and the open thod.

The open thod is not a major surgery; it only requires an incision of about 1.5 cm.

Both thods are based on similar principles and have their pros and cons.

Zhou Can prefers the open thod.

This thod is more direct and can yield quick results.

After communicating with the family, they expressed great trust in him and agreed to further treatnt.

This trust is very precious.

Because after the initial needle aspiration treatnt failed, most families would start doubting the doctor’s ability.

Zhou Can’s youth might make families think he’s inexperienced and untrustworthy.

It must be said that mutual trust between doctors and patients is indeed very important, greatly enhancing the doctor’s enthusiasm, autonomy, and willingness to take bold asures in treatnt plans.

If the family is difficult and constantly questions the doctor, it leads to the doctor instinctively protecting themselves.

Conservative treatnt will definitely be prioritized in such cases.

Director Xue fully cooperates and quickly assigns a temporary surgery room for Zhou Can to use.

After infiltrating anesthesia on the patient’s pleura, the procedure begins.

This doesn’t require an operating room; it can be done directly in the ward.

With the help of the instrunt nurse, he holds a traditional leaf-shaped scalpel and makes an incision of about 1.5 cm on the patient’s chest skin, cutting through the subcutaneous tissue before using long curved vascular forceps to bluntly dissect the muscle layer until reaching the pleura.

The entire surgical action proceeds seamlessly, swiftly, and effectively.

Upon reaching the pleura, he carefully inserts the drainage tube along the dissected pathway into the thoracic cavity.

Though it looks easy, the entire operation showcases superb surgical skills throughout.

A minute on stage, ten years off stage.

After all, inserting a drainage tube into the thoracic cavity carries obvious risks.

Bluntly dissecting the chest muscle layer to the pleura is even more challenging.

If done improperly, the pleura can be torn, creating a large gash in the thoracic cavity.

After successfully placing the drainage tube, he securely fixes it in place before connecting it to the drainage system.

“Can you hear clearly?”

Zhou Can looks at the patient.

“Yes!”

The patient’s voice is still a bit weak. Speaking easily triggers chest pain.

After experiencing pneumothorax, even breathing is painful.

Many people describe feeling heartache so intense after a breakup that they can’t breathe. The symptoms are quite similar to pneumothorax.

“Try taking a deep breath!”

Zhou Can instructs the patient to take a deep breath.

The purpose is twofold: first, to observe the fluctuation of the water column in the water-sealed bottle. Second, deep breathing helps the compressed lung quickly re-expand.

The patient’s left lung is over 90% compressed, which is extrely severe.

Prompt re-expansion of the patient’s left lung is beneficial for recovery.

“It hurts, it hurts a lot!”

The patient attempts to take a deep breath, but stops halfway, crying out in pain.

“Prilocaine is still providing anesthesia! Although it’s just local anesthesia, it should relieve so of your pain. You can’t give up just because of a little pain. Continue with the deep breaths, you’re a man. Rest assured, I’ll be here watching; nothing will happen to you.”

Zhou Can encourages the patient to try deep breathing again.

For many patients, pain is one of the hurdles they must endure.

The patient takes a deep breath again and still cries out in pain, but it’s better than the first attempt.

“Okay, stop the deep breathing now!”

Zhou Can stops him while frowning at the water-sealed bottle. Although the tube is successfully placed and connected, why is there no fluctuation in the water column?

Luckily, there is negative pressure.

If there’s no fluctuation and no negative pressure, it indicates that the drainage tube is either leaking air or has slipped out of the thoracic cavity, requiring imdiate action.

Zhou Can confirms that the drainage tube is well-secured.

The presence of negative pressure implies no air leakage.

There are only two possibilities: either the patient’s lung has already expanded, or the drainage tube is blocked.

The likelihood of the lung having expanded seems low.

He suspects the blockage occurred during the placent of the drainage tube.

He adjusts the tube and asks the patient to take another deep breath. This ti, the water column fluctuates.

Finally, it’s resolved.

It seems the tube might have been inserted too deeply and got blocked by the thoracic tissue.