Chapter 2306 【2306】The Importance of Subdivision

Only this kind of practical medical student's answer can make the seniors feel the danger coming from the waves. Sometimes, it takes only a few years to be surpassed by younger generations.

Dr. Cheng Yuchen looked serious and asked her, "Have you ever had closed chest drainage?"

Closed thoracic drainage is a secondary operation, a minor operation that can be performed by daily residents. Clinically, there are usually two approaches to this operation.

One method is a very traditional method, which requires local anesthetic and a scalpel to incise the skin and muscles between the ribs. Finally, an opening was opened in the patient's chest with curved forceps, and then the drainage tube was inserted for suture fixation.

Another approach is to use a trocar to guide the drainage directly through the skin without surgery.

Last year, when the trainee participated in the car accident emergency rescue and escorted the patient, by chance, she performed a thoracentesis first aid to decompress a patient with tension pneumothorax. In the Department of Respiratory Medicine, I assisted Mr. Xin in performing a puncture for pleural effusion. In fact, the puncture she had done and then a drainage bottle was almost the second method of the thoracentesis and drainage just mentioned.

In addition to this, she Xie Wanying has done many other clinical punctures including subclavian vein puncture.

For various clinical punctures, the key point is to master the accurate operation anatomy and keep in mind the operation procedures, which is far less complicated than surgery. It's just that since puncture is classified as a second-level operation, it is not the simplest first-level operation, in order to fully explain its risk. If the puncture is wrong, it will cause serious complications such as massive bleeding.

Doctor Cheng Yuchen asked her if she had done it, and her tone was quite doubtful. Obviously thinking that she, a medical student who may not have done such operations, might be talking on paper.

You know that there are two puncture methods, so do you know which puncture method is suitable for this patient?

The first method was called thoracostomy in the past. It is to make an opening, which is very similar to the last tube left in a thoracotomy. The tube is very thick. The advantage of a thick drainage tube is that it is not easy for the drainage to block the tube, which is very suitable for patients with complicated conditions such as empyema, pneumothorax and pneumothorax.

The disadvantages are also obvious. To open a hole in the patient's chest, the length of the incision can reach two or three centimeters, and the patient is always in pain. This will bring a relatively traumatic operation to the patient, and the patient will not like it.

For the second method, the puncture needle usually used clinically is a central venous catheter needle, the needle is small, and the drainage tube brought in is thinner and softer, which brings extraordinary comfort to the patient. In contrast, the tube is soft and easy to be blocked by drainage, so it is not suitable for patients with complicated drainage.

Also, there is a difference between simple puncture and catheter drainage, otherwise it would not be a choice between puncture or catheter retention.

Apply it to specific clinical cases, and then use simpler words: the reason for keeping the tube in place is because simple puncture cannot make the lung recruit. For example, the young man she rescued last time went back to the hospital and had to undergo drainage again to keep the tube in place. If he didn't keep it in place, because the breach in his own visceral membrane always existed, he would soon have pneumothorax again and cause breathing difficulties.

The patient in the Department of Respiratory Medicine is no longer, it is encapsulated pleural effusion. The purpose of clinical extraction of pleural effusion is to confirm the diagnosis of infection. The degree of dyspnea does not need to be kept in the tube for a long time, and the more important thing is to deal with the source of infection.

It can be seen that the clinical treatment measures are very subdivided, and it is not like the same operations as laymen think.