Chapter 2446 【2446】That's Right to Ask Classmate Xie

Where is the bone piercing pain?

Generally speaking, there is pain when the needle passes through the skin, which is one of the punctures. Secondly, the nerves of the bone are mainly distributed on the periosteum, and the patient will definitely feel pain when the needle punctures the periosteum. For the above two, when the doctor gives the patient local anesthesia before the operation, these pain problems can be solved by injecting the local anesthetic on the skin and periosteum. The third pain is unresolvable pain, which is the pain caused by negative pressure when the needle enters the bone marrow cavity and pulls out the bone marrow. At this moment, in order to relieve the pain of the patient, the doctor needs to pump slowly.

How much to smoke depends on the specific case. In some cases, the bone marrow can be extracted by withdrawing one milliliter, but not necessarily in some cases. A simple bone marrow smear does not require much pumping. If you want to do additional tests such as breeding genes, you must draw more, use a large syringe or even a 20ml syringe.

The assistant stood opposite the doctor in charge of the puncture, helping to observe the condition of the child, laying hands down, and helping to make bone marrow smears, etc. Bone marrow smears are extracted from bone marrow and dripped on glass slides, which is similar to making plant leaf slides in middle school biology class. For the first diagnosis of this child today, more than five slides were required.

Dr. Tian said to the students: "Bone puncture is less risky than other punctures, so don't be nervous."

The teacher's words can be understood in this way. The bone marrow must be extracted from the big bones of the body. The bone target is large, unlike deep vein puncture, which needs to pierce deep, thin and slippery blood vessels, like a blind man feeling an elephant. Lumbar puncture is difficult and risky. As I said before, if you don't pay attention to the cerebrospinal fluid, it will affect the patient's brain.

If the bone is pierced, touch the bone that can be felt through the skin, and it is easy to get in place with one needle, the probability of error is small, and the risk of complications is also small. Moreover, there are many targets for doctors to choose from for bone piercing. If this bone feels bad or cannot be pulled out, you can find another bone to pull it out.

Usually, in clinical practice, the sternum, ilium, and tibia can be extracted by bone piercing. It is best to wear the ilium, the bone marrow in the large bone marrow cavity of the ilium is easy to pump. Children under six months have more shin splints, and the puncture position of the tibia is relatively the safest.

In view of the high risk of sternal puncture, for the sake of safety, and with such family members around, the doctor did not dare to take the risk of the sternum after deliberation, and directly chose everyone's favorite ilium. The anterior superior iliac spine or the posterior superior iliac spine can be selected as the insertion point for drawing the ilium.

Zhang Desheng had been an intern in the Hematology Department of the National Association of China before. He had seen the teacher do the bone puncture and also helped the teacher. For this reason, he was appointed by Teacher Tian to do the puncture. Zhao Zhaowei was on the sidelines as an assistant.

Several surgical students had never been to the Hematology Department of the National Association of China, so they were watching from the sidelines. What is more special is classmate Xie, who was named by the family of the patient to take care of the child, and stood beside the puncture doctor to help hold the child.

For any puncture operation, accurate positioning of the anatomical location of the puncture target is the most important.

Zhang Desheng touched the child's ilium with his sterile gloved fingers, and asked Xie with his eyes: Is the position I touched right, Yingying?

As we all know, Xie is a super student in anatomical positioning. Classmates who are smarter will seize the opportunity to ask Mr. Xie for their opinions.

The child's position is supine, and Xie Wanying infers from this that the classmate may want to insert the needle from the anterior superior iliac spine, saying: If you are not too sure about puncture, it is better to choose the posterior superior iliac spine. Compared with the anterior superior iliac spine, the posterior superior iliac spine has a larger plane and is easier to puncture. If you are afraid that the position of the child with posterior superior iliac spine will be difficult to fix, we are here to help.