Chapter 212
Lumbar puncture, thoracic puncture, spinal puncture… all kinds of puncture techniques should be mastered by operating room trainees.
In school, teachers often entice students by saying, mastering physics and chemistry and you can go anywhere without fear.
Now, Zhou Can wants to tell all doctors, perfect your injection skill, and any puncture will be done in one go.
Doctors who need two, three, or even more attempts to succeed in puncturing are those who haven’t practiced their injection skill well.
Doctor Shan doesn’t even know how to step back gracefully now.
It may succeed with a hard-headed attempt after multiple failures. But it’s more likely to fail again.
That will be even more embarrassing.
She’s considering whether to ask someone to help.
Zhou Can volunteered; although she wasn’t too hopeful, having someone to resolve the situation was still a good thing.
Otherwise, how could she continue to teach these trainees if she lost face with the first surgical patient?
They wouldn’t dare to laugh at her face-to-face.
But who knows what they would say behind her back.
“Be careful with the procedure, and if I call stop, you must immediately halt.”
She advised with some concerns.
“Got it!”
Zhou Can took the syringe and changed to a new needle.
It must be said that after a failed needle puncture, it is best to change to a new one.
Mainly to prevent bacterial entry and causing infection in the originally sterile joint cavity. Consequences of infection caused by puncture are serious.
A needle doesn’t cost much anyway.
It all counts as part of the consumables.
Zhou Can then felt the patient’s joint area and inserted the needle with one shot.
“Ssst!”
After the needle of the syringe penetrated the skin layer, it met resistance and then quickly punctured through.
A successful puncture on the first attempt.
“Is, is that a successful puncture?”
The several trainees around, including the nurse, resident doctor Doctor Tang, were all utterly silent.
Holding their breath.
Waiting to see the outcome.
Doctor Shan’s eyes widened in shock, not until she saw the needle deeply embedded in the skin did she confirm Zhou Can got it right with one shot. He easily accomplished the knee joint cavity puncture.
“Damn impressive!”
Someone whispered in admiration.
Several trainees felt despair in their hearts. How could they compete when their competitor was so intimidatingly strong?
Fortunately, there were six spots in the operating room.
What they hoped most was that among the eighteen trainees, Zhou Can was the only monster.
“Don’t move, I’ll check!”
She squatted down and after a careful inspection, her expression showed disbelief.
Indeed, an accurate one-shot puncture, it was a success.
“Good, you’ve done well. After puncturing into the knee joint cavity, you need to first extract the synovial fluid inside.”
She demonstrated the procedure herself.
“After the synovial fluid is extracted, inject approximately 10ml of 0.25% lidocaine.”
The purpose of injecting the anesthetic is to facilitate subsequent treatment.
“This solution contains about 5mg of triamcinolone. It’s mainly injected at the patient’s painful spots. Then help the patient move the knee joint to allow the medication to take full effect.”
Doctor Shan continued to observe the patient’s reactions.
The medication seemed to be working; the patient was no longer crying out in pain.
“Grandma, this treatment needs to be done in five sessions. Come back to the hospital in a week for the second round of treatment,”
She told the elderly woman.
The old lady no longer felt the pain in her knee and seemed very pleased.
“Thank you, thank you all!”
The old grandma thanked Doctor Shan and Zhou Can repeatedly.
Although she was old, she was clear on who had healed her.
“Miss, I am old and my memory is not good. Can you please tell this to my son again later?”
“Alright! We’ll remind your son later!”
After the treatment, the patient was wheeled out of the operation room.
Doctor Shan glanced at Zhou Can, then swept her gaze over the other resident doctors.
“This treatment typically takes place over five sessions. The first two involve the injection of the liquid we just used. Starting with the third session, sodium hyaluronate, which Dr. Zhou mentioned, will be injected. The difficulty in treatment is usually the joint puncture. You need to watch closely, reflect, and practice more.”
She still felt somewhat embarrassed when recalling the recent joint puncture.
Up to now, she didn’t know why her punctures kept failing.
This kind of issue seldom happened.
She was too embarrassed to ask Zhou Can directly; she would die before she could muster the courage to pose such a question.
But this wouldn’t stump the clever her.
“Dr. Zhou, please share with everyone your experience with the successful puncture.”
“Sure!”
Zhou Can looked meaningfully at Doctor Shan.
He was well aware of her little schemes.
And he couldn’t help but admire Doctor Shan’s oratory skills.
As Director Shen had eloquently spoken yesterday, a disciple mentored by him certainly wouldn’t be any less adept.
“I was able to puncture successfully, which is mostly attributed to luck. Besides, as Doctor Shan mentioned, changes like bone deformation even severe malformation can occur when the joint is affected by disease. So I felt around and indeed found her joint space had narrowed. During the puncture, I deliberately chose a location slightly above the medial line.”
Zhou Can rolled up his trouser leg and demonstrated to everyone.
After listening, Doctor Shan suddenly understood.
So that was it.
No wonder there had been several failed punctures with patients having severe joint abnormalities.
Each patient’s joint condition is different.
The elderly lady just now probably belonged to one of the more rare types.
Zhou Can’s words were modest, attributing most of it to luck.
In reality, she knew that he was subtly protecting her dignity.
And for that, her affection for Zhou Can had greatly increased.
“Great! Thank you, Dr. Zhou, for sharing. Let’s move on to the third patient’s examination reports.”
The patient’s examination images displayed on the screen were of the hand, using both MRI and X-ray inspections.
Generally speaking, MRI is quite expensive, and doctors with any professional ethics wouldn’t just recklessly prescribe such a test to patients.
It is only prescribed when the cause of the disease is unclear, or the doctor deems it necessary for a more thorough examination.
The doctor would discuss it with the patient and ask for their opinion.
The examination report was shown for a full four or five minutes, and yet, nobody was quick to answer.
It was because this patient’s condition was complex.
After two rounds of quick-response sessions, everyone understood that it was better to answer correctly than to answer quickly.
“Nobody understands it?”
Doctor Shan seemed quite pleased.
Finally, a chance to reestablish her authority and her status as the main surgeon.
This group of resident doctors couldn’t understand it, and her explanation would show off her high level of expertise more.
She had been embarrassed during the puncture attempt earlier and was somewhat eager to save face.
“All I can tell is that the patient’s extensor tendon has ruptured, and it seems that the joints also have Rheumatoid Arthritis?”
Zhou Can was also uncertain.
This involved knowledge related to orthopedics, which was quite a challenge to answer for a junior resident doctor like him.
“I also think it’s the extensor tendon rupture caused by Rheumatoid Arthritis.”
Another resident doctor agreed with Zhou Can’s opinion.
He probably, like Zhou Can, wasn’t too certain either.
The havoc caused by Rheumatoid Arthritis in the hands is significant, as it easily leads to extensor tendon ruptures.
Many patients do not engage in heavy lifting or forceful actions in their daily lives,
Yet they hear a “ripping” sound, like the tearing of cloth.
Then comes the severe pain in the hand, and the loss of grasping ability.
How severe is this pain? It’s like taking too big a step and straining one’s groin, the tearing kind of intense pain that’s persistent and unbearable.
In such cases, a tendon tear is mostly to blame.