What to do (2)
Aortic dissection.
This refers to a condition in which the aorta is ruptured due to an aortic aneurysm (a phenomenon in which the aorta becomes stretched and weakened without elasticity) or other trauma.
The newly created area due to this rupture is called false, and the space where blood originally flowed is called true.
The treatment is to completely excise the false part and replace the true part with an artificial blood vessel.
Suuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu
The scalpel split the aorta vertically.
As the aorta opened, the inside was revealed at a glance.
‘ruler. shall we start?’
Choi Ki-seok deliberately damaged blood vessels. At the level of patients who had surgery with Song Myeong-jin in the past.
Then, the inside of the aorta quickly became soaked with blood.
Cheeeeeeeek.
I suctioned with one hand and held an electric cautery with the other.
The moment the cauterizer touched the caustic, the smell of burning flesh passed my nose.
After emergency hemostasis using a cautery, the falsetto was cut boldly with a scalpel.
Empty!
The flaccid blood vessels fell onto the curved plate.
‘Faster!’
I pushed myself and set out to suture the true nature.
The key to aortic dissection surgery is speed. There is no time to think about anything else or relax.
Choi Ki-seok picked up the artificial blood vessel with forceps and aligned it with the real part.
‘shit!’
Blood continued to flow from Jinseong.
As my vision was obstructed, I had a hard time aligning the ends of the real and artificial blood vessels.
Normally, a surgical assistant should be at the side to provide suction and hold the end of the true bone and blood vessel in good contact. Only then can the completeness of suturing be improved.
But you can’t hope for that in your hideout.
At this moment, Choi Ki-seok has to play the role of a surgeon, a surgical assistant, and even a nurse.
We managed to match the true and false blood vessels and began suturing them.
End-to-end anastomosis.
This is a suturing method that connects both ends of the surgical site.
Choi Ki-seok accelerated his hand movements, recalling the time he was sewing a stuffed toy.
A long-awaited opportunity to show off my skills in front of my teacher has come.
Shouldn’t we show our growth and show off our pride?
click!
The first step was completed by cutting the sutures with scissors.
Ki-Seok Choi examined the next surgical site, the aortic arch.
The aortic arch refers to the area where the aorta, which used to extend straight, is bent like a bow. It was known that the standard practice was to treat the aortic arch after repairing the rupture of the ascending aorta.
‘maybe. ‘It was like this, right?’
Choi Ki-seok’s brow twitched.
In a past surgery, the false space burst when an attempt was made to treat the aortic arch.
Because the bleeding could not be stopped, the patient died.
Suuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu.
As Choi Ki-seok moved the scalpel, blood overflowed from the vascular branch in the aortic arch.
“Teacher Choi. Are you going to recreate that situation?”
“…yes.”
Choi Ki-seok nodded slightly. Then he held a suction device in both hands and sucked out the blood.
Cheeeeeeeek.
The fishy smell of blood wafted through the hideout.
However, even though I was suctioning with both hands, blood continued to build up and obscured the view of the surgery. Even two-handed suction is not enough to stop the bleeding from both the true voice and the false voice.
This is also the same situation as before.
‘Are you saying you found the answer on your own?’
Song Myeong-jin stared at Choi Ki-seok.
Now Song Myeong-jin knows how to deal with this situation.
After going to Meijo Hospital, I learned new tricks by talking to other thoracic surgeons.
However, it is questionable whether Choi Ki-seok discovered the method.
‘let’s go!’
Immediately after completing the suction, Choi Ki-seok grabbed one of Jin-seong’s blood vessels and the artificial blood vessel with one hand.
Then I tried suturing with my remaining hand.
This is the so-called one-handed suture.
Without suction, the aortic arch quickly turned into a sea of blood.
In addition, the true voice and falsetto were not visible as they were soaked in blood.
‘are you okay. you can do it.’
Ki-Seok Choi continued the suturing technique with confidence.
Even though it was not visible, the feel of real and artificial blood vessels remained on the hand.
If you trust this sense and suture, there will be no problem.
When one side was sutured and the other side was sutured in the same manner, the bleeding was reduced.
Ki-Seok Choi carefully removed the falsetto and burned it with an electric cauterizer. As a result, the aortic arch, which had been a sea of blood, returned to its original state. The ascending aortic dissection procedure and aortic arch dissection procedure were completely completed.
When the surgery was completed, I felt a sense of pride.
Through hard work, he was able to shake off the pain of the past in front of his teacher.
match. match. match. match.
When the treatment was over, Song Myeong-jin applauded.
“That’s great, Mr. Choi.”
“Thank you, but I think we still have a long way to go before we can catch up with you, Professor.”
“That’s right.”
Song Myeong-jin joked and smiled.
It seems that Choi Ki-seok’s growth rate was underestimated.
The skills he showed were closer to that of a fellow rather than that of a first-year resident. What resident could perform an aortic dissection without assistance and achieve smooth results?
Moreover, the way he deals with bleeding is also amazing.
Choi Ki-seok learned the method on his own, which he discovered after discussions with foreign thoracic surgeons.
“I worked hard and I had a good time at home today. Anyway, it’s such a waste to be at Uijin University Hospital at this level.”
“….”
“I can already afford to live at home, but I have to only assist in surgery… I guess I would have to become a fellow to perform surgery without worrying about the people around me.”
“…yes.”
When Song Myeong-jin hit the nail on the head, Choi Ki-seok responded helplessly.
This is correct in every detail.
It is said that CABG was performed with the help of Jang Hyuk-pil, but that was a very special case.
In fact, I have never had a surgery since then.
“I guess we’ll have to push the timing of Mr. Choi’s arrival to Meijo.”
Song Myung-jin rubbed his chin.
“Meijou is free when it comes to living at home. And if I work hard, there’s nothing I can’t do.”
“Thank you. But what happens to the Saber team if I go to Meijo early…” “
Don’t worry about that. I’ll tell Professor Jang well. Besides, it’s not like Professor Jang didn’t know about Mr. Choi’s Meijo actions. ?”
“That is correct.”
“Right now, don’t worry about others and only think about yourself, Mr. Choi. If you grow well, one day you will be in a position where you can take care of the people around you.”
“yes.”
“After seeing Mr. Choi’s skills, I feel relieved. I can return to Meijo with peace of mind.”
Song Myeong-jin smiled and tapped Choi Ki-seok on the shoulder.
* * *
The next morning.
Choi Ki-seok was sitting on a chair in the duty room, looking at the monitor.
“Now you care.”
I smiled after checking the review of the paper Youngho Lee sent me.
Since the last time I went, the quality of the reviews has increased noticeably. There were many parts that referenced domestic and foreign data or contained my own thoughts.
If you continue training at this level, your knowledge will quickly increase.
I stretched out and headed to the hideout.
“Good.”
I was glad to see a small Styrofoam box placed in front of the hideout.
Today, for the first time, I was able to practice pediatric heart surgery using a lamb heart.
After quickly completing the setup, we began the tetralogy of Pallor surgery.
Tetralogy of Fallot surgery is one of the most common surgeries performed in pediatric thoracic surgery.
It is also a necessary surgery for the long-term mission of reaching the top.
It was definitely necessary to master it.
“Whew…”
Choi Ki-seok let go of the needle holder and stared at his phone. The surgery was completed before the alarm went off. This means that the surgery has become familiar.
Tiring!
[Surgery mastery has increased by 1 level.]
[Tetralogy of Fallot surgery: 4/5]
I left the hideout with a pleasant notice behind me.
As I was heading to the pulmonology ward to see Choi Mi-soon, a broadcast caught my ear.
“Code Blue. Code Blue. Code Blue occurred in the Department of Pulmonary Medicine. We would like to inform you once again. Code Blue in the Department of Pulmonary Medicine.”
An ominous feeling ran down my spine.
Ride, ride, ride.
Choi Ki-seok’s steps became faster.
However, when I arrived at the respiratory department, two respiratory staff members came running from the opposite hallway, dragging a bed.
‘Ah…’
The moment I checked the person lying on the bed, I let out a groan.
The main character of Code Blue is Choi Mi-soon.
“Is there anything I can help you with?”
Ki-seok Choi matched his running speed with Cheol-hwan Yoo, his bed-pulling classmate.
“Please squeeze the ambu (airbag that helps breathing).”
“okay.”
Choi Ki-seok used the Must Be Saved skill and applied the awakening CPR buff.
In addition, we examined Choi Mi-soon’s condition through the eyes of Hippocrates.
The diagnosis was acute myocardial infarction.
The condition is emergency and the outcome is poor.
Although Choi Mi-soon suffered from stomach cancer and metastatic lung cancer, her heart was healthy. But I couldn’t believe that I was having an acute myocardial infarction.
Soon, Choi Ki-seok and the staff arrived at the internal medicine intensive care unit.
“Please give me the epinephrine IV. I’m going to do chest compressions.”
“No. I’ll do the chest compressions, so you can give me the IV. That would be best.”
Choi Ki-seok quickly began performing chest compressions.
This is because you must perform chest compressions in order to see the effects of awakening CPR.
A ten-minute struggle followed.
Choi Mi-soon barely regained spontaneous circulation.
Considering his age and chronic illness, he did not use a defibrillator, which is quite an achievement.
“Thank you. Thanks to you, I survived.”
Yoo Cheol-hwan breathed a sigh of relief.
“Of course it has to be done. Well, what happened?”
“Well… the old lady had a seizure while the nurse was checking her vitals.”
“It’s a seizure…”
Choi Ki-seok continued, rubbing his chin.
“As far as I know, there is no reason for the elderly person to suffer from AMI (Acute Myocardial Infarction). He does not have high blood pressure, has no family history, and does not smoke.”
“I think it’s because of the lung cancer treatment. Severe overwork can cause myocardial infarction.”
“Well, the old man is just lying in bed after receiving treatment. It’s hard to understand that he’s overworked.”
Choi Ki-seok paused before continuing.
“Could it be because of Elita? It hasn’t been long since you started taking Elita medication.”
“Elitara… Now that I think about it, I think the side effect was AMI…”
“You didn’t administer the medication without checking the indications, right?”
“…wanna die?”
“sorry.”
Choi Ki-seok quickly apologized.
I ended up making a mistake because I was worried about Choi Mi-soon.
As there was a moment of silence, Choi Ki-seok’s gaze rested on Choi Mi-soon.
To him, Choi Mi-soon is a special patient.
He spent his early days with her and received his first title through her.
‘Elder. Please hold on a little longer.’
Choi Ki-seok bit his lip and made up his mind.
I will definitely find the reason why she suffered an acute myocardial infarction.
Only then will you be able to complete lung cancer treatment normally and leave the hospital.
“Professor Kim Cheol-woo, are you going to work today?”
“Why? Talk to the professor about Elita?”
“Huh. Professor, I think you know something.”
“You’re not planning on fighting with the pharmaceutical company, are you? You can’t overturn a new drug that has already been released with just the case of Choi Mi-soon’s patient.”
“We’ll have to wait and see.”
“Anyway, anyway, Professor Kim only has treatment this morning. “I won’t be able to see you if I’m late.”
“Thank you.”
Choi Ki-seok smiled and headed to the isolation room.
