Practicing Medical Skills in a Small Clinic novel Chapter 744

Chapter 744: Chapter 345: A Diuretic Shows True Skill, The Joy of Success

This is no longer just simple favoritism but has elevated Li Jingsheng to a level where he can truly converse with him as an equal.

If Deputy Director He is Director Zhang’s left arm, then Li Jingsheng is now Director Zhang’s right arm.

Perhaps even at a higher level.

"My medication advice is digoxin and hydrochlorothiazide diuretics. As for antibiotic treatment for respiratory infections, amoxicillin should be sufficient."

When the infection is not severe, the simpler the medication, the better.

Only in the case of troublesome severe infections would a combination of multiple antibiotics be considered.

The role of diuretics is to reduce blood pressure.

There are three major categories of diuretics, and Li Jingsheng did not choose the high-efficiency diuretic furosemide. Although its effects are excellent, it also has relatively significant side effects. It can easily cause hypokalemia.

The patient is about to undergo major surgery, so the ordinary hydrochlorothiazide is instead the first choice.

Furosemide is mostly used to treat heart failure and tissue edema.

It can be used now, but Li Jingsheng believes it is not the first choice medication. It is the first choice in heart failure complicated by pulmonary edema because it can quickly reduce the water content in the blood, promoting reabsorption of pulmonary edema.

A doctor with a higher level of medication expertise would only consider using this drug when edema is severe and other diuretics are ineffective.

Spironolactone is also a commonly used diuretic.

It belongs to the category of aldosterone antagonists, primarily used for treating resistant hypertension.

The side effects of this drug are the opposite of furosemide; it easily causes elevated blood potassium levels, leading to hyperkalemia.

It seems to be a very simple medication, yet it tests a physician’s knowledge and expertise in all aspects of medication. As for the dosage, administration method, and timing, these require strong pharmacokinetics to support.

Li Jingsheng is merely providing a medication plan.

If adopted, he will naturally strictly calculate dosage, administration method, timing, etc.

"Hmm, very good. Dr. Li’s medication plan is basically similar to mine; no other issues, let’s begin then!"

Director Zhang praised him with satisfaction.

At Director Zhang’s level, he could easily see Li Jingsheng’s progress in medication.

Surgical preparations are being completed one by one.

General anesthesia, tracheal intubation to maintain respiration, establishing extracorporeal circulation, myocardial protection...

In the midline incision of the patient’s chest.

Because traditional intracardiac repair surgery has many drawbacks, such as poor long-term effects, time-consuming and laborious operations, and numerous risks.

Therefore, this time they are using the advanced RASTELLI procedure.

Simply put, it’s a double-switch of the atria and great arteries.

Establishing extracorporeal circulation and stopping the heart is a crucial step.

Fortunately, the entire team is already very experienced in this area.

Even Li Jingsheng can already independently command completion.

After coronary perfusion with cold cardioplegic solution, nurses and medical assistants use ice slurry around the heart, aiming to protect the myocardium.

Then starting intubation in the ascending aorta, directly inserting right-angled drainage tubes into the superior and inferior vena cava.

This step was completed by Li Jingsheng.

There are more than three choices for this intubation, which can be chosen based on the patient’s specific situation.

For instance, via the right superior pulmonary vein, which is the most commonly used.

After the heart stops, a decompression tube can also be inserted via the patent foramen ovale.

Due to Li Jingsheng’s highly advanced proficiency in catheter insertion, when it comes to intubation, he is the strongest presence in the team.

The surgery is in tense progress.

Li Jingsheng closely collaborates with Director Zhang’s work; stopping bleeding when necessary, providing exploration assistance likewise without Director Zhang needing to say more, always accurately and timely executing auxiliary tasks.

This is one of the reasons why Director Zhang likes to make him the first assistant.

Convenient, relaxed.

Along with Li Jingsheng’s strong skills in all areas, he can lend significant help at critical times, naturally leading Director Zhang to prefer him as the first assistant.

"Xiaoli, do you feel confident in handling this incision?"

Director Zhang seems to have encountered a small problem.

At this moment, he actually needs to request support from Li Jingsheng.

"Is it a longitudinal incision in the right ventricle?"

On the way to the hospital, Li Jingsheng already reviewed the surgical plan in his head numerous times, including every step.

Since the team is performing this surgery for the first time, although everyone possesses ample experience in various aspects, many issues may still arise.

The more prepared they are, the higher the success rate will be.

"Yes!"

Upon hearing this question, Director Zhang directly moved aside.

Indicating for him to go over and stand at the lead surgeon position to make this incision.

Li Jingsheng did not hesitate, stood at the lead surgeon position, and took the scalpel handed over by Chang Yueyue.

She has assisted with Li Jingsheng multiple times and is very familiar with his surgical habits.

Knowing he prefers using a scalpel, minimizing the use of electrocautery.

This is especially true for high-difficulty incisions and separations.

He grasps the scalpel and makes an incision from the upper end of the pulmonary artery trunk, then slices through the right ventricle.

This process is fraught with danger and demands extremely high requirements for incision skills.

Director Zhang’s incision level is not low, but he possesses a negative personality trait—once nervous, his hands tend to sweat and even tremble.

Excessive hand sweating, despite wearing gloves, still impairs tactile sensation to some extent.

Not to mention cutting open the right ventricle, even cutting through the skin layer, tactile sensation is extremely important.

Because it directly affects the feedback of the knife sensation.

If tactile sensation is dull, it’s easy to be unaware during the incision process.

For example, already having cut a major blood vessel, realizing you’ve cut too far only then. Additionally, it will affect the stability of the incision to some extent.

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