The left 6th and 7th costal space and the middle clavicular line were marked and disinfected.

    Chu Zhixi has prepared the anesthetic. Wu Mian used a 5ml syringe to extract the anesthetic and local infiltration anesthesia.

    The incision of about 1.5cm was taken with a leather knife, and Wu Mian was blunt separated with hemostatic forceps. Open and close the pliers and separate Cheng Linhai''s intercostal muscles several times.

    "Dr. Wu, your hand is very light and doesn''t hurt at all." Cheng Linhai wanted to comfort Wu Mian as much as possible. He said with a smile.

    "Big man, why did you say the mountain fire started again?" Wu Mian asked.

    Chu Zhixi prepared the chest tube, cut two side openings, clamped it with hemostatic forceps and handed it to Wu Mian.

    County hospitals use fewer chest tubes and bottles, and they will have closed drainage at most. Thoracic surgery is a little more high-end than brain surgery to some extent. At least the county hospital can do neurosurgical drilling and drainage.

    The chest tube is still the oldest, not the steel core. But for Wu Mian, everything is the same. With pliers in one hand, he dipped into the incision, with a chest tube in his hand, ready to go.

    "Isn''t it good for greening? The old forest leaves fall year by year. In some places in the mountain, the leaves are too thick to walk." Cheng Linhai said. "Sometimes there is an open fire, which lights the forest. It''s OK to say. But thunder fire... Our captain said that a dew refracts the sunlight. By coincidence, it can... Ah!"

    Just then, Cheng Linhai suddenly shouted.

    "Well, it''s all right." Wu Mian had sent the chest tube in while he was concentrating on the mountain fire.

    Cheng Linhai is in good health. With tension all over his body and hard pleura, it is almost impossible to finish the operation unknowingly. Wu Mian used a hemostatic forceps to penetrate the pleura and immediately opened the jaws. Another hemostatic forceps directly sent the chest tube in, clean and neat.

    Chu Zhixi connected the chest bottle, and the dark brown chest water gurgled out.

    Suture, fixation, angle needle, No. 7 line, Wu Mian''s hand seemed not to move, and a beautiful thread knot appeared, which firmly fixed the chest tube on the chest wall.

    Wu Mian didn''t let Cheng Linhai get up. He squatted in front of the disposal bed and looked at the fluctuation of the breast bottle carefully.

    The chest water volume is very large. There is 500ml normal saline below. The saline is mixed with dark brown chest water, and the water surface runs up along the scale.

    At 1000ml, Wu Mian stuck the chest tube with hemostatic forceps.

    "Prepare methylene blue solution."

    After saying that, Chu Zhixi handed agalan to Cheng Linhai.

    "Want a drink?" Cheng Linhai looked at the blue cup and frowned.

    "Well, drink," said Wu Mian with certainty.

    Cheng Linhai didn''t talk. He believed Wu Mian, even if Wu mian "cheated" him once by small means.

    Like drinking, Cheng Linhai is very heroic. Whether methylene blue is good or not, he simply poured it down.

    "Drink slowly, one mouthful at a time..." before Chu Zhixi finished, he saw that the cup in Cheng Linhai''s hand was empty.

    This executive power is too strong! Wu Mian was ridiculous. He sighed and said, "it''s all right. Wait for me."

    Generally, the doctor will ask the patient to drink the methylene blue solution slowly. If there is a rupture of the esophagus, the blue solution will enter the chest along the esophageal fissure and then lead out along the chest tube.

    This is a logical and self consistent diagnostic method, which is commonly used in clinic. The only regret is that Chu Zhixi said a little slowly, and Cheng Linhai''s execution is a little strong.

    After about 10 seconds, Wu Mian opened the clamped chest tube.

    The color of the liquid led out this time changed from dark brown to a strange color. The color of dark brown chest water is even worse, mixed with extremely dark blue.

    The diagnosis is clear. It is indeed a broken esophagus.

    Director Lu has been standing behind Wu Mian, concentrating on the color of the liquid introduced from the chest bottle.

    Seeing the strange color of pleural effusion, he sighed deeply, knowing that the young doctor''s judgment was correct.

    "Dr. Wu, how do you judge?" director Lu asked.

    "Boerhaave''ssyndrome..." Wu Mian naturally said an English sentence and then paused. "Spontaneous rupture of esophagus is not very common, but there is no other reason to explain a large amount of pleural effusion in a short time. It can only be considered as spontaneous rupture of esophagus."

    "How do you know it''s a short time?" director Lu continued to ask.

    "Because you have been diagnosed," Wu Mian said.

    "Me?" director Lu was confused. He looked at Wu Mian suspiciously and didn''t understand what Wu Mian said.

    "You are the old director of the respiratory department of the county hospital. You have done all the simple tracheoscopes. How can you not listen to auscultation? My judgment is that you didn''t have so much effusion when you checked your body. The breathing sound on the left side is clear and slightly weak, and there is no wheezing sound, so you can judge that there is no problem."

    What director Lu wanted to say was finished by Wu Mian. He could only keep silent.

    "When I listened, the patient''s breathing sound in the left lower lung was very weak. At this time, the patient had no sign of cyanosis of the lips. In addition, I said you shouldn''t have missed auscultation before, so I judged that it was esophageal rupture. It is estimated that the big man drank a lot of water after your examination, resulting in pleural effusion."

    It turned out that he had become a part of the patient''s disease judgment. Director Lu tasted carefully and felt that the young man in front of him was not simple.

    "Dean Zhou, can you sign?" Wu Mian turned and asked.

    "Sign what?"

    "Esophageal rupture requires thoracotomy and surgical suture," Wu Mian said.

    "..." Dean Zhou was stunned and said with a stiff head, "yes!"

    If not, he doesn''t want to make trouble for himself. Esophageal rupture and suture, that''s the esophagus, not the prostate!

    Prostate pick casually, even if there is a side injury, how big can it be. The tension of esophagus is very large, the blood supply after suture is very key, and the possibility of postoperative esophageal fistula is quite high.

    But this is a firefighter fighting a mountain fire. He needs emergency surgery, and his family is not around. Moreover, the front line is urgent. The people of the headquarters and captain Li are not in. This word can only be signed by the president himself.

    "Big man, I have to have an operation," Wu Mian said.

    Cheng Linhai has been listening. He asked suspiciously, "Dr. Wu, why do you think my esophagus is broken? There''s nothing wrong elsewhere."

    "I consider that when the flame rises, you conditionally shut your breath, reflex strong contraction of abdominal muscles, increased abdominal pressure, spasm of cricopharyngeal muscles and rapid increase of pressure in esophageal cavity.

    At the same time, you suddenly stop inspiratory stress during inspiratory process, and the negative pressure in pleural cavity increases, resulting in esophageal rupture. "

    "..." Cheng Linhai regretted asking what he had just said. He didn''t understand Wu Mian''s explanation.

    "In fact, it doesn''t matter how to break it. The important thing is that I''ll sew it for you. Pull out the chest tube 2 days after operation. You can go home in 1 week and remove the suture in 2 weeks. You''ll be like someone who has nothing to do." Wu Mian said with a smile.