Medical Simulator
Zhou Cheng is just a small doctor, and his salary is low. The training is coming to an end, and there is a chance to stay in the hospital, but his competitors are all academic bullies and academic gods. Fortunately, Zhou Cheng got a medical simulator by chance. "You see a patient." "You're on the operating table!" "You have successfully reached the position of the main knife." "You severed the patient's nerve during the operation..." "You have had your doctor's license revoked." "..." "Surgery simulation is successful, you can choose to keep one of the skills..." Constant trial and error, continuous improvement. Zhou Cheng climbed to the top of medicine step by step...
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"Medical Simulator" by The Lancet
Copywriter:
Zhou Cheng is just a small doctor, and his salary is low.
The training is coming to an end, and there is a chance to stay in the hospital, but his competitors are all academic bullies and academic gods.
Fortunately, Zhou Cheng got a medical simulator by chance.
"You see a patient."
"You're on the operating table!"
"You have successfully reached the position of the main knife."
"You severed the patient's nerve during the operation..."
"You have had your doctor's license revoked."
"..."
"Surgery simulation is successful, you can choose to keep one of the skills..."
Constant trial and error, continuous improvement.
Zhou Cheng climbed to the top of medicine step by step...
Chapter 1 Medical Simulator
"You really don't intend to fight? The hospital decided to choose one of Gui Peisheng to stay in the hospital this time."
"It's not like this in previous years."
"Are you really going to give up like this?"
Shashi, Shashi No. [-] Hospital's orthopedic second ward, at the door of the doctor's office, Qin Min looked at Zhou Cheng, tilted his head, and asked in a puzzled manner.
The person standing opposite Tan Min was Zhou Cheng. Zhou Cheng hung his white coat on his elbow, his delicate face was full of helplessness.
He replied, "Miss Min, this is different."
"The hospital said to choose a regular trainee to stay, it is for the group of graduate students who are merged into the regular trainee, not just regular trainees."
"Besides, there are two academic postgraduates in the department who come to regular training after graduation. They want articles and academic qualifications. Where can I get it?" Zhou Cheng replied a little bit bitterly.
Before Zhou Ben graduated, he failed the postgraduate re-examination and was rejected, so he could only take the regular training.
Then came the Eighth Hospital in Shashi, an authentic third-class hospital.
Now is the third year and is about to graduate!
Originally, Zhou Chengcheng had already found the unit he was interested in, the town hospital where he was located, his parents had already greeted the hospital, and he could go there anytime.
Now the county hospital has to recruit postgraduates or better undergraduates. For ordinary second-year students like Zhou Cheng, the only way out for postgraduates is to go to the township hospital.
But eight months after the completion of the training program, the hospital suddenly notified that among this batch of training students, a small number of them should be selected to get places in the hospital.
I don't know what the hospital is based on to spread this news, but Zhou Cheng feels that this news may be a layer of fog, just to let Gui Peisheng do his job well and be better exploited.
The normal recruitment principle of the No. [-] Hospital in Shashi is that it is best to have a doctorate and start with a master's degree.
Zhou Cheng didn't think so.
This is a smoke bomb, a play on words.
Zhou Cheng is not the only regular trainee in the department. Zhou Cheng is a social regular trainee, and some postgraduates are merged into the regular traineeship. There is even an academic Ph.D. who worked in the institute after graduation.
Compared with them, Zhou Cheng felt that he was basically hopeless.
What's more, even if one Gui Peisheng is really fished ashore in the end, it will have to be another Gui Peisheng——Xu Yanlin.
After all, Lao Xu is the deputy chief physician of the Department of Hepatobiliary Surgery of Eighth Hospital.
Zhou Cheng himself, a second-rate university, has no education, it doesn't matter, why should he have such a daydream?
And Zhou Cheng has more important things to study.
Therefore, Zhou Chengcheng hurriedly bid farewell to Tan Min again: "Sister Min, I was on duty for 24 hours yesterday, so I went back to rest first."
Qin Min was the same age as Zhou Cheng, two days older than Zhou Cheng.When Zhou Cheng came to the department for regular training, Qin Min happened to come to work after graduating from a university, and he was still a staff member. Since they were both newcomers that year, they got along pretty well.
After listening to what Zhou Cheng said, Qin Min felt that it made sense.
He said: "It's up to you, I just think it's better for you not to give up so easily. What if?"
"It's an opportunity after all, isn't it?"
Zhou Cheng smiled, then turned and left.
In normal times, Zhou Cheng might really want to chat with Tan Min, but not today, because Zhou Cheng really has more important things to do.
After get off work, he hurried back to the rented house opposite the hospital, and then Zhou Chengcai began to look at the strange scene in front of him.
[The medical simulator is loaded successfully. 】
Zhou Cheng was a little confused, whether this was "Gold Finger" or schizophrenia.
The main thing is that Zhou Cheng is a medical student, otherwise, he wouldn't bother to think about schizophrenia, and just do it like the protagonist in the online novel.
There is also a single simulated copy on the emulator.
【Open reduction and internal fixation of fractures—it needs to consume 10 gratitude points to open it.Displays the cooling time when turned on.Cooldown resets to zero every other day. 】
[Current thank you value: 11! 】
[After the simulation is over, you can choose to keep one of the experience and skills. 】
The remaining darkness was covered, and Zhou Cheng couldn't see clearly.
Just this thing?
Is it a copy?
Open reduction and internal fixation of fractures is a solid surgical skill and a basic skill for orthopedic surgeons, and it can be regarded as one of the basic skills.
But Zhou Cheng was afraid that this was just his imagination.
Because the director of the second orthopedic ward said that in response to the call of the hospital, the orthopedic department will also choose one of the regular trainees to stay in the hospital. The most basic condition is to open, reduce and internally fix the fracture before the regular training is completed Art to learn.
Isn't this bullshit.
Fracture open reduction and internal fixation is a grade II operation, and the minimum professional title of the chief surgeon is the attending physician, which is an intermediate professional title.
Ordinary graduate students who are merged into the regular training may also have their own graduate tutors who let them take the lead, or the relationship is hard.
As for yourself?
Which superior dares to rest assured that he will perform a level II operation, and then give me back the bottom line?
No chance, how to learn?
No need to learn.
So it's not that Zhou Cheng doesn't want to fight, it's that the director has already excluded people like Zhou Cheng from the door when setting up the basic conditions.
"Try first before talking."
Zhou Cheng looked at that he now has 11 points of gratitude, and bought the permission to open the simulated copy.
【Open reduction and internal fixation of fractures—cooling time: 00:00:00.Optional simulation, do you want to enter a simulated copy? 】
Enter!
Zhou Cheng thought secretly.
[You have received a patient with a fracture. 】
[The patient was diagnosed with a mid-tibial fracture and required surgical treatment. 】
【You entered the operating room, stood at the chief surgeon's position, and performed the operation on the patient. 】
【Due to your inexperience in anatomy, you cut off the patient's saphenous nerve. 】
【You hurriedly called the superior doctor to rescue the scene, but the patient still had irreversible sequelae after the operation. 】
【You have been reported to have skipped the surgery and caused a major medical accident. 】
[You have had your doctor's license revoked. 】
[The simulation ends. 】
[Comprehensive score: Very poor. 】
[You can choose to keep the memory: you have visited the related memory of the superior tibial open reduction and internal fixation in detail. 】
Zhou Cheng finished reading: "..."
Am I so good now?Even the patient's saphenous nerve was cut off?
[Do you want to keep it? 】
Of course keep it.
Zhou Cheng made sure with his mind, but nothing happened.
[The memory has been preserved, and you will carry this memory with you the next time you simulate. 】
[The copy is in cooling, the current cooling time. 00:04:58]
Well, 5 minutes to cool.
I still don't believe it.
Zhou Cheng turned on the live broadcast platform, and then watched the live broadcast for 5 minutes casually, but in fact he was not on the live broadcast at all.
5 minutes later!
The mock dungeon has finally reached its cooldown time.
Chapter 2 Undead!
A prompt indicating whether to start the simulation is displayed on the panel.
Hurry up hurry up!
Zhou Cheng was racing against time to wait for this moment, and he came at the right time.
Zhou Cheng gave an order.
The second simulation begins!
[You have seen many patients with fractures. 】
[The patient was diagnosed with a mid-femur fracture and required surgical treatment. 】
[You avoided the lessons of the last simulation, you gave up the idea of being the chief surgeon, and began to concentrate on studying basic anatomy and surgery teaching videos. 】
[As an assistant, you devoted yourself to learning surgical operations from your superior physician. 】
【Five months later, your basic anatomical knowledge has been relatively solid, and you are already very familiar with the operation process of fracture reduction in your heart. 】
[Seeing that the training career is about to end.Finally, in the fifth month before graduation, you were so determined that you impulsively made the decision to be the surgeon again. 】
【You entered the operating room, stood at the chief surgeon's position, and performed the operation on the patient. 】
【You successfully exposed the broken end, and you successfully performed traction reduction. 】
[However, during the process of installing the steel plate, due to insufficient operation proficiency, the screw slipped. 】
【You are a little flustered, but you still insist on taking out the slippery screw and continue to complete the operation. 】
[In the first week after the operation, your patient re-examined and found that the steel plate did not fit the bone end. 】
[One month after the operation, your patient suffered a slippage of the steel plate and underwent another operation. The patient began to trouble your superior physician, and you were reported to the medical department by your superior physician. 】
【You have been reported to have skipped the surgery and caused a major medical accident. 】
[You have ended your training career. 】
[You have had your doctor's license revoked. 】
Report chapter Comments
[The simulation ends. 】
[Comprehensive score: Poor. 】
[You can choose to keep one of the following]
【Skills: open reduction and internal fixation of femoral fractures (defective). 】
[Memory: experience of human limb system and local anatomy (introductory), surgical anatomy of human limbs (introductory). 】
Zhou Cheng finished reading: "..."
I have devoted myself to studying with the superior doctor for five months, and I have been watching the operation video alone for so long. I still have no way to complete a simple fracture open reduction and internal fixation?
Why do I usually see the director doing things smoothly?
Is my talent so bad?
Zhou Cheng responded with his thoughts: Keep the memory.
Skills are only defective products and are unsuccessful, so what's the use of keeping them?
Forget it.
[Memory preservation is successful, and skill synthesis materials are obtained: human limb system and local anatomy experience (introductory), human limb surgical anatomy (introductory). 】
【Materials can be stored and reused.Before the next simulation, you can choose three materials or skills as the start of the simulation. 】
[Current dungeon cooldown, cooldown time: 30min! 】
hmmmm!
Man, this is quite interesting.
Skill synthesis materials, how about making materials in the next instance?
How did it take so long to cool down?
Forget it, order a takeaway first, and then watch the live broadcast for a while. By the way, it seems that the StarCraft game is about to start, and a round is only a matter of ten or twenty minutes...
Half an hour is up.
Zhou Cheng saw that the takeaway was still on the way. Although the third zVSp match was in full swing, Zhou Cheng immediately focused on the simulator panel.
Then choose Start Simulation.
[Please select the opening skills or materials you want to bring. 】
"I still have to choose? Choose all of them." Zhou Cheng cursed.
Then he moved his neck, ready to fight...
[You have seen many patients with fractures. 】
[Because you have a relatively solid foundation in systematic anatomy, regional anatomy, and surgical anatomy, your superior physician quickly noticed you during the operation. 】
[Until one time, you brought up a nerve ending that even your superior physician didn't pay attention to.Impressed your superior physician, so you get more first assistant opportunities. 】
【Your superior doctor devoted himself to teaching you, and during the operation, he devoted himself to teaching you some basic principles of fracture reduction, reduction skills and screw driving skills. 】
[One month later, your superior physician decided to give you a chance to operate, and began to teach you how to remove the internal fixation device after fracture surgery. 】
[Two months later, you successfully performed the first internal fixation device removal operation alone. 】
[Four months later, your superior physician decided to give you the bottom line and asked you to perform the first open reduction and internal fixation of the fracture. 】
【You were so excited that you didn't sleep well for several nights.You know that this is still a leapfrog operation, but you still don't die. 】
【You entered the operating room, stood on the chief surgeon's seat, and performed the operation on the patient. Your superior physician will be your assistant. 】
【You successfully exposed the broken end of the fracture, you successfully performed traction reduction, and you successfully installed the plate and screw. 】
[Your superior physician encouraged you. 】
[In the fifth month, your superior physician began to let you go, hoping that you would perform the fifth fracture open reduction and internal fixation alone. 】
【Your experience is still insufficient. Your fracture patient was accompanied by vascular injury, but you failed to detect it in time. 】
[After the operation, your patient's reexamination results are good, but the fracture does not heal. 】
[One month after the operation, your patient still has no fracture line and begins to develop osteonecrosis. 】
[In the third month after the operation, your superior physician performed another operation on your patient. 】
【You have lost the trust of your superior physician. 】
[You left the current hospital and returned to the township hospital. 】
[The township hospital where you are located has already disqualified for fracture surgery.You start to become mediocre...]
[The simulation ends. 】
[Comprehensive score: general. 】
[You can choose to keep one of the following]
【Skills: open reduction and internal fixation of femoral fractures (defective). 】
[Skill: Removal of internal fixation device after fracture (common). 】
[Memory: Debridement and suture (primary). 】
After watching it, Zhou Cheng scolded MLGB.
Do I really have such a dish?The vascular injury in the fracture was not found?What kind of fracture open reduction, plate and screw internal fixation did I do?
It's not fake.
Zhou Cheng didn't believe that he had such good food, but his basic skills were pretty good.
Looking at the things that can be kept, Zhou Cheng chose a skill, but it was an ordinary fracture internal fixation device removal technique, and it was still a skill.
After choosing to keep it, Zhou Cheng immediately had some wonderful things in his mind, but when he really thought about what he got, he found that there seemed to be nothing.
Look at the panel of the simulator again:
[Skill: Internal fixation device removal after fracture (common): Level I surgical skill, one of the advanced skill synthesis materials, skill proficiency: normal, highest proficiency: proficient. 】
[Dungeon cooling time: 12 hours!At 00:00:00 in the morning, the cooling time is reset to zero. 】
Skills are a good thing.
But the emulator is useless.
Watch the live broadcast, eat and eat...
But Zhou Cheng secretly glanced at the two practical orthopedics books at a 45-degree angle. It seems that they have been bought for more than a year, and they have not been touched, and they are all covered with dust.
In the end, Zhou Changcheng sighed, and said to himself: "I may be really ungrateful."
Stand up, take down the book...
Chapter 3 Simulation again!
Zhou Cheng found that he couldn't concentrate on reading at all. It lasted no more than 10 minutes before he was defeated by the boring and thick 4-page A[-] stacked book.
Maybe this is the reason for my own food.
"Boom boom boom!"
There was a knock on the door, it should be the takeaway.
When I opened the door, I found that the landlord was standing at the door with a takeaway, and said, "Xiao Zhou, you ordered takeaway again, I'll bring it up for you on the way."
The house that Zhou Cheng rented was an old-fashioned residential area with low floors, with a total of seven floors. Zhou Cheng rented the third floor, and the landlord himself lived on the fourth floor.At the beginning, the landlord bought two houses in this community, one for himself and the other for the landlord's parents.
Later, the parents passed away, and the son and daughter moved out, so they rented it to Zhou Cheng.
Fortunately, the Eighth Hospital of Shashi is also in the star district. If it is in the inner five districts of Shashi, it will definitely not be able to get it without one thousand five six.
The landlord is a 60-year-old retired old lady who lives with her wife, and occasionally asks Zhou Cheng to have dinner.She is a very warm-hearted person, and she often brings things up for people along the way. She probably saw the takeaway brother climbing up today, so she brought the food up along the way, but it just happened to be Zhou Cheng's.
"Thank you Grandma Lu. I was on duty for 24 hours yesterday, and I didn't come back until almost five o'clock in the afternoon. I don't have time to cook by myself." Zhou Cheng replied shyly.
Although takeaway has been popular among the younger generation and hospitals for a long time, Grandma Lu and her parents feel that eating takeaway is not clean enough.
Whether it is clean or not is another matter, but it is really convenient and quick.
If I have to go shopping for vegetables after get off work, it will take a long time, and it is really difficult to cook alone. I accidentally cook too much, and then there is a meal without a meal, and it is broken. If it is wasted, the cost will not be saved much.
Zhou Cheng was unwilling to explain too much to the landlord, trying to break the concept of the two generations, so he just gave a reason.
Grandma Lu handed the takeout to Zhou Cheng, and said with emotion: "It's really hard for you to be a doctor. My daughter is a nurse, and it's also hard. She often has no time to eat at home because she is on duty, and she doesn't know what my two grandsons eat. what."
"I'll go see them in two days..."
Said and left.
Zhou Cheng watched Grandma Lu go upstairs, then closed the door, and then transferred the rent for the next three months to the landlord on WeChat.
Although it's not yet time to pay the rent, every time Grandma Lu will call Zhou Cheng to come over for dinner or order something for him every time. Zhou Cheng is also used to Grandma Lu's special way of urging rent...
Then Zhou Cheng used various methods to pass the time.
After much difficulty, it finally reached 00[-] in the morning, and the cooldown time of the copy of the emulator was refreshed.
[Please select the opening skills or materials you want to bring. 】
"It's better to choose all." Zhou Cheng thought to himself.
Now there are only three skills and memories in total, so of course the more you bring, the better.
Watch me kill all directions...
[You have seen many patients with fractures. 】
[Actually, you are eager to give it a go for the chance of staying in the hospital, but you know that you can't easily try the main operation and make fun of the patient, so you decide to hide your strength and bide your time. 】
[Your anatomical foundation is very solid, so you have been appreciated by the superior physician. 】
【No. On the 20th day, you performed the first internal fixation device removal operation after fracture surgery by yourself.Your superior physician observed the whole process of the examination school and felt that you are a talent that can be made.Begin to teach you some tips on fracture reduction and internal fixation. 】
It should work this time, and the internal fixation will start after 20 days.
carry on.
[In the third month, you entered the operating room, stood on the chief surgeon's seat, and performed surgery on the patient, and your superior physician was an assistant to you. 】
[Half a month after the operation, your patient was discharged from the hospital. The fit of the fracture end is good, there is already a small amount of callus, and he can walk under partial weight-bearing. 】
[The results of the three-month re-examination of your patient after the operation are all good, and there is no non-union of the fractured end. 】
【Your superior doctor thinks you are a talented person, so let you start learning open reduction, plate, screw and internal fixation for complex fractures. 】
[Your learning progress is slow. 】
This?
Looking at the information displayed on the screen, Zhou Cheng was almost drunk, what about me?
As long as you get in touch with new things, there is no need to play?
[You failed to get the qualification to stay in the hospital, but you became a labor dispatcher and continued to work in the unit. 】
[In the second year, your superior physician asked you to operate alone on patients with complex fractures. 】
【During the operation, you start to feel at a loss. 】
【You have lost the trust of your superior physician.You gradually lost the opportunity to operate, and your superior doctor began to teach other students, and you began to become a tube bed machine...]
[You finally chose to leave the current hospital and return to the town hospital to retire. 】
[The township hospital where you are located has already disqualified for fracture surgery.You are starting to forget that you used to know how to perform surgery...]
[The simulation ends. 】
[Comprehensive score: general. 】
[You can choose to keep one of the following]
【Skills: open reduction, plate and screw internal fixation for simple fractures (introductory). 】
[Skills: open reduction, plate and screw internal fixation of fractures (common-). 】
【Memory: Debridement and suture (intermediate level). 】
Choose to keep skills.
hiss!
Zhou Cheng became depressed. Is his aptitude really that bad?
Is it true that I am not suitable to be a surgeon?
Is my home just the town hospital?
With a solid basic knowledge of anatomy, and ordinary proficiency in the removal of internal fixation devices, can you still end up going to the town hospital? ?
No!
In this simulator, I have already started open reduction and internal fixation of fractures. Is it still not enough to qualify for hospital stay?
Can only go to labor dispatch?
Staying in the hospital is at least hired by the hospital, and the labor contract is signed with the hospital. The labor dispatch is a third party. If there is a third party to exploit again, it is of course better to stay in the hospital.
How much competition will there be at this time?
Forget it, it's just a simulation, and I still have many opportunities to simulate.
However, after choosing to keep the skills, Zhou Cheng had something more in his mind, and there were traces to follow.
It feels as if I can go to the stage to do open reduction and internal fixation of fractures now.
At the same time, although the copy of the emulator fell into cooling, another reminder came.
[Obtaining Simple Fracture Open Reduction, Plate and Screw Internal Fixation (Introductory): The skill can be analyzed, and the skill will not disappear after the analysis.Do you want to parse? 】
Chapter 4 Friends in the department!
Simple fracture open reduction, plate and screw internal fixation (entry) was successfully analyzed.
Analyze the following skills.
【1. Surgical anatomy experience in long bone surgery of extremities (general);】
【2. Manipulative reduction of fractures (introductory);】
【3. Closed reduction and Kirschner wire internal and external fixation for simple fractures (common);】
【4. Skin and subcutaneous tissue suture (common). 】
[Analysis skills can be used as initial skills for the next simulation. 】
After reading it, Zhou Cheng felt that it was quite scientific. Every operation, no matter how simple or not, actually contained a large amount of knowledge reserves of the surgeon. If you can't do it, it's too fake.
Gained a lot of new knowledge.
Look at the cooling time for the next simulation, it only takes 5 minutes.
Go ahead and wait.
After casually playing with the phone, swiping the live broadcast, at 00:05:30, Zhou Cheng accurately controlled the cooling time of the simulation copy, and started a new round of simulation.
It's just that this time, what skills should be attached to the simulation?
In the end, Zhou Cheng decided to choose the best.
【1. Open reduction, plate and screw internal fixation for simple fractures (introduction)】
[2. Removal of internal fixation device after fracture (common)]
The other skills are already included in these two major skills, and they are just some details, so there is no need to repeat the selection.
Zhou Cheng started a new round of simulation.
……
[Your progress in learning about complex fracture surgery is still slow, you have lost the appreciation of your superior physician, and you still haven't been able to get the qualification to stay in the hospital. 】
[You became a labor dispatcher and continued to work in the unit. 】
This?
Adult Zhou is numb.
Such a strong start can be 'played' by myself like this.
Could it be that besides being handsome, he has no talent to be a doctor?
Ah, life.
[In the second year, your hard work brought you the opportunity to deal with complex fractures from your superior physician, but you still haven't grasped it. 】
[During the operation, you feel that your ability to deal with complex fractures is still insufficient. 】
【You start to become a tube bed machine...】
【You are persistent, devoted yourself to learning, observed many operations, and finally at the age of 32, you mastered open reduction and internal fixation of complex fractures (introductory). 】
[At 40, your peers have already become deputy chief physicians or associate professors, and you are still just an old attending physician, becoming their junior physician...]
[At the age of 50, you became the oldest attending physician in the department. Through a lot of surgical practice, you improved the open reduction, plate and screw internal fixation of fractures and the closed reduction and intramedullary nail internal fixation to (proficient), But your peers have long dismissed simple fracture surgery. 】
【You have also left the duty career, but you suddenly feel that life is boring, exhausted, and the motivation to study is missing, without any sense of career accomplishment...】
【70 years old, you died depressed...】
[The simulation ends. 】
[You can choose to keep one of the following]
[Skills: open reduction, plate and screw internal fixation of fractures (skilled). 】
[Skills: open reduction and intramedullary nailing of fractures (skilled). 】
[Memory: experience in diagnosis and treatment of fractures (unremarkable). 】
[Dungeon Cooling: Cooling time: 30min. 】
Zhou Cheng is a little tired!
However, after careful analysis, it was decided to choose the skill of open reduction and intramedullary nail fixation (proficient).
The standard treatment for fracture patients today is intramedullary nail fixation, because the opening of intramedullary nail fixation is relatively small, relatively less traumatic, and the fixation is firm and stable.
It is basically the gold standard in the treatment of fractures.
Then Zhou Chengcheng decided not to wait for the next simulation, Sujue, the dog's life is the most important thing.
He has to go to work in the hospital tomorrow morning.
In the morning, at exactly seven o'clock, the damn alarm clock rang.
Zhou Cheng hates 'Zhou Zhen' very much, and disturbs his good dreams every morning!
Brush your teeth, take a shower, buy breakfast.
At 25[-, I came to the department on time.
However, when Zhou Cheng arrived, he found that there were already many people in the doctor's office.
They are all regular training doctors who need to manage the bed just like him.
There are three groups in the department, all led by chief physicians.
The leader of Zhou Cheng's group is Chief Physician Cai Dongfan, and under Cai Dongfan there is another attending physician named Luo Yun.General daily affairs are managed by Luo Yun, and some simple operations are also performed by Luo Yun.
Chief Physician Cai Dongfan only conducts occasional ward rounds and complicated operations on operation days.
In addition to the senior doctor, Zhou Cheng's group also had two regular trainees who were the same as Zhou Cheng.
Du Yanjun, Zhang Zhengquan.
Each person manages four beds.
But now only Du Yanjun came to the doctor's office, Zhang Zhengquan was still there.
"Brother Zhou Cheng, good morning." Because of a group, Du Yanjun greeted Zhou Cheng.
Zhou Cheng is one year older than Du Yanjun, and now he is in the third year of regular training. Du Yanjun is the second year of postgraduate merged into regular training, and is also a student of Chief Physician Cai Dongfan.
But Zhou Cheng came a year earlier than Du Yanjun, so he called Du Yanjun slightly smaller: "You are early too, Yan Jun."
"A patient was discharged from the hospital yesterday, so come early to see if there are any new patients admitted." Du Yanjun said.
Then he asked: "Brother Zhou Cheng, have you had breakfast? I'm going to order some noodles, do you want to come together?"
Du Yanjun has a master's degree, and he is still working so hard, probably because he is eyeing the quota for staying in the hospital.
After all, the hospital did not say that they must choose from the batch of graduates.
Really enough volume.
Zhou Chengdao: "I have eaten, thank you."
"By the way, Yan Jun, you seem to be on duty today, right? You can help me track down my patient's postoperative blood test results this afternoon."
The second orthopedic department of the No. 24 Hospital is on duty [-] hours a day. Zhou Cheng has not discharged patients today, and if Du Yanjun is on duty today, he will have another operation tomorrow.
So Zhou Cheng planned not to come to the department in the afternoon, but to stay at home and read for a while.
Since everyone is working hard, you have to read the book carefully.
"Okay, no problem." Du Yanjun smiled, he often does this kind of thing.
He is a master's degree candidate who was incorporated into regular training.
After graduation, you can combine the four certificates into one, which looks wonderful.
But he not only needs to complete the final exam of the regular training, but also has to be busy with the graduation of the graduate student. Now he is in the second year of the graduate student, and he is about to start his graduation thesis. Besides the opening of the graduation thesis, he also needs to write a CSCD article. Satisfy the master's graduate graduation requirements.
What's more, if he still wants to get that place in the hospital, the article Du Yanjun plans to write is not CSCD, but SCI.
In this case, he has hope.
After all, there is another academic master student in the department who graduated and was later trained here. The requirement for master graduation is to publish an SCI, if only the clinical ability is equivalent to him.
Really not enough to fight for.
There must still be a lot of things that need Zhou Cheng's help in the future.
Anyway, Zhou Cheng is fine.
Du Yanjun was thinking...
Chapter 5 Involution starts with small things!
After Zhou Cheng got acquainted with the patient himself, it was time to hand over the shift early.
After the on-duty doctor and the on-duty nurse handed over the general situation of yesterday's new admissions and surgical patients, the right to speak was handed over to the director.
The director of the ward is Yan Haihan, a middle-aged man in his 50s, with a medium build, thin body, slightly dark skin, a little hot temper, and a lot of prestige in the department.
Yan Haihan said: "Let me emphasize again, safety is the first priority, safety is the first priority, and the director who leads the team must take responsibility."
"In addition, it is necessary to strengthen the teaching work of the regular trainees and graduate students in our department."
"The hospital now attaches great importance to the teaching situation of each department!"
"Even the hospital has even given the number of places to stay in the hospital. We have two wards in the orthopedics department, and there are two places in total. Comrades in our department, Gui Peisheng, you have to work hard. This is your senior brothers and sisters from the previous sessions. There is no chance."
Yan Haihan's words obviously encouraged many people. Zhou Chengyou noticed that the eyes of Zhang Zhengquan and Du Yanjun in his group became brighter.
Finally, after the shift was over, Luo Yun took Zhou Cheng and Du Yanjun to the ward rounds. Chief Physician Cai Dongfan was in the outpatient clinic today and was at the outpatient clinic on time at eight o'clock, so he didn't even attend the early shift.
There are three groups in the department, with a total of 48 beds including extra beds!The three groups are divided equally, each group has sixteen beds.
The beds belonging to Cai Dongfan are 25-36 beds, 9 to 12 beds.
There are only three doctors in charge of the bed, and each person has an average of five to six beds.
Zhou Cheng and Zhang Zhengquan are two people, each with five beds.
Du Yanjun manages six beds by himself, and the extra bed is because Du Yanjun is a graduate student in the department, so he needs more learning opportunities.
However, having more beds does not necessarily mean that there are more learning opportunities. Now the department is not full of patients, and there are only twelve patients in Zhou Cheng's group.
Ward rounds are daily rounds. Under the leadership of Luo Yun, after a detailed look at the existing twelve patients.
Then Luo Yun looked at the duty list again and said, "Is it Yan Jun's turn to be on duty again today?"
Because Du Yanjun is on duty, Luo Yun, as Du Yanjun's superior doctor, needs to be on the second-line shift.The time is not fixed.
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There are a total of ten people in the department, and each person has three sets of classes per month.
In any case, Luo Yun will also be on duty for nine second-line consulting classes, mainly dealing with emergency patients.
"Yes, Teacher Luo." Du Yanjun nodded.
Then said: "It's okay, Mr. Luo, I can call you anytime if there is a situation. You can come back in time."
Du Yanjun wanted to reassure Luo Yun that he was in the department and took care of common emergency patients, so he would not trouble Luo Yun.
Of course, asking this question is also a test. If Luo Yun dares to let go more, then he will have more opportunities to operate. The more opportunities to learn and operate, the greater the chance of getting a place in the hospital in the future.
Zhang Zhengquan frowned slightly when he heard the words, and thought to himself.
Has this scheming boy, Du Yanjun, started desperately involving himself from now on?
But he has a natural advantage. The director who leads the group is a teacher, so Luo Yun and Cai Dongfan must be more at ease to let him go. If he and Zhou Cheng don't have such a natural status advantage, everything has to be done by themselves. strive for.
Luo Yun thought for a while, nodded and said, "Okay, I won't go far either, if you have any questions, please call me anytime."
After all, Luo Yun was following Cai Dongfan's doctor, and Du Yanjun was Cai Dongfan's student, and Luo Yun himself had a doctor's qualification certificate, so there was nothing wrong with being on duty alone.
However, in order to balance the psychology of Zhang Zhengquan and Zhou Cheng, Luo Yun said again: "Zhou Cheng, Zhang Zhengquan, after you finish the preoperative preparations for tomorrow's surgery patients today, don't go far away."
"If there is an emergency operation, you may be on stage."
"Okay, Mr. Luo. I don't have patients for surgery tomorrow, and I have time anytime today." Zhang Zhengquan immediately raised his hand and volunteered.
Compared to Zhang Zhengquan's initiative, Zhou Chengcheng was a step slower, and he also nodded to Luo Yun.
"Okay, Teacher Luo."
I sigh in my heart, I am not the only one who is not willing to die.
……
Zhou Cheng happened to have a preoperative patient. Tomorrow, he had to arrange an operation. It was a simple fracture of the distal fibula. It was the fifth day after the injury. At present, the swelling of the calf has subsided and the operation can be performed. What Zhou Cheng has to do is to carry out the operation Routine preoperative talk and sign these.
Then, by the way, inform the patient and the patient about the risks associated with the operation, and obtain informed consent.
Only then can the corresponding operations be performed.
……
There is a template for signing the conversation, and Zhou Cheng can memorize the risks related to fractures, so Zhou Cheng finished signing the conversation before eleven o'clock, and then informed the patient and family members of the corresponding precautions, because Du Yan Jun is on duty and can help him track down the blood test results of postoperative patients.
I went back to the dormitory.
In the afternoon, Du Yanjun reported that the patient's blood test results were good after the operation, and Zhou Cheng was relieved.
Then start emulator simulation with peace of mind.
Zhou Cheng is quite looking forward to it. Now that he starts the game with two skills, he won't be in a bad situation, right?
get started.
[Are you sure you have the skills to carry: open reduction and intramedullary nailing for fractures (proficient), simple open reduction and plate and screw internal fixation for fractures (introductory) to start the simulation? 】
Yes!
[You have seen many patients with fractures. 】
[You know that you can't easily try the main operation and make fun of the patient, so you decide to hide your strength and bide your time. 】
[Your knowledge of anatomy and traumatic fractures is very solid, and you were quickly appreciated by your superiors. 】
[You started to cooperate with the superior physician to perform open reduction, plate and screw internal fixation of fractures. In the collaborative operation, you performed extremely well, which made your superior physician admire you. 】
[In the first month, your superior physician felt that you could perform the operation alone, so he was willing to give you the opportunity to perform the operation. 】
It's been a month since I went on stage for fracture surgery, so this time it shouldn't be too bad.
Keep going……
[The level of surgery you performed is no less than that of the director of the department, and you started to move towards closed reduction and intramedullary nailing of fractures.Your senior doctor was very impressed by your surgical talent and recommended you to the hospital. 】
【Your superior doctor thinks that you are a talented person, and let you start learning open reduction, plate and screw internal fixation for complex fractures. 】
[In the third month, you once again gained the trust of the superior physician, and you started to be the chief surgeon of open reduction, plate and screw internal fixation for complex fractures. 】
[Because you have proficiency skills, you have successfully completed the first complex fracture operation, even more beautifully than your superior doctor, who attaches great importance to you...]
[After half a year, you successfully got the opportunity to be hired by the academy. 】
[Your superior physician started to develop business in the direction of pelvic fractures. You have little understanding of pelvic fractures, but your superior physician still encourages you, I hope you will not give up...]
[One year later, you have made considerable achievements in the field of basic limb fractures, and you can gain a firm foothold in the department.But your progress in pelvic fractures is still very slow, and your superior doctor feels that the department is restraining you, so he decides to send you to further study...]
Seeing this, Zhou Chengcai breathed a sigh of relief. Has he finally got on the right track and started to go out to study?
Zhou Cheng laughed.
Chapter 6 The Charm of Adventure!
Zhou Cheng wanted to understand one thing, this simulator was simulated by himself based on his own ideas and current conditions.
Therefore, it is not that it is deliberately targeting itself, it is possible that its talent in surgery is really limited.
In the previous simulations, it took a long time to practice open reduction and internal fixation of fractures [skilled] and fracture closure, open reduction and intramedullary nailing and internal fixation (skilled).
And it's just a type of fracture for a lifetime.
Only this height proves that his aptitude is really poor. If there are no other accidents, it is estimated that the end point in the simulator is very likely to be the encounter of rushing to compete for a place in the hospital.
Fortunately, there is an emulator.
Zhou Cheng looked down with emotion.
[You came to the Orthopedics Department of the Second Xiangda Hospital of Shashi, where you are studying. After entering the department, you found that your theoretical level and operation level are extremely poor. 】
[The professor of the advanced study unit is very dissatisfied with your usual performance during the advanced study in the department. 】
[You basically have no chance to learn, so you can only rely on your diligence to perform surgery. 】
[During the training period, you got nothing.You returned to the original unit, still unable to complete the operation of the pelvic fracture. 】
【Your superior doctor started to give up on you, thinking that you might not want to go any further. 】
[So you start to delve into side jobs and develop your own hobbies. 】
[At the age of 52, you caught up with the reform of the medical system, and you were finally promoted to deputy chief physician. 】
[This year you went to the Huaguo Orthopedics Association, and you met your undergraduate classmate by chance, who is now a professor of orthopedics at the Ninth Hospital of Shanghai, and you had a long talk with him, which benefited a lot. 】
[During this exchange, the other party once again made a breakthrough in open reduction, plate and screw internal fixation and intramedullary nail internal fixation, and you faintly regret that you gave up so easily to further study pelvic fractures of the technique. 】
[At the age of 65, you retired normally, you refused to stay in the hospital and re-employed, and you went to settle in your hometown. 】
[Died without illness at the age of 80. 】
[The simulation ends. 】
[Comprehensive score: average. 】
[You can choose to keep one of the following]
[Skills: open reduction, plate and screw internal fixation of fractures (proficient). 】
[Skills: Open reduction and intramedullary nailing of fractures (proficient). 】
[Experience: Pelvic fractures give up halfway learning experience.It has certain reference value. 】
[Adventurous Encounter: The content of the long talk with an old professor of orthopedics may give you a lot of inspiration. 】
There were also adventures.
But it was really a fortuitous encounter. If it wasn't because of the simulator, Chengfeng was promoted to the deputy chief physician by a coincidence, and he might not be able to go to the Huaguo Orthopedic Annual Meeting, nor would he meet his own who has become a magic city. A classmate of the professor of the Ninth Academy.
It's just that the content of the long conversation is only useful for Zhou Cheng in the simulator, right?
How to choose this?
Zhou Cheng hesitated for a while, feeling that he seemed a little too serious.
No matter how you choose, you still have an emulator for multiple trial and error, just choose the one with the least frequency.
I didn't choose the skill this time, and I will choose it next time. For an adventure like this, it's not necessarily the case.
Therefore, Zhou Cheng chose Qiyu.
Then the dungeon fell into cooling, and it had to wait until the early morning to reopen it.
After choosing Qiyu, Zhou Cheng thought that he could hear the conversation that happened decades later, but it was obvious that Zhou Cheng was thinking too much.
That adventure remained in the simulator, that's all.
Lose it! Lose it!
Big loss.
Zhou Cheng immediately regretted it. If he had known this before, it would be great to choose a skill of the proficient level.
Skill proficiency level, beginner, normal, proficient, proficient, perfect.
Proficiency is currently the skill with the highest level of proficiency that Zhou Cheng knows. The internal fixation of fractures at the proficiency level before surprised his superior physician. The proficiency level of surgery must be even rarer.
In the end, he only got this adventure?
Obviously not worth it.
However, as I thought before, isn't it just a mastery of skills? Zhou Cheng doesn't care about such trial and error costs.
After much difficulty, it was finally early in the morning, and a new simulation copy was opened again.
Zhou Cheng waited excitedly.
Do it do it do it.
[Please determine the initial skills, materials or adventures to carry. 】
[Note: Adventure is a one-time consumable, it disappears after use, please choose carefully. 】
MLGB.
Lost, lost, this is definitely a big loss!
Zhou Cheng regretted it.
[Are you sure you have the skills to carry: open reduction and intramedullary nailing for fractures (proficient), open reduction for simple fractures and internal fixation with plates and screws (introductory) and fortuitous encounters.Start simulation? 】
Yes!
Zhou Cheng gave an order, and a new round of simulation began.
[You are an ordinary training doctor, but you are not satisfied with your current life. 】
[Other Gui Peisheng are fighting for a place in the hospital, but you didn't participate in it, although you know that you are going to participate in such a competition now, you definitely have an absolute advantage. 】
【But deep down in your heart, you will always remember that once in your dream, an old professor appeared, and what he talked to you about. 】
[Although your psychiatrist said that the dreams you firmly believe in are false, but you must detail those words as facts.So, you make a change. 】
It's starting to look different.
Zhou Cheng immediately came to his senses. Will the appearance of Qi Yu change the originally established life trajectory to such a large extent?
[In spite of the objections of your family and friends, you resolutely chose to take the postgraduate entrance examination after the regular training, and you started to study and study hard. 】
[Eight months later, you will graduate from the regular training. This year, you will be 26 years old.Your peers have already started looking for jobs, and you are still reading books, preparing for December. 】
[One and a half years later, you successfully passed the initial and re-examinations for graduate students, and were admitted by Shonan University as an academic master's student.Then you dove right into the lab.And you've done quite well in the lab. 】
[In the second year of graduate school, you got the opportunity to study abroad at public expense, and you chose to go abroad. 】
[In the third year, after you returned to China and completed your postgraduate defense, you went abroad again in a hurry and went to the United States to study for a doctorate.This year, you are 31 years old. 】
Good guy, what is this adventure?
Continuous adrenaline?
How can you be so awesome, and turn me from a study-fighting scumbag into such a college bully all of a sudden?
Studying abroad at public expense, studying for a Ph.D.
[When you were 34 years old, you finally completed your doctoral defense, obtained a doctorate from Harvard Medical School, and then returned to China to work.Your friends, teachers and classmates all advised you to stay and continue teaching. 】
[But your determination to return to China is resolute. 】
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[After you return to China, your parents are already very old. They hope that you will get married early and start a family with a stable job. 】
[You easily found a third-class hospital in Shashi, and you were introduced to the hospital through the method of talent introduction. The hospital, Shashi, and Hunan Province gave you a total of 150 million for resettlement expenses.You bought a house back then, and found a nice girl to marry...]
With the 150 million settling fee, Zhou Cheng's eyes were straightened.
Look, is this the difference between the high school students looking for a job and their own job hunting?
Sour sour.
Chapter 7 Adventures at Risk!
Zhou Cheng is really envious. After graduating from a master's degree or a doctoral degree, he will have a great advantage in finding a job.
As for myself, I got GG in the first postgraduate examination when I graduated from undergraduate, and I failed to pass the exam when I prepared for the second year. Going to graduate school is a waste of time.
And it may not be possible to pass the exam.
Maybe my qualifications are really bad.
Zhou Cheng thought for a while regretfully, and then continued to look at the content behind the simulator.
【Your parents are very happy, but because they have been studying for you for so many years, although you don't need them to pay for your studies, they still work hard, so their bodies suffer from fatigue. 】
【You took them to Shashi and let them spend their old age peacefully, but your parents only chose to go back to their hometown after undergoing a comprehensive medical examination and taking the medicine. They are not used to the way of life in the outside world. 】
[You are doing well in your work. When you were 36 years old, because of your early research published papers with high scores, and you applied for the National Natural Science Foundation of China, you were exceptionally promoted to associate professor. 】
[In the same year, your wife gave birth to a pair of twins for you.And she is also very happy for your rapid promotion in title. 】
[No. 40 is one year old, you have been promoted to a professor by exception.But you get into trouble when someone reports you for plagiarism.In fact, you collided with the research direction of the team led by another well-known domestic professor. 】
Ah this?
That's okay too?Could it be my old classmate?
I belong to open-type plagiarism?
Keep watching.
[You have a very rich foundation and experience in previous research, and you even got involved in this field earlier than the other party's research team. Therefore, the other party failed to sue you and was punished accordingly. 】
[Because you killed the team of professors in Shanghai in terms of scientific research, you are famous in your unit, and your hospital has started to let you manage scientific research positions, and the affiliated hospital of Shonan University where Shashi is located, throws it for you olive branch.You think twice and decide to stay in the original unit for development. 】
so far so good.
It should not be an old classmate. The other party should not be a well-known professor at this time, and it is impossible to have a large team.
[No. 40 is five years old, your scientific research career has reached its peak smoothly, but your adventure potential has been exhausted, and all the researchable fields you know have fallen into a desperate situation.So you start digging in new directions, and at the same time you start to step back and leave the lab and the team to your students. 】
[Year-old, because of your limited talent, your own original topic has not yet been published, but you have retreated behind the scenes, and there are still students with excellent qualifications who can provide you with new research directions, and under your 'leading' , Continue to apply for a steady stream of topics. 】
[When you were five years old, you once again went to Shanghai as a speaker to share your experience and lessons in scientific research-related fields.This time, you met your old classmates again, and you are grateful to your old classmates. 】
【He was a little scared of you, but he still accepted your invitation out of the friendship of his classmates. 】
[During that meal, your old classmate drank a little too much, so he vomited bitterness to you. The team you defeated back then was his father-in-law.He is also a very well-known professor in Shanghai. 】
[You become a little at a loss after listening to this, with guilt on your face. 】
[But your old classmate comforted you and said, Zhou Cheng, I checked your resume, and you have never appeared in Shanghai at all. Since your master's degree, you have been doing research in related fields, and a direction appeared later. The overlap on the above is just an accident, you don't have to feel guilty. 】
[My father-in-law said before he retired that it was just a simple, academic exchange, his team was not as fast as you, that's all.No one can be jealous of you because of this, otherwise, don't mention the matter of having a mentorship with him...]
[After you came back from Shanghai, you became taciturn.Your wife thinks you're just tired. 】
I go?
This is too much.
Such a thing is a bit unkind.
However, for things like scientific research, whoever comes first gets first, and I am concerned.
Read on.
【No. When you were 60 years old, you went to Shanghai to visit your old classmate. At the same time, you also met his father-in-law, a gray-haired old doctor who still insists on attending the outpatient clinic. 】
【He extended a warm welcome to your arrival. Although half of his sixtieth year has passed, he is still very energetic.He also said that you are a very interesting young man. Although he was forced to no longer engage in scientific research since then, his clinical ability has been greatly improved. 】
[He communicated with you a lot, from scientific research to clinical practice.You and your old classmates also exchanged a lot.Then at that time, you realized that you are nothing but a thief in the field of scientific research. 】
[You have basically never been to a clinic.Your professional direction is still limited to what you looked like in your 20s. 】
[After you go back again, you start to feel unhappy, and you have a knot in your heart. 】
[In the year before your retirement, after you paid for your parents' pension, you finally passed away. 】
[Age at death: 64 years old. 】
It was finally over, Zhou Cheng felt a little tired and guilty even watching it.
Such an adventure is a bit too much, because I plagiarized the research results of another professor's life in advance, and as a result, I put the other party and the other teacher down. This kind of thing is really not a kind thing that people do.
[The simulation ends. 】
[Comprehensive scoring: Unable to score. 】
Zhou Cheng: "???"
What the hell is it that can't be rated?
[Because you included adventures in the simulation process, the simulation direction exceeded the development direction of the dungeon simulation, so a final evaluation cannot be given. 】
[During this simulation, you did not acquire new skills or abilities. Your scientific research was all brought about by the adventure, and you did not gain anything new during the adventure. Therefore, you have no new things to keep. ability. 】
[The development direction of this simulation is affected by the adventure, not the change of personal will. 】
[So you have received a special reward: aptitude 2. 】
[Your aptitude will be slightly (20%) improved, and the specific increase depends on the player's own initial aptitude. 】
[Fixed rewards, cannot be selected. 】
After Zhou Cheng finished reading, his pupils shrank.
Damn it, if I'm a genius, then I'll make a lot of money, but what about my own aptitude?
It took nearly a hundred years of accumulation to improve open reduction of fractures to proficiency.
This qualification?
An increase of 20.00% is useless.
Well, adventures are risky, so be careful when using them.
If you harm the people in the simulated copy, you haven't reaped any benefits.
The aptitude has been improved. Although it is not very useful for the time being, it must be of great help to the subsequent simulation.
As long as it is not a negative value, it should be useful.
Zhou Cheng is sure.
Benefits of Chapter 8 Qualification!
But in fact, Zhou Cheng himself is not sure whether this is the case, but this is the only way to go.
This improvement in aptitude is equivalent to spending two simulation opportunities to obtain it, and I don't know if it is worth it.
If the statistics are equal, a simulated opportunity = an adventure.
Second chance to simulate adventure = improvement of basic qualifications...
Originally, at the end of the last simulation, Zhou Chengcheng was able to obtain proficiency in open reduction, plate and screw internal fixation of fractures at the proficiency level. If this is the basis, then the next simulation may be able to go further to perfection. .
Of course, the number of simulations that have been consumed before cannot be repeated, and the gains and losses cannot be recalculated.
But with the simulator, Zhou Cheng has enough chances of trial and error...
After 5 minutes, the cooling time of the simulator finally came again.
Zhou Cheng looked forward to it again, this time his aptitude has been improved, let's see what kind of changes will happen?
[Please confirm the initial skills and materials to carry. 】
The adventure options are gone.
Zhou Cheng determined the skills.
【Are you sure you have the skills to carry: open reduction and intramedullary nailing for fractures (proficient), open reduction and internal fixation for simple fractures with plates and screws (introductory).Start simulation? 】
Sure!
【You have treated many fracture patients and you are very cautious to hide your strength and bide your time, knowing that the opportunity to be the surgeon needs the right timing. 】
【You have extremely solid knowledge of anatomy and the theoretical basis of traumatic fractures, and your superior physician soon discovered your differences and was appreciated. 】
[You cooperated with the superior physician to perform open reduction, plate and screw internal fixation of the fracture, and your performance was excellent, which made your superior physician admire you.I don't think he picked the wrong guy. 】
[After half a month, you won the first opportunity to be the chief surgeon of a simple fracture. 】
Half a month earlier than last time.
carry on.
[Your level of surgery has amazed your senior physicians.So let you start learning about open reduction, plate and screw internal fixation for complex fractures. 】
【You quickly and satisfactorily completed the first complex fracture operation, and even the level of completion made your superior physician feel astonished and ashamed. He appreciates your surgical skills...】
[You got the chance to be hired by the college naturally. 】
Well, this time it was a matter of course, not a success.
【Your superior doctor and you started researching in the direction of pelvic fractures. Although you don't know enough about it, your superior doctor didn't dislike you, and even gave you a lot of encouragement...】
[After half a year, you and your superior physician have made some achievements in the field of simple pelvic fractures.And your learning progress is faster than your superior physician. 】
【Your superior doctor realized that you are bound by the platform of this hospital, so he decided to send you to study...】
[You came to the Orthopedics Department of the Second Xiangda Hospital, Shashi, where you are studying. After entering the department, although the professors in the department thought that your aptitude was average, it was still within the scope of cultivation. 】
It's dull, but it can be cultivated, and it's still better than before.
From this point of view, the improvement in aptitude obtained in exchange for two simulation opportunities is definitely not a loss.
Qualifications can increase the upper limit of achievements!
[Because you are diligent enough, your improvement is good. 】
[Soon, your half-year study period will be up, but your superior doctor appreciates you very much and decides to recommend you to go to Shanghai No. [-] Hospital for further study. You are very happy, your original unit has approved your application to continue your leave of absence for further study ...]
[Half a year later, you once again gained the favor of the professor of the Ninth Academy of Shanghai, and felt that you should not be limited to the trauma level in China, so I recommended you to study in the United States for three months...]
【Three months later, when you returned from further studies, you did not accept the olive branches from other hospitals ungratefully, and continued to work in the original unit. 】
[Five years later, the level of trauma surgery in your hospital has reached the first-class level in Shashi, no worse than some large third-level hospitals, and because you are studious enough, hardworking enough, high enough in surgery, and full of knowledge. 】
[Shunan University has thrown you an olive branch. I hope you can work in the Trauma Surgery Department of the Third Affiliated Hospital of Shonan University. You have negotiated with your original unit and reached an agreement. You are approved to practice in more places and serve as the original unit Cultivate reserve talents. 】
[At the age of 40, you successfully obtained an on-the-job doctor's degree, and in the same year, you obtained the title of professor and became a professional tutor for graduate students...]
[At the age of 45, you successfully became a doctoral supervisor, and your first batch of graduate students went to work in your original unit.Moreover, the rising star in your original unit can already take charge of his own work, and you can finally start the research on amputated fingers and replanted limbs in peace. 】
[At the age of 55, your amputated finger and amputated limb replantation techniques were the leading in the industry in Hunan Province, and you were successfully recommended as the deputy head of the Orthopedics Branch, Trauma Disciplinary Group and Hand Microsurgery Group of the Hunan Provincial Medical Association . 】
[In the same year, you continued to study in new fields, tendon and nerve transposition. 】
[At the age of 65, you retired normally, you accepted the re-employment, you still did not stick to the field, and studied tendon and nerve transposition in depth and systematically. 】
[At the age of 88, you died without any illness. 】
【Your wife and children, the students held a rather grand memorial service for you, and even the leaders of your unit, many people in your industry came to mourn you, thinking that your death is a great loss for the industry. 】
[The simulation ends. 】
[Comprehensive score: Excellent. 】
[You can choose to keep one of the following]
[Fusion skills: open reduction and internal fixation of fractures (perfect) (including limb fractures and pelvic fractures, internal fixation without fixation restrictions). 】
[Skills: tendon, nerve, and blood vessel anastomosis (perfect). (Dungeon limit, the skill proficiency during the simulation process is reduced to the proficient level.)]
[Skill: tendon and nerve transfer (proficient). (Dungeon limit, the skill proficiency during the simulation process is reduced to the proficiency level.)]
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There is absolutely no wrong choice, the previous aptitude, the ceiling that can be reached from the proficiency level is proficiency.
After improving his aptitude, he even perfected his skills!
This is the gap.
The previous two failures were sure to make a profit.
Stable.
just.
After the simulation ended, Zhou Cheng suddenly became a little embarrassed.
Choose one of three.
I really want these three skills. It's a bit difficult to choose one of the three skills.
Moreover, it seems that because this simulated copy is only related to fractures, all skill levels that are not related to fractures will be downgraded.
The dungeon is specialized in tempering fracture-related skills, which is easy to understand.
However, it would be great if other skills could also directly choose Perfection!
After much deliberation, Zhou Cheng chose the fracture open reduction and internal fixation (perfect).
Immediately, the skills were preserved, and at the same time, Zhou Cheng had a lot of things in his mind.
The perfect level of fracture open reduction and internal fixation is nothing compared to the previous proficiency level. It seems that the proficiency level skills are just pediatrics...
And, the simulator sent another prompt:
[Acquire fusion skills: open reduction and internal fixation of fractures (perfect) (including limb fractures and pelvic fractures, internal fixation without fixation restrictions): skills can be analyzed, and skills will not disappear after analysis.Do you want to parse? 】
Of course analysis, this perfect skill must be able to analyze a lot of things, right?
Chapter 9 Scroll Power Max!
Fracture open reduction and internal fixation (perfect) (including limb fractures and pelvic fractures, internal fixation without fixation restrictions) was successfully analyzed.
Analyze the following skills.
[1. Experience in anatomy of bones and pelvis of human limbs (perfect), surgical anatomy of human limbs (perfect), has reached the highest level at present. 】
【2. Selection of surgical approaches for limb bone and pelvic fractures (perfect); currently it has reached the highest level. 】
[3. Manipulative reduction of extremity bones and pelvic fractures, poking reduction (proficient); the highest level is perfect. 】
【4. Conventional open reduction and external fixation for open fractures (perfect), which has reached the highest level at present;】
[5. Skin and subcutaneous tissue suture (proficient), the highest level is perfect. 】
【6. Experience in film reading related to limb fractures (proficient), including X-ray, CT, MRI, B-ultrasound, the highest level is perfect. 】
【7. Fracture treatment experience before and after surgery (perfect), the highest level is perfect. 】
【8. Experience in prevention of complications before and after fracture surgery (proficient), the highest level is perfect. 】
【9. Experience in guiding rehabilitation after fracture surgery (proficient), the highest level is perfect. 】
[Analysis skills can be used as initial skills for the next simulation. 】
A total of nine hidden attributes contained in fracture open reduction and internal fixation (perfect) were analyzed.
developed!
This was Zhou Cheng's first reaction.
Then I thought about it a little bit and found it to be very scientific.
For open reduction and internal fixation of fractures, if it reaches the highest level, it is impossible not to choose the surgical approach, and it is impossible not to read the films, including preoperative and postoperative medication, prevention of complications, etc., all have to keep up.
With a lot of knowledge poured into him, Zhou Cheng felt that he could handle the diseases corresponding to fractures with ease.
Yes, just make sure.
It's like a kind of thing that can be held in the hand and pinched, and can be very well grasped for the corresponding size and heat...
I looked at the time, it was already 00:15 in the morning!
There is still more than half an hour left for the dungeon to cool down.
It's late, go to bed and go to bed.
Now, it shouldn't be a big problem to fight for a place in the hospital, right?
Thinking of this, Zhou Cheng soon fell asleep.
This is a necessary skill that Zhou Cheng has cultivated as a training doctor. After lying down, he must be able to fall asleep within 15 minutes. Otherwise, he may not be able to sleep all night on the night of duty.Knowing how to find time to sleep and fall asleep fast is a survival skill.
In the second year of regular training, Zhou Cheng started his on-duty career after obtaining the qualification certificate of medical practitioner. It has been more than a year now, so he is naturally familiar with this skill...
The next day!
Zhou Cheng got up very early again, and then had breakfast nearby.
When I came to the department, it was only ten past seven.
But Zhou Chengcheng found that when he came, besides Du Yanjun who was on duty yesterday, the other six bed doctors also arrived, earlier than Zhou Chengcheng.
Now count as Zhou Cheng.
Eight people in total.
When Zhou Cheng came, everyone else glanced at Zhou Cheng one after another.Although he kept silent, the meaning in his eyes was that he also regarded Zhou Cheng as a competitor.
The opportunity to stay in the hospital is rare, so everyone is desperately trying to roll.
"Morning, Brother Zhou Cheng." As the doctor on duty, Du Yanjun sat on the computer desk closest to the office door, and while writing the case, he broke the embarrassment in the office with some embarrassment.
Du Yanjun had never seen such a luxurious lineup on duty.
As soon as the fuck I wake up, there are seven people on duty with me.
Who should I ask for reason?
The others also smiled kindly at Zhou Cheng, because they were trained in the same department and not in the same group, so the relationship could not be said to be good, but they naturally knew each other!
Zhou Cheng also smiled at the others, then turned around, went to the doctor's lounge, and lay down on the bed.
Also look at the fart patient information!
There are six computers in the department, and there are seven people waiting for the computers in the office at seven ten in the morning.
Can you afford it?
……
However, Zhou Cheng's front foot just reached the doctor's lounge.
Du Yanjun also followed, pushed open the door, looked at Zhou Cheng, and said, "Brother Zhou Cheng, do you want to use the computer? I gave it to Chen Tanhai. It should be free soon."
Zhou Cheng's expression changed.
I thought to myself.
In the department, there are a total of nine bed doctors.
Follow the bed doctor Yan Hanhan, the director of the ward.
Min Chaoshuo is Yan Haihan's graduate student, a second-year professional graduate student this year.If you want to talk about the teacher's relationship, Min Chaoshuo has a better chance of staying in the hospital than Du Yanjun.
But it can't be calculated simply like this. The one who competes with Min Chaoshuo is the social planner Xu Yanlin, and his uncle is the deputy director of the hepatobiliary surgery department.
Yan Haihan is only Min Chaoshuo's teacher, and Lao Xu is Xu Yanlin's uncle, so it is obvious who will contribute more.
The third bed doctor, Pang Dingkun, does not belong to the ranks of competitors. He is an academic doctor who was incorporated into the regular training. Now he has a staff and is a regular employee.
Therefore, the competition for places in the hospital has nothing to do with him.
So this morning, Pang Dingkun was the only one who didn't come.
Originally, the bed doctor that Yan Haihan wanted to bring was Lin Lin, another academic postgraduate who was trained after graduation.
But in the end, Lin Lin was handed over to another chief physician in the department, Director Hu.
Maybe I still have to give Lao Xu face.
The bed doctor who followed Director Hu was trained by two academic graduate students after graduation.There are sci articles, and the competitiveness should not be underestimated.
It can be said that if both Min Chaoshuo and Du Yanjun can't publish SCI in the end, even if the two of them have a mentor relationship, they may not be able to kill the other two academic masters...
Zhou Cheng, Zhang Zhengquan, and Guo Lei who followed Director Hu were all purely social training, and they might belong to the category of competing for numbers.
"Forget it, I'd better wait until the house inspection is over, and then get the doctor's orders."
"There are too many people this morning." Zhou Cheng said with emotion.
Maybe Du Yanjun didn't regard Zhou Cheng as a potential competitor, so he said: "Yes, my classmate Min Chaoshuo has already applied for permission to perform internal fixation surgery with his teacher. So far, two internal fixation machines have been done. It's been removed."
"The number of operations for internal fixation is similar to that of Xu Yanlin."
"It must be in preparation for learning fracture surgery."
"It's the same with Director Hu. There are two academic masters. In addition to the SCI article published, Lin Lin also wrote a meta-analysis. I heard that Director Hu's name will be added. Recently, Director Hu underwent surgery. Lin Lin was the hard-hitting help."
"Even Deputy Director Jin Hongming has to stay in the position of the second assistant."
"Oh! It's hard." Speaking of this, Du Yanjun began to sigh and shook his head.
Zhou Cheng: "..."
Ok!
Xu Yanlin fully mobilized his uncle's relationship, and then Lin Lin used the big sci temptation technique to win the chance of surgery.
Volume power max!
Chapter 10 Perfect skill sequelae!
Zhou Cheng felt that Du Yanjun was giving him a hint, that Director Cai Dongfan might let him be the chief surgeon, and hoped that Zhou Cheng would not think too much.
However, Zhou Cheng didn't expose it, but followed Du Yanjun's way: "It may be that Lin Lin and Min Chaoshuo have relatively solid clinical foundations."
"Otherwise, even if you are given another chance, it will still be surgery in the end. If something happens, the superior doctor will also be responsible."
Du Yanjun nodded, his face was very tense, as if he was about to perform the surgery.
Then he said: "Brother Zhou Cheng, have you had breakfast yet? Shall we order noodles together?"
Shashi people have a unique feeling for a bowl of noodles in the morning.It is flat rice noodles, the best is the original soup, add some mustard, the entrance has a smooth feeling.
Zhou Cheng shook his head and said, "I came here after eating, Yan Jun, you can eat by yourself, I'll squint for a while."
Since the six people outside came to the department so early, and they are not like Du Yanjun who is on duty, they will definitely not let go of the computer in their hands easily, go outside and wait to put pressure on others, it is better to lie down comfortably for a while really.
When Du Yanjun heard Zhou Cheng say that he had already had breakfast, he was obviously a little disappointed.
But Du Yanjun thought about it, and said frankly: "Brother Zhou Cheng, I remember you had an operation today, right? Is it a fracture of the distal end of the fibula?"
"Shall we go on stage together then?"
Du Yanjun asked directly.
Although Director Cai Dongfan leads the group, Luo Yun is the superior as the attending physician, and Du Yanjun, Zhou Cheng, and Zhang Zhengquan are all subordinates, but according to the previous rules, he can be an assistant for his own operation, even if he is a member of the group. The other brothers came to power as second assistants.
Zhou Cheng immediately understood what Du Yanjun meant, maybe Du Yanjun had agreed with Luo Yun in private.
If Du Yanjun can explain Zhou Cheng's point, he can try closed reduction and external fixation with Kirschner wire for distal fibular fracture.
Luo Yun must have agreed, that's why Du Yanjun asked himself now, otherwise, there would be no chance of simply asking Zhou Chengrang to help.
The difference between the first aid and the second aid is not that big. It is estimated that Du Yanjun is going to take the lead.
Zhou Cheng felt a little bit bitter in his heart, but he nodded kindly and said, "That's ok, this patient is mine. You should come with me or help me."
Now that Du Yanjun has already got through with Luo Yun and Cai Dongfan, there is no need for Zhou Cheng to feel that he is still a villain in the middle.
Even if you want to fight for the opportunity to perform, you are not so stubborn to fight for it.
Have to draw it slowly.
Du Yanjun continued: "Brother Zhou Cheng, maybe you didn't understand what I meant, it's just the two of us on stage for this operation."
Zhou Cheng was bitter in his heart, pretending to be stunned, and then nodded.
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I'm not stupid, can you understand?
Du Yanjun immediately looked overjoyed, and said, "I'll treat you to dinner at noon, Brother Zhou Cheng."
……
It wasn't until after the shift was over and the house inspection was over that Zhou Cheng realized how much preparation Du Yanjun had made in order to win the chance for him to be the chief surgeon.
Because Director Cai Dongfan didn't go to rest today, he had to go to the operating room himself.
And before going to the operating room, Cai Dongfan personally ordered Zhang Zhengquan, who had no surgery today, to be sent away.Ask Zhang Zhengquan to run a material for him...
There were two surgeries today, one performed by Du Yanjun, open reduction, plate and screw internal fixation for tibial fractures, and the other small one performed by Zhou Cheng, closed reduction and external fixation with Kirschner wires for fibula fractures.
Although it is said that Zhang Zhengquan is a social trainer and does not have his own surgical patients, there must be opportunities to study in the operating room, right?
After all, regular training belongs to cheap labor.
Besides, Cai Dongfan has the task of running materials, so it should be your turn to Du Yanjun, why did it fall on Zhang Zhengquan's head?
But Zhou Cheng could only see through without telling the truth, and silently followed everyone into the operating room.
Today's first surgery was performed on Du Yanjun's patient, who had a comminuted tibial plateau fracture and displacement. On the fifth day of admission, the swelling has subsided, and he is currently suitable for surgery.
This comminuted fracture operation is a routine operation in the department, and Luo Yun can also do it. Usually, Luo Yun is the chief surgeon. Director Cai Dongfan performs complicated fracture operations such as humerus, femur, and calcaneus, which Luo Yun cannot handle. many.
After entering the operating room, Cai Dongfan and Luo Yun, as senior physicians, naturally went to the lounge to lie down first.
After Du Yanjun and Zhou Cheng, two junior doctors, finished disinfecting and laying the towels, it was their right to come on stage again.
Moreover, Zhou Cheng is already in the third year of regular training, and Du Yanjun is also in the second year of graduate school. In the second year of regular training, he is already a mature skilled worker preparing for surgery, so they are not worried!
After Du Yanjun entered the operating room, he took the initiative and said: "Brother Zhou Cheng, I'm here to lift my leg today, you should wash your hands and disinfect first."
The heavy physical work was invited away.
The pre-operative disinfection in orthopedics is slightly different from other disciplines. In other surgeries, as long as the patient maintains a fixed posture, the surgeon can disinfect the operation area three times.
But the disinfection of orthopedics requires an assistant to lift the patient's affected limb out of the air after anesthesia, and another surgeon completes the 360-degree disinfection of the limb without dead ends to achieve strict sterility!
In surgery, it is rumored that all orthopedic surgeons are strong men, but it actually started from here.
The body shape of ordinary people is not bad, but if you encounter big fat legs weighing 280 or more than 300 kilograms, it really requires a lot of strength, and it is persistent strength.
Zhou Cheng didn't say much, it would be better if he could take it easy, anyway, the rest is doomed.
Take your time and you will always have your chance.
Zhou Cheng now has perfect fracture surgery skills, and he is naturally extremely proficient in disinfecting drape.
Moreover, when entering the operating room, Zhou Cheng subconsciously glanced at the patient's film, and immediately made more careful arrangements for the operation plan.
A series of actions such as disinfection and laying towels are done in one go.
In less than 4 minutes, Zhou Chengcheng and the hand-washing nurse completed the operation of spreading the towels, saving Du Yanjun the pain of labor!
Then Du Yanjun went out to call his mentors Cai Dongfan and Luo Yun, while Zhou Cheng put on the sterile surgical gown and finished the rest of the action of spreading the drape and wrapping the legs.
Just when the legs were wrapped and the surgical area was left perfectly, Luo Yun and Cai Dongfan walked in from the operating room just after washing their hands.
Then subconsciously swept over the operating table, Cai Dongfan immediately frowned.
Luo Yun also saw something was wrong, and immediately reprimanded: "Zhou Cheng, what are you doing? What the hell are you with your swollen legs? What we are going to do is open reduction of tibial plateau fractures. You should leave it alone." What is it?"
Zhou Cheng heard the words, thought about it seriously, and replied: "Mr. Luo, what does the LL approach to the tibial plateau look like?"
"What LL approach?"
The corner of Luo Yun's mouth twitched: "Hurry up and expose the inner side, and reapply the film."
Zhou Cheng suddenly realized.
I thought in my heart, I'm dead bird, I made a fucking mistake about one thing, that is, the best choice for tibial plateau schatzker V-type fracture surgery——LL approach, few people are aware of it now, maybe Cai Dongfan and Luo Yun listened I have never heard of it, and they are more accustomed to the joint approach of the anteromedial and anterolateral.
Zhou Cheng held perfect skills and didn't realize it at all. This is not his surgery, but Director Cai Dongfan's. So all surgical habits must follow Cai Dongfan's.
Moreover, which surgical approach is the best is not clear in a sentence or two.
Zhou Chengcheng quickly admitted his mistake: "Okay, Teacher Luo, Teacher Cai. I'm sorry, I'll change it right away."
Chapter 11 Du Yanjun's inner activities!
Medicine is not a child's play, it is an extremely rigorous science.
The treatment of fractures requires the support of systematic knowledge.
First of all, we must start with the principles of fracture treatment. The treatment of fractures should pay attention to three principles.
Reset, strict immobilization, rehabilitation.
The first thing to pay attention to is reduction, and the purpose of surgery is also to serve for fixation and reduction.
just.
Whether to have surgery after a fracture is not certain.
Any kind of surgery has its strict indications and contraindications.
Patients with relative contraindications can choose whether to undergo surgical treatment depending on the situation.And if there are absolute contraindications, then surgery must not be done.
Only patients who meet the surgical indications need surgical treatment, because some fractures can be treated conservatively with plaster external fixation after manual reduction.
This can also achieve the purpose of reset and fixation.
If the indications and contraindications are just to determine whether the patient can have surgery and whether surgery is needed.
Then, in terms of the choice of surgical method, it is also necessary to choose a more suitable surgical method according to the classification of the fracture.
This patient suffered a fracture of the tibial plateau, and the classification of the tibial plateau is mostly based on the Schatzker classification, which is divided into type VI.
Basically, all tibial plateau fractures require surgical treatment. The basic principle of this will not change, unless the physical condition is very poor, unable to tolerate surgery, stepping down to the operating table, and patients with a risk of death, all tibial fractures All plateau fractures require surgery.
This point will be strictly determined before the operation.
Once the operation is determined, the surgical plan must be determined, and the surgical plan is determined according to the classification.
Type V of Schatzker classification: bicondylar fracture involving medial and lateral plateau splitting, combined with vascular and nerve injury, this type accounts for 12.0% of tibial plateau fractures!
Then, the operation method for type V fractures is that open reduction and internal fixation are required at the fractures of internal and surgical splits to firmly fix the fractures.
After the operation, the patient's treatment returns to the principle of fracture treatment.
Reset, immobilize, recover...
In addition, after determining the surgical method to be internal and external fixation, how to choose the surgical approach, how to expose the broken end of the fracture and then suture it out is also very particular. Different surgical approaches have an impact on the overall quality of the operation. ,Can not be ignored.
The traditional approach for tibial plateau fractures is naturally the medial and lateral approach, but there are better approaches to choose.
Of course, all of this is naturally what Zhou Cheng thinks in his heart, and he dare not and cannot say it directly.After all, he is just a resident doctor with a junior professional title, and he definitely cannot take over Class IV surgery such as open reduction and internal fixation of tibial plateau fractures.
Zhou Cheng silently modified the exposed parts.
Cai Dongfan remained silent, and Luo Yun didn't say much.
Zhou Cheng has not been in the group for a short time, and this year is already the third year of regular training. He is actually a very experienced and reliable junior doctor. hate.
A little mention will suffice.
Also watching Zhou Cheng modifying the exposure space was Du Yanjun. Although his expression didn't seem to fluctuate, he still smiled secretly.
Since Zhou Cheng came to the department so early this morning to read the medical records, Du Yanjun knew that Zhou Cheng must also have the intention to compete for the place in the hospital.
Du Yanjun didn't think it was ridiculous for Zhou Cheng to compete for a place in the hospital.
The number of places in the hospital is quite precious, and everyone wants it, which is human nature.
It's just that relatively speaking, Zhou Cheng really doesn't have much advantage in this competition, so the possibility is extremely slim.
In terms of connections, Zhou Cheng is just an ordinary social trainer, not as good as Du Yanjun and Min Chaoshuo who have mentors as strong connections in the department.Not to mention getting in touch with a relative like Xu Yanlin who is the deputy director of the hospital.
Compared with academic qualifications, Zhou Cheng has no advantage. There are four graduate students in the department, two academic types, and SCI papers in hand.
And he was planning to publish the second article. Du Yanjun felt that if he wanted to compete with them, he had to publish SCI. Zhou Cheng wanted to publish an article, but the chances were too small.
than chance?
Needless to say, social training does not have a mentor as a strong backing, who will rest assured that Zhou Cheng can get started?Therefore, if Zhou Cheng wants to compete, he must first gain the trust of the superior doctor.
In other words, it is to try to show yourself better and attract attention first.
However, it was obvious that Zhou Cheng acted too hastily this time, pretending to be a bully on the cow's belly, and then the bull sat down.
The consequences will naturally be dire...
But Du Yanjun will not laugh at Zhou Cheng, because Zhou Cheng is indeed not easy, there is nothing ridiculous, and he himself does not have a 100% competitive advantage.
If Zhou Cheng knew Du Yanjun's thoughts at the moment, he would definitely feel very wronged, and Du Yanjun's brain power is too strong.
……
After Zhou Cheng sorted out the surgical field, the preparations for the operation began, and Cai Dongfan came to the chief surgeon.
Luo Yun subconsciously wanted to stand opposite Cai Dongfan as a help.
But Cai Dongfan said: "Luo Yun, you change positions with Yan Jun, and you come to my side."
Luo Yun was taken aback for a moment, then nodded, and said, "Okay, Director Cai."
Then immediately turned back to back with Zhou Cheng, bypassed the operating table and went to Cai Dongfan's starting position.
The position during the operation is also quite particular, the chief surgeon stands on the direct operation side of the affected limb.
Easy to operate, good vision, all assistants should serve as the main knife.
Opposite the chief surgeon is the position of an assistant, who can assist in the operation and has the second best surgical field of vision.
Then there is the underhand side of the main surgeon, which is the position of the second assistant. The field of vision is relatively poor, but auxiliary operations are also required.The secondary assistant standing opposite the second assistant can be the third or fourth assistant, but they are complete tools.
That is to say, Zhou Cheng's current position, he basically can't see the surgical field of vision, as long as he pulls the hook under the guidance of the chief surgeon.
After the position is adjusted, the operation begins step by step.
Cai Dongfan picked up the round knife, first cut the skin, and then used the electric knife to cut the subcutaneous tissue, and soon exposed the broken end of the tibial plateau fracture.
However, after the outer severed end was exposed, Cai Dongfan frowned.
Obviously, the fracture this time was not that simple. Even if he came to reset the fracture, it would still be difficult.
Three principles of fracture, reduction and fixation.
What the operation completes is the operation of reduction and fixation.
It is clearly stated in the principle, it must be reset first.
The displacement of the fracture is very obvious, and it is pulled into a somewhat deformed displacement by the muscles starting at the femur...
"Bone peeling." Cai Dongfan shouted to the hand washing nurse, who was also called the equipment nurse.
What about fixed in Chapter 12? !
A fracture is not what we habitually imagine, it is simply a broken bone.It has its own definition in medicine!
-
Disruption of bone integrity and continuity.
Therefore, it can be boldly inferred that as long as the continuity and integrity of the bone are interrupted, it can be identified as a fracture.
This is different from what we imagined as the name suggests, the two things are separated very cleanly and rigorously.
The broken ends of the fracture are irregular, and there are a lot of residual blood and broken bone debris.This bone debris, if not removed, can form entrapped tissue between the broken ends.
Unable to achieve a perfect anatomical reduction, it is a bit like if there is mud on the soles of your shoes, you will have a feeling of unevenness when you walk on the road.
This is definitely not possible.
To clean up these bone debris, you need to use tools in the operating room, bone peeling, also called bone stripper, as the name suggests, it can separate the bones so that the debris in the middle can be cleaned.
It is similar to how we clean up the mud sticking to the soles and restore the normal walking feeling.
Moreover, bone stripping can not only remove bone debris, but also assist in the reduction of broken bones!
However, after the equipment nurse took the bone stripper to the operating table, although some debris from the fracture was cleaned away, troubles appeared during the reset process.
First, there is the medial tibial insertion point. The medial muscle group consisting of the semitendinosus, semimembranosus and tibial endometrial muscle from the ischial tuberosity pulls the stump of the medial tibial platform and tilts it up.
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The muscle strength of the lower limbs is not small, so the stretch is very tight.
And you can't use violence, otherwise, the fracture fragments that were originally separated may break when you use brute force, so what's the point of doing surgery?
If the reduction of the fracture is the key point of the whole fracture operation, then how to get the fracture displacement of this kind of muscle traction is the key point of the fracture reduction.
At this time, it is necessary to use a clever way to resist the pulling of the muscles!
Cai Dongfan continued to poke for a while, but the pulled fracture fragments were still not very obedient.
He raised his head and said, "Luo Yun, take another bone and peel it off for me!"
What Cai Dongfan wanted was to press down on the broken ends of the fracture fragments so that the fracture fragments would not be displaced under the pull of the muscles.
Luo Yun frowned slightly, and said, "Director Cai, this fracture is not big, it might break if you press it backwards."
Although this was a rejection of Cai Dongfan's opinion, Luo Yun still said that the entire operation does not belong to Cai Dongfan alone. If there is an accident during the operation, it is the entire team that will increase the workload!
"En!" Cai Dongfan pondered for a while, and took a few deep breaths.
"It would be great if it could be fixed with a Kirschner wire first, so that the whole bone will be stressed." Cai Dongfan said to himself.
This is a kind of temporary fixation during the operation. A variety of fracture operations will be applied to the temporary fixation of the Kirschner wire during the operation.
This is also the reason why Zhou Cheng also acquired the skills of fracture reduction and Kirschner wire internal fixation (perfect) after obtaining perfect fracture open reduction and internal fixation!
This is a whole and belongs to the downstream skills.
"Xuan, give me two Kirschner wires for a try." Cai Dongfan still thinks it's better to be on the safe side, otherwise, after the fractured fragment fractures again, the workload will be much greater than it is now!
Cai Dongfan called for the itinerant nurse.
For an operation, the most complete configuration in a tertiary first-class hospital is that itinerant nurses are responsible for prescribing various new instruments or consumables during the operation under the stage.
Nurses wash their hands and pass instruments to surgeons.
An anesthesiologist, responsible for anesthesia.
Then there is the team of surgeons, who do the surgery.There are also some workers who are responsible for cleaning the operating room, delivering surgical kits for the next operation, etc., and performing their own duties, so that the connection between a patient's operation and the operation stage can be smoother!
"Okay, Director Cai." The itinerant nurse naturally respected the chief surgeon's opinion.
She knew some orthopedics, but she certainly wasn't good enough to give advice on Cai Dongfan's surgery.Moreover, temporary Kirschner wire fixation in fractures is a normalized operation!
Just when Cai Dongfan got the Kirschner needle and was about to inject it, he suddenly said, "Yan Jun, change positions with you, Zhou Cheng, and I will first inject the Kirschner needle in the direction from the inside down to the outside up."
"You need to fix the insertion point of the Kirschner wire for me."
During the operation, the temporary fixation of the Kirschner wire generally requires two Kirschner wires, crossed.
What is being done now is a medial fracture. The first Kirschner wire is best to be nailed to the large tibia along the direction of the tibial plateau fracture from the inside down to the outside.
In the process of inserting the Kirschner wire, a person needs to develop the needle entry point, and it is best to assist in fixing it.
This is a good opportunity to operate.
Cai Dongfan still gave it to his student, Du Yanjun.
Zhou Cheng was also very obedient, first he asked Du Yanjun to take over the hook he pulled, and then walked around from behind Du Yanjun back to back to above Du Yanjun, and then Du Yanjun went to Zhou Cheng's previous position move!
Zhou Cheng can't go wrong with the aseptic small details in this kind of surgery.
Every surgical operation requires a strict concept of asepsis, otherwise it is killing yourself and causing trouble.
After Zhou Cheng came to the place where Du Yanjun was standing before, he sighed slightly in his heart, covered himself with a mask, smiled wryly, and then decided to help Cai Dongfan.
Because if according to Cai Dongfan's way, he forcefully nailed the Kirschner wire to the larger tibia in the state of leaving the air, in fact, it is no different from when he asked Luo Yun to hold it down.
In fact, the best way now is to find a suitable point and relieve the tension of the inner muscle group whose insertion point is on the inner side of the tibia.
Muscles are like rubber bands, but if the rubber band is not being stretched, there is no pulling power.
Before, Zhou Cheng stood under the operation site, while the inner muscles started from the ischium and ended on the inside of the tibia, and the muscles were shaped above the operation site. Even if Zhou Cheng wanted to help, he was powerless.But now that he is in this position, it is natural to help.
So, while pulling the hook with his right hand, Zhou Cheng silently placed his left hand on a very clever position on the inside of the patient's thigh, and then pressed it down, then slid down slightly.
In an instant, the increased friction brought about by Zhou Cheng's pressing down on the fingers of his left hand smoothed out the patient's muscles that originally pulled the fractured fragments.
Follow the shape of the muscles and stroke like this.
A miraculous scene appeared, the tip of the fracture, which had been pried very high, retracted its 'tail' very docilely at this moment, and joined the big army of the tibia steadily.
Seeing this scene, Cai Dongfan immediately shrank his pupils, without having time to think about why this happened.
It's just that this is very conducive to the progress of the operation, and he shouted almost without thinking: "Don't move, keep this posture, I will inject a Kirschner wire first. Don't move."
Opportunity for surgery is fleeting.
Therefore, Cai Dongfan didn't have time to ask Du Yanjun to reveal the needle insertion point to him, so he directly drilled the Kirschner wire in with an electric drill.
Du Yanjun was very embarrassed at the time, holding a vascular forceps in his hand, and opening it in the air, it was almost lonely...
I was at a loss: Master, did you ask me to fix the needle insertion point for you?
After the first Kirschner wire nailed the fracture fragments in the direction from the inside down to the outside up, the three heads and six eyes all looked in the same direction as Zhou Cheng...
Chapter 13 feels threatened!
Obviously, such a silky and safe operation timing was created by Zhou Cheng.
After all, Du Yanjun stood in Zhou Cheng's position for so long before, without any help, and Zhou Cheng stepped up, so the perfect time for surgery came.
The front and the back formed a stark contrast. How could it be possible to prevent the three of them from focusing on Zhou Cheng?
Cai Dongfan remained silent, but blinked his eyes, thinking in his mind.
Was Zhou Cheng's tendon unloading action just done by accident or on purpose?
Strictly speaking, Zhou Cheng is also Cai Dongfan's student, and has been training with him for two years.Staying in the same group is the superior and the subordinate, who manage the bed with dignity, and get along with each other day and night. Even animals have certain feelings, but the unfamiliarity of the feelings is different.
Du Yanjun is his real graduate student, in ancient times he was his apprentice, and Zhou Cheng was at most a registered disciple.
Zhou Cheng and Cai Dongfan definitely knew each other and were familiar with each other. After two years of getting along, Zhou Cheng didn't have any outstanding performances, but there were no flaws either.
In Cai Dongfan's impression, Zhou Cheng only had two words, one is ordinary, which cannot be more ordinary, and he is just one of many ordinary regular trainees in Shashi Eighth Hospital.
If there is one thing about Zhou Cheng that is different from others, it is that Zhou Cheng is extremely reliable and basically did not cause any trouble to his superiors.
If it doesn't cause any trouble, then it's reliable. What else can you expect Gui Peisheng to do?Compared with some other Gui Peisheng who want the superior doctor to wipe their buttocks, it is not easy for Zhou Cheng, a Gui Peisheng who does not cause trouble and does not cause trouble.
However, in Cai Dongfan's impression, Zhou Cheng was really ordinary, with average qualifications and basically no outstanding performances.Otherwise, how could he fail to discover Zhou Cheng's bright spot after spending such a long time together in the past two years?
However, one possibility is not ruled out that the time he really paid attention to Zhou Cheng was actually very short. Since Du Yanjun came to the department and became his student, he has focused most of his attention on Zhou Cheng. Du Yanjun's body, but ignored Zhou Cheng...
Moreover, in Zhou Cheng's first year, he just came to the department, and he was learning the rules. When he was integrated into the team, he didn't pay much attention to him.
……
Luo Yun wanted to touch the back of his head very much at this moment, because he couldn't figure it out!
Zhou Cheng, Luo Yun and Zhou Cheng's contact and time together can be said to be the deepest.
Luo Yun participated in all operations, big and small, and was Zhou Cheng's immediate superior, who also supervised Pearson.And before Du Yanjun came to the department, Zhou Cheng was a newcomer, and the rules and basics that Zhou Cheng learned now were all taught by Luo Yun.
In other words, all the skills in Zhou Cheng's hands were brought up by Luo Yun.
Where did he teach Zhou Cheng this?
He himself will not.
I haven't taught it before, Zhou Cheng hid it really deep enough that time, I'm afraid it was blown out by the quota of staying in the hospital this time.Otherwise, Zhou Cheng would not be bothered to express himself.
Zhou Cheng is usually very low-key and hardworking. He completes the writing of the medical records on time, and Luo Yun doesn't have to worry about the admissions and discharges since Zhou Cheng has just entered the department for two months.Later, Zhou Cheng was on duty alone, and Luo Yun didn't need to pay attention to simple fractures and plaster casts.
Therefore, Luo Yun seldom paid attention to what Zhou Cheng was doing. Anyway, for simple operations, Luo Yun had only recently been promoted to attending doctor at that time, so he needed to practice by himself, so naturally he would not give Zhou Cheng many opportunities.
Later, when Du Yanjun came, with Cai Dongfan's order, Luo Yun would naturally give Du Yanjun more opportunities.
And the other Zhang Zhengquan, who came more often than Zhou Cheng, would occasionally treat him to food and drink, so for yesterday's emergency surgery, although both Zhou Cheng and Zhang Zhengquan were free, Luo Yun called Zhang Zhengquan.
At the same time, Luo Yun also found a very good reason for himself.
Well, Zhou Cheng has just finished his shift, so he needs to rest!
From this point of view, it seems that I don't pay enough attention to Zhou Cheng.
……
Du Yanjun was a little confused at this moment, as if he had returned to the time when he first arrived in the department, Zhou Cheng was already mature enough to be on duty, but he was still an "apprentice", learning basic skills with Zhou Cheng, and following Zhou Cheng's on-duty staff day.
At that time, he felt that he was a graduate student, that is, he had a solid basic knowledge, and he was just a graduate student.
The real clinical skills are his undergraduates, which are still far behind Zhou Cheng.
But later, after Du Yanjun gradually became familiar with him, and he was on duty alone, he felt, well, I am a graduate student, so I can learn things quite quickly, and I have to start writing articles. This is the gap with Zhou Cheng.
But now it seems that he is still too young.
……
Zhou Cheng looked into the three pairs of eyes, organized his words in his mind, and said, "Mr. Cai, why don't we inject the other Kirschner wire first, and I don't dare to relax now."
"It's quite strenuous to press like this."
Hearing this, Cai Dongfan immediately reacted.
Immediately ordered the roving nurse to install another Kirschner wire on the electric drill, and then found the correct position.
Sternly said to Du Yanjun: "Yan Jun, be smart, don't be in a daze, fix the needle insertion point for me."
"Didn't you see how hard it is for Zhou Cheng to remove the muscles?"
Now that you are undergoing surgery, do things first. This is the first principle on the operating table.
In the hospital, the patient's condition is the first priority.Even more so in the operating room!
Cai Dongfan stood at the chief surgeon position and was responsible for the quality of the patient's operation. All the assistants assisted him in the operation, so it was a matter of later to study how Zhou Cheng did this.
Because Cai Dongfan, as the chief physician, heard many powerful professors say that in the process of dealing with fracture displacement, he should be smooth, not brute force.Muscles are sometimes very cute, we have to use their shapes and characteristics skillfully!
It's just that Cai Dongfan didn't know how to complete the movement and mastery of smoothing the hair. He tried it a few times before giving up. It's a bit advanced!
After completing the cross fixation of the two Kirschner wires, the operation on the inside becomes quite simple.
Three principles of fracture.
Reset, immobilize, recover.
Now that the reduction and temporary immobilization have been completed, it is only necessary to do firm immobilization.
I chose a T-shaped steel plate dedicated to the medial tibial fixation, click, click, click.
It was very smooth, with the help of Du Yanjun's first help and Luo Yun's second help, Cai Dongfan nailed the steel plate. Now, he is no longer afraid of the inner fracture being displaced again. The treatment of the inner platform is complete!
Then do the outside.
Zhou Cheng still has to go to the opposite position of the third assistant!
But Cai Dongfan pulled Zhou Cheng back, and said, "Zhou Cheng, you stand at my starting position. Luo Yun, if you are dealing with the outside, you can pull the hook."
Luo Yun nodded, but felt a little bitter in his heart.
Director Cai, I am your first 'student', even earlier than your first graduate student. Are you giving up on me now because I am old?
Du Yanjun stood in the first assistant's seat, looked at Zhou Cheng, feeling a little apprehensive.
There is a sense of status being threatened.
Chapter 14 There are high and low levels
Cai Dongfan's position as chief surgeon remained unchanged, and Du Yanjun's position as first assistant remained unchanged, but Zhou Cheng was obviously moved from the position of secondary assistant to second assistant.
That is, Cai Dongfan's starting side, here, has a better surgical vision.
In fact, Luo Yun doesn't care. He can also perform open reduction of tibial plateau fractures, but the level is not good. If Cai Dongfan didn't perform this operation, he can also do it, but it may take a long time, and the operation The quality is not as good as Cai Dongfan.
In fact, Luo Yun was already familiar with the procedure of the operation, and having followed Cai Dongfan for so many years, he also knew the root of Cai Dongfan's surgical habits.
What he lacks now is the heat. It is not to see how Cai Dongfan performs surgery, but to figure out how to improve the quality of his surgery. This is the key.
Seeing one more operation and one less operation is not much different.
So Luo Yun was just complaining in his heart.
For Zhou Cheng and Du Yanjun, it is very important to watch the complete operation process and operation techniques up close.To personally teach Du Yanjun is also the purpose of Cai Dongfan taking over the operation today.
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Whether it was Zhou Cheng or Du Yanjun, no matter what, they were only fighting for a place in the hospital, and there was no competition with Luo Yun.
Even if they are admitted to the hospital, it does not belong to their peers and still does not constitute competition.Luo Yun's attitude was naturally relaxed, and he looked at Du Yanjun and Zhou Cheng.
He found that Zhou Cheng was very calm at the moment, and he was not very excited because he got the second assistant position. Instead, he looked at Du Yanjun with slightly guarded eyes, with helplessness.
Yes, Zhou Cheng's face was full of helplessness, and Du Yanjun's eyes were full of guard, which was fleeting.
Of course Zhou Cheng was helpless, because in fact, from the beginning of this operation, Zhou Cheng felt that he had a sense of control over the operation process from beginning to end, and with perfect skills, he could do better than Cai Dongfan .
Just like the choice of surgical approach, at least Zhou Chengcheng will not choose the combined anteromedial and anterolateral approach, but will choose the LL approach.
During the operation, Zhou Cheng would not stop and stop like Cai Dongfan. This is just a simple V-shaped tibial plateau surgery.
After Zhou Cheng watched the medial open reduction and internal fixation in the first half, he knew that Cai Dongfan's level was probably proficiency, not even proficiency.Even after seeing Cai Dongfan's surgery, he still won't get any improvement.
Instead, it made Du Yanjun wary of him, and Zhou Cheng naturally felt innocent and helpless.
But on the bright side, Zhou Cheng still said: "Thank you Teacher Cai, thank you Teacher Luo."
Cai Dongfan let him take the second assistant position, and Luo Yunrang was grateful for this position.
Cai Dongfan remained silent, and continued to choose the next operation. Cai Dongfan just felt that although Zhou Cheng was only a regular trainee, he was at least a junior doctor brought by him, and he was also a "registered student". too much.
Including the same for Zhang Zhengquan in the future.
This is what I should do as a superior doctor and a teacher. Today, Zhang Zhengquan was dismissed to let Du Yanjun take the stage more, which is indeed a bit unkind.
But there was no way, Du Yanjun was his student, and he wanted to fight for the opportunity to stay in the hospital. As a teacher, he could only help him.If Du Yanjun could stay, it would be a closer relationship than Luo Yun.
A true master-student relationship.
However, the next step is to deal with the lateral platform of the tibia. The lateral bone fracture is not like the medial side where there are too many and strong muscle insertion points, so there is not much muscle traction, and the displacement of the fracture is within a relatively normal range.
Cai Dongfan, as the chief physician, after exposing the broken end of the fracture, used bone peeling to apply a little pressure, and then restored the split fracture to a better position. Because external pressure can be applied, even temporary fixation with Kirschner wires is not enough. No need to fight.
The outer steel plate was also hit directly.
At this time, the reduction and fixation of fracture treatment principles have been completed, but this is not over yet.
The entire operating room must have a surgical process and rigorous thinking.
Next, it is natural to return to the tibial plateau classification itself.
Tibial plateau fracture, type V of Schatzker classification: bicondylar fracture involving medial and lateral plateau splitting, combined with vascular and nerve injury, this type accounts for 12.0% of tibial plateau fractures!
This is a classification in the strict sense, and the definition is written like this, but in fact, whether the blood vessels and nerves have really been damaged has to be explored during surgery.
The nerve that is most likely to be injured is the common peroneal nerve. The fibula is on the outside of the tibia, so the place that needs to be explored is the outside of the tibial plateau, the common peroneal nerve and blood vessels near the head of the fibula.
This is the basic operation!
Common fractures are caused by violent trauma, and the exploration of tendons, nerves, and blood vessels during surgery is part of the basic operation.If it is an open fracture, it is even more necessary to explore.
In the simulator, Zhou Cheng once failed to master the exploration technique systematically, resulting in undiscovered damage to blood vessels, non-union of fracture ends after surgery, and avascular necrosis of bone.
To Cai Dongfan, this kind of operation was nothing more than an extremely simple matter.
The Chief Physician is rated, if he can't even do a good job, then the Chief Physician is too good.
The operation ended without any disturbance, and Zhou Cheng did not have too many outstanding performances after the treatment on the inner platform, and Cai Dongfan and Luo Yun did not deliberately require Zhou Cheng to have an outstanding performance.
After the operative surgery is over, however, there is one more step.
That is stitching.
While taking off his clothes, Cai Dongfan said, "Luo Yun, don't step down yet. Later, Zhou Cheng and Du Yanjun will sew up the wound on one side. Watch it."
"After internal fixation of this kind of tibial plateau fracture, because of the intervention of the steel plate, the suture should be more rigorous."
After finishing speaking, Cai Dongfan took off his clothes completely, then picked up the mobile phone on the storage table, stepped on the sensor door of the operating room with his foot, and went outside, probably to the lounge or smoking room of the operating room .
This is Cai Dongfan's right as the chief physician and the top doctor leading the team.
For the rest, Luo Yun looked at Zhou Cheng and Du Yanjun's two pups, and said, "Du Yanjun, you sew the inside, Zhou Cheng, you sew the outside."
"Tour, prescribe two 2-0 and 1-0 antimicrobial microjoe."
Antimicrobial Micro Joe is a common name for a stitch with a needle.
2-0 and 1-0 are the diameter of the suture, also called the model.The inner part of the skin needs to be stronger, so 1-0 sutures are used to suture the subcutaneous tissue, and the surface of the skin requires smaller scars, so 2-0 sutures are used.
Because the steel plate is added, the tension of the skin is relatively high, and the sutures below 3-0 are easy to break and rupture the wound after the operation.Of course, if the subcutaneous suture is good, you can also choose cosmetic suture.
But the beauty line of cosmetic sutures is not cheap.And it's not covered by health insurance.
Except for children and girls who love beauty, basically they will not deliberately ask patients if they need cosmetic sutures, unless the patients themselves ask for it.
Soon, the circulating nurse brought the sutures to the table.
For skin suturing, one 2-0 suture on one side is definitely enough, but for subcutaneous suturing, the periosteum, muscle layer and subcutaneous layer are sutured, and one suture is probably not enough.
Zhou Cheng and Du Yanjun each held a pair of tweezers and a needle, and waited for the stitches to come.
Du Yanjun looked at Zhou Cheng with a smile on his mouth, but his eyes were fixed.The reason why I dare to laugh is because there is a mask that blocks it, and the reason why my eyes are not clear is because I don't want to be too obvious.
For surgeons, suture is the foundation of the foundation, and the level of suture also has a level.Although Zhou Cheng came to the department earlier than himself, but with one more year of experience, the level of suturing may not necessarily be better than his own.
Chapter 15 The Aftermath Continues
It was not the first time that Du Yanjun met Zhou Cheng, nor did he just know Zhou Cheng, so Du Yanjun had seen Zhou Cheng's stitching level before.
Du Yanjun actually wanted to say, Brother Zhou Cheng, although my teacher gave me the opportunity on purpose, I fought for it. Although I entered the clinic later than you.But my level may be more solid than yours.
This is actually the real reason why my teacher is willing to give me the opportunity to be the chief surgeon.
This is a very normal self-comforting psychology. It often occurs when you have left a different relationship, or obtained something by chance, and you will find some objective reasons that you think you have. Advantage.
To put it simply, it is obvious that I got in by virtue of connections, but in fact I don't admit it, I actually got in by strength.
You can't compare to me in terms of strength, I don't rely on relationships...
It is definitely not because I am a student of my teacher that I can easily obtain the qualification of the chief surgeon.
It's the same psychology.
Zhou Cheng also couldn't figure out what Du Yanjun was thinking, otherwise he might have laughed happily.
Because if Du Yanjun is not a graduate student, if he is not a student of Cai Dongfan, he usually has a lot of opportunities, and Zhou Cheng can understand his level.
Now that Zhou Cheng is holding the needle holder, he is still a little bit embarrassed.
I wondered in my heart, should I intentionally close the stitches later, so as to save some face for Du Yanjun.
Then he sighed with emotion, and thought to himself, I'm sorry, Yan Jun, we are doctors, and as doctors, we have to be responsible for the patients.Bring out your best level.
The sutures are opened one by one.
The hand washing nurse gave Du Yanjun the stitches first, because she also knew that Du Yanjun was Cai Dongfan's graduate student, and he might be able to stay in the hospital in the future.Give yourself first, which is as it should be.
This is a very normal way of thinking.
After Du Yanjun got it, he devoted 120% of his attention to the stitching, because he wanted Zhou Cheng to relieve his burden of being the surgeon later.
However, Zhou Cheng was more casually waiting for the arrival of the second suture.
Then after Zhou Cheng got it, he even used the needle holder to make a little gesture. After all, after getting the perfect skill from the simulator dungeon, Zhou Cheng hadn't used it once.
Luo Yun holds the thread scissors in his right hand and the vascular forceps in his right hand, ready to cut and hold the thread for Zhou Cheng and Du Yanjun at any time, one to two, and he can handle it in time!
The reason for supporting the thread is that when the level of suture is not enough and the tension of the subcutaneous tissue is relatively high, it is easy to loosen after the first knot is tied. .
Of course, those with good suturing skills can complete the stable operation of the support thread by themselves after the single knot is tied without the need for thread support.
Soon, Du Yanjun finished the first knot before Zhou Chengcheng started sewing.
Luo Yun pressed the vascular forceps up, clamped it, and couldn't get the teeth.
When supporting the thread, the vascular clamp cannot be attached to the teeth, because the vascular clamp must be loosened quickly before the second knot is tied.After the upper teeth, the suture time will be delayed. Another reason is to avoid clamping the soft tissue. The clamping after the upper teeth is very tight, and the cells of the soft tissue are pinched to death...
Zhou Cheng just started to sew.
It's just simple interrupted sutures, nothing fancy.
Moreover, Zhou Cheng's soft tissue suturing technique is also at the perfect level. After strictly mastering the principle of 3 ones, the needle goes in and out very quickly, and then the knot is tied.
After tying the first knot, pull the suture back and fix it to the side where the needle enters. This operation, even the two sutures in the first knot, can form a relatively strong temporary fixation force without assistance Help line.
After the first knot is completed, quickly tie the knot with the needle holder instrument.
After tying three firm knots.
Then Zhou Cheng used his hands and tweezers to lift up the two knotted sutures and waited for Luo Yun to cut them.
And at this time, Du Yanjun's third knot was tied, even a little later than Zhou Cheng's.
Luo Yun was stunned for a moment, and decided to cut the thread for Du Yanjun first, but just looked at Zhou Cheng, not understanding why Zhou Cheng finished the first stitch earlier than Du Yanjun when he got the thread later than Du Yanjun.
The length of subcutaneous sutures needs to be very short, basically two millimeters.
After Luo Yun finished cutting the thread for Du Yanjun, he came to cut it for Zhou Cheng.
Then, while Du Yanjun was sewing up the first knot, Zhou Cheng pulled up two more stitched rabbit ears and waited for Luo Yun.
When Du Yanjun saw this scene, he was a little flustered and almost lost his grip on the thread.
Luo Yun smashed his needle holder with a vascular forceps, and cursed: "Concentrate on suturing, and watch what others do."
Then, while supporting the thread for Du Yanjun, he cut off Zhou Cheng's second stitch.
Du Yanjun tied the second knot in a hurry.
To open again is to tie a third knot, and three knots are necessary to ensure that even if one knot falls off, it is still a dead knot.
Then, Zhou Cheng's hands turned into small motors, and the third stitch was finished, which was more than a little slower.
The corners of Luo Yun's mouth twitched under the cover of the mask, cursing in his heart: You two are deliberately playing with me, right? You are deliberately waiting for me to cut the thread.
This time Luo Yun cut Zhou Cheng's thread first, because Zhou Cheng obviously sewed faster.
When Zhou Cheng saw it, he said, "Mr. Luo, how about I get a pair of scissors myself?"
After Luo Yun finished listening, he looked up at Zhou Cheng who was half a head taller than him.
I was stunned for a while, and asked in a slightly abnormal tone: "Can you do it yourself?"
What Zhou Cheng meant, Luo Yun understood, is that one person completes the operation of suturing and thread cutting, and uses the ring finger to hold the needle holder and the thread cutter at the same time, and then turn one 180 degrees when it is used up, and use the other.
This is a relatively advanced technique that requires hand speed and operational ability.
Luo Yun himself can't do it.
"You can try it." Zhou Cheng didn't finish his sentence.
Because Zhou Cheng disliked Luo Yun for being too slow, and also knew that Luo Yun couldn't just stare at him, so he focused more on Du Yanjun.Du Yanjun is a graduate student, Zhou Chengcheng can only rely on himself.
Du Yanjun also heard Zhou Cheng's words, and he was dumbfounded for a while, and for a while he couldn't even do anything by himself.
When did Zhou Cheng become so powerful? ? ?
Countless question marks approached the door like his old friends.
The hand-washing nurse has seen the operation of suturing and thread-cutting at the same time, but that was when she went out for further studies. In top hospitals, some skilled attendings of general surgery and trauma surgery were forced to develop skills due to lack of manpower.
She was a little curious, could Zhou Cheng do it too?
Also cut the thread to Zhou Cheng.
After Zhou Cheng got the thread cutter, he put one ear through his ring finger, fixed the middle of the thread clipper with his little finger, and fixed the needle holder with his middle finger.
After suturing, the little finger and the middle finger push hard at the same time, swish swish swish, the thread scissors and needle holder immediately rotate 180 degrees at the same time, and when they reach the previous position of the needle holder and thread scissors, they are caught by the middle finger and little finger at the same time.
Cut, click!
Then the middle finger and the little finger exerted force again, and rolled 180 degrees again, as if they were performing acrobatics in their hands.
It seemed that Zhou Cheng was doing acrobatics, as if he was showing off on purpose.But in fact, Zhou Cheng is not even interested in paying attention to other people's stunned expressions. The handle of the needle holder and the handle of the thread trimmer will bump and rub when they are turned.
The sound of guang, chug, guang chug keeps ringing...
Zhou Cheng played by himself, and everyone else, including Luo Yun, became spectators.
Zhou Cheng sewed about five or six stitches. Seeing that no one else was moving, he cut the thread silently and put it down. He looked at Luo Yun with some blank eyes and said, "Mr. Luo, did I block your way?" It's up to you to cut the thread."
Zhou Cheng forgot again, Luo Yun doesn't seem to know how to do this stuff.
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Chapter No.16 Calm down
Although medicine does not allow showing off skills, the operation process can be pleasing to the eye.
Luo Yun was stunned, and said: "No, no. You continue to sew yours, and get off the stage sooner."
At the same time, I said to myself, it seems that the hospital's decision to "fry fish" this time is right.The news released by the hospital is that they are selected from regular trainees. Of course, the Eighth Hospital welcomes doctoral students to come to work, but the problem is that doctors usually don't come.
Graduate students are also graduate students, so in order to retain talents, the hospital dropped a bomb in advance, saying that it would select a group of students from the regular trainees to stay in the hospital.
This is to choose some familiar people.
After this news was released, the very obvious change is that most of the bed doctors have become more active, quick and proactive in doing things, wishing to stay in the department every day, and escape when they can, and fish when they can. , forming a stark contrast.
Moreover, Luo Yun also felt that this might accelerate the learning and growth curve of Gui Peisheng and graduate students, and make some people more courageous.
But what Luo Yun never expected was that a shark would explode out.
Just like Zhou Cheng, the tricks he is playing now are not only beautiful, but even he can't play them.It's a bit too difficult to do.
Moreover, Zhou Cheng was just juggling between thread cutting and suturing, not operational juggling on the patient's body, this is the performance of skills.
Luo Yun really didn't know whether Director Cai would have such a gorgeous transformation technique, because after he came to the department, Cai Dongfan basically didn't touch sutures.
Luo Yun even sighed to himself. Du Yanjun, who secretly wanted to sew up with Zhou Cheng, seemed to have been hit by reducing his dimensionality on the spot. After Zhou Cheng looked at him, he silently lowered his head and sewed his own.
Bitter in my heart, it seems that the gap between me and Brother Zhou Cheng is not as big as I thought, and my own talent is better than his.
Zhou Cheng was just unlucky, he didn't pass the first pass in the two postgraduate exams, otherwise?
The gap between myself and Zhou Cheng now is probably bigger than when I first entered the department.Although I used to be on duty with Zhou Cheng before I got the doctor qualification certificate, but no one took the initiative to give Zhou Cheng any chance.
Zhou Cheng estimated that he had been preparing for the postgraduate entrance examination, so he didn't want to spend more time in clinical practice.
It just so happened that the hospital had leaked the news that a batch of Gui Peisheng would be retained, and Zhou Cheng's family fortune was blown up.
It seems that the opportunity to be the chief surgeon later on, I really got it because my teacher is Cai Dongfan.
Isn't this a bit invincible?
Du Yanjun's heart was bitter, and he sewed it up step by step, and he didn't mean to compare his sewing level with Zhou Cheng at all...
After Luo Yun finished speaking, Zhou Chengcheng continued his operations.
When Du Yanjun had just sutured to the subcutaneous layer, Zhou Cheng had already finished suturing on his side. The skin was flattened and the seams were tight, without any unevenness. The standard one-centimeter interval was pulled by the sutures to form a A pile of good-looking 'little meat buns'.
The suture of the skin is slightly turned outwards and closed, which is the most perfect, which is the way Zhou Cheng sewed it now.
After Zhou Cheng finished sewing, he didn't untie his clothes and step off the stage as gracefully as Cai Dongfan. Instead, he silently took the thread scissors from Luo Yun's hand and said, "Mr. Luo, let me cut the thread. Go and have a rest."
Zhou Cheng is now just Gui Peisheng, Luo Yun's junior doctor, and he still can't do the thing of putting his superiors on the stage to do things, and then yo-yoing himself first.
Luo Yun nodded, without saying anything, he took off his gloves, untied his clothes and stepped off the stage.
Du Yanjun said apologetically, "I'm sorry, Brother Zhou Cheng, I delayed the progress of the operation."
When I said this, my mentality returned to the moment when I first entered the department. I felt that Zhou Cheng was very good, and I still had to learn more from him.In fact, it's the same now, it just depends on how much strength Zhou Cheng will slowly reveal later.
Zhou Cheng's expression changed, and he said, "It's okay, just sew slowly."
In fact, strictly speaking, Zhou Cheng felt that his stitching might be a little bit better than Du Yanjun's if he hadn't suddenly obtained the simulator, but the gap was not as big as it is now.
Stitching itself is a delicate job that doesn't require much talent.
……
After both people were sutured, a piece of cut glove was placed on one side of the sutured wound on the inner and outer sides for drainage.
Fracture surgery, unlike joint surgery, only needs to drain the accumulated blood under the skin, and then remove the drainage piece the next day after the operation.The reason for drainage is to avoid accumulation of blood under the skin, resulting in delayed wound healing.
Then the sterile dressing was applied, and the cast was applied. Zhou Cheng and Du Yanjun cooperated quite tacitly and completed it quickly.
Only then was he able to step down, and then the itinerant nurse and the anesthesiologist were responsible for sending the patient to the recovery room to wake up from anesthesia.
For this fracture operation, the estimated operation time is more than three hours. In order to avoid the patient's nervousness and affect the operation, the anesthesiologist chose general anesthesia.
But in fact, because of Zhou Cheng's intervention, the operation was advanced by at least an hour.
When sending the patient out, the anesthetist smiled and said, "If I had known that Director Cai's operation would be so fast today, I would have had a spinal anesthesia!"
"Who knows, such an operation used to take up to three hours." The itinerant nurse was also puzzled.
In fact, the anesthetist and the itinerant nurse don't even look at what happened during the operation, or how the chief surgeon operates. They are only responsible for their own part, and they do what they have to do.
Unlike the equipment nurse, who always pays attention to the operation process, and at the same time thinks about how to pass the equipment and which one to pass.
So, after the patient went out, the nurse cleaning the equipment still found it very novel. Gui Peisheng, who was under Director Cai, had hidden it so deeply!Even better than his own graduate students.
You really can't tell what you look like.
However, when she thought this way, she didn't realize that she had never seen Zhou Cheng's face at all.The time she spent with Zhou Cheng was in the operating room, and masks were required to be worn in the operating room.
……
The next operation was still carried out step by step, with Cai Dongfan directing beside him.
Luo Yun was the second assistant, Zhou Cheng was the first assistant, and under Cai Dongfan's guidance, Du Yanjun began to act as the chief surgeon.
Because the fracture was simple, it only took Du Yanjun a little more than an hour to complete the closed reduction and Kirschner wire internal fixation of the distal fibula fracture with great difficulty.
The intraoperative C-arm fluoroscopy showed that the alignment basically met the requirements for reduction, and at least functional reduction could be achieved.
Moreover, the fibula is not used as a load-bearing bone, so this is fine. If you step off the stage reluctantly, it will not cause any impact on the patient after surgery.
Today's operation is complete.
Zhou Cheng returned to the department, issued the postoperative doctor's order, wrote down the operation records, completed the postoperative course of disease, and prepared to go back to study a new round of simulation.
Opening a new dungeon requires gratitude, and Zhou Cheng doesn't have that much gratitude yet.
The value of gratitude requires you to play an important role in the operation, so that the patient may appreciate you, or you are careful enough for the patient and have a good attitude, otherwise, how can it be so easy?
It seems that there is more chance to fight for the master.
Otherwise, he can only continue to repeat this dungeon that has already obtained perfect skills.
However, when Zhou Cheng was about to leave, Du Yanjun hurried up and said, "Brother Zhou Cheng, wait a minute!"
Chapter No.17 The Eight Immortals Crossing the Sea and Showing Their Abilities
Du Yanjun stopped in front of Zhou Cheng a little out of breath.
Zhou Cheng was carrying a backpack and was about to walk towards the elevator. Du Yanjun ran up from the stairs. He patted his chest and said, "Brother Zhou Cheng, we agreed to have lunch together at noon."
"If Min Chaoshuo hadn't told me that you were going to leave, I would still be downstairs with my master."
Downstairs is the first ward of the orthopedics department. Director Cai Dongfan used to be in the first ward of the orthopedics department.So Du Yanjun often went downstairs to visit Cai Dongfan.
Zhou Cheng replied: "Yan Jun, you don't have to be so polite, you and I don't have much money. I still have the allowance for regular training. You don't get as much as I do."
Zhou Cheng is telling the truth.
The standardized training of resident physicians is a national policy, and now every medical student must do it.Although professional postgraduates can be included in the regular training, professional postgraduates do not receive subsidies for the standardized training of residents issued by the state, and the hospital does not give this money to postgraduates.
The money for postgraduate students is issued by the Graduate Department, and the monthly amount issued by the university that Eighth Hospital relies on is [-] yuan.This is the only four thousand and four that Du Yanjun can get.
But Zhou Cheng was issued by the country, and he could get [-] to [-] a month. It mainly depends on the performance of the participants each month, and a small amount of rewards can be given for first, second, and third grades.
Du Yanjun is financially poorer than him if he only counts the money he earns.
Although it was said that Du Yanjun took the lead, it was an opportunity given to Du Yanjun by Cai Dongfan. Cai Dongfan was the chief physician and his teacher, and he was willing to give Du Yanjun the bottom line.
Cai Dongfan didn't need to give Zhou Cheng the chance to be the chief surgeon.
Because according to the regulations of the National Health and Health Commission, resident doctors, that is, people who have passed the qualification certificate of practicing doctors and have junior professional titles, can only perform type I operations under the guidance of superior doctors.
Senior resident physicians can routinely perform Type I surgery operations, and carry out Type II surgery operations under the guidance of superior physicians.
If no one is willing to guide you, you are not qualified to perform such an operation.Otherwise, if something goes wrong, the superior will have to take responsibility for you. Is he too idle?
The surgery performed by Du Yanjun just now - distal fibular fracture, closed reduction and internal fixation with Kirschner wires, is a type II surgery, supervised by a superior doctor, and performed under the specified conditions, even if there are mistakes, That can also be justified in the medical department and the graduate department.
Du Yanjun said: "Brother Zhou Cheng, look at what you said, can't I treat you to dinner if you don't have much money?"
"When I was on duty with you before, didn't you often order lunch for me?"
"Walk around, I've already chosen the location, I'm going to eat sauerkraut sausage, this is the special signature dish in that shop, it's enough for dinner."
Zhou Cheng knows the family Du Yanjun is talking about, and he has also eaten it. It is called Juxinpeng sauerkraut sausage. The sauerkraut sausage and shredded lettuce in it are really delicious and not expensive. Basically, it only costs [-] yuan for two people. Small enough to be full.
And Zhou Cheng was also hungry, so he said: "The seats have been selected, so let's go together. It just so happens that it's time for dinner."
The relationship between Zhou Cheng and Du Yanjun is pretty good. When Du Yanjun first came to graduate school, he didn't have a certificate and couldn't be on duty alone, but at that time Zhou Cheng already had a certificate and could be on duty alone.
Naturally, Du Yanjun was arranged by Luo Yun to hang out with Zhou Cheng.
At that time, Du Yanjun naturally fought for many opportunities, such as taking advantage of Zhou Cheng's on-duty opportunity to do plaster external fixation and other operations.
In this way, Zhou Cheng also felt more relaxed, and it was also a matter of convenience to invite Du Yanjun to eat a boxed lunch.
Soon, the two of them took a taxi to the dining place. After ordering the two signature dishes of fat sausage and shredded lettuce, they ordered an ant climbing a tree, which is crab roe vermicelli.
Both Du Yanjun and Zhou Cheng have a lot of food, and the half-staple and half-vegetable dish of ants climbing trees is more suitable.
After ordering, Du Yanjun said mysteriously: "Brother Zhou Cheng, do you know what my teacher asked me to say just now?"
"Well, I can't guess that." Zhou Cheng replied with a smile.
He is not a roundworm in Du Yanjun's stomach, nor is he a close friend of Cai Dongfan's. If Zhou Cheng knew what they were talking about, he would earn more money than a doctor by doing wiretapping work.
"Mainly talk about two things. One is about you, and the other is gossip." Du Yanjun even kept it a secret.
Zhou Cheng pretended not to know:
"Are you talking about me?"
In fact, he also guessed that during the operation before, his performance would definitely get Cai Dongfan's attention.
And this is what Zhou Cheng is happy to see. He has already opened up the simulated copy of the fracture. If he needs to open up a new copy, he needs gratitude.This is a virtuous cycle.
Although I can also stay in the department all day, chat with the few patients I manage, try to talk about their gratitude, and treat them very thoughtfully.
But Zhou Cheng still felt that medical service was different from the general service industry, and it was really impossible to call him out for a joke.Selling one's own professional skills is almost the same.
"Well, my teacher told Luo Yun to give us more chances in the future. The two of us will take turns. If there is a simple fracture next time, I will let you try as the chief surgeon." Du Yanjun smiled meaningfully say.
Zhou Cheng was not immediately overjoyed after hearing this, but asked, "What about Zhang Zhengquan?"
There are three people in the group, myself, Du Yanjun, and Zhang Zhengquan. If both myself and Du Yanjun have the chance to be the chief surgeon, Zhang Zhengquan does not.
"This is related to another gossip I want to tell you." Du Yanjun continued to play tricks.
Du Yanjun really aroused Zhou Cheng's curiosity: "Huh? Gossip?"
"It was Teacher Luo Yun who told me that Zhang Zhengquan was chasing a girl recently." After Du Yanjun finished speaking, he stopped, as if he wanted to hook Zhou Cheng on purpose.
Zhou Cheng's heart twitched, brother, it's a pity that you don't talk about cross talk and storytelling in this way of speaking.
Why don't you change your career?
"Quickly say it! It's long-winded. I don't care if I don't say it, I'm too lazy to guess." Zhou Cheng said a little impatiently.
Zhang Zhengquan's pursuit of girls has something to do with the chance of surgery?
Will Zhang Zhengquan have no objections then?
"Let's put it this way, as long as you catch up with this girl, it will be easy to stay in No. [-] Hospital, No. [-] Hospital or No. [-] Hospital. You don't need any chance of surgery." Du Yanjun said in shock.
"Fuck!"
Zhou Cheng was taken aback by this, and asked in surprise, "Is it true?"
Rich woman?
280 pounds?
flowery?
For a while, many images of "girls" flashed in Zhou Cheng's mind.
"Then why am I lying to you?"
"Anyway, that's what Teacher Luo Yun said. It seems that not only Zhang Zhengquan is chasing him, but people from other departments are also chasing him. This is a shortcut after all..." Du Yanjun's tone was a little wretched and serious.
Chapter 18 Calculate!
Ok.
Girls are indeed attracting creatures.
This time, the number of places in the hospital was released, and it really exploded a lot of people, each of them was calculating their own methods and advantages.
Naturally, including myself.
Zhou Cheng glanced sideways at Du Yanjun and said, "Have you ever seen this girl? Don't you have any ideas?"
Du Yanjun sighed with emotion, and jokingly said: "If I had Zhou Chengge's good looks like you, I might still want to give it a try. But I don't. And I don't have money or time. I have to face the challenge of graduation." There are a lot of things."
Du Yanjun shook his head himself: "If I were a girl, I wouldn't find a boyfriend like me."
……
The two chatted for a while, and the dishes came out one after another. The two young men hadn't eaten since they had breakfast at seven o'clock in the morning, so it was important to eat quickly.
After dinner, Zhou Chengcai and Du Yanjun went back separately. Because Du Yanjun was a graduate student with little subsidy, he lived in a cheap dormitory, while Zhou Cheng rented a small single room by himself.
After returning to the dormitory, Zhou Cheng did not immediately start the last opportunity to simulate the dungeon left today, but first sorted out the current situation.
The hospital did not say how many places will be available in the second orthopedic ward.
But as it stands now.
Min Chaoshuo and Du Yanjun are graduate students of the ward director Yan Haihan and Cai Dongfan respectively, taking advantage of the advantage and convenience that their teacher is the chief physician of the department.
This point is very important. Everyone likes to be cronyistic. They hope that the people they serve are people they are very familiar with. The apprentices who are brought out by hand are the best, because they are familiar and there is no psychological pressure.
Relatively speaking, Min Chaoshuo has a greater advantage than Du Yanjun. After all, Yan Hanhan is the director of the ward, and Cai Dongfan is not.
In addition to the two of them, Lin Lin and Du Ruiqi, two academic graduate students who were incorporated into regular training, should not be underestimated.They originally published sci when they graduated, and now Lin Lin is going to publish another sci, and he also uses the sci article as an exchange for his own practice opportunities.
Articles and scientific research are now an area that the Eighth Hospital attaches great importance to.
The No. [-] Hospital of Shashi is located in the Star District, and it is already a third-class general hospital. There is no way to improve the level of the hospital. If you want to improve the overall strength of your hospital at this time, you can only increase its popularity in the industry.That is to rely on academic research to increase the soft and hard strength of one's own department.
Without innovation, if you just simply learn, you will always catch up with others. Therefore, in general, the hospital now attaches great importance to scientific research and clinical talents. Idle people come to enhance the soft power of their own hospitals.
Moreover, the temptation of the article to superior doctors is quite great.Especially Director Hu in the department is quite obsessed with this.
Without him, the three chief physicians in the department, Cai Dongfan and Yan Haihan are all postgraduate tutors, but he is not.
What is lacking is that there is no subject, and without a subject, there is no way to lead a graduate student, and the prerequisite for applying for a subject is to show that you have the ability and strength in scientific research. Sci articles become a very important resume.
Therefore, in the process of Lin Lin and Du Ruiqi's competition, there is a certain possibility that Director Hu will give them a helping hand.In order to look forward to their reciprocation after they stay in the hospital.
Let's talk about social planning and training personnel.
Xu Yanlin from Yan Haihan, Guo Lei from Director Hu's group, and Zhang Zhengquan from his own group.
Zhou Cheng didn't know how Guo Lei was doing and what he was doing.
But Xu Yanlin's family background is good, he often asks his superiors to eat and drink, and he has an uncle who is the deputy director of the hospital, which has a huge advantage in social relations.
Zhang Zhengquan is already planning to take a shortcut.
Thinking of this, Zhou Cheng frowned slightly. Compared with these people, what is his biggest advantage?
If I want to compete with them, I must often sort out this advantage and comparison, as well as my own advantages, and then do it with a goal.This is the more important part, otherwise, if you mess around in the clinic for a while, you must not be whimsical.
What are your advantages?Perhaps only the clinical ability is stronger than them, which is what Zhou Cheng himself is confident of.
But it is obviously unscientific to only have strength but no chance to show it, just waiting for the passive opportunity to come.
But in order to strive for opportunities to perform, I lack a lot of things.There is no mentor to tell the truth, and there is no article in exchange, so why should Cai Dongfan give himself a chance to operate?
Speaking of which, if he were Cai Dongfan, he wouldn't want to tell someone he didn't know very well, and take the risk of possible medical disputes.
This is reality.
Although Du Yanjun said that Zhou Cheng would have a chance to perform on stage next time, Zhou Cheng naturally couldn't just wait.
But within the stipulated range, Zhou Cheng is now a mature resident doctor. He has had a junior professional title for more than a year, and is about to go in the direction of the second year.Under such conditions, the operations that Zhou Cheng can perform independently and without reporting to his superiors are Class I operations.
For example, plaster external fixation, suture removal, suture and simple debridement and suture.
Debridement and suture patients belong to the trauma type, which can be divided into simple and complex. As long as there are such patients, if you encounter them on duty, you must report to Luo Yun, because some complicated debridements may be accompanied by blood vessels and nerves. And tendon injury, the corresponding operation should be classified as type III surgery.
Class III surgery, even if it is performed by Luo Yun, it is a bit reluctant. Strictly speaking, he is a leapfrog operation, let alone Zhou Cheng.
Moreover, now that Zhou Cheng has simulated the skill level to perfection on the first copy, if he continues to simulate, although there may be a breakthrough, the timeline will be very long, and the significance is not very great.
Zhou Cheng thought to himself that the proficiency of open reduction and internal fixation of fractures (perfect) has already exceeded the ceiling of corresponding surgical operations in the Eighth Hospital, so it is impossible for Zhou Cheng and others to have a higher ceiling. too much meaning.
Continue to simulate in this copy, and get other skills, which will be downgraded.The adapted copy must therefore be turned on.
To open a new simulation copy, you must have a thank you value. The fastest source of thank you value is to let the patient know that you let him avoid or alleviate the pain, that is, you face the patient yourself.
Since I got the simulator, I have to make good use of it. Of course, I don't just wait blindly.
It needs to be planned more systematically.
Then, it seems that what I can do is to downgrade the surgery and operation.
After figuring this out, Zhou Chengcheng started a new round of simulation.
Simulate with purpose.
……
[Please confirm the initial skills and materials to carry. 】
[Fracture Open Reduction and Internal Fixation (Perfect)] Zhou Cheng only needs to have this skill, because it contains many things in itself.
Chapter 19 Perfect Level Above!
[You have a perfect level of open reduction and internal fixation for fractures, but you don't have many opportunities for surgical operations. 】
【So you decided to lower the classification of operations, and started to study fracture manual reduction and plaster external fixation.You start to read all kinds of literature, but you find that you are not simply satisfied with Chinese literature. 】
[You go to see sci, and you find that your English level is slightly lacking, so you start to focus on English learning. 】
[Your superior tried to let you go for a surgery, and your performance was so impressive that even your superior doctor couldn't understand it, so he attached great importance to you and decided to give you more Opportunity to operate. 】
[But you refused, you know what your purpose is. 】
I rely on.
This simulator can also follow your own general thinking, which is not bad!
[One month later, you studied English hard and persisted in reading literature every day, and finally you can read professional English literature proficiently, so you began to read and accumulate crazily to understand the corresponding knowledge of the world's cutting-edge fracture manipulation. 】
[After half a year, because you rejected your superior doctor's suggestion, you did not get the chance to stay in the hospital, but you did not return to the town hospital, but decided to go to Shenzhen City in the south, relying on your own strength, in the Worked in a private hospital with very good treatment for five years. 】
[Five years later, you have accumulated a certain amount of capital, and finally, under the confusion of everyone, you chose to resign.After you sent a large sum of pension funds to your parents, you started to travel and study, visiting domestic famous experts in traditional Chinese medicine and trauma surgery. 】
[In the tenth year, you already have a good understanding of manual reduction, and you have a faint feeling that the current indications for fracture surgery are actually limited.So you start to study abroad and visit famous orthopedic hospitals. 】
[Your knowledge in manual reset has been appreciated and recognized by many masters.So you turn around in these places and start to practice and think about manual reduction of fractures. 】
【20 years later, you have entered middle-aged and old age. At this moment, you have married a wife and have children. You know that you should not wander around, and you have to explain to your parents.So you settled down and founded a small clinic, mainly treating bruises. 】
[Because you visited many famous experts during your study tour in China, so these professors helped you a lot when you opened the clinic.And some professors will bring their students to visit your small clinic to learn your fracture reduction techniques. 】
[Five years later, because of your superb fracture reduction techniques, you have won praise and reputation from many patients, so more and more people come to see you.But you still failed to systematically make extended indications for manipulative reduction. You tried several cases of manipulative manipulative reduction of fractures that were listed as surgical contraindications, but all ended in failure. 】
[Your reputation has become mixed, and the number of patients in the clinic has relatively decreased. 】
[20 years later, you will be very old.Although you are proficient in fracture manipulation, you still haven't made a theoretical breakthrough. 】
[When you were 70 years old, you were exhausted physically and mentally because of the overwork and study over the years, and you died all your life.But you left a good fortune to your wife and children. 】
[The simulation ends. 】
[Comprehensive rating: quite regrettable. 】
[You can choose to keep one of the following! 】
【Memory: Experience of manipulative fracture reduction at the age of 70. 】
【Memory: Cognition of manual reduction of fractures at the age of 70. 】
[Adventure: What you have seen and heard during your years of study tour. 】
After the simulation was over, Zhou Chengcheng felt a little bit pained. It was so difficult to choose these three options. Why do adults still have to do multiple-choice questions? They can't choose all.
One is the experience of manipulative reset, which is the accumulation of quantity.
One is cognition, which is the accumulation of knowledge and academics.
The other is what I saw and heard during my study tour, which is considered a type of adventure.And the last adventure brought Zhou Cheng a lot of pitfalls.
Say nothing this time.
So Zhou Cheng chose Qiyu.
Perhaps, compared to the accumulation of the number of cases and the accumulation of knowledge and academics, the growth of knowledge will be more important.
After all, the accumulation and accumulation of quantity can be completed through time, but the growth of knowledge will have a considerable impact on a person's starting point.
Although the adventure is a one-off, being able to take the direction to an unknown place and go to an unknown direction is a breakthrough in itself.
The perfect level of skills is the ceiling and constraints of this industry. If you want to break through, you must not take the usual path.
……
After the simulation was over, Zhou Chengcheng looked a bit pained.Because there is nothing to do, it is only in the afternoon, and there is still a long time before the early morning.
What should I do?
Zhou Cheng chose to exercise, then found a nearby unit and got a fitness card.Leaving aside other things, the body is still more important, and it can pass the time, which is better than staying at home and watching live broadcasts...
Finally, after finally staying up until the early hours of the morning.
The cooldown of the simulated copy has been refreshed again.
Get started quickly.
This time, Zhou Cheng chose to bring perfect skills and adventures.
A new round of simulation begins.
Because this time it was still with a purpose, Zhou Cheng still refused the invitation of his superiors in the department to let him perform the surgery, and left Shashi No. [-] Hospital after the training was completed honestly.
[Because of your extensive knowledge, you finally chose to work in a small traditional Chinese medicine hospital for bruises. 】
[After entering the hospital, your perfect-level surgery and proficient-level manipulation reset ability were quickly appreciated and valued by the department.You were given a private house call. 】
【Two years later, you already had a good reputation in the local area, and you also applied to the local city for the subject application of fracture manipulation reduction.But you have insufficient qualifications and were rejected. 】
【20 years later, because of your perseverance in applying for a project, your application for a project was finally approved, so you once again started to focus on the research of manipulation reduction.Finally, when you were 49 years old, you broke the surgical contraindications for double fractures of the upper limb and radius, and formed a systematic manual reduction standard. 】
【Thirty-two years later, you broke the surgical contraindications and formed a systematic manual reduction standard in the tristalleolar fracture. 】
[At the age of 67, you broke the current surgical contraindications in the double fracture of the tibia and fibula, formed a systematic manual reduction standard, and then you started lobbying.But no one agrees with your technique to reset the standard. 】
[Because in their view, the manual reset standard you formed will only increase the learning burden for young doctors, without much achievement and meaning.The indications for the standardized manual reduction surgery you gave are not very strong, but simple surgery can achieve more reliable results. 】
[And there is no need to bear the corresponding risks. 】
[At the age of 78, you still failed to convince the domestic academic circles, and you died in depression. 】
[The simulation ends. 】
[Comprehensive score: perfect.You have broken the limit of your current skills! 】
[You can choose to keep one of the following! 】
[Closed reduction of fracture (leading - Li Shuo level)]
[Note: The current highest level of closed reduction surgery for fractures is perfect, which leads to a new breakthrough in the proficiency of the perfect level. It is said that you have formed a relatively systematic theory, but whether this theory is applicable and beneficial to clinical practice, Whether it is popular, economical and beneficial needs further confirmation. 】
[Your failed lobbying experience. 】
Ugh!
Seeing the result of this simulation, Zhou Cheng sighed.
Well, came up with something new, but no one found it useful, is it a waste of time?
It doesn't matter, just trial and error.
Chapter 20 Settling down
[Closed reduction of fracture has been successfully retained (leading - Li Shuo level)]
[The current skills have not yet been fully systematized, and other skills cannot be analyzed for the time being. 】
After reading it, Zhou Cheng felt that his talent might be really poor. After two lifetimes of experience, he failed to further expand the adaptability of manual reset after fracture.
Then narrow down the surgical indications.
But Zhou Cheng is also very open-minded. It took him so long to obtain the perfect skill, let alone above the perfect skill level, it will definitely take more time, let's take it slowly.
The principle of fracture treatment is reduction, fixation and rehabilitation.
Reset first, reset is either manual reset or surgical reset, there is no third option.
What Zhou Cheng has to do is to expand the adaptability of manipulative reset.
Normalize the closed reduction of fractures as soon as possible. Even if Zhou Cheng can't perform in front of senior doctors like Luo Yun and Cai Dongfan, he can still perform manual reduction on some patients who need fractures when he is on duty alone later. With the money, you can also get a lot of thank you points to open new copies.
Five minutes later, Zhou Cheng started the dungeon simulation again!
This time, Zhou Cheng's purpose was pure, and he only brought the skills of closed reduction of fractures (leading - Li Shuo level) and open reduction and internal fixation of fractures (perfect level), and did not choose other miscellaneous skills.
If it weren't for the fact that the skill of closed reduction of fractures could not be translated into other skills for the time being, such as anatomical experience, Zhou Chengcheng would be too lazy to use open reduction and internal fixation of fractures.
It can be reset manually. If it is not based on anatomy, any research progress must be rootless duckweed, a castle in the air.
[You have fracture reduction surgery (leading - Li Shuo level) and you are obsessed with fracture closed reduction surgery, so after you completed the training, you visited well-known domestic trauma experts and TCM orthopedics experts again, and communicated with them Exchange of experience. 】
Zhou Cheng simply understood that the progress in the simulator is all based on his own thinking, as long as he doesn't starve himself to death, he doesn't need to pay too much attention to the social factors in the simulation scene.
Anyway, you can do it all over again, so you don't have to be afraid of the cost of trial and error, otherwise, in reality, it is impossible for Zhou Cheng to stop working and choose to wander!
His parents won't allow it.
[Your parents asked you to find a stable job first, because you have visited many famous experts, and they are quite convinced of your knowledge and skills in the field of orthopedics.So I recommend you to go to a very famous Chinese medicine hospital as a contract worker. 】
【You agreed, and because of the teacher you visited, you quickly obtained the authority to be the chief physician and treat you. 】
【Five years later, your traditional Chinese medicine hospital is unique in manual reset and bruise injury. Therefore, it has won the trust of many colleagues and began to send training staff to your unit. 】
【You have participated in many conferences related to traumatic injuries in traditional Chinese medicine. During this period, you had detailed exchanges with many old Chinese medicine practitioners.They are very enthusiastic to talk freely with you, and discuss systematic knowledge together, hoping to close and reset the technique and establish it as a separate discipline. 】
【They let you rush boldly with confidence, and they will fully support you. 】
[In the eighth year, you once again completed the corresponding theoretical research on the closed reduction of humeral fractures, and once again added a strong stroke to your fracture manipulation reduction.Your prestige in the industry has once again been enhanced. 】
【The muscle strength involved in the humerus is very strong, so manual reset is quite difficult, but you solved this problem. 】
[In the tenth year, you found that the communication with the seniors still couldn't solve the problem of systematic knowledge.So you started to concentrate on research again, and kept visiting famous experts in Chinese and Western medicine. 】
【You send your parents a lot of money, but they start urging you to get married.You can't beat it! 】
[No. 15 years, your first child was born, and you enjoy the happiness brought by family very much.I began to doubt whether my attachment was correct. 】
【No. In 17, your child suffered a fracture of the humerus due to an accident. Your wife is going to send the child to the hospital for surgery, and she doesn't trust you to heal him.But the hospital she went to invited you to a consultation for manual reset.Your child recovered successfully without any scars or sequelae. 】
[No. In 18 years, your wife is determined to fully support you in continuing your career.Because of the support of your wife and family, you once again devoted yourself to research in related fields.Ready to start gnawing closed reduction of femur fracture. 】
[No. 20 years, you have entered the year of knowing your destiny, but you still have no progress, you start to slow down the pace of research, and take your wife and children out to play. 】
[During your travels, you accidentally heard that some animals can still stand up normally after a period of recovery after accidental fractures. 】
[So you are greatly inspired!Dip into research again. 】
[When you were 70 years old, you felt that you were only one step away from perfecting the theory of the whole set of fracture manipulation reduction surgery, but you were already old and suffering from various diseases, so you had no choice but to stop the research. 】
[When you were 75 years old, you finally died of depression. 】
[The simulation ends. 】
[Comprehensive score: perfect.You have broken the limit of your current skills!And enrich the theory of current skills again. 】
[You can choose to keep one of the following! 】
[Research progress on closed reduction of femoral fractures when you were 70 years old. 】
After reading it, Zhou Cheng frowned.
Well, this time, I have only achieved a theoretical breakthrough in the manual reduction of humeral fractures in my lifetime, and there is still no substantial progress in the manual reduction of femoral fractures.Therefore, the skill level of manual fracture reduction has not been improved.
What can be preserved is the research progress.
However, at this time, Zhou Cheng couldn't fall asleep, as if a cat's claws were scratching his heart.
We waited until 00:39!After the third dungeon cooled down, Zhou Cheng started the dungeon simulation again.
This is already the fourth life, Zhou Cheng wants to see if he can make a breakthrough and how bad his aptitude is.
Four generations, it has been almost hundreds of years, and this skill has not yet been broken to the full body.
The simulation begins!
【You temporarily gave up the research on the femur, but switched to manual reduction of fractures of the cuboid, talus, navicular, etc. 】
【After your regular training, you chose to work in a small traditional Chinese medicine hospital. Your parents are quite satisfied with your job. 】
【Your superior doctor and leader also value you a lot, and decided to give you some support and let you see the doctor alone...】
Well, Zhou Cheng's start this time is different, because he already has the research progress of the 70-year-old in his previous life, so there is no need to visit those famous experts, and the exchange of experience with those famous experts is completely in the research progress.
When a man wants to do something, he has to settle down first.
Then you can die.
Chapter 21 Redefining perfection
[At the age of 30, you have strictly mastered the expanded indications for manipulative reduction of ulnar radius, tibia and fibula, humerus, and hand and foot fractures, and you did not forcefully expand the indications for reduction again, so the patients you reset will receive Had a great healing. 】
[You have gained a lot of fame in the local area.Your unit and leaders hope that you will participate in academic exchanges, so as to further expand and enhance the reputation of the school.You say no. 】
[Although you rejected the suggestions of the leader and the hospital, your position in the department is irreplaceable, so you have gained more freedom to operate. 】
【Finally, when you were 45 years old, you completed the theoretical research on closed reduction of femur fractures, and practiced it with great success. 】
【Your skills in technique reset have finally been further improved.Breaking through the barriers of current skills, redefining the most perfect fracture reduction technique!So you start to submit articles to the magazine, hoping to be recognized by your peers. 】
【It's just that the number of cases you involved is very small, and your research has damaged the interests of some medical device companies that make steel plates, intramedullary nails, etc., so you were assassinated. 】
【You died in a car accident! 】
[The simulation is over! 】
[Comprehensive rating: quite regrettable.You have successfully re-broken the definition of perfect level proficiency in closed fracture reduction, but you died unexpectedly! 】
[You can choose to keep one of the following! 】
【Closed reduction of fracture (perfect - redefined)】
[Note: The highest level of proficiency in all skills is perfect, which leads to a new breakthrough in the proficiency of the perfect level. It is said that you have formed a relatively systematic theory, but whether this theory is applicable and beneficial to clinical practice, Whether it is popular, economical and beneficial needs further confirmation. 】
【Perfect—redefinition means that your new theory has been clinically approved, and it is popular and economical.Promoted as a textbook, it redefines the perfect level of this skill! 】
[Become the pinnacle. 】
[Your life comprehension before death. 】
After reading it, Zhou Cheng was a little stunned, but also overjoyed.
He died unexpectedly, but it is also understandable that this world has never been a pure world, and conflicts of interest have always existed. Therefore, this simulation, in addition to bringing me a breakthrough in skills, also told me about my own personality. reason.
That is, before you have a certain weight and popularity, you must not think about subverting the current industry regulations, otherwise you may be crushed by the power of capital.
For medical device companies, surgery is the source of their livelihood.If you make other people's research useless, or narrow down the usefulness, make less money, and have no certain weight, then who will mess with you if you don't?
This was the first time that Zhou Cheng didn't get a good death during the simulation.
Let Zhou Cheng think for a long time, and then decided that in the future, this skill can only be used by himself in reality. Before he has a certain self-protection power, he must not think about promoting it.
After recalling the theoretical details of the corresponding skills in his mind again, Zhou Cheng fell into sleep.
The next day, Zhou Cheng had the experience of yesterday, so he didn't get up until 07:30, and when he rushed to the department after having breakfast, it was already [-[-].
The doctor's office is still overcrowded.
Du Yanjun, Zhang Zhengquan and others arrived early and occupied the computer.
But after seeing Zhou Chenglai, Du Yanjun was the first to stand up and said, "Brother Zhou Cheng, here, you have a new patient today. You should familiarize yourself with his examination information in advance."
"Have you used it up?" Zhou Cheng asked Du Yanjun in astonishment.
Zhou Cheng never thought that Du Yanjun would give him the computer.
"Well, I have already recorded all the inspection results that should be recorded. Brother Zhou Cheng, your new one is the 9 bed." Du Yanjun stood up and gave Zhou Cheng a very kind reminder.
"Thank you!" Zhou Cheng was a little uncertain what Du Yanjun meant, but he always felt that Du Yanjun's sudden enthusiasm must not be for no reason.
It's not too early to start without profit, Du Yanjun, a person with such a quick mind, must have a plan.
However, since a new patient came, and there was not much time left, Zhou Cheng decided to check the patient's diagnosis and examination results first, and then ask about the medical history.
After reading the patient's outpatient X-ray of the right calf, it is almost confirmed that the patient must have a double fracture of the tibia and fibula.
However, his examination results are only X-rays, so it is impossible to determine whether there are other injuries, or whether there are soft tissues, or whether there is any problem with the nearby joints. This can only be deduced after Zhou Cheng has personally seen the patient.
Otherwise, it is enough to have a radiologist to make a diagnosis, so why do you need a bed doctor?
When he came to the bedside, Zhou Cheng asked about the medical history in detail, and found out that this middle-aged man was knocked down by an electric car.
The place where I hit was that I knocked down my right calf from the side, and after I fell to the ground, I was sent directly to the hospital, where it was said that there was a fracture.
Zhou Cheng did a detailed palpation and found no tenderness in the nearby joints.
There is no tenderness. Although it is impossible to completely rule out the existence of ligament and other injuries, the probability is estimated to be low.
After taking a look at the patient's right lower limb, it was already covered with plaster!
Zhou Chengcheng said: "Okay, Brother Li, I have already cleared up your situation. Our director will come to make rounds later, and we will arrange your diagnosis and treatment plan together!"
"Well, okay, thank you, Dr. Zhou."
"You are my doctor in charge, right?" The patient didn't know who the director was, but Zhou Cheng was the first doctor he saw, so he felt that Zhou Cheng was in charge of him.
"Well, I'm your bed doctor. We are divided into groups, and the doctors in our group are all your doctors in charge. If you have anything to do, you can call me. If I'm not around, you can find other doctors in our group. A doctor can do it too." Zhou Cheng explained in detail.
After finishing talking, Zhou Cheng walked towards the shift room. He needed to familiarize himself with the patients before the ward rounds, but everyone had to attend the shift at eight o'clock on time.
When Zhou Cheng entered, he saw Yan Haihan and other directors, Luo Yun and others were already sitting in their seats, and opposite to the doctor was a nurse with a bachelor's degree.
Behind the team of doctors and nurses are full of trainee nurses and training doctors.
Only the employees of the hospital are assigned seats, and there are more new employees.
Before Pang Dingkun came, his chairs had not been added.
Those who are standing are quite envious and looking forward to one day being able to sit on a chair and become a formal employee.
"..."
Chapter 22 It's Over, Too Hard Again
Although for the department, adding more chairs will certainly not constitute an economic burden.
It's just that the shift room is so big, it's impossible to fit so many chairs.
It's like, the normal operation of Shashi No. [-] Hospital requires so many people, but the proportion of formal employees is actually not much.
The reason why there are intern nurses standing in the shift room and no intern doctors is because it is October and most of the interns are already preparing for the nationally organized postgraduate entrance examination with all their heart and soul.
During the handover, Yan Haihan once again emphasized that Dr. Guipei should work hard and not give up lightly.
After the shift was over, Yan Hanhan actually wanted to lead the rounds in person after a long absence.
It's been less than three days since the last time he led someone to round the room.According to the regulations of the hospital, the chief physician and the deputy chief physician only need to make ward rounds once a week.
However, Yan Haihan, as the director of the group, whenever he wants to come to the rounds, this is his freedom, and he can't ask to come at other times.
Cai Dongfan's beds range from 25 beds to 36 beds.
Zhou Cheng is in charge of 25-28, 9.
Du Yanjun was in charge of 29-33, 10.
Zhang Zhengquan is in charge of 34-36, 11, 12!
Such distribution is also particular.
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Generally, patients will be assigned to extra beds only after the main beds are full.
Du Yanjun has five regular beds and one extra bed, a total of six beds, and the number of patients in the department is usually not so large that the extra bed needs to be filled up.Even so, Du Yanjun will still have more patients than Zhou Cheng and Zhang Zhengquan.
Zhou Cheng is much more reliable than the lazy Zhang Zhengquan, so Zhou Cheng has four regular beds and one extra bed, while Zhang Zhengquan has two extra beds.
The first thing to check is Zhou Cheng's 25-28. The three patients are postoperative patients, so it is only necessary to look at the wound, and then look at the X-ray results and inflammation indicators of the reexamination.
After the surgery is done, the workload of ward rounds is not too heavy.
Therefore, Zhou Cheng quickly reported the medical histories and examination results of the patients in the three beds.
Cai Dongfan said: "Well, they are all patients after conventional surgery, nothing special, let's focus on new patients."
Luo Yun relayed to the patient: "Your surgery is done pretty well, now you just need to wait for the care, and take care to protect the wound from water and avoid infection."
After speaking, the group went to Du Yanjun's bed 29 again.
Du Yanjun hurriedly reported: "This patient is a new patient with an upper femur fracture caused by trauma. He was just admitted to the hospital yesterday and has already had X-rays and CT."
"At present, the diagnosis is clear, waiting for the operation."
This is a set of reporting methods that Du Yanjun summed up by himself. The key content of the report is also the key point that the superiors care about.
The key content of a patient is the diagnosis. As for the medical history of surgical patients and other irrelevant examination results, that is what your doctor in charge of the bed should reflect in the medical record.Senior doctors don't need you to teach them how to write medical records.
Du Yanjun passed the patient's examination results to Cai Dongfan and Luo Yun. Cai Dongfan directly looked at CT, and Luo Yun looked at X-ray.
However, Cai Dongfan's reading speed was much faster than Luo Yun's. After watching the film, he calmed down a little, and handed the CT results to Zhou Cheng and Zhang Zhengquan.
Question: "Zhou Cheng, Zhang Zhengquan, although this patient is not under your care, you should come and see this patient and see if you can see something."
There were a lot of CT examination results, so Zhang Zhengquan and Zhou Chengcheng shared one of them.
Zhou Cheng just glanced at it briefly, then pointed the CT image at the incandescent lamp in the ward, read it carefully for about half a minute, and muttered, "I might need a consultation for this."
Hearing what Zhou Cheng said, Du Yanjun's eyelids twitched immediately.
no?Brother Zhou Cheng, this patient has such an obvious fracture, who do you want to ask for consultation?Are you going for an orthopedic consultation?
Ask the orthopedic department for consultation. Either the orthopedic teacher scolded me to death, or my teacher scolded me to death. Even if you think I am your competitor, you can't hurt me so much, right?
And because of Zhou Cheng's words, Zhang Zhengquan felt panicked.
As a resident physician in orthopedics, I can still see the fracture, the fracture line is obvious, and the surrounding soft tissue has edema. The diagnosis is obviously relatively clear.
What else do you need for a consultation?
But Zhou Cheng would definitely not say that for no reason, so he continued to search carefully, otherwise, if he is too good at it, no shortcuts will work...
Luo Yun had already finished reading the X-rays at this time, and after hearing Zhou Cheng's words, he was a little confused. He really wanted to correct Zhou Cheng's words, but he was afraid.Because the inspection window of X-ray is not as detailed as that of CT.If there is content on the CT that is not shown on the X-ray, then I can't talk nonsense.
Cai Dongfan glanced at Zhou Cheng quite unexpectedly. He really didn't expect that Zhou Cheng could still see this, which is still a bit level.
Then he said to Luo Yun: "Luo Yun, you also look at CT."
Luo Yun panicked, good guy, sure enough, Zhou Cheng told me he was right, he didn't see it on the X-ray, why did he ask for a consultation?
I am the attending doctor, when did Zhou Cheng have such a level?
After about 2 minutes.
Cai Dongfan looked at Du Yanjun, and Du Yanjun picked up the CT and X-ray results again tremblingly. Obviously, he had read the examination results dozens of times, but he still didn't see the key part. And Zhou Cheng, who had only read the film for a while, said the key points.
But what is that?
Which department should I ask for consultation?
Neurology?
Can neurological consultation be seen on CT?
Brother Zhou Cheng?Master?Don't think that you bullied me because I was young and didn't understand, so you lied to me.
spine?
Du Yanjun gradually became sad.
1 minutes later.
Cai Dongfan didn't find the answer in the faces of Luo Yun and Du Yanjun, so he didn't make things difficult for them.
Then he said to Zhou Cheng: "Zhou Cheng, tell me your thinking."
Zhou Cheng nodded and talked eloquently, "Teacher Cai!"
"When we look at fractures, we generally look at them from the following five aspects."
"Looking at the definition, the definition of a fracture is the continuity and integrity of the middle part of the bone. Looking at the examination results, the patient's X-ray can indeed find signs of fracture."
"Secondly, look at the location. It's also simple. The shape and position of different bones are different. This is a fracture of the middle part of the femur."
"The third is to look at the nature, that is, to see whether it is a traumatic fracture or a pathological fracture. Looking at the film, we can see that there is no normal structural shadow of the trabecular bone at both ends of the fracture."
"Bones are composed of trabecular bone structure. The trabecular bone structure of normal bones, you see, on the X-ray, it is a very smooth and continuous line shape, which is especially obvious in long bones."
"However, similar structures were not found on both sides of the fracture. Therefore, this patient cannot be simply classified as a traumatic fracture, but should be classified as a pathological fracture."
"Once the characterization is confirmed, the subsequent characterization and treatment plan can be postponed!"
After Zhou Cheng finished speaking, he found that Cai Dongfan and the others were all looking at Zhou Cheng in astonishment, all with bewildered expressions, is this what you, Zhou Cheng, should say?
Zhou Cheng immediately realized: It's over, too much force.
Chapter 23 Invisible pretense, the deadliest!
When Cai Dongfan and Luo Yun were listening to Zhou Cheng's analysis, the structure listed was too detailed, right?
Such a strong sense of hierarchy?In-depth and simple?
Teaching like this, let alone a medical student, even a layman should be able to understand it...
Then Luo Yun turned his head and looked at Cai Dongfan, his eyes seemed to say: Teacher Cai, if you were a teacher like this usually, I would have learned it a long time ago.
Cai Dongfan's face twitched, and after listening to Zhou Cheng's analysis, he thought to himself that he was definitely not as organized and clear-minded as Zhou Cheng in teaching.
Then he glared at Luo Yun, meaning, don't be naughty.
It was only then that Zhou Cheng came to his senses. Damn it was Cai Dongfan who was leading them to teach the ward rounds today, not him leading Cai Dongfan and others to teach the ward rounds. He was still a junior doctor, not the one leading the group in the mock copy...
So Zhou Chengcheng smiled awkwardly, and pretended not to say, "Mr. Cai, I don't know what's going to happen next. You should tell me."
At that time, the saliva in Cai Dongfan's mouth began to pour into the trachea, and he almost choked to death.
Me?
Are you broken here?
Pretend not to.
Isn't it a bit unkind.
If I'm not as clear as you said next, then the fuck is it embarrassing for you or me?
However, since Zhou Cheng transferred the right to speak to himself, Cai Dongfan still had to pick it up, and said, "Zhou Cheng's speech is very good, his thinking is clear, you all should learn more from him."
"Especially you, Luo Yun, you are now the leading teacher. You have to learn more about his lecture ideas with Zhou Cheng, which is very important for your professional title promotion."
Luo Yun suddenly felt that he had suffered an indiscriminate disaster!
Aggrieved little eyes rolled in the eye sockets: Teacher Cai, this doesn't seem to have anything to do with me, does it?
But the face of the superior has to be given, good good good...
You have to bear the blame.
Cai Dongfan's professional title has already been fully promoted. It is estimated that it will not be easy to be promoted to a teaching title like a professor.
No, I can only turn around and beat myself.
Following Zhou Cheng's explanation, Du Yanjun and Zhang Zhengquan immediately saw the difference in the fracture ends.
Oh, I see.
The structure of trabecular bone still has such a function.
I really hope that Zhou Cheng will continue to talk.
Cai Dongfan continued: "So Du Yanjun, you have to ask for a consultation from the CA department."
The patient was a young man in his teens. He smiled with him on the bed and asked, "Doctor, my condition is not very serious. I don't feel particularly painful."
This is true.
For pathological fractures, bone destruction has occurred before. Although minor traumas lead to fractures, the swelling will not be as severe as high-energy traumas, and soft tissue traumas are not serious. Except for a small amount of nerves in the periosteum of simple bones , Bones have no nerve tissue.
If pathological bone changes invade the periosteum, leading to interruption of nerve tissue, pain will be relieved a lot.
Cai Dongfan said, "This needs to be further diagnosed. First diagnose what it is, and then treat it accordingly."
In fact, Cai Dongfan already had the answer in his mind. This young man was more likely to be transferred to Xiangya Hospital or the Second Xiangya Hospital. The Provincial Cancer Hospital is a hospital that treats bone tumors well. The Eighth Hospital does not have a special department for this.
Although there is also an oncology department, the oncology department cannot perform surgery, and most of them still do postoperative chemotherapy.
……
Because Zhou Cheng accidentally enjoyed a ward round with an instructor, Cai Dongfan hurriedly ended the subsequent ward round.
There was no way, because he was not sure that he could speak better than Zhou Cheng, so it was better not to force him too much, lest Luo Yun and his students make a sharp comparison between himself and Zhou Cheng, and regard himself as a frame of reference.
However, after checking the house, Cai Dongfan also became puzzled.
How could Zhou Cheng, who looked honest, very ordinary and ordinary before, hide so deeply.Usually do not show mountains and dews, no profit can not get up early.
Now that I know that there is a place for staying in the hospital, I immediately jumped out.
A big shark really exploded out of this hospital.It seemed that his previous decision was not wrong, Zhou Guo was not as simple as it seemed on the surface.
After the ward round was over, Luo Yun struggled for a long time, then walked into Cai Dongfan's office, smoked a few cigarettes with a smile on his face, and at the same time, the two exchanged with Zhou Cheng the changes they saw in Zhou Cheng.
Then it was unanimously decided to release Zhou Cheng, the big shark, and give Director Yan Haihan and the chief orthopedic department a big surprise.
In fact, they knew that after the news about the number of hospital stays was released, these people's minds were very active, and they were going to exchange this thing for some favors.
Cai Dongfan and Luo Yunke really wanted to see their plans come to nothing. Anyway, the benefits of exchanging favors would not be their turn now.
Anyway, it's bad, it just wants to destroy...
After the ward round, Zhang Zhengquan walked to a computer very depressed, and then silently made his own plan.
I thought to myself, no, absolutely not.
Compared with Du Yanjun, I can't compare with Du Yanjun in academics and education, but my strength may be stronger than Du Yanjun, but it's useless, Du Yanjun still has something to do.
Now even Zhou Cheng, I can't compare with him, I can only take a shortcut, I must take down that little girl.
She's also really good-looking, and I really like her, so it's not considered taking advantage of her.
So the beauty who sent him ten messages but didn't reply sent another message: Beauty, where do you go for lunch?
The girl was afraid of being stalked, so Zhang Zhengquan decided to stalk her to death.
……
Du Yanjun immediately took the back of a computer stupidly and actively, and then gave it to Zhou Cheng, saying very enthusiastically: "Brother Zhou Cheng, here, here."
"Come on, you should prescribe a doctor's order first."
He even pulled out the chairs for Zhou Cheng.
Zhou Cheng touched the back of his head and said, "Yan Jun, if you have something to say, just say it."
"Brother Zhou Cheng, look at what you said." The smile on Du Yanjun's face was brighter than the chrysanthemums of this season.
"I've only been on duty by myself for a short time, has our relationship faded? Of course not, you are still my brother Zhou Cheng, I'm with you."
Du Yanjun knew very well that he couldn't beat Lin Lin's academic graduate students academically, so he had to stand at a higher position than their clinical ones, so as to have an advantage.
In terms of academic qualifications, everyone is evenly matched, which is better than regular trainees like Zhou Cheng.
If you are inferior academically, then I am better than you professionally and clinically. This is also the case. At least everyone still has the strength to fight. If you only compete with them academically, it means giving up your own advantages.
Professional postgraduate students should pay attention to professionalism.
To recruit people in the department, no matter what, the ability to do things must be considered.
Unless there is a group of people who are particularly academically strong, but this group of people will not come to the Eighth Hospital.
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Zhou Cheng didn't speak, nor did he sit down.
If Du Yanjun doesn't express his thoughts and demands, he will not be at ease.Knowing what others are asking for can really put your mind at ease.
"Brother Zhou Cheng, I just want to continue to learn from you. For example, how do you read books? What you talked about today is not in books." Du Yanjun still stated his purpose.
He wants to learn from Zhou Cheng.
Wanting to learn is a very solid desire.
Zhou Cheng didn't hide his secrets and said: "It's the textbook for undergraduates. Is it written in the book? Why didn't it be written?"
"Which chapter do you go to look at? Isn't it about defining first, then positioning, then finalizing, finally classifying or typing, and finally talking about treatment?"
Du Yanjun was dumbfounded after hearing this.
It seems that what Zhou Cheng said is true in the textbook.
But how did Zhou Cheng find out?
How did he find out?
Du Yanjun would never have imagined that Zhou Cheng had stood at the same height as them.
After Zhou Cheng finished speaking, seeing Du Yanjun's expression of enlightenment and confusion intertwined, he immediately reacted, as if he was a little bullying.
I didn't mean it, Yan Jun!
Chapter 24 Surgical Empowerment!
"Well, Yan Jun, this is not appropriate! After all, even Pang Ge is on duty alone."
"You have obtained the certificate now, and you are still on duty with me. Other brothers will think that I am unconventional, which is inappropriate." Zhou Cheng quickly refused.
Are you kidding, Du Yanjun is going to be on duty with him, so how can he go beyond the surgical adaptation and reset the patient's manipulation.This is the only opportunity that Zhou Cheng can win at present.
If Du Yanjun was not around, Zhou Cheng could still turn a patient with surgical adaptation syndrome into a manipulative reduction syndrome patient. After all, his manipulation reset is a bit different.As long as the principles of fracture treatment are strictly grasped, and the reduction and fixation are done well, even if the superior finds out by accident, they won't say much.
But this is also to dismiss patients who are suitable for surgery and patients who need surgery with manual reset.
From a moral point of view, Zhou Cheng did it for the benefit of the patient and saved the patient a lot of money.
But from a professional perspective, Zhou Cheng did not strictly implement the guidelines, and you performed manipulative resets on patients who clearly stated in the guidelines that needed surgery, which was a wrong choice of treatment method.
You, Zhou Cheng, are not Cai Dongfan, you are at the director level, where do you have the power not to follow the guidelines?
What's more, from the perspective of department efficiency, if Zhou Cheng does one more manual reset, there will be one less surgical patient in the department. The current hospital is a differential establishment, and basically all departments are responsible for their own profits and losses.
As far as surgery is concerned, because of the volume purchase of equipment, only when the number of operations is increased can more money be paid for bonuses. Otherwise, the basic salary of 4000 yuan obtained by relying on the establishment, will the superior doctors eat dirt?
The profession of doctors is a bit special. When they basically work, they all start a family and start a business.
If they found out that Zhou Chengming was violating the guidelines and doing things that affected their bonuses, they would really jump out and remove Zhou Cheng's authority on duty, and even expel him from the second orthopedic department.Zhou Cheng can go for training wherever he wants.
Therefore, it is impossible for Zhou Cheng to let Du Yanjun follow him on duty.
It's just that you can't tell the real reason out of your mouth, so I dragged Pang Dingkun, an employee of the hospital and a master of academic doctorate, to be on duty alone, so as to stop Du Yanjun's mouth.
But Du Yanjun just smiled and said: "It's nothing, Brother Zhou Cheng, I just started to be on duty. And I used to follow you."
"Brother Pang is not in our group, and the deployment of our own duty in our group will not affect him, and it's not that I am not on duty, so I let him be on extra duty. It doesn't matter."
Speaking of this, Du Yanjun actually unilaterally said: "Okay, brother Zhou Cheng, it's settled. I will write the progress record of the newly admitted patient with 9 beds later. If you have nothing to do, you can go early." Go back and rest."
"I'll contact you on WeChat when the time comes."
"Me!" Zhou Cheng was so suppressed by Du Yanjun that he couldn't say anything.
This Du Yanjun's thinking is too weird, even if you want to learn, get in touch with patients to practice more, but you are on duty with me, grabbing the operation opportunity that should belong to me, what does this mean?
Even if you are a student of Director Cai Dongfan, you can enjoy certain preferential treatment. Both your teacher and Teacher Luo Yun are willing to give you the opportunity, so they just give it.
But the way you eat now is too ugly, right?
But now there are quite a lot of people in the doctor's office. After Du Yanjun snatched the computer, Zhou Chengcheng had no computer to use.
I could only walk slowly into the doctor's lounge rather depressed, and kept touching my head.
Good guy, he said why Du Yanjun was so warm to him all of a sudden in the morning, so he was here waiting for him.
There is nothing to be courteous, and it is either a traitor or a thief.
Zhou Chengzheng really wanted to hit someone.
While walking towards the doctor's lounge, Zhou Cheng happened to meet Tan Min, who just came out of the nurse's lounge next to the doctor's lounge.
Maybe today is her day shift, so when she saw Zhou Cheng, she hurriedly said, "Zhou Cheng, is your patient prescribed it? Why are you going to rest so early?"
"Don't you suddenly come out with a bunch of doctor's orders when we are resting at noon?"
Nurses on the day shift already execute a lot of doctor's orders. If they are concentrated in one time period, they can be processed in batches.They were afraid that some new doctor's orders would pop up all of a sudden, which would annoy them to death.
Of course, Tan Min actually knew that Zhou Cheng would not be such a person. She mainly wanted to remind Zhou Cheng that you really work hard and don't give up so easily.
Running to the lounge so early, isn't it obviously thinking about fishing?
Didn't you see how diligently the other Gui Peisheng have been courting the superior doctor recently?
"Sister Qin Min, don't worry, I will definitely not increase your workload. It's just that the computers are limited, and there is no rush, so I won't be free for a while." Zhou Cheng will definitely not mention Du Yanjun's matter, so as not to be upset.
Qin Min frowned slightly and said, "I don't believe you are someone who can't grab a computer. I think you have lost your fighting spirit, right?"
"In the past, you were the most active in prescribing medical advice."
Qin Min is telling the truth. Zhou Cheng is the most reliable when other training doctors are still trying to fish, and he is the most punctual to complete the doctor's orders of the patients under his care.But in recent days, the time for Zhou Cheng's bed to be prescribed by the doctor has obviously moved later.
Although there is a certain reason that other people have become more diligent, relatively speaking, Zhou Cheng must have also become lazy.
Qin Min really didn't want to see such a change.Although Qin Min analyzed what Zhou Cheng said last time, he also felt that what Zhou Cheng said was very reasonable, but there may be a glimmer of hope in arguing. If you don't even have the idea of arguing, you really can only wait. was eliminated.
"Don't do that again."
"After all, it hasn't been decided yet, how many people will stay in the end." After Qin Min told Zhou Cheng, she hurried towards the nurse's station.She also has a lot of things to do, and now is the peak time for ordering medical orders, and her nurse in charge is still waiting for her to do things.
"Okay." Zhou Cheng also responded to Tan Min's kindness, and then he was about to open the door and walk into the lounge.
But at this moment, Luo Yun suddenly appeared from the door of the director's office, and shouted from a distance: "Zhou Cheng, just in time, I have something to do with you. Come here."
Zhou Cheng was quite surprised, but he didn't think much about it, so he replied, "Oh, yes, Mr. Luo."
Then he took a few steps back and walked towards the director's office, still hesitating in his heart whether he should tell Director Cai Dongfan and Luo Yun about Du Yanjun.
But in front of Cai Dongfan like this, if he makes a small report on his students, will he hit the wall?
After entering the door, Zhou Chengcheng saw that Cai Dongfan looked at him with a smile in his eyes, and there was no malicious intent.
"Teacher Luo, Teacher Cai." Zhou Cheng called out very politely.
"Zhou Cheng, don't be so nervous."
Cai Dongfan took the initiative to persuade Zhou Cheng to put down his guard, and then said, "The main reason I called you here today is to tell you about the authorization of Type I surgery."
"According to the regulations promulgated by the National Health and Health Commission, you are now in the second year of obtaining a doctor's qualification certificate. You are a low-year resident doctor and can perform Class I surgery."
"Besides, after the previous few surgeries, Luo Yun and I discussed with the attending physician and decided to grant you Class I surgeries and operation permissions. This is the application form, you fill it out, and then go to the director of the ward and the medical department today. Sign it and prepare a case..."
Zhou Cheng's expression gradually changed from stunned to overjoyed when he heard the words...
Chapter 25 I am actually walking ahead of you all alone!
Seeing the smile on Zhou Cheng's face, Luo Yun and Cai Dongfan's hearts moved inexplicably.
Then there was a strange emotion in my heart, a little sour and astringent.
The current National Health Commission's grading and classification of surgery is divided into one to four levels.
Level [-] surgery: Various surgeries with low technical difficulty, simple surgical procedure and low risk.
Junior resident physicians: Under the guidance of superior physicians, they can preside over first-level surgeries.
The classification of junior residents refers to those who have worked as residents for less than 3 years, or those who have obtained a master's degree and worked as residents for less than 2 years.
In other words, people like Zhou Cheng and Du Yanjun, including academic graduate students such as Lin Lin, who have not been employed as resident physicians, are all within the scope of low-year resident physicians.
In principle, both Zhou Cheng and Du Yanjun can preside over and carry out first-level surgeries under the guidance of superior doctors.
However, all surgeries and operations require authorization.
If you are not authorized, you can only participate in the operation as an assistant and cannot preside over the operation. Otherwise, it is a violation of the rules and a leapfrog operation. If there is any problem, you need to bear the responsibility independently.Although the superior physician is also jointly and severally liable.
But the responsibilities he independently assumed were enough to ruin a doctor's life.
Authorization of routine surgery, first-level surgery: the approval of the attending physician or above and the department director or the deputy director of the department authorized by the department director.
Second-level surgery: Approved by the department director. When the approval of emergency second-line surgery is under the responsibility of the second-line physicians, the attending physician and second-line physicians should carefully examine the patient.
In other words, currently only Cai Dongfan can routinely approve and grant authorization for first-level surgeries, and even Luo Yun can only temporarily grant approval in case of emergency.
Now that he can get the authorization for this operation, Zhou Cheng can complete the first-level operation such as manipulative reduction and plaster external fixation of fractures with more peace of mind.
Zhou Cheng obtained the doctor qualification certificate last year. Because he had to be on duty alone, he registered and obtained the qualification certificate. The place of practice is Shashi No. [-] Hospital, and now he has been approved by the superior doctor for surgery. Even during the reset process, There was a little accident, which was also an error within the scope of medical treatment.
It does not belong to the category of leapfrog surgery.
Therefore, Zhou Cheng thanked Luo Yun and Cai Dongfan very happily: "Thank you Teacher Cai, thank you Teacher Luo."
It is impossible to obtain the authorization of first-level surgery from the chief physicians of other groups, and others don't bother to care about you. Zhou Cheng naturally wants to thank his superiors for their appreciation.
However, Zhou Cheng's thanks made Cai Dongfan feel a little more uneasy.
After all, logically speaking, the No. [-] Hospital in Shashi is a third-class first-class hospital, which is already the highest in terms of hospital level.Basically, the resident doctors in the hospital should start to let the lower-level doctors take on the duty after obtaining the doctor qualification certificate, and at the same time, give them a certain degree of decentralization.
For example, Cai Dongfan's own student, Du Yanjun, only passed the certificate examination this year, and only got the results. The certificate has not yet been obtained, and he has obtained the authorization for surgery.Zhou Cheng had obtained the certificate for more than eight months, and it took a full year to get it after passing the grades.
So much later than Du Yanjun.
Cai Dongfan dare not say that he has no selfishness at all, he is a qualified teacher for superiors.
Of course, while Cai Dongfan's heart was touched, he said: "It's nothing, this is what our superior doctors should do. Work hard, come on."
"Go and do your own work first. Our superior doctors must have noticed your performance."
Luo Yun immediately understood what Cai Dongfan meant. Probably, it was Zhou Cheng's happy expression just now that touched a string in Cai Dongfan's heart, making him quite guilty, so he wanted Zhou Cheng to disappear as soon as possible.
So Luo Yun immediately said: "Let's go out and fill out the form, and then I have to go to the medical department."
"Well, okay. Thank you, Teacher Cai." Zhou Cheng thanked Cai Dongfan again.
Leng is once again deeply stabbed a knife into Cai Dongfan's heart.
Seeing Cai Dongfan's mouth twitch slightly, Luo Yun quickly patted Zhou Cheng: "Be quick."
But I dare not say it.
Who said you need a knife to kill?
Inner anxiety and suffering, in fact, will make people more uncomfortable.
Speaking of which, Zhou Cheng called Cai Dongfan a teacher, but Cai Dongfan rarely regarded Zhou Cheng as his student, which was the source of his uneasiness.
He and Zhou Cheng left the director's office together, and walked to the doctor's lounge together. After pushing the door and closing it, Luo Yun saw that there was no one in the lounge, so he locked the door.
Zhou Cheng looked at Luo Yun and knew that Luo Yun must have something to say.
Luo Yun didn't hold back, and said directly: "Zhou Cheng, in fact, I told you to leave earlier just now because Director Cai felt a little uncomfortable."
"Well, it's because of you, not all because of you. But it's all in the past, and the past things can only be let them go."
"I'll just tell you straight up. Up to now, among the bed doctors, you are the fifth one who has obtained the first-level operation authorization."
"The first one is Pang Dingkun, then there are Du Yanjun and Min Chaoshuo, and Lin Lin and Du Ruiqi also got authorization for surgery from Director Hu. Next, it's you."
Speaking of this, Luo Yun sighed with emotion, looked tangled and said: "The reason why I told you so bluntly is that I hope you don't hold any grudges in your heart."
"After all, even Xu Yanlin hasn't been authorized for surgery yet."
Xu Yanlin, his uncle is in the Department of Hepatobiliary Surgery, he is the deputy director, and he is also a social trainer. Zhou Cheng was greatly surprised that he did not get authorization for surgery.
"Hasn't Yan Lin got the authorization yet? I thought he got it long ago." Zhou Cheng replied in great surprise.
Luo Yun said calmly: "What's so strange about this? Although his uncle is the deputy director of the Department of Hepatobiliary Surgery, medical treatment and clinical practice are not child's play. Even clinical operations are not repetitive and rescue. ."
"Under such circumstances, who would want to take responsibility for him? Director Yan is not his real uncle."
"The main thing is to be reliable and capable. In clinical practice, patients and family members will not give you any chance of trial and error."
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"Of course, congratulations, you have been approved by Director Cai. In fact, you are already ahead of many people."
Zhou Cheng nodded and said, "Yes."
At the same time, I secretly said in my heart, not only did I walk ahead of many people, I actually walked ahead of most people in the department, okay?
Those who walk in the front are originally lonely.
As for holding grudges or something, if it was me in the past, I might still feel a little uncomfortable.
However, my own strength will not be reduced because I am not authorized to operate.
So, it doesn't matter.
It's just that it's quite a headache if I don't have the opportunity to display my strength, but now that I have the opportunity, I can display it, so what else can I say?
Isn't it good to walk safely within the rules?
"No, Mr. Luo, I'll fill out the form right away, and then please ask Director Cai to sign it." Zhou Cheng was still happy in his heart.
The authorization of the operation by the superior represents the recognition of you and the responsibility to be shared with you.
This is their scruples, Zhou Cheng can understand them very well, because Zhou Cheng has also stood at such a height in the simulated copy...
Chapter 26 Convinced or not?
Zhou Cheng found that his thinking had slowly changed.
I don't know if it's because he has carried out more simulations, so he has a certain degree of confidence in his current strength. He feels that even if he doesn't stay in the Shashi No. [-] Hospital, he can do well, at least he won't fall into the same situation as before. To the level of going to the town hospital.
However, after Zhou Cheng analyzed his own strengths and weaknesses again, he still found that his current academic qualifications are a big constraint when he is looking for a job.
If you want to stay in a provincial capital city like Shashi, a postgraduate degree is very necessary.
However, Zhou Cheng, who had been preparing for the postgraduate exam for two years, failed the initial test. Now that the regular training is coming to an end, it is impossible for Zhou Cheng to give up the regular training to go to the postgraduate entrance examination again.After the completion of the regular training, you can only study for academic postgraduates.
This was not the path Zhou Cheng wanted to take. Therefore, the news released by the Eighth Hospital this time was really a good opportunity, and Zhou Cheng didn't want to give it up casually.
While thinking about it, Zhou Cheng completed the application form with neat handwriting very seriously, then handed it to Luo Yun, and said, "Mr. Luo, thank you for your hard work!"
Luo Yun took it and looked at it, then frowned and said, "Hey, I didn't expect Xiao Zhou to write so beautifully."
"I thought you could write cursive script." Luo Yun joked.
In fact, to be honest, even as a doctor himself, Luo Yun sometimes can't understand the handwritten consultation opinions of other departments.I also don't quite understand the outpatient cases written by Director Cai Dongfan.
The flamboyant handwriting is also a symbol of their era.
The Age of Handwritten Cases...
At this time, Zhang Zhengquan also ran out of computer, and then temporarily walked into the doctor's lounge.
In fact, Zhang Zhengquan can leave. There is no surgery in the group today, and there are not too many patients in the ward. Moreover, the orthopedic patients and general emergency patients are admitted into their own group by the doctor on duty.The surgical system does not have high requirements for medical records, so you can leave early.
You can read and rest.
But Zhang Zhengquan still planned to wait for a while before leaving. After the nurse has checked the doctor's order and made no mistakes, he can leave with confidence. Otherwise, the little nurse may not dare to push too much, but the nurse in charge above the little nurse will take turns in the group bombing.
You can either correct the small mistakes yourself, or ask someone to correct them, so that if the superior doctor sees it, it will leave a bad impression.
For a long time to come, the impression of the superior physician is very important.
Of course, there is another more important reason that Zhang Zhengquan finally added to the WeChat of Hungry Goddess, but the other party did not reply to him.
After walking in, Zhou Cheng and Luo Yun were alone in the duty room, and Luo Yun was holding a report in his hand.
Zhang Zhengquan immediately greeted Luo Yun with a smile: "Mr. Luo, have you had breakfast yet?"
At the same time, he took the opportunity of greeting to glance at the report in Luo Yun's hand.
Although Luo Yun quickly folded and put away the watch, he replied, "Have you eaten, have you finished your patient's medical order and medical records?"
"Don't drag the medical records on the shelves, write them when you should, and develop a good habit."
What bed doctors do is to write medical records and manage patients, but some beds managed by bed doctors may still be blank templates when they are discharged from the hospital, without writing a single word.
Surgery is especially common.
Although Luo Yun was quick, Zhang Zhengquan still saw the title of the document—Physician's Surgical Authorization Approval Form.
Zhou Cheng signed his name, and Zhang Zhengquan saw it clearly.
Immediately, Zhang Zhengquan was taken aback, but replied with an unchanged expression: "It's finished, it must be finished, Mr. Luo. Like Brother Zhou Cheng, I have a pretty good habit."
Zhang Zhengquan felt that he had made a mistake of [-] million yuan. What happened? Why did Zhou Cheng also get authorization for the operation?
Isn't this the patent of graduate students like Du Yanjun and Min Chaoshuo whose supervisors are in the department?Can social regulation and training also obtain surgical authorization?
Zhang Zhengquan knew that Du Yanjun had obtained the permission for surgery, even earlier than Zhou Cheng. After the test results came out, Cai Dongfan granted it to Du Yanjun.But apart from Du Yanjun and Min Chaoshuo, Zhang Zhengquan only knew Lin Lin and Du Ruiqi, two academic graduate students, who used the first work of the article to flatter Director Hu and got it.
How can anyone else get it except them?
Xu Yan Lindu?
However, during the rounds this morning, what Zhou Cheng said was really easy to understand and well-structured.
Zhou Cheng must have secretly worked hard to read the book behind his back, and was approved by Cai Dongfan and the others before he got it.
I can't fall behind, the competitive pressure of "Goddess" is not small, I can't vote all there.
But study?
Can I compare to Du Yanjun and Min Chaoshuo in comparison to learning?
Forget it, let's do some research on how to take down Wei Wei.
Luo Yun then said: "Well, it's good to develop a good habit. You will know how important such a habit is in the future."
"You can go back to rest after you finish your work, or read more books or something. Don't ask three questions during the ward rounds."
After finishing speaking, Luo Yun walked out swaggeringly.
He is the attending physician, and the direct superior of the bed-management doctor and the training doctor of Cai Dongfan's group. If he wants to go out, he doesn't need to report to these subordinate doctors.
Zhang Zhengquan could only nod his head frequently and give way to Luo Yun.
After Luo Yun left, Zhang Zhengquan looked at Zhou Cheng, who was about the same height as him, but slightly taller than him, and asked with a smile, "Brother Zhou Cheng, Director Cai is going to grant you the permission to operate?"
Zhou Cheng didn't hide it when he was seen.Deliberately set up a scheming boy's archway and the like.
Dafangfang admitted: "Well, I just asked me to talk about it. Actually, I didn't expect it either."
If Zhang Zhengquan didn't ask, Zhou Cheng would definitely not take the initiative to ask him to talk about it, but if he asked, Zhou Cheng didn't feel that he needed to hide it. Obtained similar surgical permissions.
Zhou Cheng still doesn't panic, this is the strength he has now given him confidence.
Then Zhou Cheng asked: "Hey, Zhang Zhengquan, is your computer free? I still have medical records and doctor's orders that I haven't written yet. I'll go there first."
There are a total of six computers in the department and nine doctors in charge of the bed, which is not enough according to reason.
But generally speaking, every working day is a group's operation day, and the group where the operation is located will finish the ward check very early and then go to the operating room.At most one person can be left on it to complete the doctor's order on the operation day of the entire group.
Therefore, when Zhang Zhengquan's computer is empty, it is a vacuum.
"Well, I'm free, brother Zhou Cheng, hurry up and go there." Zhang Zhengquan was actually very sour in his heart, but he couldn't say anything.
Zhou Cheng, a social Gui Peisheng like him, obtained the authorization of surgery by relying on hard power, and has no relationship with other relationships or knowledge.Zhang Zhengquan recognized and admired such authorization for surgery.
So not much envy.
However, Du Yanjun has been in the clinic for as long as himself, and he also got his doctor's qualification certificate at the same time. He got it first, and Zhang Zhengquan was actually not convinced in his heart.
Chapter 27 The scheming boy Du Yanjun!
When Zhou Cheng arrived at the doctor's office, Du Yanjun greeted Zhou Cheng warmly and said, "Brother Zhou Cheng, I'm about to call you."
"The computer is free. I sent you a message and you didn't reply to me."
"Well, I've finished writing the admission medical records for 9 beds, the first course records, and today's director's ward rounds, and I've also written the admission interview records. You just need to be responsible for writing the doctor's orders."
Du Yanjun took the initiative to tell Zhou Cheng what he had done.
Zhou Cheng was bitter in his heart, well, Du Yanjun directly blocked his way out, and wrote the medical records of the new patients first, so that it would be hard for him to say that he would not come to follow the shift tomorrow.
scheming!
"Thank you, Yan Jun, you have worked hard." Zhou Cheng could only say.
When someone offers to help you with something, you should be polite.
"It's a small matter." Du Yanjun turned his head back, and then he was busy with his own affairs. He was also busy prescribing medical orders, asking for consultations, and taking an MRI for the 29th bed under his management. The patient might be the first With bone tumors, fractures occur in low-violence situations.
Such a situation must be handled with caution.
MR can see changes in bone quality, and it is a must-do examination for bone tumor patients.In addition, postoperative orders for other surgical patients will naturally need to be adjusted.
Antibiotics need to be adjusted or discontinued, and the patient's pain will no longer be so severe, the frequency of painkillers should be adjusted, and preventive anticoagulation should be used, and postoperative inflammatory indicators should be rechecked for postoperative patients. Schedule it.
For surgical patients, surgery is not the end of treatment, but the end of operative treatment, and the postoperative medication plan must be comprehensively considered and adjusted.
Of course, it was Cai Dongfan and Luo Yun who were doing these things, and if they were arranged, a bed doctor like Zhou Cheng could do them.
Zhou Cheng's patients are not too many, three postoperative and one preoperative, which means 9 beds.
The patient with a bed of 9 has been diagnosed clearly. It is necessary to do a good preoperative examination and then evaluate whether there are surgical contraindications. Anyway, his surgical indications are very obvious.
Although Zhou Cheng could reset his fractures by manipulation, this patient had already shown his face to Cai Dongfan and Luo Yun, and the superior doctors had already assessed that he was suitable for surgery and planned to arrange surgery.
It is impossible for Zhou Cheng to reset the technique and send the patient out of the hospital directly. This is clearly against Cai Dongfan.
This is definitely not acceptable, it will affect Cai Dongfan and Luo Yun's meals and business volume...
What's more, Zhou Cheng's redefined perfect-level manual reset technique is something that others don't know about, and it hasn't been publicly recognized or written into the manual.This belongs to the operations and formulas in the new field.
According to the principle, only Cai Dongfan can carry out the techniques and operations in the new field.
Zhou Cheng wanted to go beyond the surgical indications to carry out manual reduction surgery for fractures. He had to do it secretly, and then showed the results of the post-replacement examination to other people's faces. When they saw it, oh, the situation after the reduction was okay, and there was no displacement. That's all right, put on a plaster cast and go.
Not many people will really investigate what the pre-operative X-rays show. After all, the reset operation has been completed, and the external fixation with plaster is enough.
This is what Zhou Cheng should plan...
"Yan Jun, I'm leaving first." After Zhou Cheng finished his work, Du Yanjun may still be writing his patient's medical records. He also has a new patient, and it is quite complicated. He needs to write down the medical records and analysis clearly , If you want to ask for a consultation, these messy things will definitely not be done in a short time.
"Oh, okay, brother Zhou Cheng, I'm here too soon."
Du Yanjun kept clapping his hands on the keyboard, without looking at Zhou Cheng, and then turned back.
When Zhou Cheng was about to leave the office, Du Yanjun followed him out again, and followed Zhou Cheng into the doctor's office.
Zhou Cheng watched Du Yanjun's arrival unexpectedly.
He still tidied up his white coat and the signature pen in his pocket, and put the pen back in his schoolbag.
Otherwise, when tomorrow comes, the pen must be forced to leave by someone, and Zhou Cheng simply takes it away.
Du Yanjun explained: "Brother Zhou Cheng, I have already discussed with my teacher and Teacher Luo that I will be on duty with you tomorrow, and they all agreed."
"They have already instructed us to be a little more courageous when we are on duty."
"In addition, when I am on duty, if I encounter a patient who cannot be handled, I can call you first, so that we can study and give advice together."
"Brother Zhou Cheng, I'm sorry I didn't discuss this matter with you in advance."
"However, I still think that one more person can study and supervise together, which is much better than studying alone. Especially in clinical practice, when doing some operations, it is better to have an assistant, right?"
After saying this, Du Yanjun lowered his voice and said, "Because compared to academics and writing articles, you and I, as well as Min Chaoshuo, definitely cannot write about Lin Lin and Du Ruiqi, two academic graduate students."
"They have been in the laboratory for three years, and now no one knows whether they have hidden data or published sci. Therefore, we need to firmly grasp the clinical advantages, you are right."
Zhou Cheng glanced at Du Yanjun quite unexpectedly, and immediately reacted: "Yan Jun, did you take the initiative to mention to Director Cai this morning that Director Cai said that he would grant me permission to operate?"
Originally, Zhou Cheng felt that it might be a matter of course for him to obtain the operation permission.
But listening to what Du Yanjun said now, it doesn't seem to be the case.
Du Yanjun immediately said: "I just said something casually, it must be more because of your own strength, Brother Zhou Cheng. You see, during the operation before, you knew how to remove the goose foot at the medial insertion point of the tibia. force."
"My master has already said that such an operation, he may not be able to guarantee that it will be completed."
"Brother Zhou Cheng, it's nothing."
Du Yanjun didn't mean to show off at all, on the contrary, he was very sincere, but Zhou Cheng felt a lot of pressure just because of his expression.
Du Yanjun is too smart, and he also analyzed his strengths and weaknesses very clearly. His advantage is that he has the same educational background as Lin Lin and others, and he also has SCI as an embellishment, but there is no special place to show off.
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The easiest thing to surpass Lin Lin and the others is clinical ability. If he can achieve a lot of achievements in both scientific research and clinical practice, then Du Yanjun can become the most suitable person and is most likely to stay.
On the one hand, he has his own teacher to guide him, and on the other hand, he can be on duty with him, and strive for more opportunities, which overwhelms Min Chaoshuo in operating opportunities.
Moreover, Min Chaoshuo may not be able to repeat Du Yanjun's showmanship.
Because the seniors that Min Chaoshuo followed before had completed the regular training, and now none of the people in their group had brought Min Chaoshuo before, so it must be unreasonable for Min Chaoshuo to follow him.
But Du Yanjun is fine, Zhou Cheng is still in the department, he said that he just got his certificate, and he hopes to be on duty with Zhou Cheng, which makes sense.If you have any more ideas, Cai Dongfan is still in the department.
Moreover, whether it is Xu Yanlin or Pang Dingkun, an academic Ph.D., they may not be able to surpass Zhou Cheng professionally.
Over time, opportunities and accumulation can overwhelm Min Chaoshuo in both aspects.
I have become a tool man of iron.
The power of involution is so terrifying!
Zhou Cheng pursed his lips and said, "Thank you, Yan Jun."
Even after the analysis, Zhou Cheng only felt that Du Yanjun had strong analytical ability and quick thinking.
But in fact, it doesn't pose too much threat to himself, because in the clinical aspect, Du Yanjun wants to overwhelm himself, not such a short period of accumulation is enough.
Reducing ten sessions with one force, the dimensionality reduction blow in strength cannot be made up for by quick thinking.
Chapter 28 A New Direction!
After saying goodbye to Du Yanjun, Zhou Chengcheng took the initiative to call Luo Yun.
Usually, Zhou Cheng would not disturb Luo Yun when he was not on duty.But today, I have to go to the medical department to hand in the application form for the operation permission, so it is impossible to ask Luo Yun to give it to me.
Is he the superior or is he the superior?
Zhou Cheng is very persuasive.
Luo Yun said on the phone: "You wait for me in the department for a while, I just asked Director Yan to sign."
Although Cai Dongfan can do the authorization of the first-level surgery, but the long-term authorization still requires the approval of the director of the ward.
Of course, Zhou Cheng is a member of Cai Dongfan's team, as long as Cai Dongfan agrees, he will not stop him, and he will sign when he has to.
"Okay, thank you, Teacher Luo." After Zhou Cheng finished speaking, he hung up the phone, then sat on the stool in the lounge, found the WeChat account of the owner of the canteen downstairs, and asked him to send a few bottles of drinks and a pack of Chinese medicine. come up.
Zhou Cheng himself does not smoke, the cigarettes are for Luo Yun.Luo Yun, as a senior doctor, helped Zhou Cheng go to Director Yan to sign it, because he was not putting on airs.
The drinks are for Du Yanjun and Zhang Zhengquan, brothers in the same team. It is a good thing to get the authorization for surgery, so of course we have to celebrate.
When Du Yanjun and Zhang Zhengquan had passed the doctor qualification test before, they invited Zhou Cheng to dinner.However, Du Yanjun's authorization for surgery was not publicized.
But now that both Du Yanjun and Zhang Zhengquan knew about it, it would be inappropriate not to express it.
The cigarettes and drinks arrived before Luo Yun. When Luo Yun handed the application form to Zhou Cheng, Zhou Cheng changed hands and stuffed it into Luo Yun's white coat pocket.
Luo Yun was stunned for a moment, but he didn't take out the cigarette again, but said with a displeased face: "It's just this time, don't make another example."
"Don't learn such nonsense."
Zhou Chengcheng knew that Luo Yun might not like what he did, but it didn't hurt.
"Mr. Luo, this is a good thing. Why don't you treat the guests to buy drinks, and let the boss bring a pack of cigarettes by the way. Thank you, Mr. Luo, for making a trip." Zhou Chengcheng changed the subject and said.
Then he handed Luo Yun a bottle of sugar-free iced cola.
This is the last stubbornness of the surgeon.
Luo Yun didn't refuse, and said, "Well, go ahead and work hard."
"Director Cai still values you very much. He told me yesterday that if there is a suitable opportunity next time, I will let you try as the chief surgeon."
Although he had heard such news from Du Yanjun, Luo Yun's words carried a different weight.
Zhou Cheng's face was full of smiles, and he went out to give the drink to Du Yanjun, but he couldn't find Zhang Zhengquan's person, so he simply handed it to Lin Lin who was on duty today.
Zhou Cheng just returned home.
Then I went to bed early and got enough energy to prepare for the 24-hour shift the next day.
Zhou Cheng didn't wait for the early morning simulation copy to be refreshed, mainly because his current manipulative reduction and fracture open reduction and internal fixation have reached a perfect state, and Zhou Cheng couldn't think of any skills to look forward to practicing.
It's better to wait until the daytime to find time to try again.
……
Friday morning was the beginning of Zhou Cheng's day on duty.
Zhou Cheng got up early, and besides brushing his teeth and washing his face, he also packed his toothbrush, water cup, and toiletries and brought them to the department.
He is on duty for 24 hours. Although he may not be able to sleep, Zhou Cheng still has a habit of washing up before resting.
He has a little bit of cleanliness, it's not serious, but if he can take care of himself better, Zhou Cheng will keep this habit.
When I came to the department, it was already 07:30, a little earlier than yesterday.
When he arrived at the department, he put down his bag and Zhoucheng habitually went to the doctor's office first to see if there was a computer.
It's a pity that except for the doctor on duty, Lin Lin, not to mention Pang Dingkun, the other six people were still present, full of energy.
After seeing Zhou Chenglai, Du Yanjun walked out and said with a smile: "Brother Zhou Cheng, an operation has been arranged today. After the operation is over, I will come up to be on duty with you. It is the doctor's order from our team today. I may trouble you." One person did it."
Zhou Cheng is on duty today, so tomorrow should be the surgery day for Cai Dongfan's group.
However, the hospital does not work on weekends, and elective operations will not be carried out.Therefore, there is no way to arrange surgery tomorrow. Yesterday Cai Dongfan arranged an elective surgery for today.
The operation should be performed by Luo Yun with Du Yanjun and Zhang Zhengquan. Perhaps Director Hu's group has few operations scheduled, or maybe other departments have not many operations scheduled today, so today's operation is still the first one.
A surgery requires at least one surgeon and two assistants.
Naturally, the patients of Du Yanjun and Zhang Zhengquan will be handled by Zhou Cheng.
"It's okay, you guys go to the surgery, I'll prescribe the doctor's order." This is the rule in the group, helping each other, after all, everyone has a time when the operation is the first.
……
Today Cai Dongfan just came to the department for a shift and disappeared. Then Luo Yun took Zhou Cheng and others to check the room in a hurry, and then took Du Yanjun and Zhang Zhengquan out of the operating room.
After Zhou Cheng sorted out the doctor's orders of all the people in the department, he changed the medicines for his postoperative patients.
After the operation, the dressing should be changed every two to three days until the patient is discharged from the hospital or the stitches are removed.Daily dressing changes are not required.
Changing the dressing is a basic skill. After Zhou Cheng finished it very proficiently, he went back to the doctor's lounge temporarily, and began to look at the mock copy while waiting for the emergency.
Yesterday afternoon, Zhou Cheng thought carefully about the purpose of the only simulated copy that is currently open.
The manual reset reached the redefinition level, and it was Zhou Cheng who downgraded the operation to a level where he could get started with the operation.It is to earn gratitude.
However, this does not mean that all fracture patients with surgical indications can be reset manually.
It should be said that there are still many comminuted fractures caused by high violence that require surgery for treatment.
I have completely mastered the conventional open reduction and internal fixation of fractures.
However, there is still room for improvement.
There are two main directions for improvement. One is to redefine the perfect level of fracture open reduction and internal fixation and make a breakthrough.
The second direction is to think about open reduction of fractures with small incisions, this direction.
Everyone has a desire for beauty. Regardless of men, women, or children, they don't want to leave a long scar on their body. It is for this reason that today's minimally invasive surgeries, such as arthroscopy, cosmetic sutures, and medical aesthetics Only then did it develop rapidly.
And there is a growing market.
However, arthroscopy belongs to the discipline of sports medicine, and sports medicine belongs to the business scope of the Department of Orthopedics, which Zhou Cheng has no access to for the time being.
However, for small incision fracture open reduction, Zhou Cheng thought he could try it.
Small incision is definitely the trend of the times. It can reduce the surgical incision for patients and make it more beautiful. Moreover, because the incision is small, the trauma of soft tissue will be reduced, and the postoperative pain will also be reduced. Compared with traditional surgical incision, it has great advantages. .
Of course, open reduction of fractures with small incisions is very difficult.
Even this concept belongs to the category just proposed, and it still belongs to the concept stage in the current Huaguo and even world-class fields.If Zhou Cheng wanted to make achievements in this area based on his own qualifications, then Zhou Cheng probably wouldn't think in that direction.
Time-consuming and labor-intensive.
But the simulated copy can be infinitely trial and error, and it can lengthen Zhou Cheng's learning growth line, which can be used for a good job.
Just as Zhou Cheng was about to start the simulation, the nurse came and shouted.
"The doctor on duty is in the emergency department."
Chapter 29 Sister Qin Min, keep your voice down
Zhou Cheng walked out and saw that the person at the door was Tan Min.
Seeing Zhou Cheng, she said, "Oh, so you are on duty today. If I have something to do later, I will call you directly, so I won't come over to call you."
The nurses at the nurse station basically don't remember or check who is the doctor on duty today every day.Because nurses and doctors may change shifts, they do not strictly follow the schedule. When looking for a doctor on duty, they should first go to the office or lounge to call.
"Okay, Sister Tan Min, you can just send a WeChat message." Zhou Cheng knew that Tan Min would not take the initiative to call other bed doctors under normal circumstances, and even if he did, he would use the department's phone number.
It was also his luck that he and Tan Min came in a year ago, so they exchanged WeChat and other contact information very early.
"Are you on the long day shift again today?" To be honest, even though Zhou Cheng had been in the department for two or three years, he still hadn't figured out how the scheduling mechanism at the nurse's station was.
When he is on duty, it doesn't matter which nurses are on duty. Speaking of which, he is such a regular trainee.
Nurses in this hospital like Qin Min may not be favored, so you are lucky to remember you.Otherwise, I don't even bother to remember your name, anyway, after three years at most, you have to leave.
"Well, I changed a long-day shift with Jiaojiao."
"Don't talk, let's go see the patients. The patients have all come to the nurse's station. I'm afraid they will be noisy if they go late." Qin Min was still extremely serious and responsible during her working hours.
"Okay!" Zhou Cheng quickly put on his mask and set off to the nurse's station.
There are two types of emergency patients. One is special emergency, which is the kind that is about to die in the emergency department or ICU. Such real emergency patients need to call the superior doctor of the doctor on duty to ask them to be there.
That is to say, an attending like Luo Yun must be present.
The other is sub-emergency, where there is a fracture, but the situation is not serious. The doctor in the emergency department will ask the family members of the patient to push the patient to the ward and see the doctor directly.
It can save the time of running a trip.
Because specialist treatment is mostly carried out in specialist operating rooms, if you need to be hospitalized, you can directly arrange a bed first.
Zhou Cheng came to the nurse's station, and then saw an uncle in blue overalls covered in lime, being pushed in front of the nurse's station by a middle-aged man of the same age who was dressed in the same clothes as him.
He himself was holding the image kit printed with the Imaging Department of Shashi No. [-] Hospital, while his fellow workers were asking the nurses if they wanted an operation.
The nurse who was questioned replied: "This will be evaluated after the doctor sees it. We are nurses, so we don't know how to read it."
Turning her head while speaking, she saw Zhou Cheng coming behind Tan Min, and immediately said: "The doctor on duty is here, you can ask him later."
Seeing Zhou Cheng, the two uncles turned their heads shrewdly, waiting for Zhou Cheng to approach.
Zhou Cheng's pace was not slow, and he quickly reached the two of them. While picking up the impact information bag in the patient's hand, he asked, "How did you get injured? Did you fall or hit it?"
Even though Zhou Cheng's current strength is much higher than when he was on duty before, Zhou Cheng is quite confident.
However, the patient's injury mechanism is still the most important thing, and it needs to be understood, because the injury mechanism can help you find hidden fractures that are difficult to find by routine film reading.
"It fell. When we were painting the outer wall, we accidentally fell down. It was about four or five meters." The patient himself shook his head helplessly.
After the injury, no matter whether to have surgery or not, it has to be delayed for so long.Still have to spend money, how can this be good.
"Are there no safety measures?" Zhou Cheng glanced at the two of them.
Generally, there will be safety measures at such a height, usually a seat belt around the waist, such patients are not uncommon in the department.
"It's just for convenience, so I didn't do it. And my friends are all old workers, so nothing happens to them usually." This sentence was explained by his fellow workers.
"Doctor, in my situation, do I need an operation?" He looked at Zhou Cheng eagerly, his eyes full of helplessness.
"I'll tell you after I've read it. Whether you need surgery or not depends on the actual situation."
"You guys, is this a work-related injury?" Zhou Cheng asked while continuing to read the films.
Don't look at people wearing construction site clothes like this, they must be working on the construction site, and they may have fallen and injured themselves while doing private work.
This is the Star District of Shashi, a very suburban place, many people are repairing houses by themselves.Then the person invited, such a relationship, may not necessarily compensate for these.
The man didn't speak.
His co-worker rolled his eyes a little and asked, "Surgery? How much will it cost?"
It is estimated that when they were in the emergency department, the emergency doctor who gave them the first visit told them that they might need surgery after seeing the fracture.And this situation is definitely not a work-related injury, so they are a little nervous.
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"Not in a hurry."
"Come on, move your toes and curl them up."
Although Zhou Cheng has passed the film reading and clearly distinguished the patient's fracture type, he can manually reset such a fracture type, but he must first rule out nerve and blood vessel damage.
The best way to rule out nerve damage is to check the patient's movements.
Although most of the activities are limited due to the fracture, the normal plantarflexion and dorsiflexion functions on the injured side still exist. As long as you see such a range, you can know that the nerve function is healthy, otherwise if the nerve is broken, It is impossible to move.
Manipulative reduction is not a simple reset, and the absolute contraindications of manual reduction must be ruled out first.
The patient tried to move a little, but then gave up and said, "It hurts, I can't move."
He thought that what Zhou Cheng wanted to see was his usual activities.
"It's okay, it's okay." Zhou Cheng said, handing the film bag to the patient's worker, and then said: "You push him into the operating room first, in your situation."
"It is certain that the bone is fractured, but the current fracture situation is not particularly complicated. We can try manual reduction."
"If the manipulation is restored, there is no need for hospitalization and surgery, but if it is not restored, then hospitalization and surgery are necessary."
"If you don't want to try or can't accept the result that the manipulation can't be done, then go to hospital and wait for surgery."
Zhou Cheng is also quite good at blocking the patient's words, so before the patient even selectively asks whether he should not have the operation, he blocks the back road.
"No, no, I'll do manual reset." The patient said quickly.
This does not belong to the category of work-related injuries, so he has to pay for the surgery himself, and even if he cannot work later, no one will subsidize him.
He repaired the house for his elder brother's house, and his elder brother is not a professional, so he reminded them to pay attention to safety.They do this themselves, and they don't take protective measures themselves. Under such circumstances, they can ask their elder brothers for compensation, so the money doesn't come from the wind.
Zhou Cheng smiled: "Whether the manual reset can be reset is not certain. I will prepare the materials and tools for manual reset first, and you may have to wait for me for a while."
When hearing these words, Tan Min at the nurse station frowned slightly.
When the patient entered the operation room and Zhou Cheng went to the equipment room to prepare plaster, local anesthetics and other supplies, Qin Min sneaked into the equipment room and asked:
"Zhou Cheng, are you really going to reset his hand?"
"Is this too risky?" She was a little worried about Zhou Cheng's recklessness.
Zhou Cheng explained, "No, Miss Tan Min."
"Fracture manipulative reduction and plaster external fixation is a first-level operation. Yesterday, Director Cai authorized me a first-level operation. Moreover, anyone who performs manual reduction may fail, so just make it clear." Zhou Cheng is also impossible. Bao Dalan just smiled.
After hearing this, Qin Min was surprised and said, "Oh? Have you also been authorized for surgery?"
"Other rules and training?"
"Miss Qin Min, keep your voice down." Zhou Cheng interrupted quickly. There are still many people working in the department and they haven't gone back. Zhou Cheng doesn't think that he needs to be exposed about getting authorization for surgery, and then there is a commotion.
……
Chapter 30 Fracture line?
"Oh, good." Tan Min just realized it, and obediently closed her mouth.
Then he asked with bright eyes: "Then do you still want to compete for that place in the hospital?"
"Let's see." Zhou Cheng didn't give a definite answer, that is, an affirmative answer.
The last reply to Tan Min was that Zhou Cheng felt that he had no advantage in competition, but that was before.
"Don't give up. Come on." Tan Min was overjoyed immediately, and then encouraged Zhou Cheng.
Zhou Cheng smiled and said, "Thank you, Miss Tan Min. I'll treat you to dinner next time."
Tan Min didn't reply, and didn't know whether she took it to heart or not.However, Tan Min has at least fulfilled his duty as a friend, that is, he has been persuading Zhou Cheng not to give up.
……
Manipulation reduction surgery is not something that can be done recklessly. Although it is a first-level surgery, it still has to follow the procedure.
Explain to the patient the risks and benefits of the current diagnosis and manual reduction treatment, and at the same time explain the risks and benefits of the operation.
The general difference is that manual reset has the risk of failed reset, which will be very painful, and even if the reset is not done, Zhou Cheng does not need to charge the fee for manual reset, but the fee for anesthesia is also charged.
Then it also explained that if surgery is performed, the recovery speed may be slightly faster than manual reset, and there are advantages such as being able to get out of bed earlier.
To sum it up, just one.
Manipulative reduction saves money, but there is a risk of failure, and fractures may relocate after reduction.
Surgical reduction is expensive, but the risk of failure is almost negligible, and early mobilization is possible.
Allow patients to choose their own treatment.
Both treatments are certainly feasible.
"I'll listen to you, Doctor Zhou. I will treat you as you tell me." The patient may have understood, but he is still unwilling to take the risk, so he hopes that Zhou Cheng can choose one for him.
Zhou Cheng had heard this kind of words countless times.
I also know that before patients and doctors, there are actually cognitive errors.However, doctors really have no right to advise on options.
Zhou Cheng said, "This is not a question of how I tell you to treat it, but a question of how you want to treat it yourself."
"Going to the hospital to see a doctor is not going to eat in a restaurant. You can eat whatever you want and don't want to eat. If you choose something that doesn't taste good, you can choose another one."
"It's up to you to choose. If you haven't understood the risks of manual reduction and surgical reduction, I can tell you again. Or you can call your family members."
"If you want to be safe, go for surgery. Go for hospitalization first."
Zhou Cheng pretended to accept the informed consent form.
It is impossible for him to give a tempting choice.
Even if Zhou Cheng really wanted to reset the technique for this patient, it is impossible to say that the technique is better and highlight its economic advantages.
Otherwise, if something goes wrong, the patient's first sentence must be, am I short of that little money?
"Then? Don't."
"Doctor Zhou, I'd better reset the method. Try it first." The patient hurriedly said when he heard that Zhou Cheng was going to hospitalize him.
As I just asked, the operation will cost at least 1 to [-, and it may not be reimbursed. (For this kind of work-related injury, there is usually a third party, just like there is a third party in a car accident. Conventional medical insurance does not provide reimbursement, and the regulations are not stipulated by the author.)
"Okay, then you sign here..."
……
At about [-[-, Luo Yun had already completed the key operations of the operation, and then left all the finishing work to Du Yanjun.
Du Yanjun will gradually start the first-level surgery as the lead surgeon, and the finishing work is also part of the surgery, so of course practice should be given priority.
Luo Yun didn't go back directly, although he lived not far from the hospital.
Zhou Cheng in his group is on duty today, so he belongs to the second-tier class.If there is an urgent emergency, he needs to arrive at the emergency consultation site within 15 minutes, and he may not be able to make it at home, so during normal working hours, Luo Yun will not go back.
Moreover, Zhou Cheng was the only one who issued a doctor's order this morning, so he had to check it out.
Although Zhou Cheng was trained in the old fashion, it was quite reliable.
But medical work, the more meticulous the better.
It was just that Luo Yun had just arrived at the department when someone from the nurse's station stopped him and secretly said, "Luo Yun, that Zhou Cheng in your group is doing a fracture reset for a patient. You have to be careful."
The nurse who spoke was Zeng Linhui, and she actually wanted to warn Luo Yun.
Zhou Cheng, as a junior doctor, should take responsibility for anything that happened during his shift, and Luo Yun, as the superior of the second-tier class.
"Ah?" Luo Yun was slightly taken aback by Zeng Linhui's words.
"Really, it's in the operating room. We are nurses, so it's not easy to talk about your doctors."
"And it seems that they have already finished. The patients and their family members just brought up the re-examination films, and they are probably still looking at them in the operating room. You'd better take a look." Zeng Linhui frowned slightly.
Manual reset, this is a rather taboo topic in the department.
Because just a few years ago, Director Hu once performed a manual reset on his relatives, and relatives who were not close to each other. As a result, he was sued by the relatives, and the department paid for the follow-up surgery expenses and nutrition expenses.
Moreover, Director Hu almost had his title revoked from senior high to deputy high because of these incidents.
But this matter happened before Zhou Cheng came to the department, so Zhou Cheng may not have heard of it.
Sometimes, if you are willing to do good deeds, you may not be able to get good rewards.
Luo Yun quickly trotted into the operating room, but when he reached the door, he pushed the door slowly and walked in, pretending that he was not in a hurry at all.
When Luo Yun pushed the door, the patients and family members inside were a little startled.
And after seeing Luo Yun, he voluntarily stepped aside.
"Zhou Cheng, I heard from the nurse in the nurse's station that you were in the operating room, so I wanted to come over and take a look." Luo Yun said without blushing and panting.
There was no sign of worry or fear of Zhou Cheng's rebellion.
When Zhou Cheng saw Luo Yun, he sighed slightly in his heart. The patient struggled for a long time, so Luo Yun stepped down from the stage.
However, sooner or later, I will not be able to hide the fact that I have to do manipulation reset in the department.
Then he said: "Mr. Luo, it's just right, come and have a look. This is the X-ray of this patient after the manipulation was reset. I think it's okay. Please give me the details."
Luo Yun looked at the plaster cast on the patient's leg, feeling very bitter.
I'm a crutch, Zhou Cheng really reset the technique.
How can this be good?
But since it has already been done, this is the only way to do it, let's cover up Zhou Cheng's matter first.
Luo Yun took a look at the reset X-ray, then shook the film in his hand, and rubbed his eyes again.
What the fuck?
Have you ever broken a bone?
What about the fracture line?
"It's okay, Mr. Luo." Zhou Cheng inserted a knife into Luo Yun very 'timely'.
Luo Yun felt bitter in his heart at that time, and glanced at Zhou Cheng, wanting to see if Zhou Cheng did it on purpose.
I cursed in my heart.
urge urge!
Urge what?I'm your superior, you know?
I haven't found the location of the fracture yet.
Then I continued to look carefully, and finally found a blur in the middle and lower part of the tibia, but I couldn't confirm whether it was the fracture location.
Luo Yun didn't dare to say that he didn't find the fracture, so he pursed his throat and said seriously: "Show me the film before reset."
Chapter 31 You are too Menglang!
Xia?
Luo Yun's words frightened Zhou Cheng into a guilty conscience.
Originally, Luo Yun's arrival was beyond Zhou Cheng's expectations. If it wasn't for the patient's entanglement, he would have finished the reset and the patient would have gone out.
At that time, I just need to show Luo Yun the film after the reset, and prove that my reset is no problem.
Luo Yun wants to watch the movie before reset?
Wouldn't it be that you will find that you have gone beyond the relative contraindication of manipulation reset to do manipulation reset?
Zhou Cheng was still thinking about how to explain it.
The patient was enthusiastic and active at this moment. When Zhou Cheng called Teacher Luo Yunluo, he knew that Luo Yun was Zhou Cheng's superior. He was older and looked more mature.
Then he quickly dug out his video data bag, handed the film inside to Luo Yun, and said, "Doctor, here, this is the film from before."
"You're holding the one you just took."
After speaking, he continued to look at Luo Yun eagerly, hoping to get definite news from Luo Yun again.He actually didn't want to have surgery, but he was afraid of his own condition, so if he didn't do surgery, the treatment would be unsuccessful.
The manipulative reduction was done, even with local anesthesia, but the fracture still existed, the pain still existed, and with the plaster cast, he couldn't use the pain to measure whether his treatment was effective.
Zhou Cheng's right hand, which was placed in front of his abdomen, stretched forward a little bit, but it retracted within five centimeters.
Although he didn't want Luo Yun to see the pre-reset film, because it might cause disputes and differences, but Zhou Cheng didn't know how to stop it, and the patient had already given it out.
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Simply, you can only treat a dead horse as a living horse doctor.
It's a pity that if this happens, it will be almost impossible to reset the technique in private later.
I managed to reset the method of redefining the level obtained through the simulated copy, but I only got a little thank you value, so I'm going to put it in dust?
Opening a new dungeon requires 20 thank you points, 10 points were spent before, and 1 point is left, and now I get another point, a total of [-] points.
Originally, Zhou Cheng's plan was to not reset the tricks after opening a new simulation copy...
On Luo Yun's side, after receiving the pre-reset film, he felt embarrassed at the time.
Damn it, the fracture is still in the middle of the tibia, not in the middle and lower part. The phantom in the middle and lower part is the overlapping shadow of bone perforating blood vessels.
Getting the wrong position made Luo Yun feel very embarrassed.
Then he scanned Zhou Cheng again, cursing secretly, Zhou Cheng did it on purpose this time, right?Do you want to make a fool of yourself by doing the reset so well?
But thinking about it, cursing, Luo Yun's face changed.
Read the film of the fracture carefully again.
Then quickly put away the film, and then looked at the film after reset.
The eyes blinked rapidly.
Can these two films be related?can be contacted?
Is it alone?
"How is it, Dr. Luo?" The patient has been paying attention to the changes in Luo Yun's expression, seeing such complicated fluctuations, he panicked a lot.
"It's okay, the reset is done pretty well."
"Look, this is a comparison of pre-operative and post-operative films. You can understand the pre-operative fracture, right? Here, it's broken."
Luo Yun made the description easy to understand.
"Look at the following film again. The reduction is so good that the fracture line can no longer be seen. This reduction is very good, but your cast may take a little longer. Doctor Zhou told you how long it will take to wear the cast what?"
"Two months." When the patient heard that he could recover well, his smile suddenly became stronger, and he quickly replied.
"Less, less than two months, at least three months, and after one month, you have to come to the outpatient clinic for reexamination, and then come directly to the ward for reexamination, and you don't need to go to the outpatient clinic to register."
"If I'm not around, tell the staff at the nurse's station that you are here to see Dr. Luo Yun, and they will contact me." Luo Yun confessed seriously.
"Oh, okay, thank you, thank you, Dr. Luo." The patient was quite happy to hear that he could come directly to Luo Yun in the ward.
I just went to the emergency department, and they know that even in the emergency department, there are too many procedures to go through.It took a long time to see the doctor, and now Luo Yun let them come to the ward directly, which can save a lot of trouble.
Really a good doctor.
Then Luo Yun hurriedly dismissed the patient and his family members.
Seeing the patient and family members walk out of the department door, Luo Yun's expression became slightly serious, and he said to Zhou Cheng, "Come with me to the director's office!"
Zhou Cheng knew something bad was going to happen when Luo Yun wanted to see the pre-reset check.
But he still followed behind Luo Yun's ass, came to the director's office, closed the door very honestly, and looked at Luo Yun with some anxiety.
I'm afraid that Luo Yun will directly revoke the authorization for the operation that he just received less than a day ago.
Sure enough, as soon as Zhou Cheng closed the door, Luo Yun directly pulled Zhou Cheng in, pointed at Zhou Cheng's forehead in a high-pitched voice, and asked, "Do you know why I pulled you in?"
The point at this moment is not to criticize Zhou Cheng, but to let Zhou Cheng know where he is wrong.
"I know, the patient who is suitable for surgery has been reset by manipulation. It violates the current guidelines." Zhou Cheng is very confident, because this is what he wants to do during this period of time. downgrade.
"Know it and commit it again? How many brains do you think you have?"
Zhou Cheng remained silent.
No one has a few heads, but Zhou Cheng hopes to open a few new dungeons with more thanks, and Zhou Cheng has already made sufficient technical preparations.I have confidence in this method of reset.
But Luo Yun didn't know about this kind of thing, who would have thought that Zhou Cheng would be able to redefine the ability to reset the technique?
Seeing that Zhou Cheng didn't speak, Luo Yun also knew that Zhou Cheng might still realize his mistake.
Then he said: "You are too Meng Lang, do you know that?"
"Although, for the time being, I haven't figured out how to do manual reset in this situation."
"And, judging from the results after the reset, it can be seen that you have this strength. The results before and after the reset are released, and no one will misunderstand the results of this treatment wherever they are placed."
"But, have you thought about it?"
"What if the patient goes to Director Yan or Director Hu for reexamination, what will happen?"
"Director Yan told me face to face. Moreover, Director Hu has been scolded by Director Yan. He is not allowed to perform manipulation resets in the department, and no one else does."
"Forehead!"
"You don't know about it."
When Luo Yun said this, he suddenly remembered that this kind of thing happened three years ago, before Zhou Cheng came to the department.And since Director Hu is also the chief physician, in order to save his face, no one in the department babbled about resetting.
After all, if a few director-level people don't take action, who would dare to reset the technique casually?
But Luo Yun still reprimanded: "But even if you don't know, why don't you communicate with us in advance?"
"If I don't explain to the patient today, I want him to come to me directly for reexamination."
"He went to Director Hu and Director Yan for reexamination. How are you going to deal with it? Have you thought about the consequences?"
Zhou Cheng thought about such a question, but it was only a month or two later. At that time, Zhou Cheng felt that he could already be recognized.
It's just that Zhou Cheng never imagined that Director Yan and Director Hu would have any kind of conflict in the reset technique.
Although it is unexpected, it does not mean that the ignorant are innocent.
Zhou Cheng immediately admitted his mistake: "I'm sorry, Mr. Luo, I'll make sure next time."
Luo Yun heard that Zhou Cheng was going to say that he would definitely not commit another crime next time, so he changed his tone and said, "It's not that absolute."
"Manipulative reduction itself is an indispensable part of fracture treatment. In the department before, it was taken out of context because of Director Hu's affairs."
"Nowadays, the hospital has not performed manual reduction surgery for several years, which is actually wrong."
"It's just that this kind of thing is not something that you and I can face and carry. You have to tell us, and then Director Cai will talk to Director Yan. Moreover, Director Yan himself is actually a little bit stuck right now. He has a Patient, surgical contraindications at the physical level..."
Chapter 32 Children cannot be taught!
"Patients in Director Yan's group?" Luo Yun wanted to say that, and Zhou Chengcheng became interested, and his eyes lit up.
If Director Yan wants to take the lead in performing manual restoration in the department, then he is right on the cusp.It's just that Zhou Cheng is a junior trainer in Cai Dongfan's group, and he is not qualified to see patients in other groups.
"This is not the focus of your consideration." Luo Yun quickly dispelled Zhou Cheng's idea of asking other groups of patients.
Among the patients in Yan Haihan's group, even Cai Dongfan couldn't say much, what is Zhou Cheng asking here?
However, Luo Yun hesitated for a moment, and still said: "However, Director Cai Dongfan mentioned to me some time ago that Director Yan Haihan is going to reset the technique in the department again. This is actually related to the positioning of our hospital. "
"You should also know another name of our hospital, right?"
Zhou Cheng nodded repeatedly and said, "Yes, I know, Shashi Hospital of Traditional Chinese Medicine."
Luo Yun looked at other places, probably knowing that no one would come in now, so he found a stool and sat down, and then asked Zhou Cheng to find a place to sit down as well.
Cai said: "Yes, in the past, the characteristics and positioning of our hospital were mainly traditional Chinese medicine. At that time, it was the same, including orthopedics."
"It's just that, around the 80s and [-]s, because of the gradual rise of clinical medicine..."
Luo Yun even told Zhou Cheng the history of the development of the department.
It turned out that the current Shashi No. [-] Hospital was formed by merging the original Shashi Hospital of Traditional Chinese Medicine and the No. [-] Hospital. There were many reasons for the merger, but Luo Yun only mentioned something related to orthopedics.
In the past, there was only one department of orthopedics, and the main thing was traditional Chinese medicine treatment. Even Luo Yun heard about it from Cai Dongfan. At that time, a group of old professors who were still alive were very capable in the conservative treatment of fractures. And this is the characteristic of traditional fracture treatment in Huaguo.
But it has to be admitted that Chinese medicine has great limitations in the treatment of fractures.
Because there are some complex comminuted fractures, it is simply impossible to treat them with manual reduction and conservative treatment, and some patients who can barely be reduced by manual reduction, the final functional recovery is completely incompatible with open reduction and internal fixation of fractures. patients on a par.
Moreover, the surgery for fractures is not too complicated and reliable, with relatively few sequelae.Therefore, more and more patients are inclined to surgical treatment.It's because of the fear of repercussions.
Because of the selective change of the patient population, in fact, under the impact of modern clinical medicine, the department had to change its direction and shift its focus to the surgical treatment of fractures in clinical medicine. For a period of time, it did gain more patient populations. .
Moreover, the patient's degree of activity, recovery speed and other satisfaction after surgery have also been improved.
And then the new generation, just like the younger generation like Luo Yun, didn't even have the chance to get in touch with the manual reset technique of those old seniors.
Over time, instead, the characteristics of the techniques used by the Eighth Hospital at that time were gradually lost...
Luo Yun continued to analyze: "However, as you can see now, although our orthopedics department has also developed for decades, the current situation is rather embarrassing."
"Compared to the real surgical strength, there is definitely no way to compare with the three affiliated hospitals of Shonan University in Shashi. There is no way to compare with the Provincial People's Hospital, the Central Hospital and other hospitals."
"On the contrary, we have gradually lost the unique characteristics of our hospital. The current patient flow is much lower than that of the affiliated hospital of Hunan University of Traditional Chinese Medicine."
"Nowadays, there are many vacancies in the beds in the department."
Zhou Cheng nodded. In Shashi, this is indeed the case. Patients can easily receive the top medical resources in the province.
Although the fracture is simple, several leading hospitals in Hunan Province may not be able to say that they are much ahead of other hospitals.But what cannot be denied is that there is a certain gap between the No. [-] Hospital in Shashi and the top hospitals in the province when it comes to internal fixation for complex fractures.
Therefore, the only patients left in the department are some simple patients, and they are also nearby patients.
The number of this source of disease is not many.
Therefore, if the department does not change its strategy, the existing number of patients cannot be maintained.In a hospital without a source of disease, there is no need to talk about the development of any department. It would be good if it can keep doctors who can't eat enough.
While this sounds snobby, it is the truth, and being a doctor is just a profession, and doctors rely on it to support their families.
Therefore, in the past period of time, some directors of the No. [-] Hospital in Shashi had one or two exodus incidents, which took away a large wave of patient flow. They believed that the skills of the previous directors, The star district has a reputation, even if they go to other districts, they are still willing to go to the original directors for medical treatment.
It's not too far anyway.
"So in fact, the current department is in a critical period of transformation. I guess, whether it is Director Yan of our department, or our chief director of orthopedics, Director Zeng Yi, have thought about it, and we must continue to find the treatment that belongs to our department. feature."
"That is to see if we can make a breakthrough in conservative treatment, and then bring back some patients who hope to use conservative treatment to solve their fracture problems."
"Besides, we still need to make some clinical breakthroughs."
"And for this breakthrough, there are only a few choices. Either it is to improve the level of fracture reduction and internal fixation to catch up to the top level of Shashi, and compete with them hard, or it is to develop some new surgical methods. come out."
"Find a direction that is currently popular, and then go for it."
"Either change direction, turn to the direction of sports medicine or joint surgery."
"It's just that the risk of changing the direction is too great. Nowadays, several old directors in the department are not professional joint surgeons. This is more difficult."
After Luo Yun said something casually, he calmly stopped.
There are some words, just click and stop. If you really want to talk to Zhou Cheng, it means that you are too small for Zhou Cheng, which is not fair to others.
Then the subject changed and asked: "The patient just now, how did you reset it?"
"This kind of patient belongs to the contraindication of manipulative reduction, is it not so easy to do manipulative reduction?"
Hearing this, Zhou Cheng explained: "It is strictly following the steps of manual reduction. I usually like to search for some special manual reduction materials. For this patient, I first considered the classification of his fracture."
"It belongs to type B2. Although it seems to have a wedge-shaped bone fragment, it is an unstable fracture type, but it can achieve stable fixation after the wedge-shaped bone fragment is reset through the intercalation force of the soft tissue, and then external fixation with plaster can fully meet the fracture type." Therapeutic purposes of reduction and immobilization."
"And then, it worked."
After hearing this, Luo Yun immediately rolled his eyes.
I TM asked you how you did it, not for you to give me the principles of fracture treatment.
It's useless to ask.
Zhou Cheng looked at Luo Yun's expression, and knew that what he said was clearly the essence, but Luo Yun didn't listen at all.
It's useless.
Children cannot be taught.
Chapter 33 Timely Rain
"Okay, you should be on duty, be careful, don't be reckless."
Luo Yun cut off the conversation with Zhou Cheng, and after pondering for a while, he said: "Being a doctor is different from being an ordinary person. Don't think that you can do what you can do without the law."
"It's better to let the superior doctor know what you are doing, and then analyze it according to the actual situation."
"After all, the one who is going to wipe your butt is also the superior doctor."
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"Not your teacher." Luo Yun deliberately added a meaningful sentence.
Zhou Cheng was stunned for a moment, then nodded and smiled back: "Okay, Mr. Luo. I understand."
Seeing Zhou Cheng's expression, Luo Yun walked out.Zhou Cheng has always been a reliable person, and the word Zhongcheng is a perfect description, and he never troubles his superiors.
It is estimated that this time it is not a hospital frying fish, and Zhou Cheng will not take the risk.
He could imagine how difficult it would be for socially trained people like Zhou Cheng to stay. If they didn't want to express themselves, they would sink into the crowd.
It is gold that always shines, and it has to shine before it can be discovered.
After Luo Yun left, Zhou Cheng also quickly left the director's office. This is not a place where he can stay alone. It would be a bad thing if other directors found him in a daze with a doctor on duty.
After all, even Luo Yun, and even several other deputy directors in the department would not randomly break into the director's office, let alone a small guy like Zhou Cheng.
The director's office is the exclusive resting place for the three bosses in the department.
Zhou Cheng walked to the doctor's office. As a doctor on duty, except at night and meal time, he read books in the office with a dedicated attitude!
Although it is not required to wander around in every ward at all times, at least patients and nurses can find you quickly.
But Zhou Cheng didn't start reading right away, but began to ponder Luo Yun's words carefully.
Luo Yun's words obviously meant something.
Why did Luo Yun tell me the history of the department and a plan for the future?
This is pointing out the maze for myself!
After a little analysis, Zhou Cheng found that the current situation of this department and the directions of its upcoming transformation coincided with his own.
Whether it is to create the characteristics of traditional manual reset combined with traditional Chinese medicine therapy, or to pursue high-tech technology, or to compete with other units in the city in fracture surgery, I can now top it.
As for opening up new fields, although it is difficult to go in the direction of joint surgery, because none of the senior doctors are trained in joint surgery, there are also tricks that can be played with fractures.
Today's fractures, the traditional open reduction and internal fixation of fractures, basically can't do any tricks. Everyone who knows it will know it. If the level reaches a world-class level, then Huaguo is also the top batch of hospitals. up.
In other hospitals, there are more than [-] steps out of a hundred steps, and the gap is not that big.
There will be a slight difference between performing such an operation in the county hospital and performing the same fracture operation in Shashi No. [-] Hospital, but it is not big.
However, at present, in all surgical fields, it is the general trend to develop in the direction of aesthetics and minimal trauma.
Luo Yun's advice, isn't this just letting him use the dungeon simulator to develop in this direction, which coincides with each other again.
Therefore, Luo Yun decided that although Luo Yun's understanding is not very good, if there is a chance in the future, he can support him more, and it will be regarded as reciprocation.After all, he also started a small stove for himself.
After thinking this through, Zhou Cheng started a new round of simulation.
Among Zhou Cheng's existing skills, there are only two that can be used as a commander.
[Fusion skills: open reduction and internal fixation of fractures (perfect) (including limb fractures and pelvic fractures, internal fixation without fixation restrictions)]
[Closed reduction of fracture (perfect - redefined) (analyzable!)]
[Skills can be analyzed, and skills will not disappear after analysis.Do you want to parse? 】
Because the closed reduction of fractures has reached the perfect level of redefinition, it can be reanalyzed, but Zhou Cheng has been a little busy before, so he hasn't played this aspect yet.
Resolve.
Zhou Cheng silently said yes.
There are quite a lot of skills that can be analyzed for the skills of the perfect level, so the newly defined perfect level must be able to obtain a lot of downstream skills, right?
Successful skill analysis:
【1. Experience in local anatomy of human limb bones and pelvis (perfect). 】
[2. Muscle anatomy of limbs and interpretation of anatomical muscle strength (perfect); the highest level is perfect. 】
【3. Rehabilitation guidance experience after manual fracture reduction (perfect); the highest level is perfect. 】
【4. Joint anatomy experience and interpretation of joint linkage (perfect); the highest level is perfect. 】
[The skill analysis is complete. 】
[It is detected that the skill materials obtained by the player can be fused into new skills. Is it fused? 】
Seeing this reminder, Zhou Cheng was taken aback for a moment, and then looked overjoyed.
Before, when skills could be analyzed, Zhou Chengcheng knew that the analyzed downstream skills might be able to be integrated into new skills, but it was a pity that he had been trying his best to improve the proficiency level of skills before.
So there is no chance to try to gain anything after the integration.
Now that speculation has come true.
"Fusion." Zhou Cheng said silently again.
[The new skill fusion is successful, because the player has closed reduction of fracture (perfect - redefined) and experience in joint anatomy and joint linkage interpretation (perfect), and acquires new skills. 】
[Joint dislocation reduction surgery (perfect), the current skill can be used as the next copy to simulate the opening skill. 】
Another perfect skill.
The redefined perfect-level skill is really a bug.
However, it can also be understood that the redefined perfection, on another level, belongs to the leading level of fracture manipulation reset, and it is a skill that has created a new height. Even the downstream skills of analysis are perfect levels!
So merged into a new perfect skill.
Isn't this a very common thing?
Joint dislocation reduction surgery?
This works.
Zhou Cheng then recalled the current business classification of the first orthopedic ward and the second orthopedic ward.
Strictly speaking, the first ward of orthopedics should be spine surgery and upper extremity trauma surgery.The main business is upper limb fractures and spinal surgery.
This is the earliest traditional department in the Department of Orthopedics of the Eighth Hospital. Originally, lower limb trauma was also in the first ward of the Department of Orthopedics.
But at that time, the second orthopedic ward was newly established, so the lower limb fractures were allocated to the second orthopedic ward, and then the second orthopedic ward was allowed to engage in joint surgery, bone disease and hand surgery.
However, although it is allowed to do so, Yan Haihan and the others dare not easily break through the original business scope. Most of the patients in the department today still mainly deal with lower limb trauma, and the number of joint, bone disease and hand surgery is very small. .
Such patients rarely come here to see a doctor.
In the past, patients with joint dislocations also came, but at that time, most patients in the department were fracture patients.
The treatment of joint dislocation is mainly based on manipulative reduction, and the lower-level doctors generally cannot handle it, so the higher-level doctors must be present.
Neither economically beneficial nor tiring.
And the joint dislocation that involves surgery is extremely difficult to deal with.And the volume of patients in the department was okay at that time.
Therefore, patients with simple dislocations were simply sent to the Second Hospital of Sha County, which is also in the star area.
For complicated patients, it is recommended to go to Hunan Provincial People's Hospital, which is a relatively powerful hospital in the city.
If you really can't get rid of it, a superior doctor will come to the department to talk about it...
However, Zhou Cheng doesn't need to care about any economic benefits. When a patient comes, he can deal with it. On the contrary, it can add a lot of benefits to the department, and Zhou Cheng can also get gratitude. This is a win-win situation.
Don't worry about the pressure on it yet.
It was just in time for rain.
Chapter 34 New Thinking
[Are you sure to start the simulation with open reduction and internal fixation of fractures (perfect), manipulative reduction of fractures (perfect——redefined), manipulative reduction of joint dislocation (perfect)? 】
[Do not carry. ] This time, the direction he was going to simulate was not to learn specialized techniques.
Because Zhou Cheng found that in the process of learning skills, the reading of English literature and daily communication in English are very important, so he planned to use a simulation opportunity to try to see if he could acquire English skills in the fracture simulation.
Because when the copy is simulated, the direction of the simulation can be changed according to independent thinking.
At present, the pinnacle of almost every major in clinical medicine is abroad, and whether it is the ceiling of clinical treatment or the top-level materials of basic research, they are all written in English.Therefore, the skill of English is very important for medicine.
The current Zhou Cheng is only at the sixth level, but the pure sixth level is completely unable to meet the requirements for reading professional literature.
If he can acquire English skills, he can broaden his horizons, be more comfortable in the simulation, and save a lot of time.
If sharpening the knife does not cut firewood by mistake, even if he gets nothing, Zhou Cheng's loss will not be too great.
It was a trial and error.
【You see a lot of patients, but you feel very tired, and you start to think whether you are not suitable for the medical profession. 】
【So you discussed with your parents, and you decided to change careers. Your parents scolded you, but you didn't give up. 】
【You start to study English hard because you know that you need to read a lot of literature as a knowledge reserve for learning new skills. 】
【Half a year later, if you insist on reading literature every day, you can finally read professional English literature proficiently, and acquire skills: medical English, proficiency. 】
[One year later, you graduated from regular training, because your clinical ability is not strong, and you don't want to go back to the town hospital, so you fell out with your family.So you chose to join a company that does scientific research and became a small employee. 】
【Two years later, you began to try to write meta-analysis-related articles by yourself, so as to exercise your English writing skills and read a lot of English literature crazily. 】
[Six years later, you successfully published an SCI article. In the process of revising the article and in the process of continuous learning, you have mastered medical English proficiently and improved your skills to proficiency. 】
[Because you already have the experience of writing and publishing sci, so you quit your job and went to a small company that specializes in ghostwriting sci. 】
[In the tenth year, your annual salary has reached 20, and your parents have acquiesced in your changing jobs and will not interfere with you any more.I just want you to have a family. 】
[No. 20 years, suffered severe crackdown due to academic fraud.You are being prosecuted for ghostwriting articles and allegedly providing opportunities for academic fraud.And all the articles written by you will be taken off the shelves.At the same time your wife divorced you, you have to support your family, and your reputation in the industry is already bad. 】
Ok.
Zhou Cheng looked at the display on the simulator.
The thinking of changing careers does not seem to work.
Keep watching.
【You are not young anymore. Under the pressure of various aspects, you chose to end your life. You began to reflect on your life and found it a bit ridiculous. 】
[Perhaps, from the moment you decided to change careers, it was a wrong decision. 】
[The simulation is over! 】
[Comprehensive score: Poor.The Sims are not compatible with dungeons. 】
[You can choose to keep one of the following! 】
[Memory: A low-scoring medical meta-analysis sci article. 】
[Skill: Medical English (proficient). 】
[Life perception: Your wrong experience of changing careers. 】
Fortunately, at least I have obtained the proficiency level of medical English, but it is enough.
After all, English is only an auxiliary skill. No matter how good English is, it cannot replace real clinical skills.
Immediately, Zhou Chengcheng started the next round of simulation.
This time, the skills Zhou Cheng chose to carry were open reduction and internal fixation of fractures (perfect) and the medical English he had just acquired (proficient)!
[You have a perfect level of open reduction and internal fixation of fractures, so you quickly gained a foothold in the department, and after a year, you successfully obtained a place to stay in the hospital. 】
[And, because of your existence, your group has been recognized by your peers in fracture surgery, and you feel that your surgical talent is quite good. You started to study as a postgraduate student, and at the same time started open reduction and internal fixation of small incision fractures. Research. 】
[Your postgraduate tutor expressed a warm welcome to you as a postgraduate student, and strongly recommends that your department director allow you to go to his unit for full-time close-up observation and study. 】
Yes, it can still be like this!
It is my own thinking that is restricted. Sure enough, the simulation of the dungeon can not only allow me to acquire skills, but also provide myself with a lot of ideas.
With a mentor, you should be able to make rapid progress after studying as a graduate student, right?
[Because you have a perfect level of open reduction and internal fixation of fractures, you have been recognized and sighed by other brothers and sisters as soon as you joined the team where your instructor is.Your supervisor has passed the peer review of the Trauma Surgery Group of the Orthopedics Branch of Hunan Medical Association as a matter of course. 】
[Ten industry giants from Hunan Province were invited to evaluate your current surgical level, and under the supervision of the Hunan Provincial Health Committee, the hospital's medical department, and other sub-specialties of orthopedics, you will be awarded a third-level surgery in advance permission. 】
Well, this is going well.
Quickly obtain surgical permissions and have more surgical opportunities.
【You started to cooperate with the attending physician who followed your mentor to start the operation. At the same time, you learned new techniques with him. 】
[You proposed new developments in current fracture surgery to your supervisor, so your team started to work on open reduction and internal fixation of small incision fractures. 】
[But soon, your dull aptitude began to show. The attending physicians who studied with you have made a lot of progress, but you still haven't started.So your mentor begins to wonder if his previous choice was wrong, but imagine that at your current age, you still have enough opportunities. 】
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【Two years later, you are still standing still, open reduction and internal fixation for small incision fractures requires too much comprehension.The attending physicians in your group, and even your fellow apprentices, are beginning to be able to operate some of them, but your thinking is still limited to the perfect level of surgical civic. 】
This?
I?
Zhou Cheng got up helplessly.
[Three years later, you end your postgraduate career, and you need to return to your original unit. 】
【Your instructor is in a complicated mood, and he is beginning to persuade you to go back to work.Your existing technology is enough for you to spend the rest of your life in peace, so don't worry about it. 】
【You returned to the original unit, but you are still not reconciled, but you still worked honestly in the original unit for two years. 】
[Your traditional incision surgery is still top-notch in the eyes of your peers, and you can't pick out any flaws, and because your surgery patients have a good reputation for you.So you will soon face a promotion in your job title. 】
【But you are still not reconciled, and proposed the idea of going out for further studies.Considering your influence in the department, the unit leader and department director once again agreed to your application for further study. 】
[You went to Shanghai and studied for half a year.But you still get nothing.You plan to extend your study period. 】
Ok.
Three years of postgraduate study, plus half a year of advanced study, did not yield any substantial gains.
However, in fact, it is said that it is a postgraduate study, and it is said that it is a further study. In fact, open reduction and internal fixation of fractures with small incisions has not yet formed a systematic theory. point, can also understand.
Chapter 35 How can you be so noisy!
【Your superior physician and leader rejected your application, and began to persuade you to stop tormenting.So does your wife. 】
[So you can only start to study silently, read various literatures, continuously purchase various learning materials on the progress of small incision surgery, and participate in various training courses. 】
[But such unsystematic learning makes your progress very slow. 】
[Finally, when you were 50 years old, you had excellent skills, and you had always been a famous figure in the department for traumatic fractures. With mature qualifications and strength, you became the director of the department. 】
[Five years later, your reputation has reached its peak, and you have already gained a lot of fame in Shashi. Someone even suggested that you serve as the deputy director of the Traumatology Group, but you refused.You made a decision that is beyond everyone's comprehension. 】
【You resigned and started to study abroad.By this time your children are grown and starting families, but you've left them a decent financial nest egg. 】
I rely on courage!
I knew that even if my aptitude was poor, Zhou Cheng never lacked courage and determination, and I kept my thinking clear at all times.
Zhou Cheng has no way to control the life in the entire simulated copy, so he can only provide a rough initial idea.But the impact of those ideas, from the start of simulation to the age of 50, has passed more than 20 years.
At that time, I still had such a strong obsession.
Yes, future me.
No matter whether there is a breakthrough in the result or not, I have to praise myself for this alone.
[At the age of 65, your wife filed for divorce with you. You were still far away overseas at that time, obsessed with the study and research of open reduction and internal fixation of small incision fractures that have not yet been matured.You agree. 】
【Your wife doesn't actually want to divorce you, she just wants to be with you when she grows old, so she starts to get depressed, and dies of depression two years later.Your son had a big fight with you and disowned you. 】
Ah this?
This is a bit too much, right?
Old scum?
But who cares, I haven't seen the shadow of my wife yet.
[You left most of your property to your son and daughter, and then drifted abroad with your pension.Because you are too old, no team is willing to take you in anymore. 】
[Finally at the age of 80, you died on the street because you couldn't afford the medical bills. 】
[The simulation ends. 】
[Comprehensive rating: worth looking forward to.Your whole life has been constantly struggling forever, although the end is rough, but the spirit is commendable! 】
[You can choose to keep one of the following! 】
【Skill: Medical English (Proficient Level)】
【Memory: Research progress of open reduction and internal fixation for small incision fractures. 】
【Experience: Experience in small incision fracture open reduction and internal fixation. 】
Zhou Cheng pondered for a while, and finally chose memory.
Although operating experience is also very important, research progress is the key factor to break the existing routine and traditional open reduction and internal fixation of fractures, not just the operation.
With these research progress, I can quickly make up for the operation.
To break through the limit of a skill, simple operation is definitely impossible and unscientific. Although it is useful, it is not very useful.
Keep going, half an hour later, there is another chance to simulate!
Zhou Cheng's luck was pretty good, no emergency patient came for the next half an hour, so he just sat on his seat and read for a while, and the third simulation came soon.
After spending 4 minutes reading the simulation carefully.
Look at the ending again.
Zhou Cheng lamented that with his own qualifications, learning existing technologies might make progress faster, but it is really difficult to learn new technologies or make breakthroughs.
[Comprehensive score: I have regrets.Although you quickly gained a foothold professionally by relying on the perfect skills you carried at the beginning, and you have been constantly striving for eternity all your life, you still fell short and failed to reach the other shore! 】
[You can choose to keep one of the following! 】
[Skills: open reduction and internal fixation of small incision fractures—incomplete, no systematic theory, and the success rate cannot be guaranteed]
[Memory: open reduction and internal fixation of small incision fractures, new research progress due to your existence. 】
【Experience: Experience in small incision fracture open reduction and internal fixation. 】
Ok……
This is a good choice.
Although there is no mistake in choosing new research progress again, the value of incomplete skills is not lower than that of new research progress.
After all, incomplete skills are also a part of skills, which can allow oneself to quickly gain a foothold when starting a new game.
Moreover, during the simulation process of this simulation copy, I mentioned more than once that I was always stubborn in the traditional thinking field of open reduction and internal fixation of fractures (perfect) during the simulation process.
Hey, is it because the initial skills I carry will hinder me from opening up new areas of skills?
Zhou Cheng feels that such a possibility cannot be ruled out, because everyone has their own mindset, and they habitually use their own familiar thinking to think and solve problems.
So, next time, you can try to simulate it as a rookie without carrying this perfect skill.
But that's at least for tomorrow.
……
After the opportunity of the simulator was exhausted, Du Yanjun came to the department from the operating room in a hurry, and even enthusiastically brought Zhou Cheng a drink.
Although Zhang Zhengquan also came to the department, he was a little curious about what Du Yanjun and Zhou Cheng were up to, but he still couldn't find a reason to stay, so he left the department after issuing the postoperative doctor's order.
During this interval, Zhou Cheng secretly went to see Luo Yun and asked, "Mr. Luo, if I encounter a patient with dislocated joints while on duty, can I handle it alone?"
After hearing this, Luo Yun frowned, and then replied, "Do you want to take care of patients with dislocated joints?"
"No one said that the manual reduction of joint dislocation patients cannot be performed in the department, and it is also within the scope of Class I surgery. However, if you want to do this, I have to watch you in the department all the time."
"Can you do it?"
"The manual reset of joint dislocation is simple and simple, but complicated and complicated. In fact, I don't recommend you to touch it."
Luo Yun was in a bit of a dilemma. Just now he told Zhou Cheng that the manual reduction of fractures in the department was not very good. Zhou Cheng remembered the manual reduction of joint dislocations in the department.
This is a very feasible alternative. After all, joint dislocations do account for a large proportion of clinical orthopedic patients.
However, Luo Yun himself rarely comes into contact with this kind of patients.
Logically, he wanted Luo Yun to watch, but Luo Yun was afraid that he would not be able to take care of it, what should he do if he couldn't understand?
"I think I can give it a try." Zhou Cheng said expectantly.
"That's fine." Luo Yun finally agreed with Zhou Cheng.
At Zhou Cheng's current level, what he can do is first-level surgery and operations. If Zhou Cheng is not allowed to do anything, it is better not to authorize him.
However, it is not a bad thing to develop more patients in the department. Anyway, this is a patient that no one else wants to touch.
"However, every patient, before deciding to reset, has to be screened carefully by me before proceeding." Luo Yun still did not forget to explain the principle.
How can you be so fussy?Luo Yun complained in his heart, I have never seen you so active before.
Alas, it's still a problem with the number of hospital stays in the hospital.
In clinical practice, junior resident physicians can independently perform level I surgery under the full knowledge and guidance of superior physicians. After proficiency in performing it, superior physicians can be lazy. Naturally, Luo Yun will not forget this thing, otherwise, Zhou Zhou Cheng messed up the patient.
If you say he, Luo Yun, or Cai Dongfan is responsible, it must be Luo Yun!
Therefore, it was quite difficult for Luo Yun to make such a decision!
But he is still willing to give Zhou Cheng more opportunities.
Chapter 36 click
However, there is also a reason why Luo Yun finally decided to let Zhou Cheng try to reset the joint dislocation.
After all, the department needs to be transformed. The senior doctor does not have a background in joint surgery, but when Luo Yun was a graduate student, he stayed in the joint surgery department for three years. It was just a postgraduate degree, and he had to come back before he could get a doctorate. Shashi.
When I came to Shashi No. [-] Hospital, I almost started from scratch in terms of trauma.
Moreover, Luo Yun also considered that if the Department of Orthopedics is to be divided into different departments in the future, it must be divided into a separate Department of Joint Surgery...
The junction of joint surgery and trauma surgery is joint dislocation.
When he first came to the department, Luo Yun felt quite depressed when he heard that the dislocation of joints had been released in the department.It is a good choice to take this opportunity to bring back the dislocated joint as the first step of the department's extension to joint surgery.
Moreover, the manual reduction of joint dislocation is also a conservative treatment, which is similar to the manual reduction of fractures. This can also help to regain the unique characteristics of the hospital of traditional Chinese medicine, killing two birds with one stone.
"Okay, Mr. Luo." Zhou Cheng naturally nodded honestly. He is not a roundworm in Luo Yun's stomach, so he naturally doesn't know what Luo Yun is thinking.
But strength is strength, and rules are rules.
Medicine has its own circle and its own rules.
Before the rules cannot be formulated, activities within the rules are the greatest protection for oneself.Similarly, all doctors act within the rules, which is also the protection and respect for patients.
Otherwise, the rules and regulations will become messy, so who should patients choose to trust?
Moreover, under reasonable regulations, it is not that there is no way to break the rules, but that way is difficult.
Zhou Cheng didn't know it before, but through this simulation, Zhou Cheng knew that if he could pass the assessment of the Orthopedic Branch of the Medical Association, he would be able to obtain the authorization for surgery in advance, which he could strive for later.
However, to enter the Orthopedic Branch of the Hunan Provincial Medical Association, you need a guide. Luo Yun is not qualified yet, so I don't know if Cai Dongfan is qualified to introduce him.
If there is, it is the correct way to let Cai Dongfan get him in first, and after getting familiar with him, he can fight for the second and third level of surgical authority.
Otherwise, the current Zhou Cheng can obviously do the third-level surgery, but he can only stick to the first-level surgery because of his professional title, and Zhou Cheng himself feels quite restricted.
……
As soon as Zhou Cheng bid farewell to Luo Yun and came out, Du Yanjun outside came to find Zhou Cheng.
"Brother Zhou Cheng, there is an emergency patient in the emergency department below. It's a joint dislocation."
"The superior doctor in the emergency department just joined the emergency department this year, so he called the department directly. He asked our doctor to come down and see him." Du Yanjun frowned when he said this.
"However, it is also understandable that there are many affairs in the emergency department. Those who have just joined the job have only undergone simple training before taking up the job. Maybe these minutiae matters have not had time to be familiar with."
"Look, are you going to see it? Or call Teacher Luo Yun?"
Du Yanjun asked Zhou Cheng, but he didn't dare to make up his own mind.
Today's doctor on duty is Zhou Cheng. If it is a simple debridement patient, Du Yanjun may report to Zhou Cheng, and then pull him into the operation room.
Patients with dislocated joints were rarely encountered in the department before, and he had never done it.
And if Du Yanjun was on duty by himself, Luo Yunyi would definitely lose this matter.But he just came to learn from Zhou Cheng, so he couldn't decide what to do by himself.
There is quite a sense of helplessness under the fence.
Zhou Cheng was stunned for a moment. When he first heard what Du Yanjun said, he thought he was thinking about the dislocation of the joints, so he felt that he had heard it wrong.
As soon as the authorization was obtained from Luo Yun, patients came to the emergency department immediately. How could there be such a coincidence?
However, coincidences in reality are sometimes more coincidental than stories written in books.
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"Let me go down and check the situation. We are the doctors on duty, and the emergency department called. No matter what happens in the end, I still have to go." Zhou Cheng thought about it, and then walked towards the emergency department.
Du Yanjun may think that this trip is meaningless, after all, such patients are rare in the department!
When I went there, I would either call Luo Yunlai, or persuade the patient to go to another hospital, and then explain to the superior doctor in the emergency department what to do when he encounters such a patient in the future.
Then he said: "Brother Zhou Cheng, you go there by yourself, I will stay in the department and look at the medical records."
"Oh, good!" Zhou Cheng didn't think much about it, since Du Yanjun didn't want to go, he could go by himself.
On the way, he went to the duty room where Luo Yun was.
Luo Yun was taken aback for a moment, then stood up, and looked at Zhou Cheng suspiciously: "Xiao Zhou, you're not deliberately planning on me, are you? In fact, this patient has already come, so you just came to look for me on purpose." ?"
When Zhou Chengcai went out, he was asked to go to the emergency department to see a patient with joint dislocation, such a coincidence.
Luo Yun doubted that he was arranged by Zhou Cheng.
Zhou Cheng quickly shook his head and said, "No, it's Du Yanjun who told me the news. The emergency department just called. If you don't believe me, Mr. Luo, you can go to the nurse's station for verification."
The corners of Luo Yun's mouth twitched for a while, and he said, "That's not necessary. If there is a patient coming, let's see the patient first."
The two came all the way to the emergency department.
Then Luo Yun and the new doctor in the emergency department introduced themselves to each other. The other was a graduate student in the emergency department of the Affiliated Hospital of Shonan University. After graduation, he worked in the emergency department of Shashi No. [-] Hospital.
They belonged to the third batch of employees recruited by the No. [-] Hospital this year. They just completed the entry procedures recently. Today is the fifth day in the department.
He is tall and thin, with dark circles under his eyes and bags under his eyes.
Either stay up late on duty, or stay up late reading.
"Mr. Luo, the patient is here. Because there is no traumatic bleeding, I asked him to wait in the treatment room next to him. Sorry, Mr. Luo, I didn't know that we can call the patient directly to the ward. "Liang Xueya explained to Luo Yun very apologetically.
Liang Xueya is from the emergency department of the Affiliated Hospital of Shonan University. Over there, the emergency treatment process for emergency patients is very organized. There is no such thing as calling the patient to the ward for the on-duty doctor to see. Each department has eight hospitals that do not exist. The chief resident physician is responsible for running emergency consultations.
Although Luo Yun's heart hurts, he could only say: "It's okay, the emergency department meets an emergency patient, and the procedure of calling a specialist doctor to the emergency department for consultation is the most formal."
There is no way, the health system stipulates the consultation system for emergency patients, you can't say that Liang Xueya is wrong.
I saw this patient soon, and the results of the plain X-ray film were at hand. After careful reading, no fracture was found, and it was just a relatively common patient with anterior shoulder dislocation.Zhou Chengcheng read the film with Luo Yun.
Ask about the medical history, consistent with the history of anterior dislocation features.
Then Zhou Cheng was asked to perform a physical examination on the patient, while Luo Yun was reading the films while making a careful diagnosis to completely rule out occult fractures.
Diagnosis of joint dislocation requires medical history, physical examination, and auxiliary examinations.
After basically being diagnosed.
Luo Yun then said to the patient: "Your condition is anterior dislocation of the shoulder joint. Manipulative reduction is required, but you have to go to our orthopedic ward with us and sign a signature by the way, so that we can perform manual reduction on you and beat you. Plaster, and then..."
"Okay." Although the patient felt that it was quite troublesome to go to the orthopedic ward, at least a professional doctor took care of him now, as if he had met a savior.
He had been left here before, and he was so panicked that he almost thought about whether he was hopeless, and he didn't find the right doctor when he came to the hospital...
"Come with me." Zhou Cheng kept supporting the patient's affected limb with both hands, and then pointed the way to the patient with his head.
"Okay, thank you!" The patient expressed his gratitude to Zhou Cheng for his enthusiastic help.
Sudden.
"Ah!~"
"Click!"
The two voices sounded at the same time, and everyone in the room was stunned!
Chapter 37 What unit did I come to? !
The patient suddenly felt a sharp pain in his left shoulder, and immediately let out a painful exclamation.
It was the left shoulder, and there was a sudden sense of emptiness, as if his hand had been separated from his physical body in a short period of time.In medical specialist examination, this is called fear sign, which will be accompanied by pain.
The sudden pain made him subconsciously tilt the left side of his body, and the brief pain immediately made his forehead covered with fine sweat!The veins are all erected.
The right hand covered his arm with great grievance and resentment, and looked angrily at Zhou Cheng who was standing on his left.
Zhou Cheng is tall and strong, and he is not small in strength, he only has one hand.
Can't beat it.
Cursed in my heart: You don't talk about martial arts, didn't you agree to go this way...
At the same time, Luo Yun and Liang Xueya were both stunned.
Didn't figure out what the situation was.
Liang Xueya turned her head slowly and stiffly to Luo Yun, with question marks all over her face.
What are the people you brought here doing?
Luo Yun looked at Zhou Cheng.
Zhou Cheng immediately let go of his hands, and said to the patient: "Try to move this hand?"
"It hurts me!"
"I can't move, I couldn't move before." The patient's tone was not very good.
I'm scolding my mother in my heart, you just messed with me like this, I won't have my surname Huang if I don't report you later, and you still let me move, do you have any conscience?
If it wasn't for the fact that my hand is injured now, do you think I will have a fight with you, where is there a doctor like you?
"It's okay, you move. It was dislocated before, and it should be reset now. The pain you just had is a sign of fear during the reset process. The short-lived existence will disappear immediately, and the original pain will also be relieved immediately."
"Am I right?" Zhou Cheng said while showing him a demonstration.
"Come on, learn from me and lift your hands up slowly."
Zhou Cheng seemed to have entered the role at this moment, and he didn't even bother to care about the expressions of Luo Yun and Liang Xueya.
Because this simple anterior dislocation of the shoulder joint is too simple.
Shoulder dislocation is a very common joint dislocation in clinical practice!
Anterior shoulder dislocation is the most common type of shoulder dislocation!
Zhou Cheng, who has a perfect proficiency level of joint dislocation manual reset, has at least four or five ways to deal with it, lifting weights like light.
If I had to use one word to describe Zhou Cheng's attitude towards the anterior dislocation of the shoulder joint, it would be to be sure.
Clinically, the most commonly used and most common method for the reduction of shoulder dislocation is the pedal hand pull method.
The scientific name is the Hippocratic reset method, but it is often called the pedal and hand pull method in clinical practice.
The method of this surgical reduction is: the surgeon puts the foot against the armpit of the affected side, and while longitudinally tracting the patient, rotates the humeral head alternately internally and externally.
This technique is classic and simple, and its success rate of reduction is not bad, but there is a relatively high degree of brachial plexus traction injury, and it is quite laborious, so it is no longer commonly used.
There has long been a relatively labor-saving and simple and applicable other reduction method in clinical practice, that is, the external rotation reduction method.
The patient, who happened to be standing on the patient, was perfectly positioned.
And the timing is just right.
The difficulty in repositioning a dislocated patient is that the joint is not in place, causing the patient to be painful and alert, so the muscles contract very severely.
For routine reduction, it is necessary to resist the patient's stress muscle contraction due to pain and the patient's defensive muscle contraction. It needs to rely on strong force or brute force traction with the addition of anesthesia or muscle relaxants. Then reset.
According to clinical research, it can be found that the protective contraction force produced by the patient's self-defense is greater than the stress contraction force produced by pain.
Therefore, it is the best time to reset the patient inadvertently and completely unprepared.
And just now the patient happened to be talking to Luo Yun, and Zhou Cheng even showed him where to go in a 'fake form' to let the patient know that he had to go to the ward before treatment.
Unexpected effects can be achieved completely.
This is the perfect level of proficiency, this is the sense and degree of control over a disease.
Of course, only Zhou Cheng knew these things, not the patient. He still looked at Zhou Cheng resentfully, and then glanced at Luo Yun who looked older.
Do you care?
Otherwise, I'll file a complaint with you later.
However, when he scratched Luo Yun with his eyes, he also clearly felt the pain in his shoulder, which became more and more mild. If the pain is compared to a tangible object.
The pain during the dislocation before may have been the size of an egg, but the pain just now suddenly turned into a basketball, and now it is only the size of a grain of rice.
Zhou Cheng was right.
And my own feelings will definitely not lie to myself.
So the patient dubiously started to move his left hand!
Lift slowly.
Well, it's okay.
Outreach, too.
Lift it up, and lift it up.
Immediately, the patient's eyes lit up, and he looked at Luo Yun and Zhou Cheng, and his tone became much better immediately: "Doctor Zhou, Doctor Luo, who am I?"
"All right?"
Zhou Cheng replied after hearing the words: "You were dislocated before, and the main symptoms of dislocation are pain and limited movement."
"Now you can also see that the activity has resumed. If you have felt the pain and the great relief, then the dislocation of the joint has been reset. You can take an X-ray review after the reset later. One click and you will get the result."
"The reason why I took advantage of your unpreparedness just now is to reduce your defenses and reduce the force of defensive muscle contraction, just like..."
Zhou Chengcheng began to explain in detail, this is actually a sequela after the simulated copy.With perfect skills, I naturally want to fully inform patients about my treatment process and treatment ideas.
Let the patients themselves participate in the whole diagnosis and treatment process, so that they can understand, this is called the accurate measurement of the size and temperature.
Otherwise, if it is only the doctor himself who has a precise grasp of the disease, but the patient himself is not clear, it means that the communication process is not done well.
Listening to Zhou Cheng's words, Luo Yun was a little silly in a daze.
Damn, I haven't explained the follow-up treatment process to the patient yet.
Did you just finish the treatment?
Then after the treatment, you still have a live version of the teaching in front of me?
Bababababababababababa makes sense.
You, a resident doctor, want to stage a teaching session for me, am I crazy or are you crazy?
Listening helplessly to Zhou Cheng's explanation, Luo Yun closed his mouth helplessly.
Then I recalled what Zhou Cheng said, how could there be an illusion.
He knows better than me what a dislocated joint looks like?
What Luo Yun could feel intuitively, Liang Xueya could also feel naturally, and his heart was a little messed up at that time.
Damn, what unit did I come from?
I thought I was a graduate student at the Affiliated Hospital of Shonan University, and I had seen it anyway, and had a lot of clinical experience.I thought that coming here, I would be able to put my fists to good use.
But a training doctor in the Eighth Hospital is so good now?
Not only can you complete the manual reset alone, but you also need to teach on the spot in front of your superiors?
Chapter 38 Baidu cures diseases? !
"Doctor Liang, please prescribe an X-ray review for the patient after surgery." Luo Yun said helplessly after seeing Zhou Chengcheng explain to the patient.
Although he was a little shocked that Zhou Cheng was able to reset the patient's dislocated joint so neatly, and the timing he chose, the explanation for the timing selection, and the theoretical preparations were all very sufficient.
But in fact, Zhou Cheng still made a mistake in the process!
But that's not too unimportant.
Liang Xueya nodded and said, "Okay, Mr. Luo. What about the manual reduction for joint dislocation?"
"Should I drive it to your department for implementation? Or should your department charge for it yourself!" Liang Xueya has already joined the emergency department, so she is already very familiar with the patient's treatment process.
The emergency department can invite relevant specialized departments to come to the emergency department for consultation, and can also provide specialized treatment, but every kind of treatment must be issued with a doctor's order, and each doctor's order must be executed by the department.
For example, in the department of orthopedics for manual reduction of joint dislocations, the executive department can be sent to the emergency department, but this is against the rules, because in principle, doctors in the emergency department have no right to perform manual reduction of joint dislocations.
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The source department of this surgical authority can only be orthopedics.
This is also part of the orthopedic benefits.
"I'll trouble you to open one too." Luo Yun thought for a while before saying.
Treatment requires a doctor's order, and the patient has to pay. This is a matter of course. What he thought before was that Zhou Cheng had made a mistake in this process.
But when the patient heard this, his eyes rolled and he immediately said, "Reexamination? I don't think I need to reexamine."
"Dr. Luo, Dr. Liang, and this Dr. Zhou, thank you."
"You guys are really good doctors, I feel great now."
After speaking, he stretched his left shoulder again and shrugged, feeling that the pain had almost disappeared.
Then happily walked outside the emergency department.
He didn't mention anything about the reexamination, the joint dislocation manipulation and the doctor's order fee, and he didn't even take the medical records, so he left happily.
Seeing this scene, Zhou Cheng was stunned.
Is this gone?
No forearm sling yet, bro!
Zhou Cheng wanted to catch up, but Luo Yun pulled Zhou Cheng and shook his head at him.
Liang Xueya asked, "Mr. Luo, what should we do in this situation? Do we want to call him back?"
Luo Yun shook his head and said with emotion: "What else can I do? People are gone, can you still restrict other people's personal freedom?"
Then he said: "Patients have the freedom to choose whether to undergo further treatment and which hospital to go to for treatment."
Liang Xueya nodded, and knew that Luo Yun was actually quite embarrassed now, because the Orthopedics Department had already treated the patient, but it hadn't had time to issue a doctor's order, so the Orthopedics Department couldn't charge the fee, and even if the doctor's order was given to the patient in advance, The patient left without paying.
You can't say anything. The patient can say that you didn't treat him and he didn't pay the fee. Why would you treat him?
Of course, Liang Xueya saw the truth and bid farewell to Luo Yun.
Luo Yun only secretly took Zhou Cheng away, and also took away the medical records left by the patient. It wasn't that Liang Xueya forgot to take it away, but Liang Xueya left it for him on purpose...
On the way back, Zhou Cheng realized that he had made a small mistake.
Although the gratitude he could get had already been obtained, Luo Yun's trip was a waste of time.
"Mr. Luo, me." Zhou Cheng was about to explain as he walked.
On the other hand, Luo Yun said casually: "It's nothing, if you suffer, you will gain wisdom."
"Your clinical experience is still too little."
"Clinical experience is not the same as clinical experience."
"Your current clinical experience is limited to bed management and surgery experience in the ward, and experience in dealing with patients is still lacking, but this is not your fault, it is because you do not have similar experience."
"Do you think that the medical procedures deliberately emphasized in the hospital are a joke?"
Zhou Cheng really didn't think about these things. The dungeon allowed Zhou Cheng to acquire such skills. This knowledge and knowledge only reached a perfect level in terms of this skill and theoretical understanding, but the specifics of the dungeon simulation The process, and the corresponding memory, are nonexistent.
To be a doctor, in addition to your own strength, communication and communication with patients and their families is also very necessary.
Of course, Zhou Cheng's understanding in this area was not bad, and he quickly understood what Luo Yun meant.
When a patient comes to the hospital, he must first register, which constitutes a medical relationship with the department he wants to go to and the doctor who wants to see him.If there is no such medical relationship, you cannot diagnose and treat patients.
Except for emergencies and emergency escapes in special situations.
Then it is to write the emergency medical records and prescribe the doctor's orders, which is the next step of the diagnosis and treatment plan for the patient.
Patients have the right to informed consent.
Informed means that you reflect the doctor's order you want to prescribe in the outpatient medical record, and tell the patient what kind of examination or treatment you are going to do to them next, and then the patient pays.
Before the patient completes the payment, he can assume that he does not agree with the suggestion you gave him based on your interpretation of his condition.
Paying the fee means that he agrees with your proposal.
Only when the patient is informed and consented can you treat or examine the patient, otherwise, this is an unclear account...
Zhou Cheng had rarely experienced this kind of outpatient and emergency treatment before, and Luo Yun was running most of the time, so Zhou Cheng didn't quite understand.Now that Luo Yun pointed it out for him, he truly understood the deep meaning of these seemingly trivial steps that seemed incomprehensible to outsiders.
"Okay, Teacher Luo, I've made a note." Zhou Cheng nodded and said seriously.
Luo Yun also nodded, then turned his head and asked: "The manual reset you did just now is the external rotation reset method?"
"En!" Zhou Cheng nodded.
Luo Yun said with a half-smile, "Zhou Cheng, the manual reduction for anterior shoulder dislocation is written in the textbook as the Hippocratic reduction method. External rotation manual reduction is only practiced by doctors specializing in joint surgery."
"In the recent years in the department, I will take over some similar patients. How did you know this method?"
Zhou Cheng's expression was a little wary, but he replied immediately: "I often collect the methods and teaching videos of these manual reduction methods. This external rotation reduction method is also one of the eight common shoulder joint reduction methods."
"It's all over the Internet."
In order to convince Luo Yun, Zhou Cheng returned it to Luo Yun on Baidu, and immediately found out the corresponding method to reset the introduction video.
Luo Yun: "..."
Are you a fucking Baidu learning operation?
Now some knowledgeable patients don't dare to use Baidu to see a doctor. Are you demonstrating Baidu's treatment here?
fine.
It's not that I can't, I know more things than you.
But at any rate, you can still get a little bit in touch with joint surgery now, and you can be regarded as a small half of our joint surgery disciples. I will take care of you in the future and let you see the real charm of joint surgery.
Chapter 39 Don't, don't!
Luo Yun didn't bother to get to the bottom of it. Zhou Cheng had done a reset on such a difficult tibial plateau fracture that surprised even Director Cai.
Cai Dongfan didn't say much, why should Luo Yun worry about those things?
What's more, Luo Yun didn't pay attention to Zhou Cheng at all, and the group didn't think about Zhou Cheng when he had the opportunity, and Zhou Cheng didn't need to report to them in detail what he knew and how he knew these things.
"Just tell me, this common joint reset, which ones are you sure you can take off?" Luo Yun just watched Zhou Cheng's manual reset.
The timing was very good, and his understanding of joint dislocation and repositioning was quite thorough, so he simply picked up Zhou Cheng's mistakes from behind his ass.There is no need to do it, every patient does everything by himself.
Anyway, for these patients, on weekdays, the bed doctors in other groups don't do it. In the department, he just wants to not forget his old job, so he didn't lose this skill. People will take care of Zhou Cheng.
This problem is really a bit embarrassing until Zhou Cheng.
There are many types of joint dislocations. According to the size, there are large joint dislocations, such as shoulder joints, hip joints, knee joints, and elbow joints.
There are also small joint dislocations, such as interphalangeal joints, radioulnar joints...
If we really want to separate out the categories in detail, there are at least dozens, or even hundreds, of fragments.
As for the dislocation of these joints, Zhou Cheng is almost familiar with it. The only thing he dared not do is the dislocation of the joints of the spine. That thing really cannot be done by manual reset.
So Zhou Cheng asked: "Mr. Luo, what aspect are you referring to?"
"It's common, it should be fine."
Luo Yun and Zhou Cheng had already walked into the elevator at this time. Luo Yun was in front, ready to press the floor where the second orthopedic ward was located, but at this moment, half of the outstretched hand gradually froze.
Looking back, looking at Zhou Cheng with a sincere face, I felt amused in my heart.
Common, should be no problem?
I dare not say this sentence, you know?
Newborn calves are not afraid of tigers?
"What about the dislocation of the heel joint?" Luo Yun asked casually while pressing the elevator.
With the dice joint, the name is quite a mouthful.
Is the joint made up of the calcaneus and cuboid, both of which belong to the tarsal bones of the foot.
And this joint is not even involved in joint surgery. Only a professional foot and ankle surgeon can handle this dislocation.
Foot and ankle surgery is an extremely professional subject. Moti is in the No. [-] Hospital of Shashi. Even the three top hospitals in Hunan Province, the Department of Orthopedics of the First, Second and Third Affiliated Hospitals of Hunan University, have not yet divided this area in detail. Three professional departments come.
As for the dislocation of the calcaneus joint, currently only a few professors use surgery for reduction.If you really want to perform manual reset, you probably have to go to a department with extremely professional foot and ankle surgery like Shanghai or Kyoto.
Orthopedic graduate students can understand the anatomy of several tarsal bones, cuneiform bones, and phalanges of the foot. At most, they know the term calcaneus-cuboid joint. As for how to reset it?
To be honest, Luo Yun himself is not very clear about it.
The reason why he asked this question was to let Zhou Cheng know the dangers of the human heart, and that the sky is high and the earth is thick.
Zhou Cheng raised his head slightly and thought for a while.
Well, although the manipulation of the calcanoid joint is quite troublesome, in fact, as long as the appendages of the calcanoid joint, that is, the muscles and several ligaments between the calcaneus and the cuboid, are clearly out of shape, the manipulation of the reset is not difficult. .
Seeing Zhou Cheng's expression of careful consideration and consideration, Luo Yun shook his head slightly, then picked up his mobile phone and played casually.
He just wanted to let Zhou Cheng know how to advance and retreat, and he didn't want to get an answer from Zhou Cheng.
Zhou Cheng thought for half a minute, and after considering the types of heel joints one by one, he replied very conservatively: "As long as it is within the range of indications for manipulative reset, it should be acceptable."
Luo Yun's brain went down at that time, and the first consequence of the brain's downtime was that the flexor muscle of his right hand temporarily lost its contraction, so the mobile phone in his hand slipped out with the force of gravity.
Then Luo Yun was so scared that he showed the hand speed of his mother who had been single for 30 years, making the phone roll in the palm of his hand.
In the end, it was like holding a loach in both hands before holding the phone.
Turning his head, narrowing his eyes and wrinkling his forehead: "What did you say?"
The voice is a bit loud, and the tone is a bit weird.
Zhou Cheng understood Luo Yun's meaning, pursed his lips and said, "It's nothing, Teacher Luo, I mean! If I encounter such a patient, I will call you right away."
Very sensible.
Since Luo Yun didn't think he could reset the heel joints, then he could do as he wished.Anyway, there are not many such patients, and it is rare to encounter them. Even if we do not perform manipulation repositioning for such patients, nothing will be lost.
Even if he took the risk to do it, Zhou Cheng was sure of it, but he couldn't earn much gratitude, and Luo Yun still gave Luo Yun the label of not listening to persuasion.
Not worth the candle.
When Luo Yun saw Zhou Cheng's answer, he immediately waved his hands and said seriously: "No, such a patient, please don't call me, call Director Cai directly!"
Luo Yun can't handle the dislocation of the heel joint by himself!
If Zhou Cheng really called him to come, Zhou Cheng looked at the patient, the patient looked at himself, and he looked at Zhou Cheng and the patient.
What an embarrassing atmosphere.
If it really needs to be dealt with, Director Cai can only do the surgery.
Luo Yun didn't want to take the blame. Although this kind of dislocation is rare, who knows if it will happen.
If they meet, Zhou Cheng will call himself away, but he won't, then it will be so embarrassing.
"Okay. Teacher Luo." Zhou Cheng nodded again.
"Forget it!" Luo Yun didn't dare to talk to Zhou Cheng anymore. He felt that when he talked to Zhou Cheng, he didn't have the slightest advantage that a superior should have. He was completely led by Zhou Cheng unilaterally.
Luo Yun is not a cow, even if he is a cow, he doesn't like the feeling of being led by the nose.
So after returning to the department, he casually confessed to Zhou Cheng, and then quickly ran away...
In the doctor's office, Du Yanjun said to Zhou Cheng who was coming in with a very happy smile: "Brother Zhou Cheng, are you back?"
"A patient came here just now. It was a simple debridement with an incision of about four centimeters. I was about to call you to ask you to come and do debridement and suture for him."
Seeing that Du Yanjun took out his phone belatedly, Zhou Cheng obviously couldn't help himself, so he said, "It's okay, Yan Jun. You just need to do debridement and suture alone."
"Two people go, there is no need for such a big battle."
Zhou Cheng sighed in his heart, since Luo Yun wanted to do debridement and sutures, let him do it, there was no need to bring an assistant like Du Yanjun to do it by himself. It seems to be the most special existence.
Anyway, one more debridement and suture, to him, Zhou Cheng, is nothing more than one less thing to do.
With this time, it is better to plan the following dungeon simulation, how to start is better.
Different opening options directly affect the results and rewards...
Chapter 40 The Violent Practice of Medicine
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Zhou Cheng picked up a pen to write and draw in the notebook, all of which were illogical, mainly the names of some operations.
Don't be afraid that others will understand.
However, just as his butt was getting hot, Qin Min came to disturb him again, and said after entering the door: "Zhou Cheng, another emergency patient came, and it seems that he has a dislocated joint."
"It is said that Dr. Liang Xueya from the emergency department asked them to come to our department."
When Tan Min mentioned this, he said in a little embarrassment: "It's been a long time since we have seen such a patient in our department. You can go and have a look first, and I'll give Lao Luo a call?"
Qin Min has been employed for more than two years, which is as long as Zhou Cheng's training period. He has seen no more than twenty patients with joint dislocations, and Luo Yun is basically handling them.
And when she met Luo Yun more often, she called him Teacher Luo, and in private, she referred to Luo Yun as Lao Luo.
Zhou Chengcheng stood up and said, "Miss Tan Min, don't call yet, let's go see the patient first."
"Teacher Luo Yun just told me that for patients with dislocated joints, I can try to reset them by myself."
Tan Min took out her phone, and was about to search for cloud from the address book, when she heard Zhou Cheng's words, her hands froze.
Looking at Zhou Cheng and blinking, he asked, "Really? Zhou Cheng, don't lie to me?"
As Zhou Cheng walked out, he said, "Sister Tan Min, don't you worry about me? Teacher Luo Yun must have said this, so I dared to say this. Otherwise, I wouldn't just violate the rules."
"You have to be responsible for this."
When Tan Min thought about Zhou Cheng's usual habits, he thought it was the same.Zhou Chengsu has always been a steady person, and he has just obtained the fourth or fifth first-level surgical authority in the department, so it is not incomprehensible for Luo Yun to grant him the manual reset of joint dislocations alone.
And this kind of thing, you can know it as soon as you ask, if Luo Yun didn't say it, Zhou Cheng can take this responsibility by himself?
Certainly not.
"Of course I believe you." Tan Min said without hesitation.
"Then I'll go to work first. If you need any consumables, remember to ask me to get them."
As Tan Min said, he passed Zhou Cheng first, walked towards the nurse's station, and then explained to the patient: "The doctor on duty has arrived, and he will be able to see you soon, so you have been waiting for a long time..."
The patient and his companion quickly stood up and walked towards Zhou Cheng.
After careful questioning, Zhou Cheng confirmed the patient's basic information and medical history.
The patient, male, 46 years old, suffered right shoulder joint pain with limited mobility for 1 hour due to trauma.
The results of the current physical examination have a square shoulder deformity in the right shoulder joint!There was tenderness at the shoulder joint, the humeral head was palpable anteriorly and inferiorly, the scapular fossa was empty, the movement of the shoulder joint was limited, and the movement of the distal limbs felt normal.
Square shoulder deformity, as the name suggests, is a hallmark sign of shoulder dislocation.
However, it is not a diagnostic sign.However, based on the displacement of the humeral head and the empty socket of the shoulder joint, it can be basically diagnosed as anterior dislocation of the shoulder joint.
Anterior shoulder dislocation is the most common joint dislocation, and the number of patients is really quite a lot.
However, physical examination alone is definitely not enough to diagnose shoulder dislocation, and it is necessary to strictly check for occult fractures.
X-ray, the patient's companion had already brought it, and immediately handed it to Zhou Cheng to see.
After reading the films, the diagnosis can basically be confirmed.
This time, Zhou Cheng carefully recorded the entire medical history with the patient's emergency medical records, and then completed the physical examination and film reading in detail.
Write down the diagnosis and treatment plan in detail in the medical record and inform the patient.
"According to your current situation, it can be diagnosed as anterior dislocation of the shoulder joint, which requires reduction treatment."
The patient immediately said: "Then doctor, please treat me quickly, I am going to die of pain."
The companion also said: "Yes, doctor, my elder brother has been in pain for almost an hour. We rushed to the hospital at the first time and tossed for more than 40 minutes. The pain is really unbearable."
Zhou Cheng said: "Don't be in a hurry, because the current reduction treatment, there are two kinds of manual reduction and surgical reduction, each has its own advantages and disadvantages. Come with me to the office."
"I have to tell you in detail."
The accompanying person is the younger brother of the injured patient. He looks about 40 years old and is tall and strong. He is obviously impatient: "So what are you talking about? We definitely agree to the treatment. You should treat it quickly!"
Zhou Cheng said: "Then do you agree to surgical treatment or manual therapy? If it is surgical treatment, you have to be hospitalized first and complete the preoperative examination before surgery."
"I can give you a hospital certificate right away."
The companion immediately puffed up his eyes, and the corners of his mouth twitched: "My brother, is he going to have an operation?"
Then he took two steps back and asked his elder brother:
"Just now, that's not what the doctor said."
Zhou Cheng said: "You didn't wait for me to finish, so how do I know which treatment method you choose? You can't make a decision right away, of course I have to tell you the pros and cons first."
"Because manipulative reduction and surgical reduction are both optional treatment methods, and you can only choose by yourself. Our hospital only provides medical services and cannot make decisions for you. In your case, you can only be treated with surgery, right? ?"
Learning from the past, Zhou Cheng can only choose to be more stable now.
In the end, the patient and his companion listened to Zhou Cheng's lecture in detail for 5 minutes, and finally signed their own names, and wrote down their own names and the words requesting manipulation reset under the emergency medical records in the emergency medical record book.
Zhou Chengcai wrote another doctor's order for the two of them, and scanned the QR code to pay the fee.
Only then did he take two people into the second operating room.
There are two operating rooms in the department, which are actually two adjacent single rooms.
When Zhou Cheng and the patient went in, they happened to meet Du Yanjun who finished the debridement and suturing of the patient in front of him!
It took Zhou Cheng more than 20 minutes to go through various procedures such as consultation, conversation and signing.In addition to the previous time, Du Yanjun has already completed a debridement and suture.
Seeing Zhou Cheng bring the patient into the operating room, Du Yanjun opened the door suspiciously and took a look inside.
Then saw the following scene.
While supporting the patient's affected limb, Zhou Cheng told the patient to lie down on the bed, and then the patient's healthy limb was placed on the examination bed.
The patient immediately let out a scream.
Finished calf.
Du Yanjun quickly retracted his head!
Walking away quickly in a state of confusion...
He kept patting his chest.
Damn, Zhou Cheng is practicing medicine violently this week!
No, I have to report to Teacher Luo Yun immediately.
Otherwise this is going to be a problem...
Chapter 41 Reverse Assist!
Du Yanjun felt that the current situation was very serious.
Zhou Cheng is simply too daring this week.
Even he just dared to use the name of the teacher to do a little debridement and suture sneakily in the department, and then take advantage of no one's attention.
Mix in some emergency surgery from Luo Yun alone to do it.
But it's all violent and 'fighting' with the patient.It is not of a nature.
Du Yanjun heard the scream from the patient just now.
Is this still available?
Zhou Cheng was on duty, and Luo Yun was on the second-line shift. When the patients Zhou Cheng couldn't handle came, Luo Yun would handle them.But whether it is Luo Yun or Zhou Cheng, they all follow Cai Dongfan.
In case this patient goes to report, the first thing to deal with is the leader of the group——
Cai Dongfan.
Let's talk to Luo Yuntou first.
But Luo Yun had already slipped away, so Du Yanjun patrolled the department, but couldn't find where Luo Yun was.
Therefore, Du Yanjun could only walk into the walking stairs and secretly call Luo Yun.
In fact, for this kind of thing, I had to talk about it in private in front of Luo Yun, and it was not appropriate to make a phone call.The law does not spread to six ears.
However, the walking stairs are basically unused. This is the 11th floor. Who would take the walking stairs on the [-]th floor?
After dialing the phone, Luo Yun answered.
Then Du Yanjun immediately told what he saw.Then he said: "Mr. Luo, I think this is a bit inappropriate. The patient just now was in pain and would definitely want to hit someone. Will he report it later?"
"Brother Zhou Cheng's method may be a little violent."
Luo Yun was driving at this time, and the phone he answered was directly connected to the car's Bluetooth.After hearing what was going on, he let out a sigh of relief.
Say: "Okay, I see, you don't have to worry about this matter. Just do your own thing."
At the same time, I was shaking my head in my heart, this Du Yanjun still owes a lot in clinical practice.Although he is not a graduate student in joint surgery, and Cai Dongfan is not a professional in joint surgery, you don't even understand that Zhou Cheng is doing joint dislocation.
You even called me directly to report it to me. You said this happened?
Du Yanjun was obviously taken aback, and asked in confusion, "Do you care? Teacher Luo?"
"Our department should also pay attention to humanistic care?"
"If the patient reports it and the medical department investigates it, Teacher Cai may be implicated. If Teacher Cai gets angry, we will all suffer."
Du Yanjun was still explaining the seriousness of the matter. He felt that Luo Yun didn't understand what he was talking about, and didn't consider the seriousness of the matter for a while.
Luo Yun sighed slightly, and while turning the steering wheel, said a little tiredly: "Yan Jun."
"To tell you the truth, it was Zhou Cheng who was doing a dislocated joint reset for the patient."
"This kind of manipulation should go to the operating room for anesthesia, or even general anesthesia, but the cost of anesthesia is not low. Therefore, Zhou Chengcai chose a manipulation with the lowest cost and good effect. Timing method."
Speaking of this, Luo Yun felt that what he said might be too profound.
He said: "Although you are not a graduate student in joint surgery, joint surgery is also a big branch of our orthopedics department. If you are free, you can also read some books on this topic."
"Speaking of which, you went to the emergency department with me, and more or less came into contact with more than a dozen patients with joint dislocation and reduction. Zhou Chengquan learned it by himself."
"You don't even know what he's doing, so think about it yourself."
"Okay, that's it, don't bring this matter to Director Cai."
"It won't do you any good."
After speaking, Luo Yun hung up the phone directly.
This was the first time Luo Yun felt that Du Yanjun was a little too narrow-minded, or too scheming.
I don't know how to do my own thing well, and I don't want to study hard, so why do I engage in these speculative things?
In the past, although Du Yanjun won more learning opportunities by virtue of being Cai Dongfan's student, he also felt that Du Yanjun was a more refined person and good at using his own resources and advantages, so he easily won a lot of opportunities for him. Chance.
But thinking about it now, it seems that I am completely redundant.
I followed myself to do more than a dozen joint dislocation manipulations, but I didn't even read any books!
When I co-authored it, I felt that I, Luo Yun, called him to help, and he came here to help me with things.
If you think like this, why should I call you?
Otherwise, as long as you read a little bit of books, as for making such a big oolong today?
Looking back at Zhou Cheng, he does things without arrogance or impetuosity.
Oh, except today.
I could have done a lot of things, so I definitely didn't want to do everything, just keep my voice down, study hard, learn surgery well.Such a person is fully prepared, and if given a chance, he can ride the wind...
How to learn to accumulate knowledge is also a compulsory course for medical students. If you show off yourself with a little bit of knowledge, you are eager to express yourself, and you will suffer a loss one day.
……
Du Yanjun was in the stairwell, his face pale.
He could tell that Luo Yun was obviously angry today.
There may be two reasons.
One was that he had misunderstood Zhou Cheng, and went to inform him without even understanding what Zhou Cheng was doing.
The second must be that I secretly reported to Luo Yun, with impure motives.
After thinking about it, Du Yanjun tapped his forehead lightly with some regret, and scolded himself in a low voice: "Du Yanjun, Du Yanjun, you are so stupid."
"You only think about whether you and your teacher will be implicated. This will definitely make Teacher Luo Yun feel unhappy."
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"You have to be steady in doing things."
Immediately, Du Yanjun sent two messages to Luo Yun.
One is a message of admitting mistakes, and the other is a message of apology.
Admitting mistakes and apologizing are two aspects. Du Yanjun did not confuse them. After sending out, Du Yanjun walked out of the stairwell, and then greeted Zhou Cheng who was coming out of the second room of the operation room with a smile, and said, "Brother Zhou Cheng, Have you finished restoring your manipulations?"
"I wanted to help, but a phone call happened to come, so I answered the phone."
Zhou Cheng didn't think much about who Du Yanjun was on the phone with, he just said: "When Mr. Luo Yun took me to do the manual reset this morning, he thought my performance was okay, so he authorized me to do this reset alone. ."
"No special report is required. Teacher Cai also granted me the operation authority before."
Zhou Cheng wanted to explain the matter clearly so as not to be misunderstood by Du Yanjun.
Du Yanjun immediately said, "Damn!"
"Brother Zhou Cheng, I don't mean that. We are all brothers."
Then Du Yanjun lowered his voice and asked, "It's just Brother Zhou Cheng, I have a question that I don't understand?"
"Director Yan clearly stated that the basic assessment for the number of hospital stays is open reduction and internal fixation of fractures."
"Now everyone is mostly leaning in this direction."
"Why are you interested in manipulative reduction of dislocated joints? Could it be? Did you get some gossip?"
Chapter 42 With sai joints!
"Gossip? No!"
"It just happened to meet me, and I thought I could give it a try. I didn't have any special ideas." Zhou Cheng blinked and looked at Du Yanjun innocently and sincerely.
In fact, Zhou Cheng didn't want to tell him what Luo Yun told him, and told the general development direction of the department in the future.
The main reason is that Zhou Cheng was afraid that speaking out would affect Du Yanjun's own direction and goals.
This is a fact.
Director Yan has made it clear that one of the basic requirements for staying in the hospital is to complete open reduction and internal fixation of a fracture, which is at least a grade II operation.
Logically speaking, Zhupei is not qualified to obtain such an authorization for surgery!
This kind of surgery, the general postgraduates can't master it right after graduation, because it is difficult for them to get the permission and opportunity of surgery.
To some extent, the conditions for staying in the hospital are higher than the requirements for recruiting graduate students.
But, this is a tertiary hospital, and I just hope that all the regular trainees can show their talents, find a way to find a way to give a chance to a superior doctor and learn this basic skill.
After entering the department, similar operations can be carried out normally.
Zhou Cheng doesn't need to bother with this step, because he has already reached the perfect level in open reduction and internal fixation of fractures.This is a level that no one in the department can reach and touch at present.
As long as he performed a little bit in the daily surgical operation and had the slightest chance to give Zhou Cheng, Zhou Cheng could be recognized quickly.
But Du Yanjun couldn't do it. It was extremely difficult for him to perform closed reduction and Kirschner wire fixation for a fibula fracture, let alone plate and screw fixation.
Although Zhou Cheng thinks that Du Yan's army can be used to reset joint dislocations and fractures, which can directly abolish a competitor, but people still don't want to be so shameless.
Du Yanjun smiled back and said, "Brother Zhou Cheng is worthy of being Brother Zhou Cheng, he has hidden it really deep enough."
"Manual reduction of fractures, manual reduction of joint dislocations."
"My decision to come to study with you seems to be the right one."
Hearing this, Zhou Cheng went to the operating room again. He had to explain to the patient and his companion that he would have to take another look at the results of the reexamination later before leaving the hospital. go home.
Du Yanjun followed all the way, and the two of them arrived in the duty room together. Du Yanjun asked again: "Brother Zhou Cheng, does Mr. Cai know about the joint dislocation manipulation?"
"After all, our department didn't accept similar patients before."
Du Yanjun naturally didn't mention that Luo Yun was dealing with this kind of patients in the department, and he had followed him many times.
"I don't know if Teacher Cai knows. I told Teacher Luo Yun. I don't know whether Teacher Luo told Teacher Cai." Of course Zhou Cheng could only push this matter to Luo Yun.
He wants to get the appreciation value as soon as possible. If Du Yanjun really thinks that Cai Dongfan needs to know, then he will tell Cai Dongfan himself.
However, Zhou Cheng felt that Du Yanjun would not do this either. Several directors in the department were not involved in the field of joints, and what they said was nonsense.
He treats patients whose manipulations have been reset, and at least he can generate income for the department.
Du Yanjun frowned slightly, but didn't say much, just changed the subject and said, "Brother Zhou Cheng, what do you have for lunch, a De Tianshun rice bowl?"
"Okay, let me call." Zhou Cheng took advantage of the situation and turned on the phone.
Detianshun rice bowls are quite good, especially the lean pork strips with green peppers.
Apart from being a bit pricey, there is basically nothing wrong with it.
A rice bowl costs more than 30 yuan, and the delivery fee is [-] yuan, which is an unshakable price tag.
"No, I'll come."
"I've already ordered and paid, Brother Zhou Cheng, don't repeat it." Du Yanjun mentioned it first, so he placed the order with quick eyesight and quick hands.
Zhou Cheng also simply searched for coffee, so AA had lunch and coffee.
Until the meal and coffee were delivered almost at the same time, no patients came to disturb him, so Du Yanjun immediately signed up to pick up the meal.
Zhou Cheng carefully checked the daily ward round records he had written. After he felt that there was no problem, he clicked Save and washed his hands before heading towards the duty room.
In the office, under normal circumstances, one does not eat, otherwise, the mixed smell left by the meal is really not conducive to the afternoon work.
After Du Yanjun brought the coffee and rice bowl to the duty room, he immediately distributed a portion to Zhou Cheng.
Just as he was about to open it, a nurse called from outside, "Zhou Cheng, a patient is here in the emergency department. Come and have a look."
"I'll go! Brother Zhou Cheng, you eat first." Du Yanjun immediately stood up, and then hurriedly ran outside the duty room.
Zhou Cheng looked at Du Yanjun's back, twitched the corner of his mouth, and then took off the mask.
This is Du Yanjun.
When the lid of the rice bowl is opened, a scent of pepper and rice hits instantly, awakening the taste buds on the tongue, and the salivary glands immediately secrete to the maximum.
Moisturizing.
However, Zhou Chengcai didn't eat two mouthfuls, and just when he felt that the cured lean meat strips mixed with chili juice were blooming in his mouth, Du Yanjun came to the door of the duty room and said with a little embarrassment: "It's another patient with dislocated joints. But it's just written in the report, I didn't see it."
"Brother Zhou Cheng, come and take a look."
Another patient with joint dislocation, but Du Yanjun was a little disappointed.
He couldn't handle this kind of patient, so he was too excited.
"What kind of joint dislocation is written in the report?" Zhou Cheng immediately picked up a tissue to wipe his mouth, then hung the mask on his face, stood up, picked up his white coat, and walked outside the duty room.
"It seems to be something with the sai joint, anyway, it's the part of the foot. It's very difficult." Du Yanjun recalled, and then said.
"I think it's okay to send patients directly to the Second Hospital. It's been done this way before." Du Yanjun's face was full of boredom.
Dislocated with sai joint?
Heel the dice joint, bro?
Anyway, it's orthopedics.
Zhou Cheng frowned slightly: "Let's go and have a look first."
I just don't know if this patient can be reset manually.
Today Luo Yun asked if such a patient would be treated. Unexpectedly, such a patient really appeared.
However, simple dislocation of the calcaneus joint is relatively rare. It depends on whether there is a fracture.
"Has the patient had a CT scan?" Zhou Cheng asked Du Yanjun.
The bones of the foot are many and short, and they overlap together. It is difficult to read the fractures on ordinary plain films. Generally, CT [-]D and reconstruction are used to better judge whether there are occult fractures.
If there is an occult fracture, an MRI should be taken to see how the ligament is damaged.
Surgical contraindications and surgical indications.
The indications and contraindications of manipulative reduction must be clearly and clearly grasped to ensure effective treatment.I didn't come rashly.
Even if it is a redefined manipulation reduction, it cannot be treated with manipulation on the indications of non-manipulation reduction...
Chapter 43 I want to become a beast!
Zhou Cheng currently has three perfect-level skills, and the manual reset of fractures is even more redefining-level.
Therefore, he felt more and more that in the clinical process, it is extremely necessary to distinguish the levels clearly.
Define first, diagnose later.
After diagnosis, classification is required.
Only by strictly classifying various diseases such as dislocations can we better grasp how to treat them.
Be adaptable.
If you don't even understand the clinical definition and classification, but simply format and apply it, you will definitely not be able to do well in clinical practice.
Clinical medicine is an evidence-based medicine and an empirical medicine.
Evidence-based, as the name suggests, is to find out the evidence, grasp the current scale of the disease, and then find out the point of treatment according to the type of the disease, so that it can be called perfect.
This is especially true in surgery.
If a surgeon can't even grasp the surgical indications and contraindications clearly, and can't grasp the size well.
There are definitely two situations.
[-]. Excessive medical treatment is like seeing a fracture and operating directly. It is simple and mindless, but it is actually a waste of medical resources and increases the financial burden of patients.
Second, reckless treatment.If patients who should not undergo manual reduction have undergone manual reduction, or patients who should have undergone internal fixation with plates and screws, they will be fixed with Kirschner wires or intramedullary nails, and the results will naturally be unexpected. outside.
As a clinician, I myself have to believe in all kinds of accidents that exist in the clinic.
The accident, how did it happen?
It was unexpected, but if we can better grasp the situation in the process of diagnosis and treatment, we can minimize the occurrence of such accidents.
Just like a foot fracture, on a simple X-ray, there will be overlap of bone development, which hides the obvious fracture line.
If the occult fracture is not discovered in time, it will cause sequelae that cannot be ignored.
However, if fractures can be completely ruled out on X-rays, or through comprehensive means such as physical examination, then there is no need for CT!
"It's been taken, here are the pictures." Du Yanjun quickly took out the patient's examination bag, and sorted out the different planes of the CT scans for Zhou Cheng one by one.
Then he handed it over and said, "There is no fracture in the CT report."
"I'll see. Professional orthopedic surgeons can't fully trust CT reports." Zhou Cheng had already entered the role at this moment, completely unaware that what he said to Du Yanjun now should actually be what the superior doctor should say.
"Let's look at the coronal plane. This is the talus, here is the calcaneus, and here is the tou (two tone) bone level."
"From these bone planes, we can see that the continuity of the bone is intact, the integrity has not been damaged, and the fracture line has not been seen. Fractures can basically be ruled out."
"Also, Yan Jun, look, from this sagittal plane, we can still see that the heel joint plane is staggered by about 2cm."
"There is a ruler here, 2cm is equivalent to the real 0.4cm, and the direction of dislocation is the cuboid upward."
"In this case, according to the treatment principles of calcanoid joint dislocation, manipulative reduction can be performed, which is within the indications of manipulative reduction, right?"
Du Yanjun blinked his eyes, completely numb.
How the hell do I know?
What are the indications for manipulative reduction of calcanoid joint dislocation?Is there still this thing?
Zhou Cheng remembered Du Yanjun's expression when he saw it!
Ok.
This is Du Yanjun, not the students he taught in the mock copy, forget it, don't embarrass others...
The patient next to him heard Zhou Cheng's calm and composed manner of teaching, and asked with a smile: "Doctor Zhou? Is my condition serious?"
"In your situation, as I just said, there is a dislocation, but no fracture!"
"Manipulative reset is possible."
"However, manipulative reduction also has its inherent risks. If you are unwilling to accept such risks, you can alternatively choose a safer surgical treatment."
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"This?" The patient was embarrassed.
Why do you still need surgery?
"Yan Jun, I'm going to get an informed consent form for surgery (operation), and I'll talk to the patient. Can you help me write a doctor's order for the patient? Then get one."
Zhou Cheng looked at the patient's body shape again, and said, "Here comes a 12.5cm*75cm plaster cast, and three rolls of gauze."
There are two models of plaster width: 10cm and 12.5cm. This patient has a rather strong figure, so choose a wider model.
"Oh, good!" Du Yanjun was stunned and left.
It's just that when he was going out, Du Yanjun's forehead was slightly wrinkled, because he just had an illusion.
That is, when Mr. Luo Yun was diagnosing and treating patients with joint dislocations, it seemed that he was not as relaxed as Zhou Cheng is now.
And the explanation was extremely detailed, but I didn't catch it.
A somewhat weird idea popped up in my heart involuntarily.
Could it be?
Zhou Cheng's realm is higher than Luo Yun's?
But Du Yanjun immediately shook his head!
Determined: Impossible, this is absolutely impossible, how could such a thing happen?
How could I have such an idea?
……
After Du Yanjun finished prescribing the doctor's order, printed the QR code, and asked the patient to scan the code to pay, he took the gypsum polymer material from the material room and prepared to go to the operation room.
Luo Yun wandered back to the department at some point and saw Du Yanjun holding a plaster cast, so he knew there was a patient in the operating room.
He whispered, "Yan Jun, come here."
Du Yanjun looked in the operating room, Zhou Cheng was talking to the patient, so he compared the plaster in his hand to Luo Yun.
"Come here first." Luo Yun continued to wave.
Du Yanjun also went to see Luo Yun first. Anyway, Zhou Cheng only talked with him, so the operation must have to wait for a while.
When he came to Luo Yun, Du Yanjun was very polite: "Mr. Luo, Brother Zhou Cheng asked me to give him a plaster."
"What kind of patient is there?" Luo Yun asked Du Yanjun.
I was afraid that Zhou Cheng would reset the fractured patient with his hands and get out again.
Du Yanjun didn't think much of it, so he replied directly: "Oh, it's a patient with a dislocated calcaneal joint."
A small question mark on Luo Yun's head.
???
Dislocated heel joint?
Is there really such a patient here?
I was just talking in the morning!
"By the way, Teacher Luo. Do you want to take a look?" When Du Yanjun said this, he turned his body to make room for Luo Yun.
Just the moment he turned his head, he missed the wonderful scene on Luo Yun's face.
I nia!
Do not go do not go.
Get away now.
"I'm not going, I still have something to do." Luo Yun replied firmly.
The fuck is really afraid of something, heel joints, or this kind of dislocation of small joints that are not big joints!
It's really not that we are not strong enough from the joint surgery class!
In fact, most of the patients in this area are foot and ankle surgery and hand surgery patients, and we don't have so many opportunities to contact them.
I'll go and see, I'll go and see a twist.
If Zhou Cheng asked me to reset my teaching method, how embarrassing would that be?
At this time, Zhou Cheng also finished his conversation. Maybe he didn't wait for Du Yanjun, so he walked out of the operating room and headed towards the direction of the nurse's station for the first time. But while walking, he turned his head to inspect Du Yanjun, and found that Du Yanjun was talking to Luo Yun.
Zhou Cheng sighed inwardly, and decided to tell Luo Yun, then turned around and walked towards the two of them, explaining, "Mr. Luo, there happened to be a patient with the dislocation of the calcaneus joint that you mentioned this morning. Let's take a look together."
Luo Yun's limb muscles trembled involuntarily.
This Nima.
Immediately, I wanted to turn into a divine beast——
Ya butterfly.
Chapter 44 Chairman Zhou Cheng!
Be reasonable!
In the morning, Luo Yunzhen deliberately chose a special one just to beat Zhou Cheng.
How to say.
The joints that were particularly biased and stabbed were dislocated, to make it difficult for Zhou Cheng, to let him know that the sky is high and the earth is strong, and he didn't say that he would know it...
Zhou Cheng naturally didn't know what was going on in Luo Yun's mind at the moment, but he happened to meet him by such a coincidence, and Luo Yun was still talking to Du Yanjun.
I don't know what Luo Yun and Du Yanjun said, it's better to tell Luo Yun openly, if there is less gratitude, the value will be less.
A little more gratitude is not enough to get rich overnight and directly achieve some small goals.
Du Yanjun started to chime in again at this moment: "Yes, Mr. Luo, let's go and have a look together?"
"Brother Zhou Cheng also wants to see your hand reduction technique. He just told me that it's a pity he hasn't seen it."
Du Yanjun was good at flattering, just right, not only caring about Zhou Cheng's feelings, but also showing his own thoughts.
Du Yanjun hadn't heard much about the dislocation of the cuboid joint, and he even mispronounced the name of the cuboid bone, which made him feel a little embarrassed.
Then Zhou Cheng had to do manual reset.
Then if you make a problem, don't you still want your teacher to wipe your ass?
Letting Luo Yun take care of it can reduce similar risks. This is also a kind of respect for the teacher as an apprentice.
If he hadn't seen Luo Yun, then Du Yanjun wouldn't have dared to make a small report, but he happened to meet him...
Luo Yun really felt that he didn't read the almanac when he went out today!
Why do you have to worry about whether something will happen to Zhou Cheng in the clinic? Will he suddenly have a life-saving emergency, so he just went back to the department after a meal?
Wouldn't it be nice to stay at home and lie down for a while?
But now that the knife is on his neck, no matter what, he can only bite the bullet and go for it.
"Okay then, let's go and have a look together." Luo Yun had no choice but to think.
Otherwise, just shirk the patient's need for surgery later, and throw the patient directly to Cai Dongfan.
Or send the patient away.
Du Yanjun smiled and said, "Hey, Mr. Luo, it's like this. Just now Brother Zhou Cheng has seen the patient's X-ray and CT, and also had a physical examination."
"There is dislocation, no fracture, and the dislocation is about 0.4cm from the anterior edge of the calcaneus, which is within the indication range of manual reduction..."
Luo Yun's feet froze, it was undetectable.
Du Yanjun welded the back door shut!
I can't get out of the car.
He looked at Du Yanjun with an extremely complicated expression.
Can you not speak?
Are you my nemesis?
Zhou Cheng handed the surgery (operation) consent form signed by the patient and the emergency medical records to Luo Yun, and then said: "Ms. Luo, the basic situation is similar to what I recorded. If you are worried, we will check it again. Clarify the diagnosis a little more."
Luo Yun took emergency cases.
Good guy, very standard emergency case writing format, simple medical history, characteristic positive test results thrown up!
Depending on the amount of touch, one is not bad.
Moreover, the results of X-ray and CT examinations have also been sorted out, and the diagnosis is certain.
Moreover, the patient himself also wrote in the medical record that he was aware of the risks associated with manual reduction and surgical reduction, and requested manual reduction!
"You don't need to read it again, just watch the patient's film." Luo Yun pursed his throat at that time.
This can only be rushed to the shelves, let's take advantage of the time to watch the film and think about how to deal with it.
If it really doesn't work, you can only use secret techniques.
The superior is the principle——
Just fucking need surgery, I said.
What are you doing.
……
Both Zhou Cheng and Du Yanjun stood aside obediently, waiting for Luo Yun to read the film.
The patient also heard Zhou Cheng and Du Yanjun say that Luo Yun was their superior.Immediately and very patiently waiting for Luo Yun to read the film, after all!
Zhou Cheng, who sounded so confident and reliable just now, only obeyed Luo Yun's orders.
Then this Dr. Luo must be more reliable.
But after waiting for two to three minutes, Zhou Cheng and Du Yanjun didn't wait for Luo Yun to speak.
And Zhou Cheng noticed that the forehead lines above Luo Yun's upper eyelids were slightly wrinkled.
He almost understood Luo Yun's difficulty at the moment.
Calcanoid joint dislocation, this disease is not common!
And it belongs to the fringe disciplines of fringe disciplines.
What's going on, the joint surgeon thinks that he is in the field of foot and ankle surgery, so he doesn't want to study this disease!
The foot and ankle surgery thinks this should be a matter of joint surgery, and mostly ignores it.
There must be a way to treat it, and the operation is over.
If manual reduction is really required, in fact, not many people can strictly grasp the indications for manual reduction and surgical indications for this disease.
Zhou Cheng knew the situation himself, so he said, "Mr. Luo, why don't I reset this patient? You stand aside and help me stabilize?"
"I have learned from you for so long before."
Luo Yun's eyes lit up when he heard this, but his heart froze again!
Zhou Cheng didn't say this for him, nor for Du Yanjun, but for the patient.
only?
Zhou Cheng, you really dare to reset it?
This method of resetting the heel joint is no joke.
Look at Zhou Cheng.
He straightened his voice and asked: "Do you want to try it? This is not easy to reset!"
Du Yanjun was a little confused, when did Zhou Cheng learn from Luo Yun for a long time?
This is not close at all, and Zhou Cheng is a little too ignorant, in front of Luo Yun, he still needs to reset his hand?
Then why did you call Luo Yun over?
He looked anxiously at Luo Yun, hoping that Luo Yun would not agree to Zhou Cheng's request.
"En." Zhou Cheng nodded very seriously.
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"Ms. Luo, you can be my assistant. Help me hold down the patient's calf, just do the volley as usual." Zhou Cheng nodded and entered the state again.
Dislocation of the calcanoid joint requires the positioning of the tarsal bones of the entire foot, so it is best to place the patient's feet in the air. In fact, it is also possible to let the patient sit on the head of the bed and volley naturally. It's not good for him not to intervene.
And Luo Yun intervened, so it was Luo Yun who took him.
Saying it makes others feel better.
"Thank you, Dr. Luo, thank you, Dr. Zhou." The patient immediately lay down. Prior to this, Zhou Chengcheng explained to him the position of manual reset.
Zhou Cheng's plan at the time was to let Du Yanjun be his assistant.
Therefore, the patient was directly told to do manual reduction while lying down.
Du Yanjun immediately followed Zhou Cheng's instructions, but he didn't know what to do in his heart.
But as soon as he got started, he saw Zhou Cheng quickly approaching the patient, and said, "Hello, don't be nervous, Dr. Luo and I are going to reset the manipulation for you, please bear with me a little bit." what."
"Don't worry, don't be nervous, we will start in about 2 minutes, and now I will give you some manual release."
The patient immediately felt confident, and replied: "Oh, okay, don't worry, don't be nervous."
The muscles also began to relax slowly, there are still 2 minutes left.
However, when Zhou Cheng felt that his muscles were completely relaxed, he directly lied to him, taking advantage of his unpreparedness, he immediately exerted force with both hands at the same time!
After hearing only a click, the foot that was originally dislocated and could not be stretched back!
Zhou Chengcheng broke it into a back extension.
The patient's upper body bounced, and his foot almost kicked up to Zhou Cheng's chin.
Zhou Cheng immediately backed away and said, "Mr. Luo, it should be reset successfully. Would you like to check?"
Luo Yun was in a daze.
Is this TM really reset?
How did you reset it?
What Zhou Cheng said in the morning, wasn't he talking nonsense?
I used a crutch to reset the joint with dice, Zhou Cheng really dared to do it!
I can really do it.
Hearing Zhou Cheng's words, he also knew that Zhou Cheng was saving face for him.
He took a warm look at Chairman Zhou Cheng in his heart, stepped down when there was a step, and immediately performed plantar flexion and dorsiflexion on the patient's range of motion, and everything was fine.
And the patient didn't react too far away.
There are two main symptoms of joint dislocation, one is pain after dislocation, and the other is deformity or protrusion visible to the naked eye.
Now the deformity and protrusion have disappeared and the pain is greatly reduced.
It can basically be confirmed that the reset is successful, of course, the final X-ray follow-up visit is still needed, and the final control will be strictly controlled.
Then he patted the patient's leg and said, "Don't worry, don't worry. It doesn't hurt anymore, and it doesn't hurt when I move like this."
"Manipulative reduction must be painful for a while, unless anesthesia is administered."
"Put a plaster cast on later, um, rest about two or three." Luo Yun suddenly realized that he seemed to be unsure how long to rest, and was going to say three months.
Zhou Cheng quickly took over the words: "Ms. Luo, I'm not you, just be on the safe side and take a six-week rest. When it comes to putting plaster on later, it's just me and Yan Jun."
"Will you come again when you watch the re-examination film later?"
"Okay." Pretend to the end, even though it was fake, but Luo Yun almost took it seriously.
mainly.
Comfortable.
Chapter 45 It's not too late!
Luo Yun left proudly, and the patient was still saying thank you behind his back.
At the same time, in my heart, I was feeling emotional.
Almost fucking died.
The thunder that was released from the hospital this time turned out to be a ruthless character. It seems that I will have to read more books in the future.Otherwise, it would be embarrassing to be yelled by Zhou Cheng left and right by Mr. Luo.
"It's much more comfortable, thank you, Dr. Zhou." The patient's own physical sensation is pain.
When the joint is dislocated, the activity will aggravate the pain, but the pain itself should not be underestimated.
pain!It is the fifth major vital sign after blood pressure, respiration, pulse, and body temperature. You will know how unpleasant it brings people.
When the pain is severe, as long as there is a slight relief, you can get a great sense of pleasure, and even feel that as long as you are not sick or in pain, you are the greatest happiness in life!
(I hope that my book friends will not have such an experience. Those who have had this experience will never repeat it again.)
"Yan Jun, do me a favor. Keep the patient's foot in plantar flexion, and I'll wet the plaster." Zhou Cheng didn't answer the patient's words, but hurriedly asked Du Yanjun to come over to help, increasing his sense of participation.
Hearing Zhou Cheng's words, Du Yanjun slowly woke up from the shock, holding back the mixed feelings in his heart.
He quickly smiled and said, "Brother Zhou Cheng, I'll just go with the wet plaster."
Then I immediately tore off the outer packaging of the polymer material, and after comparing the length, I used the bandage scissors necessary for orthopedic residents in the left pocket of the white coat to trim the length and edges.
The current gypsum has abandoned the previous gypsum and is made of polymer materials.Simple and strong.
Moisten it with room temperature water or warm water to speed up the setting time of gypsum...
Zhou Chengcheng did not compete with Du Yanjun for the operation of plaster external fixation.After putting on the plaster, instruct the patient's companion to continue to maintain the plantar flexion position. After the plaster solidifies, continue to write the explained items into the doctor's order, and then give it to the patient.
About seven or eight minutes later, the patient and his companion thanked Zhou Cheng several times in wheelchairs and left.
Once again, I would like to mention a little thank you value, reaching 4 points, which is one step closer to the 20 thank you points needed to open the next dungeon.
Then I hurried back to the doctor's lounge for dinner.
……
After eating, Du Yanjun smiled and asked Zhou Cheng: "Brother Zhou Cheng, where did you learn this technique of reset?"
"Amazing."
This was from the heart, although Du Yanjun didn't want to admit that he was better than Zhou Chengcai, but Zhou Cheng did something that he didn't even know, it was really amazing.
Moreover, the sense of operation and acquisition of joint dislocation reset is really strong.
There is a kind of immediate effect, the patient's front foot is still in pain when he comes in, but with just a pair of hands, he can rejuvenate and let the patient go out gratefully.This made Du Yanjun feel the charm of joint surgery...
"It's mainly reading books, and then looking for information on the Internet, piecemeal." Zhou Cheng's words are not true.
The main reason is that at present, there is no book that explains in detail the manual reduction of all joint dislocations. His perfect-level manual reduction is based on the manual reduction of fractures (perfect-redefined) and the perfect-level limb anatomy experience. refactored.
In order to prevent Du Yanjun from wasting time looking for related books.
That's all Zhou Cheng could say.
"That's it." Du Yanjun immediately felt rather regretful, otherwise, he would have to buy a copy anyway, and study it carefully.
It's just that Zhou Cheng can learn like Zhou Cheng through such piecemeal learning. Zhou Cheng must have worked hard.
No wonder Zhou Cheng used to yo-yo as soon as he finished his work. I thought Zhou Cheng was lying flat at home, but Zhou Cheng had been working hard on reading and studying.
Du Yanjun didn't ask if there were related books, so Du Yanjun was going to find out from Luo Yun.
When Du Yanjun knocked on the door of the director's office, he found that Luo Yun was inside, using the computer in the director's office to check the information on the dislocation of the heel joint.
When Du Yanjun saw this scene, his heart trembled slightly.
What Zhou Cheng said was actually true. It wasn't that Mr. Luo Yun gave him a small lesson in private, but Zhou Cheng learned it piecemeal by himself.
Maybe Mr. Luo Yun didn't figure out the dislocation of the calcaneal joint just now, otherwise, he wouldn't need to look for relevant information now.
"Yan Jun, what's the matter?" Luo Yun didn't completely avoid Du Yanjun, but also wanted to beat Du Yanjun.
Even he has to keep learning, why don't you, Du Yanjun, learn?After following me for so long, I don't even understand how to reset the shoulder joint, so it's not embarrassing, right?
Du Yanjun quickly threw away what he wanted to ask at first, and said instead: "Mr. Luo, I'm sorry. Before, my vision was too narrow."
Hearing what Du Yanjun said, Luo Yun scratched his chin, and said bluntly, "What? Now that you see Zhou Chenghui's stuff, you don't know how to do it yet, so you start to worry?"
"You don't even read books, how could you?"
"I'm sorry." Du Yanjun lowered his head slightly.
Luo Yun sighed, but still felt that there was no need to be so harsh on Du Yanjun.After all, Du Yanjun is Cai Dongfan's student, not his teacher's student.
Cai Dongfan is a trauma specialist, and Luo Yun's own postgraduate supervisor is a professor of joint surgery. How can students not follow the teacher's pace?
"You don't need to say sorry, it's never too late to start studying."
"The manipulative reset of the calcaneal joint performed by Zhou Cheng today is relatively rare, and the indications for this kind of dislocation manipulative reset are actually quite harsh."
"Even I don't have much exposure to this kind of dislocation, let alone any experience."
"You don't need to worry about these corners and corners. If you want to read a book, I can suggest you to buy a book..."
Five minutes later, Du Yanjun came out of the director's office with a happy smile.
I quickly placed an order on Jingdong, and the books I bought will be delivered tomorrow morning.
Then, he slipped into the doctor's lounge again, and said enthusiastically, "Brother Zhou Cheng, haven't you rested yet?"
"Lie down and rest for a while, I'll wake you up later if you have something to do!" The shelf was lowered slightly.
Zhou Cheng asked Du Yanjun, feeling a little complicated: "Aren't you going to sleep?"
"I don't sleep, I just read the literature, and I'm going to prepare for the opening of the graduate student soon." Du Yanjun found a very formal reason.
"Oh. Then you should be busy." Zhou Cheng wrapped the quilt and narrowed his eyes.
It is Du Yanjun's business to start the topic. He is a graduate student and has the requirement to publish an article after graduation.
Gui Peisheng doesn't need to ask questions?
Besides, even if you open a question, who will care what question you ask?
When you write articles, you also belong to the level of whether you like to write or not. The superior doctors don't bother to care about what articles you write.
However, this is a reality.
But I still have to write articles, otherwise, there will be a blank in academics, and I will suffer a lot compared with these graduate students.
Zhou Cheng already has a direction and an idea, but it is extremely difficult to implement it, and he is just a trainer.
If you want to do something in the department, you also need to fight for opportunities step by step.
To put it simply, the patients in the department belong to the director, and the data also belongs to the director. The director can waste his time not collecting data, and can not do research projects and research, but you can't do these things in private under the supervision and training.
It can only be done with their consent...
Difficult.
Chapter 46 Steady Progress
When I was on duty in the afternoon, I routinely admitted two emergency fracture patients. Since Zhou Cheng was on duty, I accepted them into Cai Dongfan's group and became Cai Dongfan's patients.
The regulations in the department are like this: Whichever group of doctors is on duty, the patients admitted that day will be under the control of that group.
So the number of patients in the group depends entirely on luck.
Fractures can be divided into open fractures and closed fractures according to whether they are connected to the outside world.
To put it simply, if the skin is broken and bleeding, it is an open fracture, and if it is not, it is a closed fracture.
Therefore, when many doctors are on duty, the first thing they ask a patient who has a fracture is to ask: Is there blood.
In fact, he was asking if he wanted to go on stage.
They are all closed fractures, so there is no need to go to the emergency department for treatment.Luo Yun was lonely in the department in the afternoon, and he slipped back home at the normal off-duty time.
Although he is in the second-tier class, he doesn't have to guard the department 24 hours a day.
Zhou Cheng originally planned to ask Du Yanjun to go back too, but Du Yanjun just refused to go back, and stayed with Zhou Cheng until eight o'clock in the morning of the next day, when the shift ended!
Today is Saturday, which is a weekend holiday, and there are no elective surgeries in the hospital.
Luo Yun also knew that Zhou Cheng and Du Yanjun were on duty today, so he rushed to the department at eight o'clock early, and took the two of them to check the room. Check to perfect it.
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In the evening, a patient with a fracture came and was admitted to the hospital.
Don't think that there are very few car accidents now. In the emergency department of the hospital, they can be encountered almost every day, and they get together...
In addition, the postoperative patients were adjusted.
At 08:30, the ward rounds were over before Zhang Zhengquan even showed up in the department.
After checking the ward, Luo Yun asked Du Yanjun to send a message to Zhang Zhengquan, asking him not to come to the department. For his patients, Zhou Cheng and Du Yanjun were responsible for adjusting the doctor's orders and changing the medicines, and then they all went to bed early. Go back and rest.
Of the three patients, one of them happened to be assigned to each of them. Zhou Cheng and Du Yanjun finished writing the admission medical records last night.
So at ten o'clock in the morning, I finished handing over the shift with the next doctor on duty, said goodbye to Du Yanjun and went home.
Zhou Cheng chose to go back on foot.
On the way, Zhou Cheng was actually a little tangled in his heart.
Because several patients admitted to the hospital yesterday, although according to the current guidelines, surgery is necessary, but in fact, he can achieve good fixation and reset for the patients through manual reduction, which can completely avoid open reduction and internal fixation of surgery.
But there is no way. The formulation of the guidelines was formulated by an expert group invited by the Huaguo Health Committee.
It was Zhou Cheng himself who thought things too well before.Although manual reduction of fractures is a degraded operation.
However, to go beyond the scope of surgical indications specified in the current guidelines to perform manipulative reduction on patients will suddenly raise the level of surgery, which belongs to new research and new surgical methods.
You must have the rank of chief physician to take the lead.
In the words that Luo Yun reminded him before, this layer of meaning was actually hidden.
There are not many trauma patients admitted from the outpatient clinic, and those who can be admitted from the outpatient clinic are extremely complicated, and the general director does not want to admit them.Most of those infected and patients with various complications were sent to the three affiliated hospitals of Shonan University.
As a result, it was difficult for Zhou Cheng to open his mouth to discuss with Cai Dongfan and Director Yan Haihan the topic of exploring the indications of the 'new' fracture reduction technique in the department.
This is actually a very influential topic, but it is not suitable for the current No. [-] Hospital, nor is it suitable for the current Zhou Cheng.
If you want to do this project, you have to re-evaluate the surgical indications of the current inpatients and hospitalized patients, and the department with a small number of patients will shrink even more.
The fractured patients who were finally encountered accounted for 70.00% of the surgery volume in the department. Zhou Cheng took a look at the fractured patients in the department. If measured according to his own standards, at least 40.00% of the patients could be manually reset on the spot discharge.
This is smashing the jobs of the chief physicians, can they agree?
Yes, not one or two.
Therefore, it is obviously quite unrealistic to reset the fracture by sitting up in the department.Unless Zhou Cheng can get the authorization, or Cai Dongfan and Yan Haihan are more open and open to him very openly!
But Zhou Cheng is just a resident doctor, so ordinary that he couldn't be more ordinary.
"Oh!" Zhou Cheng sighed, feeling that he was thinking too much.
Meals have to be eaten one bite at a time, and the road has to be walked step by step.Although I have mastered the redefinition level of fracture manipulation, others have not. To really realize the promotion, even if I make the standard myself, it will be a long-term thing.
What's more, the existing indications for fracture surgery are accumulated after years of clinical experience, so it is naturally not excessive medical treatment.
It is a fracture treatment guideline formulated under the current situation and based on the existing medical level and comprehensive consideration.
After all, not every doctor, every practitioner is the director from the beginning, and every hospital is the top hospital in Shanghai or Kyoto. Naturally, it is impossible to make a one-size-fits-all...
However, Zhou Cheng also considered an alternative plan, which could speed him up to start the project ahead of time.
That is to expand the volume of business in the department. For example, if you can carry out open reduction and internal fixation of fractures with small incisions, there must be a lot of patients coming here, and there will be more operations.
There are no more patients in the department.
It is the right way to follow the trend and do the manual reset of some simple fractures.Moreover, although open reduction and internal fixation of fractures with small incisions is also a new field and a new surgical method, it is enough.
If the No. [-] Hospital has mastered this kind of operation, it will be ahead of several affiliated hospitals of Shonan University in this field, and the number of patients it can attract is quite a lot.
Minimally invasive and small incisions are now the general trend, but the current progress in this field is not deep.
After thinking about this, Zhou Cheng understood that he still needs to develop the existing fracture simulation copy.
A plan must be written in detail.
Tomorrow and the day after tomorrow are both weekends, and there are not many things in the department. It is necessary to plan and study carefully how to start, so as to achieve a certain breakthrough in open reduction and internal fixation of small incision fractures.
Back home, Zhou Cheng checked the relevant literature. With a proficient level of medical English skills, reading the literature is no longer a problem. Except for a few medical terms that need to be translated, the rest are quite comfortable to read.
After searching around, there is not much to gain. At present, there are corresponding applications in the tibial plateau, but there are very few case reports.
For fractures in other parts, the traditional and safe open reduction and internal fixation is still used at present.
Surgery pays attention to the field of view, the wider the field of view, the smoother the operation process and the better the effect of the operation.
Seeking progress while maintaining stability is a necessary step in medicine.
……
Chapter 47 Correct usage of emulator?
【Please select the skill or material you want to start simulating. 】
【1. Experience in local anatomy of limb bones and pelvis (perfect), 2. Interpretation of limb muscle anatomy and anatomical muscle strength (perfect), 3. Medical English (proficient). 】
Back home, Zhou Cheng couldn't wait to start a new round of simulation.
This time, Zhou Cheng changed his mind slightly.
The research progress of small incision open reduction and internal fixation is memorized content, which exists naturally after being saved, and can be owned without being the skills and materials initially carried.
This can save a carrying slot, otherwise, Zhou Cheng would have to choose it.
He feels that the previous few simulations may be the perfect skills in other aspects, which constrains thinking, so the progress of open reduction and internal fixation of fractures with small incisions is slightly slow.
Of course, basic anatomy is mandatory.Especially the interpretation of limb muscle anatomy and anatomical muscle strength.
After going through the previous several simulations, although Zhou Cheng did not acquire the skills, he probably understood an essential feature of open reduction and internal fixation for small incision fractures.
Small incision fracture open reduction and internal fixation, in fact, strictly speaking, belongs to the fusion skills of surgical operation and manual reduction.
It is an improvement of open reduction and internal fixation of fractures, and a supplement to manual reduction of fractures.
Strictly speaking, it belongs to the field of surgery, but this surgical method is different from traditional surgical methods in that the incision is small and the field of view is small, which is another level of incomplete manual reduction.
Only with such an interpretation can a better choice of starting materials for simulations be made.
Medical English (proficiency) must be carried.During the dungeon simulation process, in fact, the simulation is also a lifetime, just a lifetime with a fixed direction.
Therefore, during the simulation process, it is also very important to read the literature and understand the research progress in the simulation world.
【You are just a resident doctor, but you are a resident doctor with a dream. You know very well that what you want to do is to seek a breakthrough in traditional open reduction and internal fixation of fractures. 】
【So, after you completed the training with pride, you rejected the hospital's invitation to stay in the hospital and went to work in a private hospital in Guangzhou. 】
【You plan to save a sum of money first, and use it for your study tour. 】
This is what Zhou Cheng thought about before starting the simulation.
The simulation copy, in the process of simulation, also needs to settle down, etc. Although you can forcefully insist on doing one thing, but in this way, in the simulated life, it will not go smoothly. In the simulated world, there will be difficulties Pressure from all sides.
Therefore, it is more important to earn some money first, and then to spend money.
Moreover, Zhou Cheng also changed his thinking, he didn't pursue to achieve a skill overnight, he got the skill first.
However, obtaining a new technique is actually not that simple.If it is just a small part, open reduction and internal fixation with a small incision is very simple, and it is enough to simulate it two or three times.
It's just that if you just use a small incision to get open reduction and internal fixation for a certain local fracture, and you are satisfied, then I'm too sorry to get this simulated copy.
Zhou Cheng hoped that he could obtain a new technique with greater applicability, so that it would be more convincing.
[Because you have a perfect anatomical basis, you were soon recognized by your superiors in the private hospital where you work.The official operation of the main knife began. 】
[With the help of perfect anatomical understanding, you will soon be proficient in the removal of internal fixation devices after fracture surgery and open reduction and internal fixation of fractures. The level of chief physician. 】
【Three years later, you were successfully promoted to attending physician.And you have made new breakthroughs in open reduction and internal fixation of fractures and reached the proficiency level.At the same time, you have also achieved certain attainments in the manual reduction of fractures, reaching the proficiency level. 】
[You have gained a lot of word of mouth, and you have gained a certain reputation in the area where you work, so there are a lot of patients who seek treatment. 】
【Eight years later, you were successfully promoted to the deputy chief physician. The prefecture-level city where you work has already gained a great reputation. The unit where you work plans to train you as a star doctor in the hospital.The future looks bright. 】
[But you still haven't forgotten your original intention. After you had ten years of financial savings, you chose to resign, took your wife back to your hometown, and bought a house.And after leaving a lot of property to your parents and wife, you can finally travel and study freely. 】
【No. In 15 years, you visited all the well-known hospitals in the country. Because you have a lot of research experience on open reduction and internal fixation with small incisions, you quickly gained recognition in the industry and became famous in the circle. Li quickly achieved a certain status. 】
[You stay in the clinical research group of a well-known professor in Kyoto as an assistant, and you discuss the process and planning of the research on open reduction and internal fixation with small incisions. 】
【Your wife and your parents are proud of you when they learned that you stayed in Kyoto to work. 】
[No. 20 years, the research of your clinical research group has finally achieved a certain level of breakthrough, and has successively completed the applicability of small incision open reduction and internal fixation for tibial plateau fractures and calcaneal fractures, and the function after surgery In terms of recovery and complications, it is better and lower than traditional open surgery! 】
[In the industry, a new wave of trends has been set off. 】
[In the clinical research group you are in, the flow of patients has increased instantly.The college also sincerely invites you to be a staff member and give associate professor treatment. 】
[But you refused again, because you learned that the professor had given up the idea of continuing research, and you resolutely chose to resign. 】
[At that time, because you already had a high reputation in the industry, many teaching hospitals offered you an olive branch. 】
[You finally chose to return to the Affiliated Hospital of Shonan University, because your son is already in high school and your parents are old, and you feel that you should fulfill your family responsibilities...]
[You have a lot of authority, so you start to lead the research team yourself and start a new clinical research project. 】
[When you were 64 years old, you finally made a breakthrough in small incision open reduction and internal fixation for new fracture sites, and completed the entire system of small incision open reduction and internal fixation for femoral trochanteric fractures. 】
[You have acquired the skill, small incision open reduction and internal fixation (common-applicable to some special fractures)! 】
[The following year, you chose to retire and started to accompany your wife and children, and your grandchildren. 】
[But you have not quit the research field, you are still active in the field of scientific research communication. 】
[When you were 69 years old, you heard about the other side of the ocean, and once again made a breakthrough in open reduction and internal fixation with small incisions. 】
[And, in the following year, there was another good news of a breakthrough in Australia. 】
[Because you are old and your learning progress is extremely slow, you have no energy to travel around, so you continue to study at this stage sincerely...]
Chapter 48 world-class opening of analog copies
"Can it still be like this?" Seeing these lines of text, Zhou Cheng was a little surprised.
In Australia and the United States, new developments in open reduction and internal fixation through small incisions have also appeared.
If this is feasible, then?
It seems that he has found a new usage of the analog copy.
Perhaps this is the correct way to open the emulator?
[At the age of 84, you finally finished your studies in the United States and set foot in your hometown. One year later, you died without any illness. 】
[The simulation ends. 】
[Comprehensive rating: quite regrettable.You've made good headway in new territory, but you still haven't seen the whole picture! 】
[You can choose to keep one of the following! 】
【Skill: open reduction and internal fixation of small incision fractures (common—applicable to some operations)】
【Memory: Research progress of open reduction and internal fixation for small incision fractures. 】
【Experience: Experience in small incision fracture open reduction and internal fixation. 】
[Adventure: All the memories during this simulation.Adventures are consumable items and cannot be retained by the player. 】
After Zhou Cheng finished reading, a bold idea suddenly popped up in his heart.
Directly chose Adventure.
And, after 5 minutes!
As soon as the cooldown of the simulation dungeon ended, Zhou Cheng immediately started the dungeon simulation again!
【Please select the skills and materials to carry. 】
[1. Medical English (proficient), 2. Limb muscle anatomy and interpretation of anatomical muscle strength (perfect), 3. Adventure: all memories from the previous simulation. 】
【The simulation starts! 】
[Although you are currently just an ordinary resident doctor, recently, you feel that you seem to have awakened the memory of your previous life.In other words, you feel that you have more memories of a lifetime. 】
[According to the obsession in memory and your own ideals, you have an extremely bold idea. 】
[You copied all the research progress and details of small incision open reduction and internal fixation in your last life, and carefully kept them as notes.At the same time, you began to translate these memories. 】
【Relying on your solid anatomical foundation, after the regular training, you refused the request of the superior doctor to stay in the hospital. You asked your family for a sum of money and embarked on the road of study tour and lobbying. 】
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[You take your detailed research plan as a nomination certificate, hoping to find a clinical research group to cooperate with you. 】
[But because you have no academic qualifications, no reputation, and no previous foundation, you spent three months visiting most teaching hospitals in China, but failed to get attention. At this time, your savings have been spent. 】
【Your parents persuaded you to work early, but you got another sum of money by pleading with them, and you went overseas. 】
[You went to the Trauma Research Center of the Mayo Clinic, and you made an appointment with the most famous professor of trauma surgery. 】
[When you met with the professor, you shared your notes and research plan. He was surprised by the project plan you made, and after a more in-depth communication with you, he invited you to be a member of the clinical research group Partner. 】
[Because of very detailed and systematic research planning and treatment experience, in the second year, your research group published the first article on small incision open reduction and internal fixation of the tibial plateau, which also attracted international attention. There was quite a stir. 】
[In the same year, you successfully applied for graduate qualifications.And, because of your contribution to the clinical research group.You got a nice reward, you sent money home, and you explained the status quo. 】
[Although your parents are reluctant to let you go in a foreign country, they also hope that you can spread your wings and fly, and stop persuading you to return to China. 】
[In the fifth year, your research group once again published the application of small incision open reduction and internal fixation in calcaneal fractures and femoral intertrochanteric fractures, directly opening the new field of small incision surgery for fracture trauma. 】
[Driven by the instinct of love for beauty, a new trend of open reduction and internal fixation of small incision fractures has been set off all over the world.As a leader, you have eaten the first crab, and your research group has created a small incision open reduction and internal fixation fixation equipment company, and you have realized the freedom of wealth. 】
[In the same year, you received open reduction and internal fixation of fractures (common—applicable to partial fractures). 】
[In the tenth year, because of the global wave of research on open reduction and internal fixation of fractures, there have been a lot of corresponding progress.So you resolutely withdrew from the clinical research group and started your study tour around the world. 】
[Because you are one of the founders of open reduction and internal fixation through small incisions for fractures, many clinical research groups have warmly welcomed you and communicated with you enthusiastically, hoping to get your support give pointers. 】
[There are also many large clinical research groups that sincerely invite you to become a research consultant, but you have refused. 】
[You start to sort out the emerging and existing theories of small incision open reduction and internal fixation, hoping to unify these theories to a corresponding degree. 】
[No. 30 years, with your unremitting efforts, the first monograph was thoroughly integrated at the World Federation of Trauma Surgery: Routine development of small incision open reduction and internal fixation and postoperative rehabilitation standards . 】
[In the same year, you got the skill: small incision open reduction and internal fixation (skilled)]
[The next year, when you returned to Huaguo, you immediately received invitations from hospitals in Kyoto, Shanghai, etc. that you had applied for but were neglected. 】
【You finally returned to Shashi, began to enjoy your old age, and began to organize further research and development plans for small incision open reduction and internal fixation. 】
[It's just that the current skills have reached a bottleneck period. It is very difficult to make further progress. You have spent your entire life and still have not made any breakthroughs. 】
[At the age of 80, he died without a disease! 】
[The simulation ends. 】
[Comprehensive score: perfect.Medicine belongs to the world, the object of medicine is patients, and the fundamental purpose of medicine is to cure diseases and save lives!The advancement of medicine should be the driving force of the whole world. 】
[You can choose to keep one of the following! 】
[Skills: Open reduction and internal fixation of small incision fractures (skilled)]
"It's doable!" Zhou Cheng laughed happily after reading it.
Yes, Zhou Cheng summed up the law, that is, since in the simulated copy, the simulated life needs to settle down!
So, why can't you borrow the power of the whole world to help me carry out research together?
Everyone researches together, I will be the opener, and then I will be the matchmaker of the research, so that I can achieve higher and faster breakthroughs.
Hua people are very smart, but in the whole world, there are definitely not only Hua people who are smart geniuses.
In this simulation, Hua Guo only completed the research on small incision open reduction and internal fixation of [-]% of the long bones of the whole body despite the backwardness of the research, which proves this point.
However, this is already very powerful.
Even the United States, with its own blessing, only completed 20.00%, and it also took the lead.
It's just a pity that no one believes my own nomination certificate...
However, I hope that is only in the simulation, not the reality.
Zhou Cheng was not in a hurry to wait for the cooling time of the third simulation copy, and fell asleep happily...
Chapter 49 Simulation Occult - I don't want to try!
Just after the early morning of Monday, Zhou Chengcheng put down the notebook in his hand, closed his eyes slightly, and recalled the upcoming simulation process again.
After about 5 minutes, Zhou Cheng's eyes opened, and he said silently.
[Bring initial materials: 1. Medical English (proficient); 2. Small incision open reduction and internal fixation of fractures (proficient); 3. Limb muscle anatomy and interpretation of anatomical muscle strength and deformation (perfect). 】
After going home and lying down yesterday, Zhou Cheng went through four more simulations.
For these four simulations, even if Zhou Cheng turned on the correct usage of the simulator, he chose to announce the small incision open reduction and internal fixation early, and then borrowed the power of trauma surgery all over the world.
It is still only to improve the proficiency of small open reduction and internal fixation of fractures from proficiency to proficiency.
During these several simulations, the biggest constraint was that no one believed it. Basically, in the simulated world, it took several years of wandering, or a long time of lobbying, before the real upsurge of research on small incision surgery began.
Moreover, it was Zhou Cheng who showed a certain two small incision surgical techniques in the research group, and collected various data and materials after the operation in detail, and successfully published them in an article, which aroused a lot of attention. No small attention from the industry.
The small incision surgery is different from the traditional open reduction and internal fixation of fractures.
Traditional fracture surgery has been developed and perfected in reality and has reached a certain height.Therefore, Zhou Cheng only needs to start learning step by step and accumulate slowly.
reach the level of perfection.
Surgery with small incisions is not available in the real world, and the simulated replica is based on the real world.
It is equivalent to Zhou Cheng having to complete the whole process from scratch to perfection in the simulated copy, which is quite difficult.
Therefore, for this simulation, Zhou Cheng intends to change his thinking and strategy again to see if it works.
[Start simulation! 】
[You are just a resident doctor undergoing regular training, but you have very profound surgical skills. 】
[You have the ambition to lead a discipline and break the shackles of existing surgery. 】
[But you didn't show too much, you started to inquire about the news in the hospital. 】
[Two days later, from your colleagues in the department, you found out about the girl who can save you effort, so you also participated in the attacking army. 】
[One month later, you finally took it down with your handsome 'masculinity'! 】
【Your girlfriend suggested that you take the postgraduate entrance examination, and you agreed to her. 】
That's right, this is the unusual path that Zhou Cheng wants to take. He has to figure out the project as soon as possible, and it's not the kind of asking for other research groups, but setting up a research group by himself.
Prior to this, Zhou Cheng had chosen various methods such as going directly to major domestic hospitals and submitting certificates abroad.
But still not recognized.
He also chose to directly shine in the department, which shocked Cai Dongfan and others.
But Cai Dongfan and others simply believed in Zhou Cheng's idea of being able to work on the project, and they just regarded Zhou Cheng as a simple surgical tool.
Without him, working in the country, education restrictions are too severe.
Therefore, Zhou Cheng can only try, what kind of role is this girl/woman/woman who can make people work less hard.
But it's a pity that there is never real-world character information in the simulated copy, and most of them are replaced by a professor, a senior doctor, etc.
Then, Zhou Chengcheng was stunned.
[Four months later, you took part in the re-examination for graduate students, and you passed the re-examination line for graduate students of the Medical Department of Shonan University! 】
[Then in the re-examination, you successfully 'killed' 32 competitors who were 30-50 points higher than you, and became the professional graduate student of the year.At the same time, you have withdrawn from the existing regular training queue. 】
Oh my god, this is very scientific!
[In the first month after passing the re-examination, you successfully published an SCI article as the first author, and you knew nothing about the content of the article.But you have already met the graduation requirements. 】
Zhou Cheng: "..."
Is this called lying down and winning?
[In the second month after the re-examination, you went to the Second Affiliated Hospital of Shonan University to study clinically under the chair of a professor of orthopedics.And, in the second week after you entered the clinic, you had the opportunity to perform a minor operation. 】
Ok.
After the successful re-examination, he will go to clinical practice in the next month, and the second week of clinical practice.
Directly take the lead.
【Although your teacher was trembling about this, he still gave you absolute support and encouragement. 】
[Because you have surgery in the new field of proficiency, so in the process of the first fracture operation, you completely overturned your superior physician's prejudice against you.And let him open up new horizons, and start to sincerely discuss the surgical process and ideas with you. 】
[You have logically proposed the concept and project design of small incision surgery. 】
[Three months later, your clinical project was approved by the Provincial Natural Science Foundation, and received high attention from hospitals and departments. 】
I'm a crutch.
Provincial Natural Science Foundation of China?
[Because your project has been approved, your teacher has joined with many professors and members of the Hunan Provincial Medical Association to test your surgical level. You have obtained the right to develop new surgical methods in advance, and It is filed with the Health Commission and the medical department and scientific research department of the hospital. 】
[Your project has successfully passed the approval of the Ethics Society. 】
【Your operation design is progressing very smoothly. The patients who have passed through your hands have excellent postoperative recovery results. The operation time and hospitalization time are all better than traditional open reduction and internal fixation of fractures. 】
[The department you are in has begun to participate in your clinical projects on a large scale. 】
This is the bottom line.
Zhou Cheng sighed.
In the past few simulations, it took a few years at the shortest time to start participating in this research on a large scale.During the period, after all, we still have to convince the research team, and then get the right to be the chief surgeon, and then collect data and show the facts to the world.
but?
If you don't take the usual road, the road will be really unusual.
Great Mystery——
I think Dafa with less effort is really effective.
Because what Zhou Cheng lacked was just an opportunity.
[After half a year, you successfully published a high-quality sci article and became famous in the industry.The concept of small incision open reduction and internal fixation has been widely recognized by peers, and research has begun. 】
[You set up a clinical teaching group at the Affiliated Hospital of Shonan University to carry out online and offline teaching classes. 】
[Three years later, you successfully completed the subject of small incision open reduction and internal fixation for all long bones and some short bones in the human body!Since then, minimally invasive surgery has been separated and completely separated from hand surgery...]
Zhou Cheng: "..."
Well, in the simulated world, another unexpected direction of development appeared.
Minimally invasive surgery? ?
[In the same year, you married your girlfriend, obtained a Ph.D. from Shonan University, and were appointed as an associate professor. 】
Zhou Cheng: "..."
Ordinary people haven't finished their postgraduate studies for three years. In the simulated copy, they have graduated with a Ph.D.?
How about trying it in real life?
Chapter 50 Lying down is really fragrant
[Because of your academic and professional achievements, your father-in-law was promoted by Bole.Your girlfriend is also often praised by outsiders as a discoverer of rough jade. 】
[Outsiders think that you and your wife are like a golden boy and a jade girl, a match made in heaven. 】
【Your father-in-law and your wife no longer feel that you have a bad stomach or that you are talented. 】
【So I fully support your idea of starting a career, and understand your inner ambition to create a world-class surgery. 】
Ammmmm...
Sure enough, if you succeed, you will eat soft rice hard. Before you succeed, you will eat soft rice lying down.
Of course men have to be tougher, and they will be softer when appropriate.
Zhou Cheng is looking forward to the progress of the next simulation.
[Five years later, the orthopedics department of your unit has risen from No. 5 to No. [-] in the national hospital comprehensive strength ranking.At the same time, minimally invasive surgery was approved as a national key specialty construction project. 】
This is great.
This is really great.
The comprehensive strength ranking of individual departments in the country, all those on the list are capable of playing. For example, Jishuitan, Kyoto Third Hospital, Shanghai No.
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Although the orthopedics department of Shonan University is also very good, but if you want to sharpen your head and squeeze into the top five, you will have to chip your brains out...
And even if they open up a new field and new discipline in orthopedics, they can't take the first place, so you know how strong the comprehensive strength of orthopedics in other hospitals is.
That's really a tyranny.
But Zhou Cheng didn't think about it, but continued to look down.
[You started a new upsurge in discipline construction, and began to promote it to the world. Many foreign teams sent personnel to your clinical research group for further study. 】
【You are invited to many countries for academic exchanges and on-site teaching operations. 】
Gee!
Currently in Huaguo, although the competition among various disciplines is fierce, one thing that has to be admitted is that so far, apart from Huaguo's traditional medicine, the ceiling of clinical medicine is still abroad.
In the past, Huaguo went abroad to study abroad for advanced studies, or to visit scholars, but now it can be reversed.
Zhou Chengcheng felt quite refreshed watching it.
Zhou Cheng had participated in the biggest academic conference, which was the Orthopedics Joint Conference held in Shashi. He hadn't even been to the Provincial Orthopedics Annual Meeting. No one in the department took him there, and he knew that he wouldn't learn much if he went there.
International exchanges have surpassed a long series of high-quality conferences of different levels such as prefecture-level city, provincial, and regional joint conferences, and Huaguo Orthopedic Annual Conference. This is an honor that only very few experts and professors can get.
Yes, even if you are eligible to be invited to participate, to attend this kind of international exchange conference is a testimony of honor and strength.
There are not many people like this in Hunan Province.
The simulated world can go as a keynote speaker.
It's worth looking forward to.
[In the seventh year, you proposed that minimally invasive surgery should not be limited to the concept of fractures, and you proposed to combine minimally invasive surgery with sports medicine. 】
[In the tenth year, you proposed that the indications for minimally invasive surgery and small incision surgery can also be larger and wider. 】
[In the same year, you took your parents with you, hired a nanny to take care of them, and you lived with your parents in a villa.Your wife chose to resign, and wholeheartedly supports you in further academic advancement. 】
[No. In 20 years, under your leadership, you finally perfected the theory of small incision surgery, and made strict classification, definition, and standardization for it. 】
[You have obtained open reduction and internal fixation of small incision fracture (perfect). 】
[No.30 Five years ago, when you were about to retire, you led the development of a new department of orthopedics, minimally invasive orthopedics (a combined department of sports medicine and minimally invasive surgery). 】
[At the age of 60, you chose to retire honorably and spend time with your family wholeheartedly. 】
[Never touch clinical and scientific research again. 】
【When you were 89 years old, you died without any illness...】
[The simulation ends. 】
[Comprehensive score: perfect.What is simulated is life, in the simulated life, every choice of step may affect your final achievement! 】
[You can choose to keep one of the following! 】
【Skill: Open reduction and internal fixation for small incision fractures (perfect)】
After reading it, Zhou Cheng was a little stunned.
In order to make sure that he read it correctly, he deliberately re-read the content up.
I am very sure that I really broke the barrier from proficiency to perfection just this time.
damn it.
Occult - I don't want to work hard anymore.
Is it so fragrant?
Who is that girl?So much energy?
Not only did he successfully quit the regular training midway, but he also helped him get rid of competitors whose initial test scores were [-] to [-] points higher than his own. At the same time, he was able to get the operation permission so quickly.
This TM is a bit.
You know, before Zhou Cheng possessed several perfect-level skills, no one believed him when he submitted the application certificate and went on a study tour.
Why did you turn a corner like this and believe everything, and everything is feasible?
Moreover, the project fund can be obtained so quickly. With the project fund, plus a greeting, the hospital and departments pay attention to it.
You have the ability, this is not going to take off right away?
But after browsing around, Zhou Cheng didn't see anything about that girl/girl/woman/female!
Little information.
never mind!
Don't think about it, just get the perfect skill.This perfect skill is not comparable to the previous perfect skills. This skill is completely enough to open up a new discipline.
Minimally invasive surgery, awesome?
Of course awesome.
The current sub-specialties of orthopedics are generally divided into: trauma, hand surgery, flap transplantation, bone disease, joints, sports medicine, foot and ankle surgery, and general orthopedics.
But there is no such thing as minimally invasive surgery.
Of course, Zhou Cheng himself is the regular trainer of orthopedics, and now he has it.
Three perfect skills, so I am not a novice, but really know that this perfect skill is the existence that can open up a new discipline.
only?
How to bring it into play as soon as possible.
is a rather tricky issue.
The sooner it comes out, of course the better.
Do you want to learn from this simulation and find the person who can save you years of hard work!
As soon as possible?
Forget it.
A simulation is a simulation, that is, knowing that it has nothing to do with reality, so you can take a slightly extreme path.
If it were real, Zhou Cheng wouldn't dare to join in so carelessly.
If that person is so ugly that he has nightmares every night when he sleeps, then his life would be worse than death.
In case it is an old aunt who weighs three hundred catties.
Anyway, now that I have three perfect levels of skills, even if I suffer slowly in the future, I won't be afraid of running out of food.
Although the soft rice is delicious!
But one of the characteristics of a man can be soft or hard.
There are still two simulation opportunities left, and Zhou Cheng does not plan to use them for the time being.
Although Zhou Cheng has already figured out what the next goal is to overcome, it is a bit laborious to write down these strategies. The simulation of the difficult technique should wait until tomorrow when he wakes up.
That technique is definitely not something that can be imitated in a day or two.
……
Chapter 51 Man of the Day!
Time flies, and it will soon be Monday.
Monday is the beginning of the week, and the early shifts of each department in the hospital must be attended by the department director, head nurse, and group directors of each group.
This belongs to the meet and greet of the new week.
Zhou Cheng still got up early, 'very early' - arrived in the department at 07:30.
But the computer in the department has been occupied by someone without any accident.
The friends in my group all grabbed the computer.
Both Zhang Zhengquan and Du Yanjun were staring at the computer seriously, not noticing Zhou Cheng's arrival.
But Zhou Cheng intentionally or unintentionally looked at Zhang Zhengquan a few more times. After all, the person Zhang Zhengquan is chasing now can really save people from working hard for many, many years.
However, Zhang Zhengquan looked a little tired at the moment, and he didn't know whether he had caught up or not. Anyway, his face was not very good-looking.
Zhou Cheng didn't think too much about it.
If you don't have a computer, you can only go to the lounge to lie down, or you can pat someone on the shoulder awesomely.
Said: Get out of the computer and let the old man take a look?
No idiot would do that...
At [-[-, Du Yanjun came to the lounge and said, "Brother Zhou Cheng, it's time to take over the shift."
"Is it so early?" Zhou Cheng looked at the time, it was 55 minutes earlier than the previous 5[-].
"The others have already gone, what if Director Yan and the others arrive early?" Du Yanjun urged.
It seems that they want to make a good impression in the mind of their superiors. Although everyone arrived early, they will definitely not leave a special impression, but if you are the only one who does not show up, the superiors will probably remember you.
Zhou Cheng had no choice but to be dragged by Du Yanjun to the shift room to stand guard, waiting for the arrival of Yan Hanhan, Cai Dongfan and other chief physicians.
Soon, Pang Dingkun, Luo Yun from Cai Dongfan's group, Dong Qiansheng from Yan Haihan's group, and Zheng Xuanlin, the attending physician from Hu Ming's group, also arrived one after another.
When they entered the shift room, they saw a large number of bed doctors and intern nurses lined up neatly, and they even took a few extra glances.However, all three of them understood the reason for this scene. They just smiled and found their seats and sat down.
At 57[-, Cai Dongfan and Hu Ming walked into the shift room with a tacit understanding and sat in their seats.
Later than the head nurse and nurses.
In an instant, only Yan Haihan's seat was subtly left vacant.
Director Hu Ming looked at the time from time to time, shaking his head slightly, wondering what he was thinking.
At 59[-, Yan Haihan stepped on the door and opened the door.
Seeing Yan Haihan, the head nurse immediately said, "The nurse on duty is starting to take over."
The nurses on duty immediately began to review all the big and small matters on duty yesterday, including the weekend, including newly admitted patients and emergency patients.
However, Yan Hanhan, who entered the door, stretched out his hand and slapped his palm after entering the door, interrupting the nurse's handover!
Said: "Wait for a while about the shift, today I will officially introduce a person to you."
Said and made a please gesture.
A young man walked in from outside the door. He was not very old. He should be about 27-1.7 by appearance, [-]-meter-eight tall, tall and thin.
He wears black-rimmed glasses and has his hair cut into a small crew cut.
The white coat he was wearing was also obviously newly-collared, with the new clothes of the No. [-] Hospital in Shashi engraved on it, and there was no badge on it. I don't know why.
He also has a few pimples on his face.This seems to be quite spiritual, and it is difficult to see his specific age.
Yan Haihan said: "I solemnly introduce to everyone, this is Xiao Yang Yang Yifeng!"
"It's a student of Professor Ding from the Affiliated Hospital of Shonan University. He came to our department to guide him for half a year."
When Yan Haihan said this, Hu Ming and Cai Dongfan were stunned. Judging by the reaction, they definitely didn't know about this matter or this person.
However, Professor Ding of the Affiliated Hospital of Shonan University, even Zhou Cheng knew this person.
Doctor of orthopedics, first-level chief physician, second-level professor, doctoral student/post-supervisor, "Cheung Kong Scholar Distinguished Professor" of the Ministry of Education, famous doctor in southern Hunan, currently the head of the Traumatology Group of the Hunan Provincial Medical Association, and the chairman of the Trauma Specialty Committee...
Then suffix suffix suffix like this.
Basically, people who are traumatized in Hunan Province or even in the central and southern parts of China know Professor Ding's name.
That's all for Professor Ding, what the hell is this Yang Yifeng?
He is only a student of Professor Ding, so he came to the Eighth Hospital as a guide?
This is a bit too much.
The faces of Hu Ming and Cai Dongfan were a little confused.
Yang Yifeng walked in right away, and after a slight apology to everyone, he said humbly: "Director Yan is speaking too seriously. My name is Yang Yifeng, and my supervisor is Ding Changle. I'm here to study, and I'm currently a postgraduate student."
"In the future, I hope that all the directors, teachers and students here will give me more advice."
Yang Yifeng's introduction was right for the limelight.
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Strong academic style.
Everyone looked at him a few more times. After all, Professor Ding's name is still a trauma specialist in the province, which is extremely resounding.
In the usual academic exchanges in the province, Professor Ding basically sits in front or is the host.
Yan Hanhan said: "Everyone, don't just listen to Xiao Yang's modesty. Xiao Yang is currently a graduate student who has been specially approved to perform level III surgeries in Xiangnan Hospital."
"I'm 22 years old this year. The sixth year of the eight-year undergraduate, master, and doctoral program!"
After hearing this, everyone present had a sudden change of expression...
The same is true for Zhou Cheng.
If it is very common to perform level III surgery alone in Shonan Hospital, there are only a very small number of postgraduates who can perform it alone.
If this age is limited to under 25 years old, it is estimated that the three affiliated hospitals in the whole school will not be able to find five.
22 years old, the sixth year of the eight-year undergraduate, master, and doctoral program.
That is to say, when he first entered his freshman year, he was only 16 years old.
Junior class?
Still skipping a grade.
This is a proper template for a famous character, a big cow who usually appears in novels.
A god-level figure, right?
Sure enough, after Yan Haihan introduced such a short message, all the eyes of the entire shift room were focused on Yang Yifeng, and Zhou Cheng deliberately noticed that the intern nurse was standing opposite him!
There was a commotion.
Someone shyly pinched the corner of his clothes.
Someone turned his head and pretended to be whispering to his companion, then secretly looked at Yang Yifeng from the corner of his eye, probably thinking that the pimples on his face were very sexy.
Yang Yifeng didn't answer Yan Haihan's words, but said, "I'm sorry, because I delayed the transition of the teachers. Director Yan, let's start the transition."
After finishing speaking, Yang Yifeng will take the initiative to stand in the team of doctors listed by Zhou Cheng and others.
Yan Haihan said: "Head nurse, prepare a stool for Xiao Yang tomorrow."
"Hu Qian, start handing over the shift." Saying this, Yan Haihan walked towards his position as the director.
……
Chapter 52 Don't play cards according to routine
After the on-duty doctor and the on-duty nurse handed over the patients admitted in their own class and the patients who are going to be operated on today in detail, the shift ended.
Then the right to speak went directly to Yan Haihan.
Yan Haihan once again solemnly welcomed Yang Yifeng's arrival.
And pursed his throat, Zheng Zheng said solemnly: "Xiao Yang came to our department, there is no set group. The specific group he will stay in after that depends entirely on Xiao Yang's own wishes."
"Director Hu, Director Cai, you can fight for it too."
"Kuku!"
After hearing this, Hu Ming laughed a little out of place.
But after making the sound, facing Yan Hanhan's slightly dark expression, he smiled apologetically and said, "I'm sorry, Director Yan, I didn't cover myself with the quilt last night, maybe I caught a cold."
I just couldn't hold back.
After speaking, he stretched his neck deliberately, and smoothed the shape of the trachea with his hands.
Anyway, believe it or not, Yan Haihan still has to do his superficial work properly.
Hu Ming laughed out loud suddenly, which made the atmosphere in the shift room suddenly a bit weird, and Yan Haihan could only order with an ugly face: "Then there is nothing else, just end the shift."
"Today at three o'clock in the afternoon, there will be a case discussion of the whole department in the department."
"Director Hu, Director Cai, you two groups have no surgery today, everyone in the group should come to participate."
Obviously, even Zhou Cheng could hear that Yan Haihan omitted all kinds of long-winded speeches that he had prepared in advance, for example, the department does not belong to me alone, but the department belongs to everyone.
The development of the department depends on everyone, and the development of the department belongs to everyone.
The resources in the department are all fair, everyone can do their best...
Then, after going around in a big circle and making everyone else stunned, he said one more sentence: Pang Dingkun will stay in my group for the time being...
Cai Dongfan and Hu Ming formally agreed to Yan Haihan this time.
After all, Yan Haihan is the director of the ward, so I still have to give him some face.
After the shift was over, Yan Haihan didn't get up and leave immediately. Instead, he signaled the people in his team to go to the ward round first, and then started to walk towards Yang Yifeng, talking to him very gently: "Xiao Yang, where is our department? It is definitely not as good as the Shonan Hospital you were in before, in terms of basic equipment and..."
Hu Ming took his own people and left without bothering to listen.
Cai Dongfan looked at Yang Yifeng, shook his head slightly and sighed, then led Luo Yun and Zhou Cheng to walk around the ward.
Then walking down in a circle, there are two patients who are about to be discharged, one belongs to Zhou Cheng, and the other belongs to Du Yanjun.
For the five newly admitted patients, the preoperative examination has been basically completed, and only one patient's CT scan and [-]D reconstruction are scheduled for this afternoon.
Moreover, Zhang Zhengquan happened to be on duty today, and tomorrow the team has the priority to arrange surgeries, so he wanted to arrange surgeries for these patients as soon as possible.
The patient was admitted on the day Zhou Cheng and Du Yanjun were on duty.
A total of five surgeries were arranged.
Two patients belonged to Zhou Cheng, and two patients belonged to Du Yanjun.
Zhang Zhengquan only had one, because the patients were not taken in when he was on duty, so Zhang Zhengquan was only allocated after his own bed arrangement was full.
After Zhou Cheng checked the house, he hurried to grab the computer!He has a total of 25-28, 9 five beds.
Among them, 25 beds are postoperative patients who are going to be discharged today.
Bed 26 is a patient with tibial plateau fracture who underwent surgery last week. He is recovering well after surgery, but he needs to be observed for a few more days.The patient is also willing to stay in the hospital for a few more days, and the intravenous drugs have basically been stopped at present.
Oral drugs were used for analgesia and swelling, and low-molecular-weight heparin sodium was used to continue anticoagulation.
The postoperative X-ray examination was done on Sunday, and the result is good so far. The patient can continue to exercise functionally in bed, and the rehabilitation training of leg raising and quadriceps has gradually improved. He is a patient waiting to be discharged from the hospital. .
There is no special arrangement, but today I will review the postoperative inflammatory indicators to avoid infection.
The patients in beds 27 and 28 were fracture patients admitted last Friday.
One was a simple mid-femur fracture, and the other was an intertrochanteric fracture.The postoperative examination has been completed, and mannitol dehydration has been applied on the weekend, and the current degree of edema is within a controllable range.
However, Cai Dongfan felt conservative, and did not arrange surgery for the 28-bed femur fracture patient, but hoped that he would go down the swelling for a few days before elective surgery, and the patient with the intertrochanteric fracture would have surgery tomorrow.
9 beds, it was the fractured patient before, the patient who Du Yanjun took the initiative to help Zhou Cheng write the medical records.
Getting ready for surgery tomorrow.
Zhou Cheng hurriedly arranged the discharge records and doctor's orders for the 25 beds he was discharged from the hospital, and also told the nurse's station that 9 beds will be transferred to 25 beds this afternoon.
9 beds will be ready for surgery tomorrow.
After the operation, it is naturally inconvenient to live in the corridor, after all, it is so inconvenient to live in the corridor.
After Zhou Cheng wrote the discharge order and handed over the discharge medical records to the patient, he sat in front of the computer and wrote the pre-operation doctor's order for 9 beds and 27 beds in a somewhat complicated mood.
Surgery is not a child's play, except for the indications and contraindications of surgery to be evaluated.
Preoperative examination and preoperative preparation are also an important process.
For example, patients whose fractures require internal fixation need to use prophylactic antibiotics. After all, the prosthesis put in is a foreign body.Surgery with foreign bodies is an absolute indication for prophylactic use of antibiotics.
Of course, there are naturally antibiotic skin tests, routine blood preparation and other routine preoperative preparations.
And talk to sign these.
However, the reason why Zhou Cheng had complicated thoughts was mainly because he felt that, except for patients with 28 beds and intertrochanteric fractures, there was no other way, they had to be operated on!The fracture here does not mean that it cannot be reset by manipulation, but that it cannot be fixed after reduction. It is an extremely unstable fracture area and must be treated surgically.
But for 9 beds and 27 beds, in fact, manual reduction and a standard plaster external fixation can completely avoid surgery.
"Forget it." Zhou Cheng thought for a while, but still shook his head.
To be safe, to be safe.
After the fracture, there is an unstable fracture.Surgical treatment is naturally the safest treatment.It's the same wherever you go, that is, here, you can be so entangled.
Just when Zhou Cheng issued the doctor's order, Yang Yifeng seemed to have escaped Yan Haihan's entanglement, and then found Pang Dingkun who was about to leave the operating room at the moment, and asked: "Brother Pang, hello, I am Yang Yifeng, please take care of me in the future." ."
Zhou Cheng glanced at the two of them.
I thought to myself: Oh.When a doctor meets a doctor, it's sympathetic to each other.
The classes are different, so naturally what you can talk about is different.
Pang Dingkun is not a Ph.D. student at Shonan University, but a Ph.D. student at Hengda University. Although he is older than Yang Yifeng and graduated earlier, Yang Yifeng's resume can beat him up.
So Pang Dingkun invited very politely: "Yifeng, today our group has three operations, and I just happened to show you our operating room."
Orthopedics belongs to surgery, and the operating room is both a battlefield and a learning paradise.
Hearing this, Yang Yifeng was a little stunned and said, "Senior Brother Pang, I won't go to the operating room today, I'll take a random walk around the department first."
"Director Yan also agreed."
Yang Yifeng actually refused, and directly dragged Yan Hanhan out.
The voice of refusal immediately caused the five people including Zhou Cheng to turn their heads away.
Pang Dingkun was a little stunned at the time, after all, there was almost no way out for the questions he asked Yang Yifeng.
But Yang Yifeng directly refused.
This TM is a bit unconventional.
"That's fine, you can get acquainted with the environment in the department first." Pang Dingkun could only find a reason to comfort himself, and then hurried away.
His initiative to show affection to Yang Yifeng was directly beaten by Yang Yifeng with a stick.
Chapter 53 It's so exciting!
There is an operation scheduled for tomorrow, so Zhou Chengcheng slowly polished the writing of the medical records and the signed consent form in the department step by step.
On the basis of the existing template, try your best to make a systematic review of all possible unexpected situations, then modify the template, and save it as your own private template again.
The existing templates in the department were all established by the previous superior physicians, and it is difficult for Zhou Cheng to make comprehensive revisions...
The modification process is quite interesting.
Zhang Zhengquan is on duty.Both Zhou Cheng and Du Yanjun had patients who needed surgery tomorrow, so they naturally stayed in the department and accompanied Zhang Zhengquan on duty.
The doctors in the other groups all finished their work one after another. If there is nothing special, they should go back to read books, go on 'dates', and write papers if they should write papers.
Anyway, as long as the case discussion in the afternoon comes, it will be fine.
Yan Haihan and other bed doctors who were about to undergo surgery naturally all went to the operating room early.
At about 11:30, Zhang Zhengquan finished talking and signing the surgery patient.
Stand up and say: "Brother Zhou Cheng, Brother Yan Jun, thank you two for accompanying me on duty today."
"I've already ordered food. If there are no other arrangements for noon, can I eat in the department?"
Zhang Zhengquan has always been quite a delicate person, not only is he good at getting along with Zhou Cheng and Du Yanjun, but he also licks Luo Yun very well every time.
Therefore, many times, when Du Yanjun was on duty and was unable to perform emergency surgery, Zhang Zhengquan had many opportunities for emergency surgery.
Blocking the escape route, Zhou Cheng could only reply politely: "Thank you, Quan Zi."
Du Yanjun said: "Thank you Brother Quan, let me order a drink. Have tea?"
"Brother Zhou Cheng or Fengqi Green Osmanthus? Brother Quan, do you drink Orchid Latte or Oolong?"
One of Shashi's specialty milk teas is Chayan. Fengqi Lvgui is the only green tea that Zhou Cheng usually drinks, while Zhang Zhengquan drinks Oolong and Youlan Latte.
Hearing this, Zhou Cheng immediately took out his mobile phone: "Let me order some!"
"Yan Jun, put your phone away."
Before Zhou Cheng finished speaking, he suddenly saw a person walking in from the door, holding a large takeaway box in his hand. The very obvious sign on it was sexy tea!
That is the English name of Chayan.
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The owner who twisted the takeaway box was Yang Yifeng who had disappeared for nearly an hour. After he entered the door, he smiled and said, "You brothers have been busy all morning, you have worked hard."
"This is the first time we've met, let's drink some drinks to quench our thirst."
"I need you to take care of me in the future."
Yang Yifeng's familiar words stunned Zhou Cheng and Du Yanjun, who were shoving each other's phone calls!
Looking at Yang Yifeng, he is gentle, and the pimples on his face are a sign of youth.
The gap between the age of 22 and the age of 26 is five years.
Three years is one generation.
Yang Yifeng was [-] times worse than Zhou Cheng and Du Yanjun.
Such a person, at such an age, with a resume that can directly beat Luo Yun, still invites them to drink milk tea?
Zhang Zhengquan, who was ordering food, also immediately canceled the payment.Then silently canceled the order and re-purchased four copies.
Yang Yifeng wears a pair of eyes, full of bookishness, and it can be seen that he naturally exudes a campus style and academic style.
Du Yanjun didn't know how to respond, maybe he felt that he would feel ashamed involuntarily when facing Yang Yifeng.
And he couldn't adapt to the sudden kindness of such a proud son of heaven.
As a result, Zhou Cheng's and Zhang Zhengquan's eyes were a little uncertain.
Du Yanjun always had this kind of mentality, and Zhang Zhengquan was even more so. He just smirked there, but felt that it was not good not to answer.
He hesitated and said, "This, why are you so embarrassed?"
In terms of strength and class alone, Du Yanjun felt that Yang Yifeng didn't even bother to hang himself up and beat him with such an existence.
Seeing that the two friends in his group were overwhelmed by Yang Yifeng's aura on the spot, he could only stand up, took Yang Yifeng's takeaway box openly, and said: "Thank you brother for spending the money. You invited three cups of milk tea, and we treat you to dinner."
"Although you are at a loss, at least you can get back some money, no problem?"
To be honest, if Zhou Cheng faced Yang Yifeng before, before he got the simulator, he would feel that he was oppressed by an invisible form, and that his sudden flattery had some ulterior purpose.
But now, although Zhou Cheng felt that Yang Yifeng was definitely an excellent existence, he himself was not bad either.
If you can't fight a fight, Zhou Cheng is worth it anyway.
As for young age, good aptitude, high talent, etc., Zhou Chengcheng didn't care even more.He only cares about what ability he has now, and having ability in his body, this is a kind of natural confidence.
After Zhou Cheng finished speaking, he took the initiative to help open the takeaway box, and then said, "Yan Jun, Quan Zi, you two should say thank you quickly."
"Especially you, Yan Jun. It's too much to eat and drink for nothing without even saying thank you."
The corner of Yang Yifeng's mouth twitched slightly, and he suddenly felt that Zhou Cheng was very interesting.
Because he had been in contact with everyone in the department today, he found that, except for a few directors, everyone else, including the graduated doctor in the department, had a slightly awkward attitude when facing him. invisible bondage.
On the contrary, Zhou Cheng is the most generous.
Either Zhou Chengcheng is the kind of person who is extremely carefree and careless, completely unaware of the gap between him and himself.
Or Zhou Cheng doesn't care who he is at all, and there is a feeling that I am invincible and you are free.
Otherwise, it would be a little out of line with Zhou Cheng's identity and personality to be able to joke around so casually when Zhou Cheng already knew his resume.
This is excellent material.
You have to understand it well, maybe you can play an important supporting role in the novel!
Yang Yifeng said to Zhou Cheng: "It's okay, my teacher always said that suffering is a blessing."
Zhou Cheng and Du Yanjun didn't expect Yang Yifeng to answer like this at all, he is also a wonderful person.
Just as he was about to speak, Yang Yifeng said again: "It seems that I came here this time at the right time. I basically had no chance to suffer in the department before."
In just two sentences, the literature of Versailles has been brought into full play.
The three of Zhou Cheng and Du Yanjun stopped answering these words, and responded with a great secret technique - silly smile!
What the hell?
Could it be that they started complaining to Yang Yifeng about how they themselves were oppressed?
After Yang Yifeng also took away his regular milk tea, he turned around and walked out of the doctor's office. Seeing this, Zhang Zhengquan also followed him away.
Only Zhou Cheng and Du Yanjun were left, who had to continue to write medical records and conversation materials.
……
But about 15 minutes later.
Zhang Zhengquan, who went out with Yang Yifeng, walked back to the department as if dazed, with an expression on his face that seemed to symbolize the four words of doubting life.
"Brother Quan. What's wrong with you?"
After Du Yanjun finished asking, Zhang Zhengquan still didn't reply.
At the same time, he stretched out his hand and shook it up and down in front of Zhang Zhengquan's face.
Zhang Zhengquan still didn't have much expression, so he asked tentatively: "The goddess ran away with someone else?"
This was also the only reason Du Yanjun could think of to make Zhang Zhengquan look like this. The person who wanted to chase was chased by others.
"Don't make trouble, this time it's a man." Zhang Zhengquan was completely absent-minded, and drove away Du Yanjun's hand.
The eyes of Zhou Cheng and Du Yanjun immediately turned into horror.
male?
Is it so 'exciting'?
Chapter 54 Crazy Behavior!
Maybe he noticed that his wording was wrong, or maybe he saw the special posture of Du Yanjun's gluteus maximus tense and his hands covering his butt at the moment.
Zhang Zhengquan regained his composure and said seriously, "Don't get me wrong."
"My fucking orientation is very normal!"
Then Zhang Zhengquan didn't care about Du Yanjun and Zhou Cheng's avoidance expressions full of disbelief.
Said, "I'm going to tell you some really big news. Definitely big news."
"Did your male god run away with someone?" Du Yanjun was sitting in front of the computer at the moment, and started to get nervous.
If it was Zhou Cheng, Du Yanjun wouldn't dare to be so skinny.
Zhang Zhengquan punched Du Yanjun.
"Don't make trouble!"
"It's the right thing to say."
"Yang Yifeng and I went out together just now, you must have seen that."
Zhang Zhengquan said to keep half and half, as if he really wanted to arouse the curiosity of Zhou Cheng and Du Yanjun.
This is called the psychology of hooking, and it is also the tactic of attacking the goddess that he has recently studied. If the opponent is still interested, he wins. Unfortunately, he has not had a chance to use it yet, but Zhang Zhengquan has already integrated this concept into his daily life.
"so what?"
"Who attacks and who suffers?" Zhou Cheng was also annoyed by Zhang Zhengquan's frantic operation, so he hesitated a bit.
"Then Yang Yifeng told me that the reason why he came to the No. [-] Hospital of Shashi City was not to give guidance, nor to study."
"He said he wanted to drop out of school, but he didn't get the consent of his tutor. The tutor suggested that he calm down for a while, temporarily leave the clinic of the Affiliated Hospital of Shonan University, and come here for a vacation."
When Zhang Zhengquan said this, the corners of his mouth seemed to be transformed into a tetanus patient, twitching non-stop.
Then watching Zhou Cheng and Du Yanjun open their mouths so wide that they could almost stuff an egg in, they were finally satisfied with their speaking skills, which really shocked the two brothers.
The explosiveness of the story itself is naturally fundamental, but how it is said is actually quite important.
It has to be amazing.
So Zhang Zhengquan stopped here, slowly waiting for Zhou Cheng and Du Yanjun to digest.
Du Yanjun was dumbfounded at the time, and carefully recalled what director Yan Hanhan said about Yang Yifeng's resume in the morning.
"Shounan Hospital has been specially approved for graduate students who are qualified to carry out level III surgeries alone."
"I'm 22 years old this year. The sixth year of the eight-year undergraduate, master, and doctoral program!"
What kind of existence is this?
To perform level III surgery alone, one must be a senior attending physician or even a deputy chief physician before it can be performed routinely, and the chief physician must check before obtaining the surgical authorization.
Yang Yifeng, he is only a graduate student, at most he has a junior professional title.
Then it was 22 years old.
It can be said that the path of medicine has a bright future waiting for him.
Then suddenly such a ridiculous statement popped up, Yang Yifeng wanted to drop out of school, the reason why he was sent to No.[-] Hospital was because his teacher wanted to calm him down.
Yes, be calm and calm, if it was my teacher Yang Yifeng, I would have to beat his head to one side.
Such a good talent, such a good qualification.
You told me halfway that you wanted to leave the division.
Du Yanjun's shock has temporarily lost his so-called demeanor, which is directly reflected in his words: "Is it true?"
"Zhang Zhengquan, are you selectively deaf because of your ears?"
"Bullshit, it's absolutely true." Zhang Zhengquan held up his index finger and middle finger, swearing to the sky.
"If I'm telling the truth, the radius of all the protruding organs in the whole body will be reduced by three centimeters."
This oath is really a bit poisonous.
However, no one cared about whether Zhang Zhengquan himself could fulfill the vowed punishment, but closed his eyes and began to reflect.
Why did Yang Yifeng want to drop out of school?If he wanted to quit school, why did he study medicine so well before?
Enough support?
"Why?" Zhou Cheng asked after he calmed down, frowning.
This Yang Yifeng, wait another two years for a Ph.D degree, a Ph.D. degree, and his job can be stabilized now, and his income is also very stable.Why do you want to drop out of school at this point?
Why did you go early?
There are mines at home, so go home and inherit the industry?
"I don't know, I forgot to ask, Yang Yifeng's words made people numb on the spot." Zhang Zhengquan shook his head violently.
"Ugh."
"I don't want a Ph.D. from Shonan University, and I don't want a job at the Affiliated Hospital of Shonan University."
"This man is absolutely insane."
"The brain must be abnormal." Du Yanjun said viciously in a very sour tone.
You know, Du Yanjun is desperately trying to get a graduate student and then compete for a place in the hospital. He wakes up earlier than a dog every day, sleeps later than a dog, and eats worse than a dog.
But as for others, the conditions in all aspects are several grades higher than their own, but they are discarded like shoes.
This made Du Yanjun very upset.
Don't give me much.
"I think it's possible." Zhang Zhengquan nodded solemnly.
Because who is a decent person would run to tell a stranger this?This Yang Yifeng is definitely not a normal person.
"Oh, by the way, Brother Yan Jun, Yang Yifeng also said that if you are free, he wants to chat with you too."
"It seems that I want to ask about some experience and insights about studying in the eighth hospital as a graduate student. Do you want to go there?"
"If you don't want to go, I'll tell Yang Yifeng that you're busy." Zhang Zhengquan remembered the reason why he walked out of the doctor's lounge. Before that, he was thinking of feeding Zhou Cheng and Du Yanjun.
"I don't." Du Yanjun subconsciously wanted to refuse.
But after thinking about it, he nodded and said, "Let me go and see, what kind of strange man is he?"
At the same time, I was thinking in my heart, although Yang Yifeng is very weird, including his thinking and temper, but he is really outstanding, let's see if he can get some study notes or ask about learning methods.
……
After Du Yanjun left.
I never came back!
In the end, it was Zhou Cheng and Zhang Zhengquan who were worried that Du Yanjun would have a mental breakdown caused by Yang Yifeng!
After all, this Yang Yifeng is definitely not a normal person.
If he said something else, he was afraid that Du Yanjun would have a big psychological gap and develop a mental illness.
So as soon as he received the takeaway, he rushed directly to the door of the doctor's lounge.
Then Zhou Cheng shouted loudly: "The lunch box is here, eat and eat."
After Zhang Zhengquan and Zhou Cheng opened the door, they saw that Du Yanjun and Yang Yifeng were talking happily, and Yang Yifeng was holding a pen and a notebook!
The black leather of the notebook is the size of a palm, and it is slightly old. It is pressed by Yang Yifeng with the index finger of his left hand. In his right hand, he is holding an old-fashioned ink-absorbing blue ink pen with light blue paint that is seriously peeled off. He is writing and drawing. , the font is very neat, and the running script is also very rigorous.
Yang Yifeng was facing the door, so he could see these details.
Du Yanjun was sitting with his back to the door. He raised his hands irregularly in the air at this moment. It looked like he was talking high-spirited there. Judging from his gestures, he was definitely eloquent, as if he was talking about the rising point.
It was interrupted by the door opening and Zhou Cheng's loud voice.
Is it not normal anymore?
Chapter 55 Broken dog!
"It's time to eat. Brother Du." Yang Yifeng watched Zhang Zhengquan and Zhou Cheng rushing in, with anxious expressions on his face, so he put the cap on the pen box with a little helplessness and reluctance, and kept screwed up.
Yang Yifeng is a sixth-year student this year, while Du Yanjun is a second-year graduate student, strictly speaking, a seventh-year university student, so he entered school one year earlier than Yang Yifeng.
Calculated according to the age limit at the time of enrollment, it is no problem for Yang Yifeng to call Du Yanjun Senior Brother.
Du Yanjun was talking excitedly, but he looked at the time immediately, and it was already a quarter past twelve, so he licked his lips and said, "Oh, it's been so long!"
"Time flies so fast."
"Then let's eat." Du Yanjun dimmed the screen of his phone while saying this, and stuffed it into his trouser pocket. At the same time, he turned around and stood up to help Zhang Zhengquan open the takeaway bags, one by one distribution.
Zhang Zhengquan stared at Du Yanjun earnestly, and Du Yanjun looked at him and asked, "Is there something on my face?"
As he spoke, he touched his face on purpose, and he didn't know whether he really didn't understand Zhang Zhengquan's intention or he was pretending to be stupid.
"Eat and eat, it will be cold later." Zhou Cheng immediately began to stir the mud.
……
Among the four, Yang Yifeng was the youngest in real age, but he looked older than Du Yanjun and Zhou Cheng, and about the same as the little black face Zhang Zhengquan.
Quite talkative.
It can be seen that his speech is not as reckless as imagined before, nor is it as impersonal as when he spoke to Pang Dingkun.
Even after eating, Zhou Cheng looked back and thought that what Yang Yifeng said was really true, he just didn't want to go to the operating room today, it wasn't that he didn't want to go down with Pang Dingkun, no matter who told him he didn't want to go down.
Zhang Zhengquan deliberately added a note when ordering the meal, and the portion of the meal should be a little larger, so the four of them were a little bit full after eating.
Du Yanjun rubbed his belly and said, "I think it's better to order drinks later than to order meals. It's definitely more comfortable to drink some drinks after meals."
"Would you like another copy?" Zhang Zhengquan thoughtfully suggested.
Zhou Cheng shook his head and said, "It's acceptable to drink milk tea occasionally, but drinking too much is bad for your health. I don't want it."
"It's not one o'clock now. I plan to go back and take a nap. Let's go first." Zhou Cheng looked at the time and thought he could go back, anyway, the rented house was very close.
Yang Yifeng also said after hearing the words: "I have to go back and tidy up, so I won't drink."
Two of the four wanted to run away, and it seemed that they could not enjoy the second cup of milk tea, so Zhang Zhengquan put away his mobile phone.
At this time, the nurse on duty outside came to call the doctor on duty, and Zhang Zhengquan ran out immediately...
Zhou Cheng felt that Yang Yifeng and Du Yanjun had not finished chatting, so he left in a low-key manner.
But as soon as he arrived at the elevator door, he found that Yang Yifeng had also left Du Yanjun, who had not finished the operation and signed the patient's talk, and ran out, and said with a smile, "Hello, Senior Brother Zhou."
"Hello." Zhou Cheng nodded to Yang Yifeng, and began to look at him.
At this time, Yang Yifeng has an extra backpack, and pens and notebooks are pinned in the hollow pockets on the side, as if they are within easy reach.
It's also really weird.
Yang Yifeng asked generously: "Senior Brother Zhou, it's actually like this. I'm writing a novel about doctors recently, but the people I usually contact are graduate students, doctoral students, and doctors in training."
"So I don't know much about Gui Peisheng."
"Brother Zhou, isn't it convenient to chat with me and accumulate some material for me?"
When the elevator came, Zhou Cheng reached out to block the elevator and let Yang Yifeng go in first, then walked into the elevator and pressed the button for the first floor.
Thumbs up: "Are you writing a novel? You are very talented. You are indeed a high-achieving student at Shonan University, a man of all arts and sciences."
"Internet novels? Which website did you post them on?"
Zhou Cheng usually surfs the Internet a lot, so he knows a lot about this aspect.
"Well, it happened at the singularity." Yang Yifeng was not embarrassed, and admitted it with a nod.
"Tell me the title of the book, and I'll bookmark it and give you a subscription." Zhou Cheng also gave face cooperatively.
"It's just been posted, only tens of thousands of words, so let's not talk about it. To avoid being urged to write offline."
"Last time."
As Yang Yifeng was speaking, he suddenly interrupted, like a very seasoned disjointed dog, definitely the leader of the disjointed class of Internet writers: "Is it convenient for senior brother Zhou tonight? I want to invite senior brother to have a meal together."
Zhou Chengdao: "We can also add a WeChat and chat casually. What aspects do you want to know? You can ask me and answer the same. You don't eat when you eat."
Zhou Cheng didn't want to have dinner with Yang Yifeng, he always felt that Yang Yifeng was quite weird.
He didn't have the heart to explore the secrets of Yang Yifeng. If he could make a fuss and drop out of school despite his great medical future, he must have the ability and confidence.
"Then add a WeChat first. I'll scan you, Senior Brother Zhou." Yang Yifeng might think that asking Zhou Cheng to go out to eat for the first time is not very good, so he decided to settle for the next best thing.
After getting off the elevator, Zhou Cheng said goodbye to Yang Yifeng.
However, after walking not far, when Zhou Cheng turned his head again, he saw Yang Yifeng chatting with a girl in a white coat again.
With a notebook in his left hand and a light blue pen in his right hand, he writes and draws, and he really looks like he is collecting folk songs.
"Brilliant!"
Zhou Cheng secretly praised Yang Yifeng, among other things, just his shameless demeanor and behavior, and his ability to stop people casually from striking up a conversation, can make him do well.
……
When Zhou Cheng returned home, he forgot about Yang Yifeng.
Then make the next simulation plan for the current fracture simulation copy in detail.
I am not in a hurry to simulate, but I am constantly looking up information, constantly filling in various ideas and possible development directions.
Because Zhou Cheng discovered that the number of simulations per day is limited, the more quickly he can find the most suitable simulation path, the more effective it will be.
Sharpening knives does not miss woodcutters.
……
At [-[-] in the afternoon, Zhou Cheng was still racking his brains.
To be honest, think of every possible way of simulating.
It is also a rather painful thing, but in order to maximize the benefits of the number of simulations, Zhou Cheng can only endure this pain.
The alarm clock rang.
Zhou Cheng had no choice but to close the notebook, carefully locked the door, and hurried to the department.
In the morning, Yan Haihan personally ordered to discuss difficult cases, so naturally he couldn't be late.
When Zhou Cheng arrived, the crowd had already arrived, and only the deputy director of Yan Haihan's team, Min Chaoshuo, and Pang Dingkun were doing the operation, and the rest of the staff had arrived in the shift room and stood in line up.
This case discussion, although no nurse team participated.
But except for the people in this hospital, everyone else can only stand and listen, otherwise who is sitting and who is not?
However, the time has already reached 14:59, and everyone in the department is here!
When Yan Haihan was about to start, the door of the shift room was pushed open suddenly, and then Yang Yifeng walked in, looked around, and then tiptoed to find a place to stand against the wall.
Yan Haihan pointed to the newly added stool in the distance, and said, "Yifeng, sit there, that's your place."
But Yang Yifeng shook his head and refused, took off the backpack and held it in his hand, and said, "Director Yan, I'll just stand and listen."
Chapter 56 Dead end!
Yan Haihan didn't forcibly make any specialization for Yang Yifeng.He said: "Since everyone is almost here, Chao Shuo, you can start reporting the cases."
Originally, the case report of Yan Hanhan's group should be reported by the deputy director Dong Qiansheng, but at the moment Dong Qiansheng is on the operating table, Yan Hanhan asked his students to take on this role, and by the way, added some impression points for him in the department.
Min Chaoshuo quickly opened the title page of the ppt, and then said generously: "Good afternoon, teachers and students, today our group is preparing 15 difficult cases."
"The basic situation of this patient is as follows."
"Patient, Liu, male, 71 years old..."
In the process of case reporting, whether it is communication within the department or outside, generally only general information is given, and any information related to the patient's private information must be hidden.
For example, the name, ID number and mobile phone number can be replaced by XX.
And this information will not affect everyone's reading of the disease itself.
"One week ago, due to an accidental fall, he caused pain, swelling and mobility impairment in his left femur. He was sent to the emergency department of our hospital immediately. X-ray diagnosis was a femoral fracture, and he was admitted to our department for treatment."
"After completing the relevant examinations, the diagnosis was clear, and the diagnosis was AO C3.1 femur fracture."
"However, after completing relevant examinations, the patient's current condition is that he has a history of coronary atherosclerotic heart disease, and his current cardiac function is nyha class III."
"In addition, there are type II diabetes, the current blood sugar control can be achieved, hypertension grade II, very high risk group."
"I invited the Department of Cardiology, Department of Anesthesiology, and Department of Respiratory Medicine for consultation. At present, it is considered that the risk associated with the operation of the patient is extremely high, and surgical treatment is not recommended."
"The ongoing treatment is plaster external fixation."
As a graduate student specializing in orthopedics, Min Chaoshuo obviously put a lot of effort into this case.
The narrative process is all professional terms.
After listening to Min Chaoshuo's report, almost everyone present frowned.
Clinically, C-type fractures are not uncommon.
History of coronary heart disease, heart function nyha III level, this is a bit cruel.
It belongs to the category of marked limitation of physical activity.
With another diabetes and high blood pressure, it is very likely that you will not be able to get off the operating table.
When Yan Haihan heard this, he interrupted Min Chaoshuo, and said: "This patient still has some conditions like this. His family members and patients have higher requirements for later stage functions."
"But the family members do not agree with the operation, but the patient himself still has a relatively strong willingness for the operation."
"It's very difficult for us."
The opinions of patients and family members are inconsistent, which makes doctors not even know how to start, let alone who to listen to.
In principle, the patient's first wish should prevail, but in China, especially the opinions of the elderly, family members and children must be respected.
After hearing what Yan Haihan said, Hu Ming said:
"Since the patient and family members disagree, it is better to do conservative treatment with bone traction. Anyway, the operation is going to be done, and the patient should persuade the patient's family members by himself."
Hu Ming felt that it was unnecessary for Yan Haihan to bring up this case.
Whether or not to have surgery depends on the wishes of the patient and family members besides whether it is possible. What is there to discuss?
Bone traction or skin traction conservative treatment it wants.
In addition to avoiding fracture shortening and displacement, bone traction and skin traction can separate the broken ends of the fracture and relieve pain.
Of course, what Hu Ming meant was to ask Yan Haihan why you didn't give the patient traction treatment.
Yan Haihan didn't reply, but Min Chaoshuo continued: "Mr. Hu, the following is the patient's film and the result of [-]D CT reconstruction."
Immediately afterwards, Min Chaoshuo released the patient's plain film and CT results.
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