medical simulator
Chapter 245
Chapter 245 (Subscription)
The process of rounds did not slow down or stop because Zhou Cheng was new here today.
Only Zhou Chengyin is a newcomer, and he is not familiar with the patient's past and current conditions, so he can only analyze it based on the report of the doctor in charge of the bed, which is equivalent to looking at the flowers on horseback.
Although I roughly remembered the general situation of the patient, but for some detailed problems, even if the subordinate doctor made a report, there was no way to restore all the details one by one at once.
Because the doctor in charge of the bed tacitly knew some details for Yu Qiuhua and others, naturally he would not report more things just because Zhou Cheng was a newcomer.
If there is only one variable factor, then it is a very small number of variable factors to adapt to most stable factors.
Without the overall control over the patient's condition, even Zhou Cheng couldn't make up for it so easily.
Of course, Zhou Cheng didn't have the opportunity to work hard to understand the other patients, but Zhou Cheng was very impressed with the two patients who were going to be operated on today.Because he deliberately spent an extra 10 minutes to read the medical records of the two beds.
After reading it, I was a little worried.
Zhou Cheng had just arrived, although junior doctors could ignore him, but Professor Xue Xiude still gave Zhou Cheng a lot of face. After he got out of the operating room, he asked Mao Yuxuan to accompany Zhou Cheng and arrange things in the department first.
Mao Yuxuan had almost figured out Zhou Cheng's current state, and felt sorry for Zhou Chengdao: "Xiao Zhou, according to what you said, then you are not making any money as the general inpatient now."
At first, Mao Yuxuan thought that Zhou Cheng was an employee of the hospital who came by airborne. Because of his relationship with Academician Zeng, he was hospitalized for a symbolic few months, and then he was promoted to attending.
He wanted to make way for Zhou Cheng, so he moved away.
But now that I think about it, things are not as I imagined. Zhou Chengcheng hasn't worked yet, so the work of the general hospital is equivalent to doing it for nothing, and both himself and Zhou Cheng are at a loss.
Naturally, Zhou Cheng would not tell Mao Yuxuan the main purpose of his visit, this had to be infiltrated slowly, otherwise he would be regarded as a fool.
"It's okay, the main reason is that Mr. Zeng wants to exercise well, and I also feel that I need more clinical polishing now."
Then Zhou Chengcheng brought the topic back to the main topic: "Brother Xuan, the two operations today are not easy to do."
Zhou Cheng said while flipping through the medical records.
The first thing to be operated on is a 5-bed tuberculosis patient. The patient's lower limb skin has sinus tracts, and the sinus tracts have pus, which is extremely difficult to treat.
What is the concept of sinus drainage? It means that Mycobacterium tuberculosis has eroded and broken the bone marrow cavity, cortical bone, and even the soft tissue layer outside the bone, eroding a channel.
Then the pus inside slowly oozes out.
Originally, according to the principle, patients with special infections like tuberculosis are definitely arranged in the last one in an operating room, so as not to increase the infection rate of patients in the latter operation room.
However, another 8-bed situation is more dangerous than this 5-bed one. In addition to tuberculosis bacteria, there are also bacteria infected.It's equivalent to a mixed infection, it sucks...
Bacteria and Bacteria are not the same thing.Therefore, 5 beds were assigned to the first station, and 8 beds were assigned to the second station.
The situation is roughly like this.
The skills that Zhou Cheng currently knows are all simple skills written in textbooks.These skills are definitely the foundation. With so many Level I-IV skills, you can basically deal with all orthopedic diseases.
Especially in the face of textbook-like fractures or diseases that require surgery, these perfect level skills are extremely lethal.
But there is another critical issue, that is, the patients encountered may not be sick according to the textbook, which requires slowly dismantling and analyzing the mechanism of the disease.
The grades of surgeries are strictly graded as I-IV. However, in Zhou Cheng’s understanding, some surgeries should not be grade IV surgeries. They should be beyond grade IV surgeries, and can even be classified as grade V surgeries…
Zhou Cheng's own experience is limited. Even in the process of using the simulator, he only honed his skills one by one according to the orthopedic surgery grading list announced by the state.
Zhou Cheng definitely has the ability to perform treatments and surgeries. However, it seems that the patients in Professor Yu Qiuhua's group simply use one or two simple surgeries, so it is difficult to deal with them.
It is necessary to analyze its pathogenesis in more detail in order to achieve a better therapeutic effect.
Mao Yuxuan smiled and asked: "Xiao Zhou, didn't you say that you are a trauma surgery major? Have you never seen such a patient before?"
Mao Yuxuan has been trying to figure out Zhou Cheng's origin, and finally determined that it should not be the inheritance of the Ninth Hospital of Shanghai, but may belong to Shanghai.But now that Zhou Cheng looks like he has never seen the world, it seems that he is not the inheritance of the devil city.
Of course, Mao Yuxuan's question did not mean looking down on Zhou Cheng, but rather.
If the unit Zhou Cheng stayed in before was on the same level as the current No. [-] Hospital of Shanghai, such patients should not be uncommon.
How many hospitals are there in the country?
Even if a hospital has two difficult patients a year on average, if they cannot handle them, the number will be thousands or even tens of thousands after they are gathered in Shanghai, Kyoto, Guangdong Province and other places.
China is too big.
Both Zhou Cheng and Mao Yuxuan felt that it was a bit too ostentatious for Mao Yuxuan to call Mr. Zhou Cheng Zhou or Mr. Xiao Zhou. In the end, it was absolutely that Mao Yuxuan called Zhou Cheng Xiao Zhou, and Zhou Cheng called Brother Mao Yuxuanxuan.
Mao Yuxuan also didn't like Zhou Cheng calling him a teacher in the friendship of young people.
"I haven't seen it much before. Patients with simple infection after surgery are rare." Zhou Cheng didn't care. Anyway, he was young, so what if he admitted his short-sightedness?
At most, you will be laughed at. If you pretend to know everything, in case you are told, since you have more knowledge, then you don’t want to learn. How can Zhou Cheng get started and gain trust?
Mao Yuxuan probably understood that Zhou Cheng's previous unit was the one that only dealt with the simple fracture and trauma patients he encountered.
Don't solve problems for others, and don't solve units that others have solved but can't solve.
It cannot be said that their technology is not good, but that the positioning of each place is different.
This also just shows that in Zhou Cheng's previous unit, because there were many patients with simple fractures, there were enough patients to support him to practice the magical technique of closed reduction and external fixation of fractures.
"After that, we can learn more." Mao Yuxuan's mentality was slightly adjusted.
Because I saw Zhou Cheng's shortcomings, and then I felt that Zhou Cheng was more real.Although Zhou Cheng has such strong skills, he also has his own shortcomings, which is normal and like a human being.
"We don't have to worry about other things. The main thing is to manage subordinate doctors and review their medical orders."
"But these things are now being done by the attendants in the hospital, and these doctors also have things to do..."
"All we have to do now is to review the operation that is scheduled for tomorrow, if."
After Mao Yuxuan told Zhou Cheng some common-sense questions, he led Zhou Cheng to the operating room.
Prior to this, Professor Xue Xiude, Gu Zhongliang and others had already gone down first.
In addition to the general hospitalization, there are still three people who are attending and above, and there are two attendant chiefs, so whether the chief doctor on duty is in the hospital or not, the operation can be carried out normally.
The general inpatient can go into the operating room and assume his role after doing his own thing well.
Zhou Cheng then asked: "Brother Xuan, in our hospital, on weekdays, do patients with this kind of infection be routinely treated and treated?"
Somewhat curious, if the 5 beds and 8 beds are routine treatment and treatment, then he feels that he has to rethink and recognize the perfect level skills he thinks.
Mao Yuxuan also shook his head and smiled wryly.
He replied: "Xiao Zhou, how can you be so magical as you think? In fact, in clinical medicine, there are only a bunch of dead principles. Surgery is surgery and medication, but the process and details of the surgery are slightly different."
"The reason why there are more patients now is because it is winter vacation. Generally, patients with this kind of infection rarely come in summer, and the summer is hot and dry. It is possible that such patients will be admitted to the ICU before they can turn around..."
Speaking of this, Mao Yuxuan hesitated to speak, probably meaning that when it is cold, there are more patients like this, and in other seasons, they may not be able to carry them to Shanghai.
But this kind of thing is not something that Mao Yuxuan can control, so he continued: "Complicated infection is better. Kyoto and Shanghai are one, but the other is Xinjiang Province."
"There are a lot of infected patients there, and the reimbursement ratio is very high, so the patients hardly need to spend money."
"But no matter how you say it, it also falls into the category of complete debridement. It's not good. If the debridement operation is done well, the number of operations can be reduced."
"If the dosage and type of antibiotics used are well selected, the course of anti-infection treatment can be reduced. But these are issues that professors should consider. We junior doctors can only slowly ponder based on experience."
Zhou Cheng had heard Luo Yun say such a conclusion before.
"What is the prognosis of such a patient on weekdays?" Zhou Cheng continued to ask.
"Not necessarily. 90.00% of the patients can still get a relatively good prognosis."
"Of course, there are still about [-]% of patients with complicated infections, and the prognosis is not very good due to various reasons." Mao Yuxuan did not hide or brag about his department's awesomeness, and admitted that there were also some patients with complicated infections. A small group of patients has a poor prognosis.
But in fact, this is Mao Yuxuan's confidence.
I was able to treat so many patients that other provinces could not handle until the cure rate reached 90.00%. This is where I am awesome.
As for why it is not 100%, there are many factors.
It may be that the patient's family cannot afford the money, or the patient is unwilling to be treated, or it may be that a small number of patients have an infection, which is very weird at all, and eventually develops into multiple infections all over the body, and finally loses their lives. Yes, it is possible to encounter.
In addition to Huaguo's traditional medical theory, which can cover 100% of diseases and has a super high "cure rate", modern medicine has always admitted its own shortcomings.
It's just that some people think that the reason why there is no one-and-done treatment in modern medicine is because of the operation and operation of capital.
Zhou Cheng knew that a person like Mao Yuxuan could openly admit that the Ninth Hospital of Shanghai had a disease that could not be cured. Just have to walk out.
Where is such a magical place?
……
Following Mao Yuxuan all the way into the operating room, Zhou Cheng is also familiar with the road, after all, he has been here before the Chinese New Year.
"Xiao Zhou, you have been in our hospital for a while, right?" Mao Yuxuan looked at Zhou Cheng's familiar movements, smiled and asked.
"Why didn't you think of coming to our trauma surgery department in advance?"
"Before, I was doing experiments along with it, and then mixed in the experience of sports medicine. And you know, Brother Xuan, that I am from Hunan Province. Professor Lin Ziyuan's senior sister Ding Dian is also from Hunan Province."
"It's almost because of this relationship, so I didn't come directly to our trauma surgery department."
To convince Mao Yuxuan, it is best to be truthful.Of course, don't be too real, otherwise, Mr. Zeng will lose face.
Mao Yuxuan didn't say much, it involved other departments, other professors, and other directors.He was always hospitalized, and he couldn't get in the conversation, and he wasn't even qualified to comment.
After going in and changing clothes quickly, the anesthesiologist is still administering anesthesia to the patient, and it will take a while before the operation can be officially started.
Both Associate Professor Gu Zhongliang and Professor Xue Xiude were not in the operating room, and Shen De and a follower were always hospitalized, that is, a doctor was watching in the operating room.
After Zhou Cheng and Mao Yuxuan arrived, they consciously helped to disinfect the towels.
The doctor in charge of the bed was still dealing with the doctor's orders upstairs. Zhou Cheng, Mao Yuxuan, and the resident inpatient's three major "inpatient chiefs" were the lowest-level doctors, especially Zhou Cheng and the inpatient's chief inpatient, Lin Yousheng, a third-year doctor.The qualifications of the two people are relatively low.
Although Zhou Cheng temporarily took Mao Yuxuan's position, he still gave Mao Yuxuan some face.Proactively begin sanitizing the drape.
After everything was done, Mao Yuxuan called Professor Xue Xiude and others up.
After coming up, Mao Yuxuan took the initiative to say to Xue Xiude: "Professor Xue, Xiao Zhou said that he has rarely seen such infection cases before. I thought about letting him take the stage today. Am I being lazy?"
This is called reciprocating, Zhou Cheng is willing to teach him that kind of miraculous fracture reduction technique, it is very reasonable for him to let Zhou Cheng participate in the operation of severe infection that he almost vomited.
Xue Xiude looked at Mao Yuxuan thoughtfully, his protruding cheekbones agitated a little, which caused the mask to rotate, but no sound came out.
Professor Xue didn't say anything, and it was even harder for Gu Zhongliang and Shen De to say anything.
To put it bluntly, like Gu Zhongliang and Shen De, the teacher is not Xue Xiude, and he is not a professor. The doctor who follows him is a professor with the title of professor, and he is staying overnight.
The things that should be managed are the things within one's own duty.For others, it is better to mix less.
A patient with a 5-bed patient after sinus resection, after returning to the ward from the last operation, there is a lot of exudate from the wound every day...
Xue Xiude and the others washed their hands, changed into sterile surgical gowns, and each put on two pairs of gloves before starting the formal operation.
Xue Xiude stood at the main knife position, Gu Zhongliang was the first assistant, Shen De was the second assistant, Zhou Cheng was left with the third assistant, and then his follower was hospitalized, and Lin Yousheng was left with the fourth assistant.
There are enough people on the operating table, so Mao Yuxuan has no place.But not being on stage has the advantage of not being on stage, but when I arrived at the best viewing position where the anesthesiologist was at the bedside, I started to look at it.
Mao Yuxuan was very familiar with the people on the operating table, but this was the first time he had seen Zhou Cheng, and he had never seen Zhou Cheng perform an operation.
Before disinfection, the gauze on the patient's wound was cleaned up. The patient's wound was a surgical wound of no more than 3-4cm, and there was a drainage tube wound below the surgical wound, but now no matter whether it is the surgical incision or the drainage tube , there is a small amount of pale pink cloudy liquid oozing out.
It looked like it was filled with pus.
In addition to being ugly, there is also a strange smell, a foul smell...
The patient had undergone surgery in other places before, and he came to Shanghai No. [-] Hospital for treatment after about half a year after the surgery.
Xue Xiude said: "For this patient, the sinus tract was connected to the right hip joint before. The first operation was intramedullary nail fixation of the femur. After the infection, the sinus tract was connected during the last operation. Right hip, but there was no pus pooling inside the hip, so I didn't clean the joint and the prosthesis."
"But I guess this time, it may be necessary to remove the prosthesis and debride the joint cavity together. Only in this case, the joint must be cleaned according to the incision of total hip replacement. Of course, this The access opening can be a little smaller."
The patient's sinus tract is located on the inner side of the thigh, and total hip replacement generally uses a posterolateral approach, which is two different directions!
After coming to the hospital, the sinus tract was cleaned and resected, and the sinus tract was naturally taken, because the result of the previous MRI showed that the sinus tract was a semi-blind sinus tract.
The intramedullary nail prosthesis is an inert metal that can be used for magnetic resonance.
Many prostheses today are materials that can be used for magnetic resonance, unlike the implants many years ago.
Before the operation, Xue Xiude discussed with Gu Zhongliang and others whether to open the original incision for joint replacement. After all, the sinus opening is too far away from the original incision.
The result of everyone's discussion is to open it and take a thorough look at the situation in the joint cavity.
Of course, the preoperative discussion of this operation was in broad daylight yesterday. At that time, Zhou Cheng had not yet decided to come to the department, so Zhou Cheng did not participate in the preoperative discussion.
However, now that Xue Xiude said so.
Gu Zhongliang suggested: "Mr. Xue, why don't we clean up the inner side first. Otherwise, when the joint cavity and the inner side wound are penetrated, and then the wound on this side is treated, there will be a lot of fluid accumulation."
Although Xue Xiude is a professor, Gu Zhongliang is still used to calling him Teacher Xue Xiude.
"Okay! That's fine." Xue Xiude thought for a while, and felt that it would be advisable to deal with the inner side first.
Although the last step still has to come to the inside, sometimes extra steps are necessary.Otherwise, the inner side is treated last, which may cause pus to pour back into the treated opening on the outer side, which will be troublesome.
Now the outer side is still a blind end, which can pass through the original sinus opening to form a certain degree of drainage.
Xue Xiude then looked at Zhou Cheng, then at Gu Zhongliang, and asked, "Xiao Zhou, can you deal with the inner sinus tract? If you can, I will deal with the joint cavity directly from here."
"Professor Gu? Can you help Xiao Zhou?"
When Gu Zhongliang heard the words, he immediately knew Xue Xiude's intentions.
When things go wrong, there must be demons. Mao Yuxuan suddenly turned his attention to Zhou Cheng, which is difficult to explain with common sense, so Xue Xiude wants to see what is weird about Zhou Cheng.
"Okay, Mr. Xue." The partial incision and debridement of this operation, for him, Gu Zhongliang, has no improvement and promotion. Doing less is rest and earning.
Get out of the way.
"Okay, thank you Teacher Xue."
"Then I'll give it a try." Zhou Cheng was slightly taken aback when he heard the words, and took only half a step back. Hearing Xue Xiude's words, he nodded impolitely.
In fact, he is also very curious, what is so difficult to deal with such a complicated condition.
This is the first time Zhou Cheng has encountered such a difficult situation, and it was an infection caused by a simple fracture operation.
He looked at his corresponding skills: [Debridement and Suture (Perfect - World Definition Level)]
What is perfection - world definition?
That is, the whole world is absolutely first-class, not to mention the first, it is definitely the best group.
This kind of debridement and suture is just a debridement and suture for simple trauma, but it is really a bit of a big skill.
But with great skill and small use, you can go to the end.
Cool is really cool...
Zhou Cheng agreed?
Both Lin Yousheng and Mao Yuxuan were a little bit stunned, because in fact, anyone with a discerning eye can see and should be able to hear that the conversation between Professor Xue Xiude and Associate Professor Gu Zhongliang just now has hidden deep meaning, and it went straight to look at Zhou Cheng Deep and shallow.
Zhou Cheng's most normal reaction should be to be humble, and then slowly plan for the chief surgeon.
I agreed when I came up, isn't it a bit rash?
If it is your own words?
Lin Yousheng felt that he must not dare to agree to the chief surgeon of this operation, because it has exceeded his ability, and it is undoubtedly boring to perform the operation on the patient by himself.
Make it harder for yourself.
Mao Yuxuan's heart was a little nervous for a while, and he was even more curious.
Zhou Cheng dared to agree, maybe it was rash, but maybe not.After all, Zhou Cheng cannot be inferred and evaluated with common sense.When I first met him, Zhou Cheng was very calm and confident.
Judging by Zhou Cheng's attainments in fracture reduction techniques, his debridement and suture shouldn't be particularly bad, at least it won't make things worse.
Therefore, Mao Yuxuan didn't open his mouth to explain anything to his teacher.
Shen De on the side looked expressionless, but when he saw that Zhou Cheng was not at all stage frightened in the face of such a complicated patient, his heart was a little tumbling again.
The complexity of this patient is not comparable to those patients with simple fractures encountered in the emergency department.
Are ignorant people fearless, or do they really have confidence?
……
Soon, Zhou Chengcheng took over the sharp surgical knife handed over by the equipment nurse.
Then, the outermost suture was opened, and at the same time, a saline pad was attached to the lower edge of the wound. The suture of the wound was opened, and then the inner suture was cut with a sharp knife, and the fat layer was discovered. Below, a large amount of liquid gushed out, very thick.
The color is an ugly thick yellow, and it is very sticky. Although I haven't smelled an unpleasant smell through the mask for the time being, I saw this sticky thing oozing out of my body, and I was a little vomiting overnight.
Shen De stood opposite to Zhou Cheng, as Zhou Cheng's assistant, very quickly inserted the negative pressure suction device in, and then:
"呲呲呲!"
"bububu!"
There was a burst of abnormal sound of turbulent air being partially blocked.
It can be seen that the liquid inside is indeed too thick.
Zhou Cheng watched as Shen De sucked away the viscous pus little by little, and then steadily picked out the sutures under the skin, including the sutures in the muscle layer one by one.
Then it was discovered that there was still a lot of thick liquid in the inner layer of the wound, even more than the previous fat layer.It's just that the color at this time is no longer dark yellow, but has become light green.
When Zhou Cheng was about to speak to remind him, he found that Shen De on the opposite side had not inserted the suction tube very forcefully.
Zhou Cheng also closed his mouth. Yes, standing opposite is Shen De, the attending physician of the No. , not as strong as myself.
However, never underestimate the other party's professionalism and foundation.
"Teacher Tour, bring me two bacterial culture tubes, and send me a general microscopic examination and bacterial culture, thank you." Zhou Cheng's voice was very decisive and calm, but very heavy.
If the entire cavity is filled with such a large number of bacteria, then the scale of this operation is not simple.
Extensive muscle compartment infection, muscle necrosis!
Moreover, it is a special infection. Although according to the treatment experience and the latest literature, the shortest period of anti-tuberculosis chemotherapy before surgery is only 2 days, but Zhou Cheng still feels that the period of anti-tuberculosis treatment before surgery may still be a bit short. up.
Of course, these are just Zhou Cheng's temporary thoughts on the disease.
After opening the sutures, Zhou Cheng was very restless in his heart, revealing pale white and dark red flesh-colored flesh of dead fish.
"Here, the culture tube!" After confirming the nature of the culture tube, the roving and equipment nurse handed it over.
"Thank you." After Zhou Cheng transferred the liquid in the wound into the culture tube, he resubmitted both to the equipment nurse: "One for quick microscope examination, and one for bacterial culture."
The itinerant nurse understands, and there is no need to explain too much.
They are all professionals, which will save a lot of effort and trouble, and allow Zhou Cheng to focus more on the subsequent surgery.
"Huh!" He exhaled, and then carefully looked at the situation inside the wound.
In the end, he decided to tilt his head and said to the tour guide who was about to send the culture tube down: "Teacher tour, please open another sharp blade as a spare."
Xun Xun was a little reluctant: "Didn't you open one? I just saw the one you were holding in your hand? Did you drop it?"
While asking, he still walked towards the spare instrument table in the operating room.
It can be heard that she said this only instinctively.
"Open a spare." Zhou Cheng returned without looking up.
The itinerant nurse was depressed when she heard that, so she drove the backup?What the hell reason is this?
The person is not big, the technology may not be very good, but the shelf is very big.
Of course, now that Zhou Cheng is the main surgeon, she can't say much.
Just complaining in my heart.
Xue Xiude had never had an operation with Zhou Cheng, so he naturally didn't know the magical effect of Zhou Cheng calling the roving nurse to prepare an extra sharp blade.However, sharp blades are not expensive, and they are not included in the conventional surgical consumables at all, so he didn't ask much.
Gu Zhongliang and Shen De also looked at each other in dismay, their eyes flickered, meaning to say.
Small things, small things, don't care about young people.
After Zhou Cheng called the roving nurse to prepare sharp blades, he told Shen De and Lin Yousheng: "Please use a little force. Expose the periosteum as much as possible."
Zhou Cheng believed that Shen De and Lin Yousheng could do it.
In fact, Shen De and Lin Yousheng quickly responded to Zhou Cheng, meeting Zhou Cheng's exposure conditions, although not so perfect, but such professional cooperation gave Zhou Cheng a feeling.
What exactly was the surgery I performed at the Eighth Hospital?
You have to do everything yourself.
With both hands, Zhou Cheng held tweezers in his left hand and a sharp knife in his right hand, starting from the skin incision, and slowly began to debride.
It's not particularly fast, and it doesn't have any unpredictable movements.
Shen De took a look, then smiled wryly.Then when he was about to make eye contact with Associate Professor Gu Zhongliang, he realized that Associate Professor Gu Zhongliang ignored him no matter how wink he was.
Then, Shen De turned his head slightly, and saw Xue Xiude who was performing the operation. At this moment, he also focused his gaze on Zhou Cheng's surgery field.
Actually—
Before Zhou Cheng made a move, Xue Xiude captured Zhou Cheng's movements very keenly. Although Zhou Cheng's sharp knife and tweezers didn't cut much necrotic skin, Zhou Cheng's right hand was floating slightly quickly.
Or dial...
The action looks like an intern doing the surgery for the first time, with nervous shaking of both hands, but.
However, this kind of jitter is absolutely different from that kind of jitter, very different.
Although Xue Xiude hadn't taken Zhou Cheng with him before, it can be seen from Zhou Cheng's operation of opening the sutures outside the surgical incision that Zhou Cheng had undergone surgery and was very skilled.
It is estimated that there are at least one or two hundred patients who have undergone surgery in his hands. Therefore, the nervous tremor like an intern's operation will definitely not appear in Zhou Cheng's hands, but now?
When Professor Xue Xiude looked more carefully, he could find that Zhou Cheng's right hand was shaking slightly, and the thumb, index finger and middle finger were constantly changing the angle slightly, controlling the tip and shoulder of the sharp blade, and quickly Scratch in the skin and subcutaneous space!
The principle of operation is somewhat similar to the curettage of benign bone tumors in orthopedics department!
Xue Xiude has always admitted that he is only a trauma surgeon, not an orthopedic surgeon, because he knows how big the gap is between trauma surgery and bone tumors.
Although he doesn't understand, as a professor, he may have more research on tumors than the general director of a prefecture-level city hospital.Because of the literature he has read, the research he has done, and the defense he has participated in, I don’t know how many...
However, bone tumors are usually inside or outside the bone, and they are relatively hard things. During the process of scraping with a curette, there will be feedback on where it is scraped.
The place Zhou Cheng is working on is only soft tissue. It is not easy to complete the scraping action in this place.
If the force is not enough, it is irrelevant. If it is heavy, the soft tissue such as muscles and blood vessels can be wiped out with one knife.
Amputation can be performed with a sharp or round knife, soft tissue can be cut everywhere, this is no joke.
"Xiao Zhou, who is this?" Xue Xiude asked immediately.
If you don't understand, you must ask.
Of course, he was also afraid that Zhou Cheng would do something wrong, although the chance of doing something wrong was very small.
There's no shame in asking questions.
Chao heard that, Xi can die.
If Zhou Cheng was messing around, he would have kicked Zhou Cheng out earlier.The reason why he still treats each other with courtesy is that Mr. Zeng's behavior is a bit unreasonable, and the second is that his students suddenly changed, which made him feel abnormal.
"Ms. Xue, I'm doing lacunar debridement."
"If that doesn't feel right to you, I won't."
Before Zhou Chengcheng said whether to do it or not, Xue Xiude shook his head, smiled and said: "No, you continue! And you have to continue."
"Of course, you still have to tell me a preliminary basic principle according to the procedure."
"After all, as the professor who leads the group, I have to give you a full account of all the operations you do. You have to let me know roughly what the worst result will be if you do this."
The Shanghai Ninth Hospital, as the affiliated hospital of Shanghai Jiaotong University, is one of the most well-known hospitals in Huaguo. If you can’t accept a new thing and don’t dare to tell the truth about a capable student, then it’s really a joke up.
However, Xue Xiude still wanted to ask Zhou Cheng, if he couldn't explain the specific principle, then he would feel embarrassed.
Zhou Cheng temporarily stopped the operation in his hands, and continued to explain: "It can be roughly divided into two parts. The first part is similar to the application of bone disease scraping and sweeping techniques in debridement. It uses micro-operations to achieve normal Muscle tissue and the ability to shave off dead tissue quickly and cleanly."
"The second part is the lacunar theory. Our conventional debridement mainly focuses on excision of necrotic tissue, and does not retain tissue that cannot be determined to be infected."
"However, I have always believed that the bacteria that infect patients' wounds are generally latent in various cavities. If these cavities can be resected in a limited manner by micromanipulation, the remaining normal tissues can be guaranteed to a greater extent."
"And it can clean up the infected tissue to a greater extent, reducing the chance of infection recurrence."
"Because according to the principle of normal debridement, the lacunae that can not be opened should not be opened as much as possible. However, we found through searching the literature that many experts at home and abroad have actually achieved complete debridement during debridement. The effect has been achieved, but there is still a recurrence rate of more than [-]%.”
"so……"
Zhou Chengxin picked it up and spoke skillfully.
Zhou Cheng, who has many perfect skills, can spark different skills with a little organization and overlap, and he can explain the principle. I borrowed the theory of bone tumor science, not out of thin air.
I also have literature and theoretical support.
Justified!
Xue Xiude nodded and said with a smile: "You can continue."
Then, Xue Xiude continued his operation...
Gu Zhongliang and Shen De continued to look at each other again, and the eyes that looked at Zhou Cheng began to reveal light slowly.
Zhou Cheng's ambition is big enough, he even thought about improving surgery, so why did he come to Xue Xiude?Isn't it good to go to Professor Yu Qiuhua?
However, it seems that this time, Professor Xue Xiude didn't mean to object too much.
The handwashing nurse stared blankly at Zhou Cheng for several times, first the documents, and then the operations of experts at home and abroad, as if it sounded like that...
Isn't it afraid of getting fucked if you boast such a big mouth all at once?
He looks so tall and handsome, it would be a pity if his eggs were lost...
Although the anesthesiologist had nothing to do with orthopedics, he had doubts about the authenticity of Zhou Cheng's theory, but he felt that Zhou Cheng's theory was a bit far-fetched.
Debridement and suture is the foundation of surgery, Zhou Cheng actually chose to start with debridement.
What is the basis of surgery, every medical student will tell you, debridement, debridement, or debridement.
The first step in the development of surgery is debridement, and the development of all surgical techniques cannot be separated from debridement.
Debridement is to teach the surgeon how to distinguish between necrotic tissue and healthy tissue. The essence of 90.00% of surgical operations above five is to remove necrotic tissue and preserve the patient's function.
It's just that basically all the techniques come from debridement, so this area, the development of surgery for more than 100 years, has basically been rotten and thoroughly researched.
Then you can still play tricks?
Of course, if you can really play tricks, then?
The foundation, what is the foundation, is the cornerstone of everything.
For example, mathematics is a tool and the foundation of various disciplines. If some theorems of mathematics come true, many things derived will immediately undergo earth-shaking changes.
Just like how long has the mass-energy formula been proposed, how much has human beings made in 100 years?
Medicine, every discipline, has two major experimental directions, one is called clinical experiment, and the other is basic experiment.
In clinical experiments, many conclusions or conjectures are not as influential as the results of basic experiments.Basic experiments are generally done in the laboratory, and once done, high-scoring articles can be published.
The reason why high-scoring articles can be published is naturally that the impact is a bit greater than clinical trials.
And some basic clinical skills, such as debridement and suture, have basically become bad street operations now. After graduating from a junior college, they can also know how to suture and some basic concepts of debridement.
At present, in the international arena, the basic operation in research is actually various fancy sutures.
Has anyone thought about doing something about debridement?
Yes, and many.
I really want to get my hands on it.
It's not that I don't want to, but it's too difficult.
So, if it is really possible to add something to the already outdated basic theory of debridement, then I'm sorry, big brother, you can't do it if you don't want to be famous.
You are all rushing to write conceptual things in textbooks.
Zhou Cheng's ambitions are not that great for the time being. Now, his theory is not particularly complete, and the theory needs to be transformed into data first, and then theorized from the data.
Don't be in such a rush.
However, Zhou Cheng's operation became smoother and smoother. He didn't perform the operation properly for some time, and it was already from the skin to the subcutaneous fat layer.
In the operation of the fat layer, Zhou Cheng has changed another operation mode...
When he saw this, he thought that he should be a very calm Professor Xue Xiude, and he couldn't calm down any more. He thought for a while, and then said: "Xiao Zhou, you have to suture this wound. For the time being, there are other things. opinion?"
Xue Xiude understood, and he heard it clearly.
It turns out that debridement can still do this?
It turns out that debridement can be reinterpreted.
Debridement, and a new understanding!
The re-understanding and interpretation of debridement, what is the concept in surgery, that is, Huaguo's characters, a new definition of initial consonants, finals and tones, if it can be achieved, then all concepts, It may all change because of this!
The foundation, though simple, is the cornerstone!
Even if this kind of thing that can change the whole orthopedics and even surgery is just a possibility, as long as there is a little sign, it can be done.
It is absolutely impossible for Xue Xiude to make Zhou Cheng give up.
Even if it persists for five or ten years, it is still useless, so what?
Zhou Cheng is still young, he can afford to delay, what if?
Zhou Cheng heard the meaning of Xue Xiude's words, but Zhou Cheng felt that it was a bit too hasty to take this debridement suture out as a topic, so he said, "There are some, but they are not systematic, Professor Xue. I am currently researching, It's another subject."
Zhou Cheng's words, like a pair of scissors, knocked out Xue Xiude's thinking.
Ga.
It is equivalent to cutting!
What could be more important than what Zhou Cheng said just now?
Xue Xiude felt that he had to find an opportunity to have a good talk with Zhou Cheng. Things had to be prioritized. Xiao Zhou, you are still young. In fact, the whole world you can see is just the tip of the iceberg.
Now is obviously not the time to talk, so Xue Xiude just asked one more question: "Xiao Zhou, what are you researching now? I think if it is not particularly important, we can still divide the research into priorities."
"Open reduction and internal fixation for fractures with small incisions, manual reduction and plaster external fixation for fractures." Zhou Cheng thought about it and said truthfully.
you.
Me? !
Xue Xiude kicked his feet and landed on Luan.
It probably means that after the vastus medialis contracted too much, it pinched a bit, and it hurt a little.
Zhou Cheng didn't notice this at all, and continued with the operation on hand.
PS: It's the end of the month, ask for a monthly pass.
Explosive change next month, preliminary plan, 4 starting coins plus one word.Unlimited accumulation.
How cost-effective, let's think for ourselves.
(End of this chapter)
The process of rounds did not slow down or stop because Zhou Cheng was new here today.
Only Zhou Chengyin is a newcomer, and he is not familiar with the patient's past and current conditions, so he can only analyze it based on the report of the doctor in charge of the bed, which is equivalent to looking at the flowers on horseback.
Although I roughly remembered the general situation of the patient, but for some detailed problems, even if the subordinate doctor made a report, there was no way to restore all the details one by one at once.
Because the doctor in charge of the bed tacitly knew some details for Yu Qiuhua and others, naturally he would not report more things just because Zhou Cheng was a newcomer.
If there is only one variable factor, then it is a very small number of variable factors to adapt to most stable factors.
Without the overall control over the patient's condition, even Zhou Cheng couldn't make up for it so easily.
Of course, Zhou Cheng didn't have the opportunity to work hard to understand the other patients, but Zhou Cheng was very impressed with the two patients who were going to be operated on today.Because he deliberately spent an extra 10 minutes to read the medical records of the two beds.
After reading it, I was a little worried.
Zhou Cheng had just arrived, although junior doctors could ignore him, but Professor Xue Xiude still gave Zhou Cheng a lot of face. After he got out of the operating room, he asked Mao Yuxuan to accompany Zhou Cheng and arrange things in the department first.
Mao Yuxuan had almost figured out Zhou Cheng's current state, and felt sorry for Zhou Chengdao: "Xiao Zhou, according to what you said, then you are not making any money as the general inpatient now."
At first, Mao Yuxuan thought that Zhou Cheng was an employee of the hospital who came by airborne. Because of his relationship with Academician Zeng, he was hospitalized for a symbolic few months, and then he was promoted to attending.
He wanted to make way for Zhou Cheng, so he moved away.
But now that I think about it, things are not as I imagined. Zhou Chengcheng hasn't worked yet, so the work of the general hospital is equivalent to doing it for nothing, and both himself and Zhou Cheng are at a loss.
Naturally, Zhou Cheng would not tell Mao Yuxuan the main purpose of his visit, this had to be infiltrated slowly, otherwise he would be regarded as a fool.
"It's okay, the main reason is that Mr. Zeng wants to exercise well, and I also feel that I need more clinical polishing now."
Then Zhou Chengcheng brought the topic back to the main topic: "Brother Xuan, the two operations today are not easy to do."
Zhou Cheng said while flipping through the medical records.
The first thing to be operated on is a 5-bed tuberculosis patient. The patient's lower limb skin has sinus tracts, and the sinus tracts have pus, which is extremely difficult to treat.
What is the concept of sinus drainage? It means that Mycobacterium tuberculosis has eroded and broken the bone marrow cavity, cortical bone, and even the soft tissue layer outside the bone, eroding a channel.
Then the pus inside slowly oozes out.
Originally, according to the principle, patients with special infections like tuberculosis are definitely arranged in the last one in an operating room, so as not to increase the infection rate of patients in the latter operation room.
However, another 8-bed situation is more dangerous than this 5-bed one. In addition to tuberculosis bacteria, there are also bacteria infected.It's equivalent to a mixed infection, it sucks...
Bacteria and Bacteria are not the same thing.Therefore, 5 beds were assigned to the first station, and 8 beds were assigned to the second station.
The situation is roughly like this.
The skills that Zhou Cheng currently knows are all simple skills written in textbooks.These skills are definitely the foundation. With so many Level I-IV skills, you can basically deal with all orthopedic diseases.
Especially in the face of textbook-like fractures or diseases that require surgery, these perfect level skills are extremely lethal.
But there is another critical issue, that is, the patients encountered may not be sick according to the textbook, which requires slowly dismantling and analyzing the mechanism of the disease.
The grades of surgeries are strictly graded as I-IV. However, in Zhou Cheng’s understanding, some surgeries should not be grade IV surgeries. They should be beyond grade IV surgeries, and can even be classified as grade V surgeries…
Zhou Cheng's own experience is limited. Even in the process of using the simulator, he only honed his skills one by one according to the orthopedic surgery grading list announced by the state.
Zhou Cheng definitely has the ability to perform treatments and surgeries. However, it seems that the patients in Professor Yu Qiuhua's group simply use one or two simple surgeries, so it is difficult to deal with them.
It is necessary to analyze its pathogenesis in more detail in order to achieve a better therapeutic effect.
Mao Yuxuan smiled and asked: "Xiao Zhou, didn't you say that you are a trauma surgery major? Have you never seen such a patient before?"
Mao Yuxuan has been trying to figure out Zhou Cheng's origin, and finally determined that it should not be the inheritance of the Ninth Hospital of Shanghai, but may belong to Shanghai.But now that Zhou Cheng looks like he has never seen the world, it seems that he is not the inheritance of the devil city.
Of course, Mao Yuxuan's question did not mean looking down on Zhou Cheng, but rather.
If the unit Zhou Cheng stayed in before was on the same level as the current No. [-] Hospital of Shanghai, such patients should not be uncommon.
How many hospitals are there in the country?
Even if a hospital has two difficult patients a year on average, if they cannot handle them, the number will be thousands or even tens of thousands after they are gathered in Shanghai, Kyoto, Guangdong Province and other places.
China is too big.
Both Zhou Cheng and Mao Yuxuan felt that it was a bit too ostentatious for Mao Yuxuan to call Mr. Zhou Cheng Zhou or Mr. Xiao Zhou. In the end, it was absolutely that Mao Yuxuan called Zhou Cheng Xiao Zhou, and Zhou Cheng called Brother Mao Yuxuanxuan.
Mao Yuxuan also didn't like Zhou Cheng calling him a teacher in the friendship of young people.
"I haven't seen it much before. Patients with simple infection after surgery are rare." Zhou Cheng didn't care. Anyway, he was young, so what if he admitted his short-sightedness?
At most, you will be laughed at. If you pretend to know everything, in case you are told, since you have more knowledge, then you don’t want to learn. How can Zhou Cheng get started and gain trust?
Mao Yuxuan probably understood that Zhou Cheng's previous unit was the one that only dealt with the simple fracture and trauma patients he encountered.
Don't solve problems for others, and don't solve units that others have solved but can't solve.
It cannot be said that their technology is not good, but that the positioning of each place is different.
This also just shows that in Zhou Cheng's previous unit, because there were many patients with simple fractures, there were enough patients to support him to practice the magical technique of closed reduction and external fixation of fractures.
"After that, we can learn more." Mao Yuxuan's mentality was slightly adjusted.
Because I saw Zhou Cheng's shortcomings, and then I felt that Zhou Cheng was more real.Although Zhou Cheng has such strong skills, he also has his own shortcomings, which is normal and like a human being.
"We don't have to worry about other things. The main thing is to manage subordinate doctors and review their medical orders."
"But these things are now being done by the attendants in the hospital, and these doctors also have things to do..."
"All we have to do now is to review the operation that is scheduled for tomorrow, if."
After Mao Yuxuan told Zhou Cheng some common-sense questions, he led Zhou Cheng to the operating room.
Prior to this, Professor Xue Xiude, Gu Zhongliang and others had already gone down first.
In addition to the general hospitalization, there are still three people who are attending and above, and there are two attendant chiefs, so whether the chief doctor on duty is in the hospital or not, the operation can be carried out normally.
The general inpatient can go into the operating room and assume his role after doing his own thing well.
Zhou Cheng then asked: "Brother Xuan, in our hospital, on weekdays, do patients with this kind of infection be routinely treated and treated?"
Somewhat curious, if the 5 beds and 8 beds are routine treatment and treatment, then he feels that he has to rethink and recognize the perfect level skills he thinks.
Mao Yuxuan also shook his head and smiled wryly.
He replied: "Xiao Zhou, how can you be so magical as you think? In fact, in clinical medicine, there are only a bunch of dead principles. Surgery is surgery and medication, but the process and details of the surgery are slightly different."
"The reason why there are more patients now is because it is winter vacation. Generally, patients with this kind of infection rarely come in summer, and the summer is hot and dry. It is possible that such patients will be admitted to the ICU before they can turn around..."
Speaking of this, Mao Yuxuan hesitated to speak, probably meaning that when it is cold, there are more patients like this, and in other seasons, they may not be able to carry them to Shanghai.
But this kind of thing is not something that Mao Yuxuan can control, so he continued: "Complicated infection is better. Kyoto and Shanghai are one, but the other is Xinjiang Province."
"There are a lot of infected patients there, and the reimbursement ratio is very high, so the patients hardly need to spend money."
"But no matter how you say it, it also falls into the category of complete debridement. It's not good. If the debridement operation is done well, the number of operations can be reduced."
"If the dosage and type of antibiotics used are well selected, the course of anti-infection treatment can be reduced. But these are issues that professors should consider. We junior doctors can only slowly ponder based on experience."
Zhou Cheng had heard Luo Yun say such a conclusion before.
"What is the prognosis of such a patient on weekdays?" Zhou Cheng continued to ask.
"Not necessarily. 90.00% of the patients can still get a relatively good prognosis."
"Of course, there are still about [-]% of patients with complicated infections, and the prognosis is not very good due to various reasons." Mao Yuxuan did not hide or brag about his department's awesomeness, and admitted that there were also some patients with complicated infections. A small group of patients has a poor prognosis.
But in fact, this is Mao Yuxuan's confidence.
I was able to treat so many patients that other provinces could not handle until the cure rate reached 90.00%. This is where I am awesome.
As for why it is not 100%, there are many factors.
It may be that the patient's family cannot afford the money, or the patient is unwilling to be treated, or it may be that a small number of patients have an infection, which is very weird at all, and eventually develops into multiple infections all over the body, and finally loses their lives. Yes, it is possible to encounter.
In addition to Huaguo's traditional medical theory, which can cover 100% of diseases and has a super high "cure rate", modern medicine has always admitted its own shortcomings.
It's just that some people think that the reason why there is no one-and-done treatment in modern medicine is because of the operation and operation of capital.
Zhou Cheng knew that a person like Mao Yuxuan could openly admit that the Ninth Hospital of Shanghai had a disease that could not be cured. Just have to walk out.
Where is such a magical place?
……
Following Mao Yuxuan all the way into the operating room, Zhou Cheng is also familiar with the road, after all, he has been here before the Chinese New Year.
"Xiao Zhou, you have been in our hospital for a while, right?" Mao Yuxuan looked at Zhou Cheng's familiar movements, smiled and asked.
"Why didn't you think of coming to our trauma surgery department in advance?"
"Before, I was doing experiments along with it, and then mixed in the experience of sports medicine. And you know, Brother Xuan, that I am from Hunan Province. Professor Lin Ziyuan's senior sister Ding Dian is also from Hunan Province."
"It's almost because of this relationship, so I didn't come directly to our trauma surgery department."
To convince Mao Yuxuan, it is best to be truthful.Of course, don't be too real, otherwise, Mr. Zeng will lose face.
Mao Yuxuan didn't say much, it involved other departments, other professors, and other directors.He was always hospitalized, and he couldn't get in the conversation, and he wasn't even qualified to comment.
After going in and changing clothes quickly, the anesthesiologist is still administering anesthesia to the patient, and it will take a while before the operation can be officially started.
Both Associate Professor Gu Zhongliang and Professor Xue Xiude were not in the operating room, and Shen De and a follower were always hospitalized, that is, a doctor was watching in the operating room.
After Zhou Cheng and Mao Yuxuan arrived, they consciously helped to disinfect the towels.
The doctor in charge of the bed was still dealing with the doctor's orders upstairs. Zhou Cheng, Mao Yuxuan, and the resident inpatient's three major "inpatient chiefs" were the lowest-level doctors, especially Zhou Cheng and the inpatient's chief inpatient, Lin Yousheng, a third-year doctor.The qualifications of the two people are relatively low.
Although Zhou Cheng temporarily took Mao Yuxuan's position, he still gave Mao Yuxuan some face.Proactively begin sanitizing the drape.
After everything was done, Mao Yuxuan called Professor Xue Xiude and others up.
After coming up, Mao Yuxuan took the initiative to say to Xue Xiude: "Professor Xue, Xiao Zhou said that he has rarely seen such infection cases before. I thought about letting him take the stage today. Am I being lazy?"
This is called reciprocating, Zhou Cheng is willing to teach him that kind of miraculous fracture reduction technique, it is very reasonable for him to let Zhou Cheng participate in the operation of severe infection that he almost vomited.
Xue Xiude looked at Mao Yuxuan thoughtfully, his protruding cheekbones agitated a little, which caused the mask to rotate, but no sound came out.
Professor Xue didn't say anything, and it was even harder for Gu Zhongliang and Shen De to say anything.
To put it bluntly, like Gu Zhongliang and Shen De, the teacher is not Xue Xiude, and he is not a professor. The doctor who follows him is a professor with the title of professor, and he is staying overnight.
The things that should be managed are the things within one's own duty.For others, it is better to mix less.
A patient with a 5-bed patient after sinus resection, after returning to the ward from the last operation, there is a lot of exudate from the wound every day...
Xue Xiude and the others washed their hands, changed into sterile surgical gowns, and each put on two pairs of gloves before starting the formal operation.
Xue Xiude stood at the main knife position, Gu Zhongliang was the first assistant, Shen De was the second assistant, Zhou Cheng was left with the third assistant, and then his follower was hospitalized, and Lin Yousheng was left with the fourth assistant.
There are enough people on the operating table, so Mao Yuxuan has no place.But not being on stage has the advantage of not being on stage, but when I arrived at the best viewing position where the anesthesiologist was at the bedside, I started to look at it.
Mao Yuxuan was very familiar with the people on the operating table, but this was the first time he had seen Zhou Cheng, and he had never seen Zhou Cheng perform an operation.
Before disinfection, the gauze on the patient's wound was cleaned up. The patient's wound was a surgical wound of no more than 3-4cm, and there was a drainage tube wound below the surgical wound, but now no matter whether it is the surgical incision or the drainage tube , there is a small amount of pale pink cloudy liquid oozing out.
It looked like it was filled with pus.
In addition to being ugly, there is also a strange smell, a foul smell...
The patient had undergone surgery in other places before, and he came to Shanghai No. [-] Hospital for treatment after about half a year after the surgery.
Xue Xiude said: "For this patient, the sinus tract was connected to the right hip joint before. The first operation was intramedullary nail fixation of the femur. After the infection, the sinus tract was connected during the last operation. Right hip, but there was no pus pooling inside the hip, so I didn't clean the joint and the prosthesis."
"But I guess this time, it may be necessary to remove the prosthesis and debride the joint cavity together. Only in this case, the joint must be cleaned according to the incision of total hip replacement. Of course, this The access opening can be a little smaller."
The patient's sinus tract is located on the inner side of the thigh, and total hip replacement generally uses a posterolateral approach, which is two different directions!
After coming to the hospital, the sinus tract was cleaned and resected, and the sinus tract was naturally taken, because the result of the previous MRI showed that the sinus tract was a semi-blind sinus tract.
The intramedullary nail prosthesis is an inert metal that can be used for magnetic resonance.
Many prostheses today are materials that can be used for magnetic resonance, unlike the implants many years ago.
Before the operation, Xue Xiude discussed with Gu Zhongliang and others whether to open the original incision for joint replacement. After all, the sinus opening is too far away from the original incision.
The result of everyone's discussion is to open it and take a thorough look at the situation in the joint cavity.
Of course, the preoperative discussion of this operation was in broad daylight yesterday. At that time, Zhou Cheng had not yet decided to come to the department, so Zhou Cheng did not participate in the preoperative discussion.
However, now that Xue Xiude said so.
Gu Zhongliang suggested: "Mr. Xue, why don't we clean up the inner side first. Otherwise, when the joint cavity and the inner side wound are penetrated, and then the wound on this side is treated, there will be a lot of fluid accumulation."
Although Xue Xiude is a professor, Gu Zhongliang is still used to calling him Teacher Xue Xiude.
"Okay! That's fine." Xue Xiude thought for a while, and felt that it would be advisable to deal with the inner side first.
Although the last step still has to come to the inside, sometimes extra steps are necessary.Otherwise, the inner side is treated last, which may cause pus to pour back into the treated opening on the outer side, which will be troublesome.
Now the outer side is still a blind end, which can pass through the original sinus opening to form a certain degree of drainage.
Xue Xiude then looked at Zhou Cheng, then at Gu Zhongliang, and asked, "Xiao Zhou, can you deal with the inner sinus tract? If you can, I will deal with the joint cavity directly from here."
"Professor Gu? Can you help Xiao Zhou?"
When Gu Zhongliang heard the words, he immediately knew Xue Xiude's intentions.
When things go wrong, there must be demons. Mao Yuxuan suddenly turned his attention to Zhou Cheng, which is difficult to explain with common sense, so Xue Xiude wants to see what is weird about Zhou Cheng.
"Okay, Mr. Xue." The partial incision and debridement of this operation, for him, Gu Zhongliang, has no improvement and promotion. Doing less is rest and earning.
Get out of the way.
"Okay, thank you Teacher Xue."
"Then I'll give it a try." Zhou Cheng was slightly taken aback when he heard the words, and took only half a step back. Hearing Xue Xiude's words, he nodded impolitely.
In fact, he is also very curious, what is so difficult to deal with such a complicated condition.
This is the first time Zhou Cheng has encountered such a difficult situation, and it was an infection caused by a simple fracture operation.
He looked at his corresponding skills: [Debridement and Suture (Perfect - World Definition Level)]
What is perfection - world definition?
That is, the whole world is absolutely first-class, not to mention the first, it is definitely the best group.
This kind of debridement and suture is just a debridement and suture for simple trauma, but it is really a bit of a big skill.
But with great skill and small use, you can go to the end.
Cool is really cool...
Zhou Cheng agreed?
Both Lin Yousheng and Mao Yuxuan were a little bit stunned, because in fact, anyone with a discerning eye can see and should be able to hear that the conversation between Professor Xue Xiude and Associate Professor Gu Zhongliang just now has hidden deep meaning, and it went straight to look at Zhou Cheng Deep and shallow.
Zhou Cheng's most normal reaction should be to be humble, and then slowly plan for the chief surgeon.
I agreed when I came up, isn't it a bit rash?
If it is your own words?
Lin Yousheng felt that he must not dare to agree to the chief surgeon of this operation, because it has exceeded his ability, and it is undoubtedly boring to perform the operation on the patient by himself.
Make it harder for yourself.
Mao Yuxuan's heart was a little nervous for a while, and he was even more curious.
Zhou Cheng dared to agree, maybe it was rash, but maybe not.After all, Zhou Cheng cannot be inferred and evaluated with common sense.When I first met him, Zhou Cheng was very calm and confident.
Judging by Zhou Cheng's attainments in fracture reduction techniques, his debridement and suture shouldn't be particularly bad, at least it won't make things worse.
Therefore, Mao Yuxuan didn't open his mouth to explain anything to his teacher.
Shen De on the side looked expressionless, but when he saw that Zhou Cheng was not at all stage frightened in the face of such a complicated patient, his heart was a little tumbling again.
The complexity of this patient is not comparable to those patients with simple fractures encountered in the emergency department.
Are ignorant people fearless, or do they really have confidence?
……
Soon, Zhou Chengcheng took over the sharp surgical knife handed over by the equipment nurse.
Then, the outermost suture was opened, and at the same time, a saline pad was attached to the lower edge of the wound. The suture of the wound was opened, and then the inner suture was cut with a sharp knife, and the fat layer was discovered. Below, a large amount of liquid gushed out, very thick.
The color is an ugly thick yellow, and it is very sticky. Although I haven't smelled an unpleasant smell through the mask for the time being, I saw this sticky thing oozing out of my body, and I was a little vomiting overnight.
Shen De stood opposite to Zhou Cheng, as Zhou Cheng's assistant, very quickly inserted the negative pressure suction device in, and then:
"呲呲呲!"
"bububu!"
There was a burst of abnormal sound of turbulent air being partially blocked.
It can be seen that the liquid inside is indeed too thick.
Zhou Cheng watched as Shen De sucked away the viscous pus little by little, and then steadily picked out the sutures under the skin, including the sutures in the muscle layer one by one.
Then it was discovered that there was still a lot of thick liquid in the inner layer of the wound, even more than the previous fat layer.It's just that the color at this time is no longer dark yellow, but has become light green.
When Zhou Cheng was about to speak to remind him, he found that Shen De on the opposite side had not inserted the suction tube very forcefully.
Zhou Cheng also closed his mouth. Yes, standing opposite is Shen De, the attending physician of the No. , not as strong as myself.
However, never underestimate the other party's professionalism and foundation.
"Teacher Tour, bring me two bacterial culture tubes, and send me a general microscopic examination and bacterial culture, thank you." Zhou Cheng's voice was very decisive and calm, but very heavy.
If the entire cavity is filled with such a large number of bacteria, then the scale of this operation is not simple.
Extensive muscle compartment infection, muscle necrosis!
Moreover, it is a special infection. Although according to the treatment experience and the latest literature, the shortest period of anti-tuberculosis chemotherapy before surgery is only 2 days, but Zhou Cheng still feels that the period of anti-tuberculosis treatment before surgery may still be a bit short. up.
Of course, these are just Zhou Cheng's temporary thoughts on the disease.
After opening the sutures, Zhou Cheng was very restless in his heart, revealing pale white and dark red flesh-colored flesh of dead fish.
"Here, the culture tube!" After confirming the nature of the culture tube, the roving and equipment nurse handed it over.
"Thank you." After Zhou Cheng transferred the liquid in the wound into the culture tube, he resubmitted both to the equipment nurse: "One for quick microscope examination, and one for bacterial culture."
The itinerant nurse understands, and there is no need to explain too much.
They are all professionals, which will save a lot of effort and trouble, and allow Zhou Cheng to focus more on the subsequent surgery.
"Huh!" He exhaled, and then carefully looked at the situation inside the wound.
In the end, he decided to tilt his head and said to the tour guide who was about to send the culture tube down: "Teacher tour, please open another sharp blade as a spare."
Xun Xun was a little reluctant: "Didn't you open one? I just saw the one you were holding in your hand? Did you drop it?"
While asking, he still walked towards the spare instrument table in the operating room.
It can be heard that she said this only instinctively.
"Open a spare." Zhou Cheng returned without looking up.
The itinerant nurse was depressed when she heard that, so she drove the backup?What the hell reason is this?
The person is not big, the technology may not be very good, but the shelf is very big.
Of course, now that Zhou Cheng is the main surgeon, she can't say much.
Just complaining in my heart.
Xue Xiude had never had an operation with Zhou Cheng, so he naturally didn't know the magical effect of Zhou Cheng calling the roving nurse to prepare an extra sharp blade.However, sharp blades are not expensive, and they are not included in the conventional surgical consumables at all, so he didn't ask much.
Gu Zhongliang and Shen De also looked at each other in dismay, their eyes flickered, meaning to say.
Small things, small things, don't care about young people.
After Zhou Cheng called the roving nurse to prepare sharp blades, he told Shen De and Lin Yousheng: "Please use a little force. Expose the periosteum as much as possible."
Zhou Cheng believed that Shen De and Lin Yousheng could do it.
In fact, Shen De and Lin Yousheng quickly responded to Zhou Cheng, meeting Zhou Cheng's exposure conditions, although not so perfect, but such professional cooperation gave Zhou Cheng a feeling.
What exactly was the surgery I performed at the Eighth Hospital?
You have to do everything yourself.
With both hands, Zhou Cheng held tweezers in his left hand and a sharp knife in his right hand, starting from the skin incision, and slowly began to debride.
It's not particularly fast, and it doesn't have any unpredictable movements.
Shen De took a look, then smiled wryly.Then when he was about to make eye contact with Associate Professor Gu Zhongliang, he realized that Associate Professor Gu Zhongliang ignored him no matter how wink he was.
Then, Shen De turned his head slightly, and saw Xue Xiude who was performing the operation. At this moment, he also focused his gaze on Zhou Cheng's surgery field.
Actually—
Before Zhou Cheng made a move, Xue Xiude captured Zhou Cheng's movements very keenly. Although Zhou Cheng's sharp knife and tweezers didn't cut much necrotic skin, Zhou Cheng's right hand was floating slightly quickly.
Or dial...
The action looks like an intern doing the surgery for the first time, with nervous shaking of both hands, but.
However, this kind of jitter is absolutely different from that kind of jitter, very different.
Although Xue Xiude hadn't taken Zhou Cheng with him before, it can be seen from Zhou Cheng's operation of opening the sutures outside the surgical incision that Zhou Cheng had undergone surgery and was very skilled.
It is estimated that there are at least one or two hundred patients who have undergone surgery in his hands. Therefore, the nervous tremor like an intern's operation will definitely not appear in Zhou Cheng's hands, but now?
When Professor Xue Xiude looked more carefully, he could find that Zhou Cheng's right hand was shaking slightly, and the thumb, index finger and middle finger were constantly changing the angle slightly, controlling the tip and shoulder of the sharp blade, and quickly Scratch in the skin and subcutaneous space!
The principle of operation is somewhat similar to the curettage of benign bone tumors in orthopedics department!
Xue Xiude has always admitted that he is only a trauma surgeon, not an orthopedic surgeon, because he knows how big the gap is between trauma surgery and bone tumors.
Although he doesn't understand, as a professor, he may have more research on tumors than the general director of a prefecture-level city hospital.Because of the literature he has read, the research he has done, and the defense he has participated in, I don’t know how many...
However, bone tumors are usually inside or outside the bone, and they are relatively hard things. During the process of scraping with a curette, there will be feedback on where it is scraped.
The place Zhou Cheng is working on is only soft tissue. It is not easy to complete the scraping action in this place.
If the force is not enough, it is irrelevant. If it is heavy, the soft tissue such as muscles and blood vessels can be wiped out with one knife.
Amputation can be performed with a sharp or round knife, soft tissue can be cut everywhere, this is no joke.
"Xiao Zhou, who is this?" Xue Xiude asked immediately.
If you don't understand, you must ask.
Of course, he was also afraid that Zhou Cheng would do something wrong, although the chance of doing something wrong was very small.
There's no shame in asking questions.
Chao heard that, Xi can die.
If Zhou Cheng was messing around, he would have kicked Zhou Cheng out earlier.The reason why he still treats each other with courtesy is that Mr. Zeng's behavior is a bit unreasonable, and the second is that his students suddenly changed, which made him feel abnormal.
"Ms. Xue, I'm doing lacunar debridement."
"If that doesn't feel right to you, I won't."
Before Zhou Chengcheng said whether to do it or not, Xue Xiude shook his head, smiled and said: "No, you continue! And you have to continue."
"Of course, you still have to tell me a preliminary basic principle according to the procedure."
"After all, as the professor who leads the group, I have to give you a full account of all the operations you do. You have to let me know roughly what the worst result will be if you do this."
The Shanghai Ninth Hospital, as the affiliated hospital of Shanghai Jiaotong University, is one of the most well-known hospitals in Huaguo. If you can’t accept a new thing and don’t dare to tell the truth about a capable student, then it’s really a joke up.
However, Xue Xiude still wanted to ask Zhou Cheng, if he couldn't explain the specific principle, then he would feel embarrassed.
Zhou Cheng temporarily stopped the operation in his hands, and continued to explain: "It can be roughly divided into two parts. The first part is similar to the application of bone disease scraping and sweeping techniques in debridement. It uses micro-operations to achieve normal Muscle tissue and the ability to shave off dead tissue quickly and cleanly."
"The second part is the lacunar theory. Our conventional debridement mainly focuses on excision of necrotic tissue, and does not retain tissue that cannot be determined to be infected."
"However, I have always believed that the bacteria that infect patients' wounds are generally latent in various cavities. If these cavities can be resected in a limited manner by micromanipulation, the remaining normal tissues can be guaranteed to a greater extent."
"And it can clean up the infected tissue to a greater extent, reducing the chance of infection recurrence."
"Because according to the principle of normal debridement, the lacunae that can not be opened should not be opened as much as possible. However, we found through searching the literature that many experts at home and abroad have actually achieved complete debridement during debridement. The effect has been achieved, but there is still a recurrence rate of more than [-]%.”
"so……"
Zhou Chengxin picked it up and spoke skillfully.
Zhou Cheng, who has many perfect skills, can spark different skills with a little organization and overlap, and he can explain the principle. I borrowed the theory of bone tumor science, not out of thin air.
I also have literature and theoretical support.
Justified!
Xue Xiude nodded and said with a smile: "You can continue."
Then, Xue Xiude continued his operation...
Gu Zhongliang and Shen De continued to look at each other again, and the eyes that looked at Zhou Cheng began to reveal light slowly.
Zhou Cheng's ambition is big enough, he even thought about improving surgery, so why did he come to Xue Xiude?Isn't it good to go to Professor Yu Qiuhua?
However, it seems that this time, Professor Xue Xiude didn't mean to object too much.
The handwashing nurse stared blankly at Zhou Cheng for several times, first the documents, and then the operations of experts at home and abroad, as if it sounded like that...
Isn't it afraid of getting fucked if you boast such a big mouth all at once?
He looks so tall and handsome, it would be a pity if his eggs were lost...
Although the anesthesiologist had nothing to do with orthopedics, he had doubts about the authenticity of Zhou Cheng's theory, but he felt that Zhou Cheng's theory was a bit far-fetched.
Debridement and suture is the foundation of surgery, Zhou Cheng actually chose to start with debridement.
What is the basis of surgery, every medical student will tell you, debridement, debridement, or debridement.
The first step in the development of surgery is debridement, and the development of all surgical techniques cannot be separated from debridement.
Debridement is to teach the surgeon how to distinguish between necrotic tissue and healthy tissue. The essence of 90.00% of surgical operations above five is to remove necrotic tissue and preserve the patient's function.
It's just that basically all the techniques come from debridement, so this area, the development of surgery for more than 100 years, has basically been rotten and thoroughly researched.
Then you can still play tricks?
Of course, if you can really play tricks, then?
The foundation, what is the foundation, is the cornerstone of everything.
For example, mathematics is a tool and the foundation of various disciplines. If some theorems of mathematics come true, many things derived will immediately undergo earth-shaking changes.
Just like how long has the mass-energy formula been proposed, how much has human beings made in 100 years?
Medicine, every discipline, has two major experimental directions, one is called clinical experiment, and the other is basic experiment.
In clinical experiments, many conclusions or conjectures are not as influential as the results of basic experiments.Basic experiments are generally done in the laboratory, and once done, high-scoring articles can be published.
The reason why high-scoring articles can be published is naturally that the impact is a bit greater than clinical trials.
And some basic clinical skills, such as debridement and suture, have basically become bad street operations now. After graduating from a junior college, they can also know how to suture and some basic concepts of debridement.
At present, in the international arena, the basic operation in research is actually various fancy sutures.
Has anyone thought about doing something about debridement?
Yes, and many.
I really want to get my hands on it.
It's not that I don't want to, but it's too difficult.
So, if it is really possible to add something to the already outdated basic theory of debridement, then I'm sorry, big brother, you can't do it if you don't want to be famous.
You are all rushing to write conceptual things in textbooks.
Zhou Cheng's ambitions are not that great for the time being. Now, his theory is not particularly complete, and the theory needs to be transformed into data first, and then theorized from the data.
Don't be in such a rush.
However, Zhou Cheng's operation became smoother and smoother. He didn't perform the operation properly for some time, and it was already from the skin to the subcutaneous fat layer.
In the operation of the fat layer, Zhou Cheng has changed another operation mode...
When he saw this, he thought that he should be a very calm Professor Xue Xiude, and he couldn't calm down any more. He thought for a while, and then said: "Xiao Zhou, you have to suture this wound. For the time being, there are other things. opinion?"
Xue Xiude understood, and he heard it clearly.
It turns out that debridement can still do this?
It turns out that debridement can be reinterpreted.
Debridement, and a new understanding!
The re-understanding and interpretation of debridement, what is the concept in surgery, that is, Huaguo's characters, a new definition of initial consonants, finals and tones, if it can be achieved, then all concepts, It may all change because of this!
The foundation, though simple, is the cornerstone!
Even if this kind of thing that can change the whole orthopedics and even surgery is just a possibility, as long as there is a little sign, it can be done.
It is absolutely impossible for Xue Xiude to make Zhou Cheng give up.
Even if it persists for five or ten years, it is still useless, so what?
Zhou Cheng is still young, he can afford to delay, what if?
Zhou Cheng heard the meaning of Xue Xiude's words, but Zhou Cheng felt that it was a bit too hasty to take this debridement suture out as a topic, so he said, "There are some, but they are not systematic, Professor Xue. I am currently researching, It's another subject."
Zhou Cheng's words, like a pair of scissors, knocked out Xue Xiude's thinking.
Ga.
It is equivalent to cutting!
What could be more important than what Zhou Cheng said just now?
Xue Xiude felt that he had to find an opportunity to have a good talk with Zhou Cheng. Things had to be prioritized. Xiao Zhou, you are still young. In fact, the whole world you can see is just the tip of the iceberg.
Now is obviously not the time to talk, so Xue Xiude just asked one more question: "Xiao Zhou, what are you researching now? I think if it is not particularly important, we can still divide the research into priorities."
"Open reduction and internal fixation for fractures with small incisions, manual reduction and plaster external fixation for fractures." Zhou Cheng thought about it and said truthfully.
you.
Me? !
Xue Xiude kicked his feet and landed on Luan.
It probably means that after the vastus medialis contracted too much, it pinched a bit, and it hurt a little.
Zhou Cheng didn't notice this at all, and continued with the operation on hand.
PS: It's the end of the month, ask for a monthly pass.
Explosive change next month, preliminary plan, 4 starting coins plus one word.Unlimited accumulation.
How cost-effective, let's think for ourselves.
(End of this chapter)
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