medical simulator

Zhou Cheng couldn't understand Zhang Zhengquan's happiness, and Zhang Zhengquan certainly couldn't understand Zhou Cheng's distress.

After the farewell, Zhou Cheng returned home first, and continued to sort out the corresponding theories of the basic anatomical structure. This thing will soon start a formal research project, and it has to be sorted out.

In addition, Zhou Cheng also found the arthroscopic joint-preserving surgery of the shoulder joint, knee joint and hip joint and its application in the previous document, and sent it to Director Zhang Jin.

Of course, in this plan, Zhou Cheng also added the corresponding concept of tumor treatment, which is a hybrid application.

The concept of tumor treatment has been relatively mature. Although it has not been carried out in the clinic, the experiment is effective. Chu Hanbo has published the corresponding article in the journal, which belongs to the follow-up research topic that can be further deepened and used for reference.

Zhou Cheng has been thinking about this matter for the past two days, and after mixing it up, he sent it to Zhang Jin.

Then, Zhou Chengcheng continued to sort out the basic anatomical theory. This is a major event, and there is no rush, but it is more tangled.

Moreover, this project is a long-term project. Zhou Cheng might as well spend two or even three years to complete it.

But this is the whole topic. If you only start from the perspective of orthopedics, it should be almost finished in half a year to a year, and then the data will be published as an article.

This is the first project that Zhou Cheng independently developed. The funds raised by himself are controlled by himself, and he is no longer living in others like before.

Time was tight, and at [-]:[-], An Ruo sent another message.

Zhou Cheng also started chatting with An Ruo.

At [-]:[-], after An Ruo fell asleep, Zhou Cheng started his simulation again.

It's just that, in the simulated world, Zhang Zhengquan, who was forced by Zhou Cheng, failed to reach a very high level. Zhou Cheng could only sigh with emotion. I don't know if there is a problem with his teaching theory, or Zhang Zhengquan's talent in medicine is really limited.

Ignore it for now, let's go to sleep first.

The next day!

This is a Friday, except for yesterday's operation day, today should be very free.

However, Director Lu Bin said yesterday that Quan Zhuolin's group has a very complicated case that needs to be discussed in the department. The main reason is that Zhou Cheng can give some advice.So Zhou Cheng didn't leave early.

Today was supposed to be Director Quan Zhuolin's operation day, Monday and Friday are all for Quan Zhuolin this month, and Director Tong only has one surgery day on Wednesday.

After the three groups finished checking the rooms, Lu Bin and Tong Xun did not leave, but stayed in the department and participated in the discussion of the problem.

As soon as the bed doctor reported the medical records, everyone frowned.

"A 2-bed patient with septic arthritis. He had undergone internal fixation of a femoral neck fracture with hollow nails in a prefecture-level city hospital before, and an infection occurred after the operation."

"Before the debridement operation, he was infected with multi-resistant bacteria, had high blood pressure, and mild diabetes. The blood sugar level was well controlled before the operation. On the second day after the operation, the blood sugar level soared to 13.2mmol/L."

"Especially the blood sugar level after dinner, the highest was 17.2mmol/L."

"At present, there are no traces of pus in the wound, but the results of the bacterial culture of the drainage fluid in recent times are a bit messy. It seems that the results of the bacteria cultured are different each time, and the sensitive antibiotics are also inconsistent."

"So the current antibacterial regimen has been changed from cefuroxime to piperacillin, and now polymyxin is used. However, the results of bacterial culture taken two days ago showed that among the currently sensitive antibiotics, polymyxin Sensitivity is average, vancomycin is sensitive."

"I asked for a consultation from the pharmacy department yesterday. The consultation opinion stated that polymyxin should be stopped, vancomycin should be changed, levofloxacin should be added, and rifampicin should be taken orally. The patient did not see tuberculosis. The doctor on duty yesterday No, I don't know whether to follow the consultation opinion for the time being." The doctor in charge explained his views on the consultation opinion while introducing.

Of course, it may also be that he had a problem with the doctor on duty yesterday. This patient was obviously very difficult, but the doctor in charge ignored it, and did not prescribe the medicine that should have been prescribed.

However, just after Xie Limin, the doctor in charge of the bed, Quan Zhuolin began to popularize science: "In addition to being used for Mycobacterium tuberculosis, rifampicin is also commonly used for the antibacterial treatment of Staphylococcus aureus. Oral rifampicin is very effective in joint infection. It is effective. It is not just for anti-tuberculosis, but for broad-spectrum antibiotics."

Quan Zhuolin probably saw Xie Jian go to comment on the consultation opinions of the deputy chief physician of the pharmacy department, so he warned him in advance not to think too much.

Xie Limin immediately shut up obediently, and honestly wrote the corresponding doctor's order on the paper, which needs to be followed later.

He really didn't know this unpopular knowledge.

Quan Zhuolin then asked: "Doctor Zhou, Director Lu, and Director Tong, what do you think of this patient?"

When Lu Bin heard this, he said: "The current anti-infection plan should be changed according to the consultation opinions of the pharmacy department. For patients with septic arthritis, if the bacteria develop multi-resistance, then the effect of vancomycin is relatively good. of."

"Since the current drainage tube is unobstructed, we will observe it for a few more days. If bacteria can still be cultured in the subsequent drainage tube, we may have to do a debridement. However, the current strains of bacteria are changeable, and may not be the real focus of infection .”

Quan Zhuolin said: "At present, patients have great opinions, saying that our hospital has not even figured out the diagnosis. Several surgeries have been done in vain, and so much time and money have been wasted. In fact, we are already I tried my best, it’s hard to explain this situation.”

Infection is a big taboo in surgery.

Lu Bin asked: "Quan Zhuolin, I just heard that this patient was operated on by another hospital. How did such a patient come in?"

"Why didn't he go back to the previous hospital, or Shashi?"

This patient had a first visit to the hospital and was transferred after infection. Then they were wiping other people's buttocks, and Lu Bin was a little unhappy.

They are all prefecture-level city hospitals. Why don’t you let them deal with such troublesome patients by themselves?

The key is that the patient still doesn't understand, thinking that the disease cannot be cured after spending money, and they only come to you, which is a thankless type.

Before Quan Zhuolin could speak, Xie Limin said, "This patient was admitted by the head nurse. I don't know what's going on. When I was on duty, I was admitted to the hospital through regular consultation."

Generally speaking, the director accepts the patients, and then the bed doctor takes over. Therefore, Xie Limin first shirked his responsibility.

Quan Zhuolin pondered for a while, glanced at Xie Limin, and said, "Director Lu, this patient was called by the head nurse. I didn't know the situation at first. The head nurse originally planned to take you there. But because of this The month is special."

"So I will take care of it for the time being. You should know about this." Quan Zhuolin's tone was meaningful.

Lu Bin's expression changed slightly, and he glanced at Zhou Cheng who was sitting next to him, and found that Zhou Cheng's expression had not changed, so he knocked on the table: "The key thing we are discussing now is how to treat this patient in the future. It is recommended to transfer to a higher-level hospital, and other matters will be discussed later."

Quan Zhuolin found that Lu Bin was making fun of him, he tilted his head, and then turned serious again.

"Director Tong, what do you think?" Lu Bin asked.

Tong Xunjin, the Chief Physician, is relatively late and has the lowest qualifications at present. He said with a cheerful smile: "I think this kind of patient should be debrided several times and find sensitive antibiotics before we can make a conclusion. Otherwise, , There is no way to rely on empirical anti-infection treatment alone."

"It's not easy to do. It's very troublesome." Tong Xun kept shaking his head, saying that it was equivalent to not saying anything.

In fact, infection, it is easy to say, is a bacterial infection, but it is very troublesome to treat it.Laymen think that hospitals are fooling around, but people who really come into contact with this industry.will find out.

But any infection caused by surgery, such a patient, the dog will shake his head when he sees it.

Anyway, if there is no cure, there is only one sentence, good medicine is not a good commodity.This kind of person is very smart, smarter than people in the whole world. He regards medical practitioners all over the world as unscrupulous people, belonging to the level of saints. As long as there are poor people in the world, they are inseparable from him. !
Lu Bin then turned around and asked, "Doctor Zhou, what do you think of this patient?"

"Let's debride the wound. At present, the drainage tube is unobstructed, but no bacteria can be cultured, but the infection cannot be controlled. I think it is possible that the current continuous irrigation and drainage has not reached the place where the infection focus is concentrated. Debride the wound, and then during the operation, Then send the bacteria for culture."

"Strive to be able to find the focus of infection."

"A large-scale infection. From below the greater trochanter of the femur to above the ankle joint, a huge abscess cavity appeared, but there was no bone destruction. Moreover, the patient's blood sugar level was also fluctuating, so, in this case, must It is necessary to thoroughly debride the wound, otherwise, if it continues to develop, there may be a risk of amputation."

"Director Quan, when will you arrange the debridement of this patient?" Zhou Cheng didn't say much before, but now, he still thinks this case is more interesting.

It's very rare. Zhou Cheng had never seen such a strange case in the Ninth Hospital of Shanghai.

"It's just this afternoon, and there's only one for today. Doctor Zhou, didn't you have a small lecture in the morning." Quan Zhuolin said flatteringly.

Next month, Zhou Chengcheng will come to him, and he can finally relax a little bit, and introduce the biggest reassurance in the department to his own group.

Quan Zhuolin is still looking forward to it.

Zhou Chengcheng said: "Then let's go to the operating room to have a look later. I just think this case is very interesting. I don't know if it's convenient for you, Director Quan?"

To be honest, up to now, there are very few cases that Zhou Cheng finds interesting.The two surgeries I performed before, one for osteotomy and correction, and one for muscle necrosis, were both slightly interesting, not that interesting type of disease.

"It must be convenient, Dr. Zhou, you can come to the stage in person, we can only wish for it."

"Dr. Zhou, you have been in contact with many infection cases before, right? By the way, Dr. Zhou, you are in trauma surgery, how could you not have contact with such patients?" Quan Zhuolin laughed at himself.

Trauma surgery covers a wide range and is the foundation of the entire orthopedics department, with a wide range of contacts.

Zhou Chengcheng said: "Director Quan, that's not true. I don't have any experience in receiving patients with similar diseases. That is to gain knowledge. Let's learn from each other."

The more in-depth study, Zhou Chengcheng will find that the current types of orthopedic diseases are more complicated and complicated. The current types of diseases are known and unknown, which means that the level is not enough.

If you jump out 100 years and look at people 100 years ago, people at that time were much healthier, free from illness and pain, and they would be considered old if they were 60 years old.

If you skip 1000 years, there will be no concept of diabetes, high blood pressure, etc. At that time, sixty will be rare in ancient times.

Looking back after a few hundred years, it was still a doom for a woman to give birth to a child at that time, with a [-]% to [-]% mortality rate, even the imperial physicians in the palace were helpless...

At that time, there was no cancer at all, no terminal illness, and no infection. It was all wind-cold and hot air, and death from wind-cold meant bad luck.

Therefore, Zhou Cheng has always been in awe of medicine. He has never denied a certain medical concept and its ability to cure diseases, but in the same way, Zhou Cheng will deny all the more reasonable cognitions he now thinks.

Because only by constantly denying can we get closer to the truth.

"Doctor Zhou, you're joking." Quan Zhuolin smiled and didn't say anything more.

In this case, the troublesome points and difficulties have been clearly explained. What is needed is time to explore. Just holding a meeting here to discuss it will definitely not have much effect on the condition.

Then, it was time for Zhou Cheng's lecture.

Everyone knew the content of Zhou Cheng's lecture, so Lu Bin and Tong Xun soon called in everyone from their respective groups.

Limb transplantation is based on the concept of replantation of severed limbs. Combining amputation with amputation is very novel and bold. However, they all have their own basic concepts and are not particularly advanced thinking.

It's just that following Zhou Cheng's explanation, everyone would feel that it was Zhou Cheng who dared to be so skilled and bold enough to reinstall the legs of an amputee patient.

In this process, I gained a lot, but most of these gains belonged to gaining knowledge. If it is really necessary to implement it in the clinic, no matter whether it is Lu Bin, Quan Zhuolin, or Tong Xun, they dare not do so.

Fear of failure, and then the patient will make trouble, and now the patient's family will make trouble, and there will be money and death!
Zhou Cheng saw that everyone was listening seriously, but after he finished speaking, except for Qin Ming who asked two questions, everyone else remained silent.

This is far from Zhou Cheng's idea of ​​teaching.

However, teaching is like this, only those who want to learn will want to teach, and those who don’t want to learn, no matter how much they can be taught, they can’t be taught. We are all adults and independent individuals. Everyone only needs to be responsible for themselves .

At noon, everyone had a fast food together, a packed box lunch.

Then, all the talents left the operating room.

Tong Xun and Lu Bin were also there, hoping to see how Zhou Cheng did the basic operation of debridement, and whether he could do tricks.