medical simulator

After the third outpatient was sent out by Fang Yun, Zhou Cheng felt that Fang Yun's basic knowledge and basic skills were really good, so he improvised.

"Xiao Fang, explain to the patients outside, and don't call the next patient in for now." Zhou Cheng ordered.

When Fang Yun heard this, he immediately nodded and said to the next patient, "Wait a minute, the patient who just went for an examination has some problems on the film. My teacher said he needs to take another look. Wait for two or three minutes." That's fine, sorry."

After explaining and getting consent, Fang Yun opened the door and walked in. He was greeted by Zhou Cheng and came to the computer.

Zhou Cheng looked at it calmly for a while, then tilted his head slightly, saw that Fang Yun was also reading the film seriously, and asked, "Can you understand?"

Fang Yun nodded: "I can understand a little bit."

"How much do you understand? What is your understanding of fracture diagnosis and surgery?" Zhou Cheng continued to ask. He really wanted to guide this student. This time, the question was from a professional point of view.

This is a patient after fracture surgery. Before the operation, he was also done in a traditional Chinese medicine hospital. This time, he came for a review and consulted about the time to remove the internal fixation device.

Zhou Cheng saw that Fang Yun's foundation was good, so he recalled his previous plain film and examination. This is the plain film of the patient when he was injured and admitted to the hospital a year ago.

Fang Yun's expression immediately became tense. After looking carefully again, he organized his language a little and replied ably: "The diagnosis of a fracture, by definition, is the interruption of the continuity and integrity of the bone."

"Bone discontinuity can be seen in imaging examinations. The existence of fracture lines is the loss of bone continuity, and bone fragments represent a loss of integrity to a certain extent."

"Physical examination showed swelling at the fracture site and deformity of the limbs. I could feel bone friction at the fracture end, and occasionally I could see abnormal movements." Fang Yun replied very decisively, every word was not nonsense.

"What about the indications for surgery?" Zhou Cheng was obviously not surprised that Fang Yun could answer these questions.

Fang Yun frowned suddenly. Zhou Cheng was asking about the indications for surgery. In fact, there should be surgical contraindications, so he replied: "Manipulative reduction failed, unstable fracture, fracture that cannot be stabilized by plaster external fixation, All require surgery.

"The type of this fracture belongs to B2.21 type, which is an unstable fracture type, or a femoral fracture. Even after manual reduction and plaster external fixation, it is difficult to achieve the fixation effect. Therefore, surgical treatment is required."

"If there is no concurrent shock and no serious medical disease, surgical treatment can be performed."

Fang Yun didn't make a long speech, but picked the key points.

He knew that simply memorizing simple concepts in front of people like Zhou Cheng would definitely not be able to please him.Besides, he hasn't memorized anything conceptual for a long time.

The answer is concise.

And it also has a sense of hierarchy, one is for surgery, the other is for surgery, and the answers are different. He thinks that Zhou Cheng will definitely be able to hear the difference and the details he noticed.

"Fracture treatment?" Zhou Cheng was quite satisfied with Fang Yun's answer, so he continued to ask.

"The principles of fracture treatment are reduction, fixation, and rehabilitation exercises."

"Reduction includes manual reduction and surgical reduction. Fixation is divided into external fixation and internal fixation. Rehabilitation treatment is a follow-up rehabilitation training plan for patients after reduction and fixation." Fang Yun's answer was still decisive and capable.

"Are manipulative reduction and surgical reduction completely separate? How do you define reduction?" What Zhou Cheng asked at this moment has gone beyond the content of textbooks, and even beyond the scope of general specialist content.

Fang Yun has a good foundation, and he wants to teach.

Now these questions should be the questions that the attending and deputy chief physicians need to think about.

Fang Yun turned his head and glanced at Zhou Cheng, still hesitating in his heart. Teacher Zhou, your question is a bit out of line, but he still replied: "Surgical reduction is actually a combination of manual reduction and internal fixation device-assisted reduction. The purpose is to Achieve anatomical reduction and restore normal bone structure.”

"There is no distinction between high and low, it is to achieve the purpose of reset. It should be adjusted
Let's see together.Fixed only to maintain reset. "

"How to distinguish the method of fracture reduction?" Zhou Cheng's eyes lit up immediately, this Fang Yun is very good, this is no longer a basic skill, it is already a skill.

Fang Yun looked at Zhou Cheng's words again, his eyes flickered, as if hesitating, should this question not be answered.After all, if we meet for the first time, if it really makes Mr. Zhou Cheng unable to get off stage, how inappropriate would that be?
"You answer." Zhou Cheng signaled Fang Yun to continue.

Fang Yun lowered his head slightly, and glanced at Zhou Cheng's expression out of the corner of his eye: "Mr. Zhou, reset is the purpose. When doing reset, the principle of attention is to fully pull the fracture to separate the broken ends before performing reset. During the process, It is the force of borrowing that differentiates and differs.”

"Blind strength can be used to antagonize the contraction of the muscles with the pure physical strength of the operator, so that the affected limb can be fully pulled, and the fractured end can be separated before the reset operation."

"You can use ingenuity. Experienced and powerful surgeons will skillfully use part of the muscle strength of the patient's affected limb and analyze the shape of the muscles. Through ingenuity, they can make the reset easier."

"Then you can use your original strength. In the non-anesthesia state, the patient's own pain stimulates many muscle contractions. With this force, the reduction can be achieved without much effort. If it is during the operation and under anesthesia, the operator needs to find a suitable one. Position to stimulate the muscle's own strength."

"I also heard that what kind of energy can be used, I don't know..." Fang Yun looked at Zhou Cheng, his tone became lower and lower.

When the skill has reached this level, according to Professor Chen Xueliang, it has reached a new level, and it is a world-class technique reset operation, which is perfect in the world.

Zhou Cheng frowned upon hearing this.

According to Fang Yun, getting started is brute force, proficiency is ingenuity, and proficiency is basic strength, then the perfect level should be what he called Huajin.

However, this strength transformation is actually not completely accurate. The perfect level of technique reset should be borrowed, but it can be borrowed from different positions, not simply relying on the strength of muscles and ligaments.

On the contrary, my current redefined fracture reduction technique has a little bit of strength.This force comes from the anatomy of the bone. Depending on the location of the fracture, it is different from the anatomy of the surrounding muscles. Through the bone itself, it can transmit force and reset itself.

This is our body's self-protection mechanism.

Zhou Chengcheng nodded, and said, "I agree with the first points you said, but I think you can change the strength you said."

"Further up, it is heterotopic borrowing. For example, if we want to reset the fracture of the tibia, the position of the tibial fracture is very strange. If there is no muscle anatomical borrowing nearby, then we may have to use the femur and above the femur. other parts of the body, such as the muscles at the iliac crest and pubic bone, to borrow strength.”

"This is also a kind of leverage."

"Further up, there is bone repositioning force. Our physical body, after being hit, will have a self-protection mechanism to a greater or lesser extent, and it will still be the same after a fracture."

"This is also related to the precise anatomy of our human body. When we are injured, our existing anatomical structure will tend to restore our body to its original structure. If this power is used well, some Complicated, short bones and even fractures that are understood in the conventional field and cannot be reduced can also be reset manually.”

"Take the femur as an example. Traditionally, we believe that the femur cannot be reduced by manual reduction or external fixation with plaster, because even after reduction, the fracture is still unstable, and it cannot be fixed by simple external fixation with plaster. It maintains the reset effect."

"However, I have done it myself. After the femur fracture is reset, it can achieve the effect of reduction, and achieve the effect of continuous reduction." Zhou Cheng laughed as he spoke.

His last sentence is a bit annoying. It became what he liked to use when he was a junior doctor and when the superior doctor was bragging. What have I done.

"You can ignore the last sentence." Zhou Cheng himself doesn't like this, so he hopes Fang Yun can filter it out.

When Zhou Cheng spoke, Fang Yun's eyes shrank suddenly, and then he was startled.

He was extremely happy, and his tone was extraordinarily excited: "Thank you, Mr. Zhou!"

You know, Fang Yun is also a person who has seen the world. He was an undergraduate at Seoul University before. Good hospital for postgraduate study.

However, during the internship rotation, the professor showed him a lot of things, such as the complicated way of medicine that is not understood by ordinary people. Chen Xueliang introduced this medicine The different realms and levels of the book are classified in an easy-to-understand method, but it is not yet perfect.

Even during the postgraduate re-examination, my teacher Bu Haoran and the teachers there did not completely classify them. Unexpectedly, Zhou Cheng found a follow-up.

Zhou Guo is indeed unusual.

What the teacher said before is correct, in Changshi, there is indeed a great opportunity.

"It seems that you understood and didn't think I was talking nonsense."

"Okay, let's call the next patient first. This kind of discussion and learning will be done one by one in the future. You learn slowly, and I will teach slowly." Zhou Cheng also felt a sense of accomplishment.

MD, if all medical students had Fang Yun's qualifications and understanding, it would be great, and it would be so easy to teach. I just need to list the scoring standards for skills with different proficiencies, and they will automatically move closer. .

However, Zhou Cheng also knew that this was almost impossible.

Every subject requires talent.

Simple efforts can only reach the height of proficiency, and it is absolutely impossible to be perfect!
Fang Yun was not in a hurry, but was more enthusiastic. He hurried out and called the next old lady in. After that, Fang Yun became more diligent...

In the afternoon, the outpatient clinic ended.

Zhou Chengcheng asked, "Xiao Fang, where are we going to eat tonight?"

"Mr. Zhou, I brought some fermented bean curd from home. It would be great to order a takeaway to mix with. I will discuss the article with Brother Li later." Fang Yun hurried out while following Zhou Cheng Said that at this moment, the eyes are full of strange colors.

"You can just call him Xiaoyue. Li Chongyue has a good talent for scientific research, but he is a mess in clinical practice. You are enough to be his teacher." Zhou Cheng confessed to Fang Yun, hoping that Fang Yun would not put his attitude too low, which is not suitable for him. The fit within the group atmosphere.

Li Chongyue was called to Changshi by Zhou Cheng for two reasons. To facilitate discipline, he was afraid that Cai Dongfan would not be able to discipline him. Moreover, Li Chongyue belonged to the kind who was good in theory but poor in operation. His current level was too high. High, and the entry threshold for teaching.

Maybe it would be better for Fang Yun to teach him, but Zhou Cheng didn't know what Fang Yun's basic skills were like now.

However, according to Yang Yifeng, Fang Yun's surgery reproduction skills are a bit against the sky, and it should not be bad! It's just that he can't touch the ceiling level of skills, so the height is not high enough now...

He taught Li Chongyue, raised his technical height by himself, and took what he needed.

"Mr. Zhou, Brother Li's theory is still very good. We will go our separate ways in private. It's okay. Mr. Zhou, I brought a lot of fermented bean curd with me this time. Mr. Zhou, do you want it?" Fang Yun hurriedly started Bribed Zhou Cheng and hugged his thigh tightly.

After all, Zhou Cheng not only gave him his dormitory, but also taught him so many things.Gotta give a gift.

It's just this gift, a little bit cold.

"It's okay, you can eat by yourself first, and I'll live right across the door from you. If you want to eat, come over anytime. I'll see if I cook at home later. If I do, you and Chong Yue will also come over." Zhou Cheng It also means a little pampering.

Although Fang Yun is the same age as him, at this moment, in his eyes, Fang Yun is like a very talented child, with a huge water tank without water, waiting for his own irrigation, with excellent talent!
"Thank you, Mr. Zhou, then I'll go back first?" Fang Yun said quickly, eager to go back and read.

"Okay!" Zhou Cheng smiled, didn't say much, and then just walked straight back to the department, then got out of the operating room and waited at the door for the off-duty

An Ruo.

After a while, An Ruo came out and said, "Zhou Cheng, my parents found out that we live together, what should we do?"

Hearing this, Zhou Cheng stiffened his feet and asked, "Why don't we go to Shashi? Confess?"

"I'm not going." An Ruo's face turned red instantly.

How inappropriate is it to confess something like this?
Zhou Cheng was also making a joke, of course, he could only follow his heart, instead, he and An Ruo had already exercised extreme restraint, and it was already a matter of course.

……

After Fang Yun came out of the outpatient clinic, he couldn't help calling his teacher, Bu Haoran: "Master, what kind of freak is that little Zhou teacher you mentioned? You said he was similar to me Big?"

Today, when Zhou Cheng was testing Fang Yun, Fang Yun was also testing Zhou Cheng.

Unfathomable, this is Fang Yun's understanding of Zhou Cheng.

Bu Haoran was on the other end of the phone, laughing loudly, with a hearty voice: "Did you get educated today? Did you get hit? Or did you just gain knowledge?"

"Master, to be honest, there are both." Fang Yun's tone was a little unconvinced.

"That's right, with your talent, if you come to graduate school, you may not be much worse than Xiao Zhou now, but don't be too arrogant and complacent, people like Xiao Zhou, even among similar people, are very rare of."

"Just Yang Yifeng, who you called me to ask about before, you know, can you compare his talent? He has said that he is far behind Zhou Cheng." Bu Haoran said to Fang Yun Looking at the facts, I hope he can recognize the gap.

Fang Yun smiled and said, "Master, I have no intention of competing with Teacher Xiao Zhou about who is smarter."

"Master, you also know that after fighting and fighting, the last thing to look at is your own realm and position. Talent is something that is useless if you don't use it. I am very happy that there are people like Teacher Xiao Zhou."

"As long as I am able to improve my teachers, I am happy. Thank you, Master." Fang Yun's tone was humble.

When Bu Haoran heard this, he said, "Xiao Fang, don't belittle yourself. Your talent is no worse than Xiao Zhou's, it's just that you are lacking for a few years. Study hard."

"Don't compare, and don't compare. If there is no competition, there will be no motivation to move forward. I just want to lie flat. It depends on your last gaze and where you want to go."

"If you only want to spend time in the county hospital, then your current level is enough in the prefecture-level city hospital. Even if you are a little bolder, it is not a big problem to go to an ordinary teaching hospital."

"But if you want to go further, you have to look at the path that can push medicine forward. That is scientific research."

"You can't promote the development of the subject, the final destination is a senior technician!"

"Xiao Zhou's technology is certainly good, but what is even more powerful is that he dares to forge ahead to the forefront when dealing with unknown affairs. This is what you want to see."

"It's not what you get now, who owns it. If you don't have this thought, you will be mediocre after all. As far as the discipline is concerned, it is just such a high-level talent who is engaged in this discipline, not the top talent who develops this discipline!" Bu Haoran saw it quite clearly.

"I see, Master. However, if I want to go to a higher place, I must first have a platform for me to stand on. Otherwise, I haven't even seen the highest place, so there is no need to talk about going to a higher place." Yes. I think, Teacher Zhou is my best chance to go to the highest platform." Fang Yun's tone was humble, but what he said was not humble at all.

"Be cautious at all times, be humble at all times, and jump at the right time!" Bu Haoran said.

"Okay, Master, I will remember." Fang Yun nodded solemnly.

The opportunity for him to learn is hard-won, and he will cherish it very much. As for where he will end up in the end, he doesn't know. Anyway, he has nothing to worry about at the moment, so he rushes forward recklessly.

In the county hospital, I have already surpassed my parents' generation. I went to the prefecture-level city hospital and made a lot of money. If I went to the provincial and municipal hospital
Hospital, it means that Zuwen has smoked, but if he can stay in a top teaching hospital, it will be the achievement Fang Yun thinks in his heart.

If you can push the discipline one step forward, it is the sublimation of the individual.

In life, people always have to do something by themselves.

Fang Yun hung up the phone and disappeared into the crowd. He was the most inconspicuous person in the crowd. No matter what he did, he was just a part of the crowd when he reached the crowd, but his heart was quite peaceful.