medical simulator

Chapter 43 Want to Incarnate as a Divine Beast! (PS: Ask for collection, ask for recommendation tickets, ask for follow-up reading!)

Zhou Cheng currently has three perfect-level skills, and the manual reset of fractures is even more redefining-level.

Therefore, he felt more and more that in the clinical process, it is extremely necessary to distinguish the levels clearly.

Define first, diagnose later.

After diagnosis, classification is required.

Only by strictly classifying various diseases such as dislocations can we better grasp how to treat them.

Be adaptable.

If you don't even understand the clinical definition and classification, but simply format and apply it, you will definitely not be able to do well in clinical practice.

Clinical medicine is an evidence-based medicine and an empirical medicine.

Evidence-based, as the name suggests, is to find out the evidence, grasp the current scale of the disease, and then find out the point of treatment according to the type of the disease, so that it can be called perfect.

This is especially true in surgery.

If a surgeon can't even grasp the surgical indications and contraindications clearly, and can't grasp the size well.

There are definitely two situations.

[-]. Excessive medical treatment is like seeing a fracture and operating directly. It is simple and mindless, but it is actually a waste of medical resources and increases the financial burden of patients.

Second, reckless treatment.If patients who should not undergo manual reduction have undergone manual reduction, or patients who should have undergone internal fixation with plates and screws, they will be fixed with Kirschner wires or intramedullary nails, and the results will naturally be unexpected. outside.

As a clinician, I myself have to believe in all kinds of accidents that exist in the clinic.

The accident, how did it happen?
It was unexpected, but if we can better grasp the situation in the process of diagnosis and treatment, we can minimize the occurrence of such accidents.

Just like a foot fracture, on a simple X-ray, there will be overlap of bone development, which hides the obvious fracture line.

If the occult fracture is not discovered in time, it will cause sequelae that cannot be ignored.

However, if fractures can be completely ruled out on X-rays, or through comprehensive means such as physical examination, then there is no need for CT!

"It's been taken, here are the pictures." Du Yanjun quickly took out the patient's examination bag, and sorted out the different planes of the CT scans for Zhou Cheng one by one.

Then he handed it over and said, "There is no fracture in the CT report."

"I'll see. Professional orthopedic surgeons can't fully trust CT reports." Zhou Cheng had already entered the role at this moment, completely unaware that what he said to Du Yanjun now should actually be what the superior doctor should say.

"Let's look at the coronal plane. This is the talus, here is the calcaneus, and here is the tou (two tone) bone level."

"From these bone planes, we can see that the continuity of the bone is intact, the integrity has not been damaged, and the fracture line has not been seen. Fractures can basically be ruled out."

"Also, Yan Jun, look, from this sagittal plane, we can still see that the heel joint plane is staggered by about 2cm."

"There is a ruler here, 2cm is equivalent to the real 0.4cm, and the direction of dislocation is the cuboid upward."

"In this case, according to the treatment principles of calcanoid joint dislocation, manipulative reduction can be performed, which is within the indications of manipulative reduction, right?"

Du Yanjun blinked his eyes, completely numb.

How the hell do I know?

What are the indications for manipulative reduction of calcanoid joint dislocation?Is there still this thing?
Zhou Cheng remembered Du Yanjun's expression when he saw it!
Ok.

This is Du Yanjun, not the students he taught in the mock copy, forget it, don't embarrass others...

The patient next to him heard Zhou Cheng's calm and composed manner of teaching, and asked with a smile: "Doctor Zhou? Is my condition serious?"

"In your situation, as I just said, there is a dislocation, but no fracture!"

"Manipulative reset is possible."

"However, manipulative reduction also has its inherent risks. If you are unwilling to accept such risks, you can alternatively choose a safer surgical treatment."

"This?" The patient was embarrassed.

Why do you still need surgery?
"Yan Jun, I'm going to get an informed consent form for surgery (operation), and I'll talk to the patient. Can you help me write a doctor's order for the patient? Then get one."

Zhou Cheng looked at the patient's body shape again, and said, "Here comes a 12.5cm*75cm plaster cast, and three rolls of gauze."

There are two models of plaster width: 10cm and 12.5cm. This patient has a rather strong figure, so choose a wider model.

"Oh, good!" Du Yanjun was stunned and left.

It's just that when he was going out, Du Yanjun's forehead was slightly wrinkled, because he just had an illusion.

That is, when Mr. Luo Yun was diagnosing and treating patients with joint dislocations, it seemed that he was not as relaxed as Zhou Cheng is now.

And the explanation was extremely detailed, but I didn't catch it.

A somewhat weird idea popped up in my heart involuntarily.

Could it be?
Zhou Cheng's realm is higher than Luo Yun's?
But Du Yanjun immediately shook his head!

Determined: Impossible, this is absolutely impossible, how could such a thing happen?

How could I have such an idea?

……

After Du Yanjun finished prescribing the doctor's order, printed the QR code, and asked the patient to scan the code to pay, he took the gypsum polymer material from the material room and prepared to go to the operation room.

Luo Yun wandered back to the department at some point and saw Du Yanjun holding a plaster cast, so he knew there was a patient in the operating room.

He whispered, "Yan Jun, come here."

Du Yanjun looked in the operating room, Zhou Cheng was talking to the patient, so he compared the plaster in his hand to Luo Yun.

"Come here first." Luo Yun continued to wave.

Du Yanjun also went to see Luo Yun first. Anyway, Zhou Cheng only talked with him, so the operation must have to wait for a while.

When he came to Luo Yun, Du Yanjun was very polite: "Mr. Luo, Brother Zhou Cheng asked me to give him a plaster."

"What kind of patient is there?" Luo Yun asked Du Yanjun.

I was afraid that Zhou Cheng would reset the fractured patient with his hands and get out again.

Du Yanjun didn't think much of it, so he replied directly: "Oh, it's a patient with a dislocated calcaneal joint."

A small question mark on Luo Yun's head.

???

Dislocated heel joint?

Is there really such a patient here?

I was just talking in the morning!

"By the way, Teacher Luo. Do you want to take a look?" When Du Yanjun said this, he turned his body to make room for Luo Yun.

Just the moment he turned his head, he missed the wonderful scene on Luo Yun's face.

I nia!

Do not go do not go.

Get away now.

"I'm not going, I still have something to do." Luo Yun replied firmly.

TM is really afraid of what will happen, heel joints, or dislocation of small joints that are not large joints!
It's really not that we are not strong enough from the joint surgery class!
In fact, most of the patients in this area are foot and ankle surgery and hand surgery patients, and we don't have so many opportunities to contact them.

I'll go and see, I'll go and see a twist.

If Zhou Cheng asked me to reset my teaching method, how embarrassing would that be?
At this time, Zhou Cheng also finished his conversation. Maybe he didn't wait for Du Yanjun, so he walked out of the operating room and headed towards the direction of the nurse's station for the first time. But while walking, he turned his head to inspect Du Yanjun, and found that Du Yanjun was talking to Luo Yun.

Zhou Cheng sighed inwardly, and decided to tell Luo Yun, then turned around and walked towards the two of them, explaining, "Mr. Luo, there happened to be a patient with the dislocation of the calcaneus joint that you mentioned this morning. Let's take a look together."

Luo Yun's limb muscles trembled involuntarily.

This Nima.

Immediately, I wanted to turn into a divine beast——

Ya butterfly.

PS: Please collect, recommend, and follow up!
Thank you for the reward of 10000 starting coins from Hengtian Priest, thank you, and add another chapter today at [-] pm.

Thank you Guess Tang for the 500 reward.

(End of this chapter)