medical simulator

Chapter 441 Deliberately leaving blank (for subscription)

When Zhou Cheng rushed to the Trauma Surgery Department, the number of patients inside had recovered slightly, but it still couldn't return to the previous number of patients, and there were still many vacant beds.

Even when Zhou Cheng was in the corridor, he heard the family members of the patients discussing whether the Affiliated Hospital of Shonan University was as deceitful as the Second Hospital.

Even, because Zhou Cheng's photo was not hung in the department, and he hadn't put on a white coat when he came in, a family member asked Zhou Cheng how much money your family spent.

Zhou Cheng was a little embarrassed: "I'm sorry, I'm a doctor in this hospital, and I'm here for consultation. You should talk to other patients about your problem."

After Zhou Cheng responded politely, he went directly to the doctor's lounge, put on a white coat casually, and rushed to the long-lost doctor's shift room.

In the shift room, the people are still the same people as before, except that the chief inpatient has been replaced by Zhou Cheng, the original chief inpatient, Huang Zong, but although Huang Zong is now replacing the chief inpatient, because of the appearance of Zhou Cheng and Yang Yifeng, the chief inpatient has been restructured. Yes, his complexion looks much rosier than before.

In the shift room, due to the "temporary absence" of Professor Cai Dongfan and Wang Yunfa, the seats were vacant. After Zhou Cheng came in, both Ding Changle and the head nurse signaled Zhou Cheng to find a place to sit down.

In the Affiliated Hospital of Shonan University, only the doctors of this hospital have enough seats. This is an unspoken secret, but most hospitals are the same.

It happened to be the end of the shift of the doctor on duty, and then the head nurse said first: "Let me convey the content of the hospital's weekly meeting last week."

"President Lei, once again carefully outlined the hospital's development plan for the first half of the year. The basis is to ensure the quality of medical care, stick to the bottom line, do a good job in clinical work, and be proactive."

"With the professor leading the group as the working unit, do a good job in the development of new surgical methods, new diagnosis, and new understanding of diseases, and use the laboratory director in charge as the scientific research team unit to do a good job in the development of new topics and new research."

"The scientific research department, as an auxiliary and supervisory unit, must do a good job in the timeliness of all clinical topics and basic topics in the hospital, ethics and many other issues. The ethics committee takes the lead and conducts spot checks on the clinical topics in the hospital at all times."

"As long as it is found that it does not conform to the basics of ethics, it will be stopped. As long as there is no violation of regulations, it will continue to progress, and no one should disturb the normal progress and operation of clinical and scientific research work."

"Third, we must implement the work of receiving patients, analyze the advantages of the department, and play a leading role, aiming to improve the quality of our medical services, and do a good job in the integration of teaching and scientific research..."

Dean Lei Zhong spoke a lot, very official, and very eloquent.

But there are several key points, that is, to do projects freely, but to be free within the rules, with ethical issues as the minimum line.

Moreover, the scientific research department and other administrative departments are not allowed to interfere with the normal operation of clinical and scientific research at will. This is a great thing, and even the business of the medical department has been adjusted to a certain extent.

Of course, all of this is based on the overall situation, and each department must have its own key points.

Ding Changle quickly took over the words: "We all need to understand the content conveyed by the head nurse. Now, Dean Lei has broadened our clinical and scientific research work for us. In such a In a relatively free environment, if we still cannot run far, we will eventually be left behind."

"If you can't keep up with the requirements of the hospital's development, if you don't make progress and stick to yourself, then you will definitely regress."

"As far as our orthopedics department is concerned, we are currently at the forefront of joint development and sports medicine. Our orthopedics department, our trauma surgery department, and our hand and ankle surgery department still have a lot to offer. Expansion capacity."

"In particular, in recent years, with the deepening of the awareness of diabetic foot, the number of patients with diabetic foot has remained high. In our province, there are many patients who cannot receive standardized diagnosis and treatment, and their quality of life is worrying. In such a Under the premise, we must do a good job in leading the work.”

"Strive to suggest a demonstration site for standardized treatment of diabetic feet in central China, and play a leading role."

"In this regard, our department is doing very well now. Professor Ning Ling takes the lead, and with the assistance of Dr. Zhou, our department has already had no less than forty patients with diabetic foot in our department this month. , which is a good thing."

"This is also the first direction of development for our trauma surgery department."

"Here, I want to do a self-examination. In the first month of the new year, my group has not made any breakthroughs, and the diseases I have come into contact with are the same as before."

"Then when I went back and analyzed the disease structure, I found that some patients should not appear in our hospital, and we should not receive them. The diagnosis and treatment process of these patients is very simple. Said that receiving such cases and diseases is a waste of time repeatedly."

"Actually, hospitals in prefecture-level cities or other hospitals in Shashi can receive patients normally. So, I hope to see that in the follow-up process, our department should think about this well in the process of receiving patients. Patients, the need to come to our department."

"Although our trauma surgery is the foundation of orthopedics, there are still many directions for development. Apart from fractures, complex fractures, and complex bone defects, I think there is still a lot of room to explore."

"For example, patients with severe infection, patients with muscle atrophy, bone atrophy, and some patients with lower limb deformities, all of which we can further develop."

"For example, foot and ankle surgery, osteotomy orthopedics, ankle joint replacement, mosaic bone grafting, etc., will also be our development direction."

"Tianzhu, you go down and do some assignments. We must follow in the footsteps of Professor Ning Ling and make progress together. We can't be complacent."

Qin Tianzhu also nodded quickly, and recorded Ding Changle's confession in his notebook, but he was worried.

"Another point, I think there are still some problems in the teaching of our department, but in the process of teaching, I also found some other problems. That is, the students of our basic medical school, what they learn and come into contact with The knowledge points are actually out of touch with our clinical practice.”

"Then how to combine our clinically applied specialist knowledge and cutting-edge knowledge with basic knowledge, and then do a good job of teaching in clinical practice is also something we need to consider. The interns in our hospital are all talented. Yes, I hope everyone pays attention to it..."

"At the same time, our interns, residents and graduate students, you should also pay attention, you should take the initiative."

"Our superior doctors are very busy with clinical work and scientific research work, so you have to focus on your own learning progress. It is best to find a more suitable anchor point, throw it out, and then let us guide you, or just do it well. The analysis of clinical cases has encountered difficulties, and progress has been made through methods such as searching literature and asking superior teachers."

……

"Okay, there's nothing to do next. We should round the wards, and discuss intractable diseases, so let's discuss it."

"Huang Zong, go and check the room with you. I'll discuss the intractable diseases with Professor Ning Ling's group." Ding Changle explained to Huang Zong and the junior doctors in his group.

After this, the bed doctor in Ning Ling's group released a case.

In fact, it is a patient with diabetic foot, but this patient, in the process of routine surgery and clinical treatment before, all followed the norms and procedures, but the result was not very good.

The doctor in charge of the bed said quite conservatively: "Professor Ding, Professor Ning, and Teacher Zhou and all the teachers, I am not complaining, mainly the patients and their families are guessing because of Professor Liu from the Second Hospital."

"Did we focus on him on purpose, so we didn't cure him, and wanted to make more money from him?"

"Because the batch of patients who were hospitalized before have actually been discharged now."

Ding Changle was a good listener, and he didn't express his opinion after listening, but looked at Ning Ling.

Associate Professor Ning Ling actually came here for Zhou Cheng, but he stepped up temporarily when Zhou Cheng left halfway. Now that he encountered such a difficult patient, Ning Ling was a little puzzled: "Doctor Zhou, this patient, In fact, overall, there is nothing special about it.”

"Blood sugar is well controlled, medication is being used normally, and the principle of debridement is also grasped, but after debridement, there is still the problem of slow wound healing."

"And during this process, the blood sugar level has not been high, and there are no other accompanying diseases."

"We also checked some information and literature, but we couldn't find a suitable method. You said, this patient still has to go to the last step as soon as possible?"

The last step is amputation as soon as possible.

In fact, the amputation rate of less than [-]% according to [-] in [-] is already far beyond the data released by the World Health Organization. It is estimated that such amputation rates are extremely rare in hospitals around the world.

Zhou Cheng did not answer the question instead: "Professor Ning, the patient's current symptoms should not be the last step. The indications for amputation are carrion, necrosis, and gangrene."

"For this patient, if conventional medication, debridement, antibiotics, and even vascular revascularization have failed, Professor Ning thinks, is there any other way to think about it?"

Zhou Cheng heard that the volatility in his heart was not strong.

The plan he gave is naturally the best, and it can handle most of the diabetic feet. The perfect plan is naturally the case.

Of course, no solution can perfectly solve all patients, and the solution given by Zhou Cheng must be properly perfected and repaired.

This is a blank space that he deliberately left when he proposed the plan, and this is also something that Ning Ling can make further progress.

The next topic that Zhou Cheng will apply for is related to diabetic foot. The patient base of this disease is large, and the current treatment is indeed relatively limited.

It’s just that Zhou Cheng is definitely not easy to do it alone, and Zhou Cheng not only only wants to do this, he also hopes to do it with Ning Ling. The most motivating thing is to let Ning Ling propose it himself.

"Debridement, blood circulation, and nutrition have all been done to the best, and the anti-infection is also effective, and there is no infection. Microcirculation and other factors are the best factors. If such treatment measures still fail to achieve results, I am serious. have no idea."

"There are other ways." Ning Ling frowned.

Because according to the idea given by Zhou Cheng before, there is basically nowhere to hide from diabetic foot. Ning Ling himself has the technical foundation of hand surgery, so it is very easy to get started.

Ning Ling was very happy to be able to get rid of such a disease just after taking over it.

He thought he was already very good at it because of his previous accumulation, but this patient really baffled him.

Zhou Cheng knew that Ning Ling had thought of a lot of ways, so he added a little more: "Professor Ning, since all the preparations have been made, the blood circulation is smooth, and the nutrition is good, why can't the wound heal?"

"No infection, adequate nutrition."

"Do you think it's possible that the local pressure is higher because the nutrition is too rich and the blood supply is too rich?"

"In fact, regardless of any treatment measures, when targeting diabetic feet, the essence is to reduce local pressure."

"What is too high local pressure?" Zhou Cheng made a point.

Ning Ling was taken aback when he heard the words.

The occurrence of local ulcers in diabetic feet is local skin necrosis caused by excessive local pressure, but that is mostly due to poor blood supply or embolism in a hypercoagulable state.

Now that Zhou Cheng said so, could it be that the local blood supply is too rich and the nutritional status is good, so the local pressure is still increased, which is the factor for the wound not to heal?

Zhou Cheng saw Ning Ling and Ding Changle thinking, and Zhou Cheng suggested: "Mr. Ning, I think that when we can't find the missing disease, we can consider whether it is an excess."

"For example, some patients' high blood pressure is caused by heart problems, but some patients' high blood pressure is caused by kidney problems."

"For cardiac problems, we can properly reduce the pumping capacity of the heart, but for renal problems, we may not be able to solve them by reducing the pumping capacity of the heart!"

"After the structural foundation is completed, we will reduce the overall flow of the body and optimize the nutritional structure to make the local blood supply less sufficient. Try it, and it may also have a miraculous effect."

All treatment principles must grasp the core.

Ning Ling was slightly taken aback when he heard the words: "Doctor Zhou, what do you mean is that this part has been repaired too much, and the blood supply is too rich, which again led to an increase in local pressure, so the ulcer did not heal?"

"The possibility of this is not ruled out. I think this is a good way for us to study in depth, especially for some patients who have a relatively rich nutritional supply."

"After the local anatomical foundation is established, other aspects need to be considered..." Zhou Cheng promptly threw out his next step of clinical research ideas.

(End of this chapter)