medical simulator

Chapter 56 Dead End! (PS: Ask for collection, ask for recommendation tickets, ask for follow-up reading!)

Yan Haihan didn't forcibly make any specialization for Yang Yifeng.He said: "Since everyone is almost here, Chao Shuo, you can start reporting the cases."

Originally, the case report of Yan Hanhan's group should be reported by the deputy director Dong Qiansheng, but at the moment Dong Qiansheng is on the operating table, Yan Hanhan asked his students to take on this role, and by the way, added some impression points for him in the department.

Min Chaoshuo quickly opened the title page of the ppt, and then said generously: "Good afternoon, teachers and students, today our group is preparing 15 difficult cases."

"The basic situation of this patient is as follows."

"Patient, Liu, male, 71 years old..."

In the process of case reporting, whether it is communication within the department or outside, generally only general information is given, and any information related to the patient's private information must be hidden.

For example, the name, ID number and mobile phone number can be replaced by XX.

And this information will not affect everyone's reading of the disease itself.

"One week ago, due to an accidental fall, he caused pain, swelling and mobility impairment in his left femur. He was sent to the emergency department of our hospital immediately. X-ray diagnosis was a femoral fracture, and he was admitted to our department for treatment."

"After completing the relevant examinations, the diagnosis was clear, and the diagnosis was AO C3.1 femur fracture."

"However, after completing relevant examinations, the patient's current condition is that he has a history of coronary atherosclerotic heart disease, and his current cardiac function is nyha class III."

"In addition, there are type II diabetes, the current blood sugar control can be achieved, hypertension grade II, very high risk group."

"I invited the Department of Cardiology, Department of Anesthesiology, and Department of Respiratory Medicine for consultation. At present, it is considered that the risk associated with the operation of the patient is extremely high, and surgical treatment is not recommended."

"The ongoing treatment is plaster external fixation."

As a graduate student specializing in orthopedics, Min Chaoshuo obviously put a lot of effort into this case.

The narrative process is all professional terms.

After listening to Min Chaoshuo's report, almost everyone present frowned.

Clinically, C-type fractures are not uncommon.

History of coronary heart disease, heart function nyha III level, this is a bit cruel.

It belongs to the category of marked limitation of physical activity.

With another diabetes and high blood pressure, it is very likely that you will not be able to get off the operating table.

When Yan Haihan heard this, he interrupted Min Chaoshuo, and said: "This patient still has some conditions like this. His family members and patients have higher requirements for later stage functions."

"But the family members do not agree with the operation, but the patient himself still has a relatively strong willingness for the operation."

"It's very difficult for us."

The opinions of patients and family members are inconsistent, which makes doctors not even know how to start, let alone who to listen to.

In principle, the patient's first wish should prevail, but in China, especially the opinions of the elderly, family members and children must be respected.

After hearing what Yan Haihan said, Hu Ming said:

"Since the patient and family members disagree, it is better to do conservative treatment with bone traction. Anyway, the operation is going to be done, and the patient should persuade the patient's family members by himself."

Hu Ming felt that it was unnecessary for Yan Haihan to bring up this case.

Whether or not to have surgery depends on the wishes of the patient and family members besides whether it is possible. What is there to discuss?
Bone traction or skin traction + conservative treatment is enough.

In addition to avoiding fracture shortening and displacement, bone traction and skin traction can separate the broken ends of the fracture and relieve pain.

Of course, what Hu Ming meant was to ask Yan Haihan why you didn't give the patient traction treatment.

Yan Haihan didn't reply, but Min Chaoshuo continued: "Mr. Hu, the following is the patient's film and the result of [-]D CT reconstruction."

Immediately afterwards, Min Chaoshuo released the patient's plain film and CT results.

Everyone in the shift room gasped for an instant!
It can be seen from the CT and X-ray levels that the broken end of the fracture is quite sharp!
The angle of lateral displacement is super large.

What appeared to be the sharp end of the fracture had, by accident, penetrated directly into a muscle or other soft tissue.

Many people looked in the direction of Hu Ming, as if they were asking, would you go for bone traction for such a patient?
The muscles on Hu Ming's face twitched, and he secretly cursed Yan Haihan!
Scheming villain!

Min Chaoshuo then added: "Although the patient's current fracture classification is C3.1, it is classified according to the fracture line and fracture part."

"But the patient's current situation is very special. We can see from the CT scan that the acute angles of the proximal end and the distal end of the fracture have been completely deformed under the pulling of the muscles."

"So our group considered that the patient's fracture end may have pierced the soft tissue and caused compression."

"Therefore, even with bone traction, the chance of traction reduction is very small. And during the traction process, if the strength of the traction cannot fully return the broken end of the fracture."

"Incomplete distraction would have resulted in severe soft tissue cuts by the sharp edges of the fracture, and the possibility of severing the femoral artery has not even been ruled out."

"Moreover, if this patient does not receive surgical treatment and chooses conservative treatment, it is absolutely impossible for the fracture to recover."

"That's right, I ask all the teachers to give you more guidance." Min Chaoshuo was very calm during the whole process.

Hu Ming was watching his nose, nose, nose and mouth, and his mouth was watching his heart, so he had no time to talk.

This TM is definitely a hole that Yan Haihan instructed Min Chaoshuo to leave for everyone, and it was reserved for himself and Cai Dongfan.

Cai Dongfan is more shrewd, he has been cultivating his temperament without saying a word.

Otherwise, according to the normal case discussion process, the X-ray results should be put on the first ppt.

Hu Ming has heard something about this patient!
Someone in the family works in the health system, and his position is not low. He was originally an acquaintance of Cai Dongfan, but Yan Haihan took him into his group.

Hu Ming didn't bother to pay more attention to the bullshit...

Now the situation is quite complicated, the side shifted at least five or six centimeters, and the broken end of the fracture pierced into the muscle.

After conservative treatment until death, the fractures on both sides cannot heal, and the bone cells can't find a way to crawl.

Bone traction does not have to fight.

The strength of bone traction is limited, if the strength of traction is not properly controlled.

It is really possible to turn the sharp edge of the fracture into a knife and swing it in the body to cut off muscles or nerve vessels.

No more surgery.

In such a situation, it has already been said.

Only then did Yan Haihan look at the crowd unhurriedly, and said sincerely: "Everyone has seen the situation of this patient, and it is quite special. No matter who has any opinions, they can speak freely."

"I'm here today to ask you for advice."

However, no one answered Yan Haihan's words.

"Director Cai?" Yan Haihan specifically named Cai Dongfan.

Cai Dongfan laughed: "Director Yan, it's better for you to grasp the patient's situation yourself, I can't control it."

Hu Ming's lesson from the past is right next to him, so of course Cai Dongfan doesn't speak!Afraid of getting into another pit that Yan Haihan left or detouring himself into a dead end.

I'm not Hu Ming, I have to prove that I'm strong.

Not worth the candle!

This is a dead end. Surgery is impossible, and there is no recovery without surgery.

Lying down all the time is almost synonymous with blood clots and heart and lung failure, and we can only wait for death.

And didn't you insist on pulling this patient into your own group before? I told you that I was an acquaintance, and you used the principle of admitting and treating patients in the department to talk about things.

Seeing that no one spoke, even Hu Ming and Cai Dongfan, who were qualified to talk to Yan Haihan on an equal footing, played with their fingers.

Yan Haihan could only take the initiative to ask: "Xiao Yang, if your teacher encounters such a case, how would you deal with it?"

Following these words, everyone turned their heads to look at Yang Yifeng.

Bright eyes.

Yes, a high-achieving student from the Affiliated Hospital of Shonan University happened to come to the department today, so you can ask him if he has ever seen such a 'wonderful' case and how to deal with it.

Yang Yifeng took a small half step forward and said: "Director Yan, this patient has a disease between relative contraindications and absolute contraindications to surgery. If the heart function cannot be improved, it will be difficult to perform surgery anywhere in the short term." It's unrealistic."

"And the case characteristics of this patient require additional intervention."

"If the conservative treatment of traction + plaster external fixation is not an option, then the only remaining option is manual reduction + plaster external fixation."

"However, my teacher has never encountered such a special patient before, so this is just my personal opinion."

Yang Yifeng admitted generously and calmly that his knowledge was limited, and he had never heard of such a strange patient.

But these words made many people turn their heads to look at Yan Haihan...

(PS: Ask for collection, ask for recommendation tickets, ask for follow-up reading!)

(End of this chapter)