Gou is practicing medicine in the clinic

Chapter 149 The Three Hundred Flowers Are Worth It, Local Anesthesia with Kidney
"Okay then!" The man agreed, and after a long time, he figured out 100 yuan and paid the fee. "You can't come to hospitals and clinics. Once you enter the door, you have to spend money, which is a lot. This 100 yuan is enough for me to buy a lot of buns!"

People in some places like to eat white flour buns.

Cheap, carry hunger.

The patients and customers around couldn't help laughing.

Watch this couple.

"Oh, can you stop saying a few words!"

The woman's face turned red.

Women are usually more face-saving, and she felt a little ashamed when she revealed her family background in public and let everyone know that his family ate white flour buns every day.

"What's the matter, we can live well now that we have steamed buns for every meal! In the past, when we were in our hometown, we couldn't eat bran and swallow vegetables for every meal?"

Men don't care.

These words naturally made everyone laugh again.

The woman wanted to get into the cracks in the ground, her face turned red to the base of her neck.

"Many hotels now regard sweet potato rice and bran rice as high-end food! Eating healthy food is very beneficial to the intestines."

Li Jingsheng rescued the woman.

She married a husband of a straight man of steel, which has both benefits and awkward moments.

For example, when speaking in front of others, she does not pay attention to her image and does not consider her feelings.

Most of these straight men of steel are more down-to-earth, and they live a fairly solid life.

I took her into the medical laboratory and took an X-ray film. Because of the limited clarity, it took a lot of effort to see a slight fracture line.

This is because Li Jingsheng has touched the bone and knows where the fracture is.

Now his small clinic has carried out manipulative orthopedic reduction business, and one X-ray can be taken once.

With a one-time fee of one hundred yuan, more than 100 patients can help him earn back his capital.

In addition, the clinic's drug sales business has started up again in the past two days, and he will have some money in hand by then. He is going to grit his molars and buy a new X-ray detection equipment.

The only problem is that the grounds are not up to par.

The advantage of renting in this kind of downtown area is that there is plenty of traffic.The disadvantage is that the rent is extremely expensive and the venue is small.

If this building can be sold, the venue will definitely be enough.

The rent for renting the first floor is enough for him to choke, and renting an entire building is unimaginable.

But the rent on the second and third floors should be much cheaper.

This building is the landlord's self-built house.

The vast majority of houses on this street are self-built.

Urban villages are like this, with dense houses and a good place for migrant workers to live together.Basically all old houses.

Except for the slightly higher rent of the facade, the housing is basically very cheap.

Moreover, compared with the rent of the facades in this area compared with those commercial facades on the main street outside, even the grandson is not counted.

Li Jingsheng heard that the rent for a two-meter counter in the commercial plaza was [-] a month.

The four facades leased by China Construction Bank require an annual rent of 100 million.It is not clear whether it is true or not, but it is definitely true that the rent for facades on Main Street is exaggerated.

Although he is ambitious now, he still focuses on stability.

According to the current rate of earning money, if it develops for about a year, as long as there are no accidents, it should be able to buy a facade.

Only then will it really take root.

The future is very bright, just don't rush, you need to accumulate slowly step by step.

"The filming is over, let's go out and talk!"

Li Jingsheng took the patient out of the medical laboratory, and the patient's husband stayed outside.

The wife and a male doctor entered the medical laboratory, and it seemed that the husband was somewhat worried.

"How about it, can it be cured?"

her husband asked expectantly.

"There is a carpal fracture accompanied by joint displacement. You can try manual reduction. After successful reduction, you need to fix it with a splint for about four to six weeks."

"How much will it cost?"

"This kind of reset will cost at least 350 yuan. Considering that it's not easy for you, let's give it 300."

Li Jingsheng really took great care of this family.

Go to the Manipulative Clinic of the Second Hospital, don't even think about it if you don't have seven or eight hundred.

Many outpatient treatments are not reimbursed.

So the difference between treatment in a clinic and a hospital is not that big.

I only charge 300 yuan, and after deducting the cost of the splint, I can earn more than 200 yuan in technical fees.If it was replaced by a patient with better economic conditions, he would charge at least [-] yuan.

"Can you have less?"

The man obviously regarded this place as a vegetable market.

I can understand that people who repeatedly ask the price are either really poor or stingy.

This middle-aged couple doesn't look like a rich person at all. They are very plainly dressed, and their nutritional performance is not very good.

"It's already the lowest price, you can think about it. She definitely needs treatment, otherwise the fracture will get worse, and the treatment cost will increase several times. There is also the risk of deformity and disability."

Fudge is a compulsory course for doctors.

When Li Jingsheng should fool around, he would never be a gentleman.

Instead of waiting until the patient has a problem and talking about them, it is better to talk about the consequences now and scare them into regular treatment.

"Okay then, let's fix it! How many buns are lost! You bitch, what do you want me to do next time you change the light bulb? You have to show off."

The man has a painful expression on his face.

I paid 300 yuan.

It turned out that his wife dropped the light bulb.

It can be seen that although he loves money, he loves his wife a lot.

At least he paid for the treatment fee without much hesitation.

Li Jingsheng performed rotation, flexion and extension and lifting, pressing and end squeezing, successfully performing bone setting and reduction for the patient.

I encountered a little problem during the operation, but it finally did not overturn on the first day of the official listing.After resetting twice, it was finally a success.

Out of caution, he felt the bone again for inspection.

The displaced bones have returned to their original positions, and the fracture line has also closed, making it almost impossible to feel.

The patient was splinted and the inspection was correct, and the business was considered complete.

"How do you feel?"

The man couldn't wait to ask his wife. His concerned tone and expression made the female patient very helpful.

"It was very painful at the moment of reset, and I feel much better now. Before the treatment, as long as my hand was hanging down like this, or like this, I would feel pain after burst of pain."

"now what?"

"Of course it doesn't hurt anymore!"

The woman smiled.

"It's not as painful as it was before the treatment, why didn't you tell me earlier?"

The man seemed a little distressed when he heard that his wife had endured pain for so many days.

"I asked a few people, and they all said that it would cost two or three thousand to go to a big hospital for treatment. Didn't I think that our family didn't have... money! I didn't expect that it would be cured here for only 400 yuan. If I came here sooner It's definitely better now."

She looked at her cured right hand repeatedly, and tried to move, with a happy expression on her face.

The worry between brows has also disappeared.

"Speaking of which, we were lucky. In the morning, I saw a new bone-setting signboard in this clinic. As soon as I asked, I knew that it might be curable. Hehe, the 300 yuan is too worthwhile. Doctor, let's go! "

"Walk slowly, both of you! Remember not to use your right hand to lift heavy objects, do strenuous exercise, and then wait for a month to come over for a review. Don't worry, there is no charge for the review. After I check that there is no problem, I will remove the splint for you. "

Li Jingsheng added some precautions.

Seeing the couple leave happily, Li Jingsheng was also very happy.

Isn't the purpose of studying medicine to help people relieve their illnesses?

If you want two or three thousand yuan, that woman will definitely not go for treatment.Now a total of 3000 yuan has been used to help her heal, and everyone is happy.

Although Li Jingsheng earned a little less, he was very happy.

He is willing to help even if he does not make money when he encounters a patient who is particularly difficult.

But let him do charity, if this one doesn't make money, and that one doesn't make money, it will definitely not work.

Appropriate and reasonable charges, this is a criterion he has set since he opened the clinic.

The woman with a very swollen face had already finished calling.

It seems that I have been hesitating whether to treat here.

Seeing that the female patient with a fractured and displaced wrist was cured quickly, her confidence in the Sunshine Clinic immediately increased a lot.

"Doctor Li, my husband agreed to let me be treated here, can I be treated now?"

"can!"

Li Jingsheng's answer was simple and powerful.

Physicians must have faith.

"Although this is only a minor operation, it is on the head and face after all. Let me talk to you about the operation plan first. The first one is to make an incision from the inside of the mouth, separate the abscess and then drain it. You cannot eat during this period. The advantage is that it is not on the face. Surgical scars are left. The second method is to incision from this part of the face, which also needs to separate the abscess for drainage. You can eat normally, and the postoperative recovery speed will be faster, but the disadvantage will be surgical scars on the face..."

"Don't think about it, I choose the first option."

The woman answered very simply.

He didn't even wait for Li Jingsheng to finish speaking before choosing the first option.

"That's all right, I'll get you a surgery risk notification letter, please sign it. Have you brought your ID card? Register it for me."

Even if the clinic performs minor surgery, as long as it is not a black clinic, it must be registered.

In fact, clinics are of the same nature as outpatient clinics in hospitals.

Any operation has risks, even if it is a first-level operation, you also need to sign a risk notification.

After everything was settled, the patient was brought into the treatment room.

Fortunately, there are now three people in the Sunshine Clinic. He and Tang Ping go in for surgery, while Xiao Gao sells medicine outside and receives other customers and patients.

At the moment, there are some people who buy medicine.

Intermittently, someone bought and left, and new customers came in after a while.

Now these people can be received by Xiao Gao alone.

……

In the treatment room, Tang Ping had already laid out the sheets and finished disinfection.

Although the aseptic control of the laminar flow operating room cannot be achieved, it is still necessary to temporarily ensure that the operating environment in the treatment room meets the standard of general surgery for the sake of surgical safety.

Even in large hospitals, many outpatient operating rooms are not sterile.

It is similar to Li Jingsheng's treatment room, with most equipment and complete supporting facilities.

For example, if a patient suffers sudden cardiac and respiratory arrest, the corresponding rescue can be done immediately.

"Let me prepare the local anesthetic!"

Li Jingsheng said to Tang Ping.

"it is good!"

She doesn't know what the boss wants to do.

Li Jingsheng took a stick of epinephrine and mixed it with local anesthetic.

Tang Ping's eyes brightened slightly, and at the same time she looked at the boss in shock.

"Your medication level seems to have improved again!"

At this moment, she adores Li Jingsheng from the bottom of her heart.

"It's mostly an incision in her mouth, with adrenaline mixed in to reduce the bleeding."

Li Jingsheng's drug efficacy and pharmacokinetic level have been raised to the Xiaocheng level, which is a real high-level medical treatment level for senior seniors.

There are indeed more cows now than before.

In the outpatient clinic, no matter prescribing medicines for patients or surgical medicines, you can use medicines precisely as you like.

And there are a variety of medication options.

In terms of combined medication, it is also a preliminary entry into the room, so that it can be easily used.

The purpose of mixing a small amount of epinephrine in the local anesthetic is mainly to reduce the bleeding in the surgical field and make the surgical field clear.

In addition, it can reduce the absorption of local anesthetics and reduce the side effects of local anesthetics.

There are many benefits.

He didn't dare to play like this before.

Before giving medicine to patients, it was cautious, cautious and cautious.

It seems random now, but it is because it has a sufficiently advanced level that it can lift weights like light.

"I heard that your medical skills here are very high, so I came here specially to seek treatment. You must help me do it well!"

The patient heard the conversation between the two and interrupted.

"I will definitely do my best to make the operation the best for you. The anesthesia will start next, so try not to talk anymore."

Li Jingsheng said to her.

"Sister Tang, push the suction machine over. It will definitely suck phlegm, pus, and blood in a while."

At that time, Li Jingsheng bought this suction machine by gritting his teeth.

Has been placed in the treatment room to eat ashes.

Do not use more than three times.

If the surgical business develops in the future, it will be useful.

Before taking a round of anesthetic, Li Jingsheng still maintained a cautious style of action.

Do a skin test first.

After there is no problem, the intraoral injection will start.

"Sister Tang, if you encounter this kind of patient with internal abscess, try to avoid injecting in the abscess area."

"I know! Our director taught me before. In fact, if conditions permit, you can also inject superficially or from the outside."

Tang Ping lifted her pretty Liu Yemei.

The expression on his face was unclear because he was wearing a mask.

You could see her pride in her eyes.

Her level is not low, and she can even teach Li Jingsheng the knowledge of nursing.

"Ha, I forgot that you used to be an excellent nurse in the compound."

Li Jingsheng laughed dryly twice.

After the local anesthetic took effect, he took the flat hook, and together with Tang Ping, one by one, they pulled the patient's mouth apart.

If manpower is sufficient, a dedicated medical assistant retractor is required.

Now this job can only be done by Tang Ping, a delicate female nurse.

Pulling the hook is actually a physical labor, which is usually done by young male interns and doctors.

In the absence of these two types of novices, the resident physicians go up.

The newcomer who just entered the operating room was very happy to get a chance to pull the hook.

After a long time, I realized that it was purely a hard work, with no technical content.

The only advantage is the opportunity to go on stage and watch the operation process of the surgeon up close.

Li Jingsheng chose to incision and drainage from the lowest position of the swollen area.

This is a hunting mistake that many novices make.

According to the textbook, incision and drainage should be made from the highest part of the swollen area.

That is to make an incision from the outside of the mouth, and only choose the highest position of the abscess.

If the incision is made from the inside of the mouth, the lowest position is chosen.

Li Jingsheng currently has only one incision technique that has reached the entry-level level, and that is the skin incision method.

Currently proficient 18/100.

Didn't even reach proficiency level.

He seemed a little hesitant when he lowered the knife.

The nerves and blood vessels in the mandible are very dense, and the force of the incision is not in place. If the nerves and blood vessels are damaged, the oral function of the patient will be damaged, and even some facial functions will be lost.

For example, some women like plastic surgery, and eventually become a zombie face, unable to smile again.

If he misses the knife, it is also possible to cause such consequences.

After thinking about it, he decided to upgrade the skin incision method to another level.

At least raise its proficiency to proficiency level to be safe.

The current health balance is 127.

Decisively spending 82 points of health to temporarily upgrade the skin incision method to the proficient level.

This is a real low-year seniority attending level.

Cutting intestines is capable, and cutting a superficial cavity in the mouth is naturally a no-brainer.

With the upgrading of this incision technique, Li Jingsheng's use of this incision method has immediately reached a big level.

Concentrate, carefully incise the lower part of the abscess.

A hole appeared instantly.

He was pleasantly surprised to find that the feedback from the tip of the knife was quite clear.It's a feeling I've never had before.

"Is this... the sense of a knife?"

I always thought that you have to reach the level of a deputy director to have a sense of knife.

I didn't expect that as long as I reached the indication level, I would be able to initially have a sense of knife.

He can clearly feel how deep the cut is with one cut.

The proficient skin incision method can accurately grasp the angle of the knife, and the cut is a straight line.

rather than jagged wounds.

For novice doctors with low incision skills, the incision wounds are likely to be uneven.

Better ones, there will be wavy wounds.

These are all manifestations of relatively low incision proficiency.

Surgical technology is very experienced.The older the doctor, the more popular he is.

Because some doctors have completed five or six thousand operations when they were in their 70s. It is conceivable how rich their experience is.

A tumor, as long as you touch it through the skin, you can know what kind of tumor it is.

Incision is the most important type of surgery and the basis of all anatomy.

Including separation surgery advanced from incision, which is also based on incision.

Li Jingsheng found that after the skin incision method has been upgraded to a proficient level, not only the depth of the incision can be grasped more accurately, but also the cut line is straighter.

Almost like a straight line drawn with a ruler.

In addition, he was extremely delighted to have the knife-feeling feedback.

He didn't cut through the abscess directly.

Incision and drainage of this kind of abscess must not be done in one go.Even the chief physician would never dare to be so fierce.

They are cut layer by layer.

Minimize the occurrence of surgical accidents.

"This feeling, the feeling of the knife is very silky!"

He felt like he was stripping his clothes.

At this point, yellow pus can already be seen, just below the tissue layer.

I don't know if it's because of the improvement in his medication level and the use of adrenaline mixed with local anesthetics, or because the skin incision method has been upgraded to the proficient level, and the amount of blood loss during the operation is very small.

So little that he couldn't believe that he could be so awesome.

It is said that for the top surgeons, the total blood loss for a major operation does not exceed 50ml.

This is something unthinkable.

However, Li Jingsheng dared to think about it now, and believed that the legend was true.

Maybe one day, he can also reach this supreme state.

"Sister Tang, is it okay for you to pull the hook?"

"I'm fine, I can hold on."

She is a woman after all, with less strength and stamina than a man.

Now it can be seen that she is gritting her teeth and persisting.

Li Jingsheng took the suction gun in one hand and cut open the last layer of tissue in the abscess layer, and a large amount of pus gushed out immediately.

But it was quickly sucked away.

The cooperation of the whole operation is seamless.

It felt like he was learning Zhou Botong's right and left hand fighting.

　With seniority attending
　　
　
(End of this chapter)