Gou is practicing medicine in the clinic

Chapter 284 Answers the wrong question and grabs the qualification for surgery

Because Jiupeng International Hospital has its own foreign contacts and various resources, it does have great advantages in developing this intermediary-like medical service.

The treatment of malignant tumors is still relatively lagging behind in China.

The most developed country in the world has always been a world leader in cancer research and treatment.

Not only does it have advanced equipment and technology, it can accurately detect and stage cancer, and determine the type, location, size and spread of cancer.There are also more advanced drugs that can target cancer cells.

It can improve the patient's quality of life to the greatest extent and extend the survival period.

For example, nasal cavity cancer is the most common, with squamous cell carcinoma being the most common.When this disease is diagnosed in China, patients will immediately feel that the sky is falling.

But in this developed country, it is just a minor surgery.

It is an indisputable fact that China lags behind others in terms of treatment experience, examination equipment, treatment equipment, surgical equipment, and drugs.We must face up to our shortcomings.

Fortunately, China has developed well in all aspects in recent years and is expected to catch up with its opponents in the near future.

But people with cancer can’t afford to wait.

Don't say wait ten or twenty years, even if you wait two or three years, people may be gone.

For some malignant cancers, the time from discovery to death may be only three months to half a year.

There are even shorter ones, with a survival period of less than two months.

In this case, if the patient's financial conditions permit, it is a good choice to find a reliable agency to go abroad for treatment.

If Jiupeng International manages this business well, it will be a boon to patients.

Several competitions in general surgery ended. The Second Hospital won the bronze medal in the competition in hepatobiliary and pancreatic surgery. It also won bronze medals with a prefecture-level hospital and the Affiliated Hospital of Jiangli Medical University.

It can also be seen that the competition is very fierce.

Every award-winning hospital has a strong medical team.

From diagnosis to surgery, to postoperative medication and care, every step requires professionals.

The General Surgery Department of the Second Hospital is very strong, but its opponents are even stronger.

It is not easy for it to win a bronze medal.

If it weren't for the two gold medals won by Li Jingsheng and the silver medal won by Xiao Linlin, then its achievement would be enough to make the hospital leaders feel excited and happy.

Now that there is comparison, there is also harm.

This bronze medal seems a bit gloomy.

After all, it is the strongest department of the Second Hospital.

Director Bi was also very depressed because his opponents were too strong.Coupled with the failure of Director Yan and two other contestants from the Department of Gastroenterology yesterday, the field of digestive surgery that should have won the award missed the opportunity.

As a result, this year's competition results have become somewhat unsatisfactory.

This year's examiners are not only industry insiders, but also extremely tricky in setting questions.Questions specifically designed to focus on the pain points and shortcomings of doctors are really hard to guard against.

In the final analysis, the level of medical skills is still weaker than others.

They also lack experience in dealing with this rather tricky skill competition.

Finally, I didn’t eat any duck eggs, and I can have an explanation after I go back.

If the most powerful general surgeon fails to win even a bronze medal, he will probably have a hard time after returning.

It's a bit like a child who gets bad grades on their final exam and has to hang their head all vacation.

I'm afraid that if I fail to do something well, my parents will be unhappy, and my grades will be used as an excuse.

"The following competition is about orthopedic surgery, which is divided into two subdivisions. The first competition is about orthopedic trauma. Please prepare the contestants from each hospital. Since these competitions are team battles, in principle, one hospital can only There is a quota for participation. In order to enhance everyone’s sense of honor, when the team they belong to wins the award, all members of the team will be on the list.”

This competition mode is more challenging than yesterday's internal medicine competition.

This model has been used in previous years.

"Doctor Li, Hu Jia, let's get ready."

Chen Anchen quickly greeted the two of them.

"The following question is a bonus point question and can be answered directly by all participants. As long as one person from the same team answers correctly, they can get bonus points. No points will be deducted for wrong answers."

After more than a day of hosting, the two hosts gradually became proficient.

Hosting is very efficient now.

There is almost no unnecessary nonsense. After explaining the rules clearly, you can start answering the questions directly.

Patient information is displayed on the large screen.

The patient, male, 61 years old, accidentally fell to the ground from a height when changing a light bulb.After examination, it was found that the patient's right lower limb had a severe fracture of the knee joint, which required surgical repair.

The patient underwent preoperative auxiliary examinations.

Hemoglobin 90g/L, red blood cells 3.2 times ten to the twelfth power per liter...

The coagulation time was 2 minutes, the bleeding time was 1 minute, the jaundice index was 10u, the total serum protein was 42g/L, and the alanine aminotransferase was 60u.

The electrocardiogram is normal.

Please give a treatment plan based on the X-rays of the knee joint.

Li Jingsheng had already started watching knee joint films.

The injury is not particularly serious.

If left to him for treatment, it may not even require surgery, and it may be cured by direct manual reduction.

However, the location of the injury is rather special, at the knee joint.

And judging from the film, the crescent plate may also have some damage.This fix is ​​the most difficult.

Therefore, surgical treatment is more reliable.

The treatment plan is not complicated, just reduce the fracture site and add internal fixation.

It is impossible for the examiner to give such a simple question to the contestants.

Based on experience, examiners seem to like to allow outstanding contestants to gain some points advantage in the early stage so that they can qualify for surgery later.

This is also to screen out some doctors who are weak or careless.

This will improve the safety of practical competition sessions.

Li Jingsheng wrote the treatment plan first, but was not in a hurry to submit it.

When a patient undergoes surgery for a partial fracture of his right lower limb, why does he need to measure jaundice and alanine aminotransferase?
You should know that these are not routine blood tests.

From these data, it can be seen that the patient has problems with liver function.

There may be more severe cirrhosis of the liver.

The patient's red blood cell count was only 3.2, which is considered very low.It is lower than the 4.8-5.8 level of normal adult men.

This further suggests that there is a problem with the patient's liver function.

There are also bleeding and coagulation tests, which are rarely done in minor surgeries.

Now it can be basically concluded that there is a problem with the patient's liver. So what are the risks that should be paid attention to during the operation?
People with liver function problems are most afraid of bleeding.

But this patient is not at risk.

So where are the risks?
Li Jingsheng usually performs surgeries in the clinic and does a skin test before injecting local anesthesia.

Because they are afraid that the patient will be allergic to the medicine and something will happen.

The anesthesia method used for this patient's surgery was local anesthesia.

In addition to testing for allergies before local anesthesia, what else should I pay attention to?
He felt that the efficacy and pharmacokinetics of his medicine were not up to par with the current level.

When I racked my brains to investigate the risks, I seemed to have made some discoveries, but I couldn't grasp the key points.

"No, we have to improve the potency and drug generation. We haven't upgraded them for a long time."

Now that he has plenty of health, he is not stingy either.

On the spot, these two medical skills were upgraded from minor to accomplished.

In an instant, his understanding of drug effect kinetics and pharmacokinetics, as well as his medication experience and analytical skills, all improved qualitatively.

Now when analyzing the anesthesia risks in this case, he seemed much more relaxed.

Already have the ability to detect some potential crises.

After careful consideration, he believed that the biggest risk should come from the patient's low liver function.

The patient had low liver function, hypoalbuminemia, and an inverted hemoglobin ratio.

This means that once the drug enters the patient's body, it is metabolized quite slowly.

Definitely much slower than normal people.

In this case, when the concentration of the drug in the blood is too high, it is very easy to cause local anesthetic drug toxicity.

Because procaine is generally the first choice for local anesthetic, it is administered by injection using local infiltration anesthesia.

After taking the medicine, the patient will not experience poisoning reaction immediately.

After a period of time, the local anesthetic enters the blood from the terminal microcirculation, causing a terrible poisoning reaction.At this time, rescue was already too late.

The patient himself was too old, had liver function problems, and suffered a fall injury.

With so many problems put together, this will be a fragile body.

By the time the medical staff realized something was wrong, they were already operating on the patient.

You are probably halfway through the surgery, or even in the finishing stages.

This requires adding one more disadvantage to the first three, surgical trauma.When the four unfavorable factors come together and a poisoning reaction occurs, even if the patient transforms into a cat, nine lives are not enough.

Thinking of this, Li Jingsheng couldn't help but break out in a cold sweat.

Hurry up and write down the risks involved in the operation, and think that it is appropriate to adopt a general anesthesia plan or closely monitor the patient's blood drug concentration.

The latter is extremely difficult.

It is almost impossible to monitor a patient's blood drug levels at all times.

After submitting, he secretly breathed a sigh of relief.

Just wait for the results to come out.

The orthopedic surgery ranking of the Second Hospital appeared on the big screen, and the seventh place was mentioned.

Chen Anchen and Hu Jia both scored zero, and the words +1 were displayed behind Li Jingsheng.

The display on the big screen looks like this.

The Chen Anchen team of the Orthopedic Surgery Department of the Second Hospital, with the team leader Professor Chen Anchen, members Associate Professor Hu Jia, and attending physician Li Jingsheng +1 point.The total team score is 1 point.

There are many more masters than you think.

Because the number of teams receiving bonus points is still increasing.

All teams with correct answers receive 1 point.

In some teams, four or five people answered correctly, which felt really awesome.

Basically, they are the two top three hospitals, People's Hospital and Qiao Bang.

In addition, the Affiliated Hospital of Jiangli Medical University also performed very well this year.

Especially in internal medicine, pharmacology, etc., it appears to be very powerful.

Surgical ability is slightly weak.

However, it still won two bronze medals in the general surgery competition.

This is very nice.

No wonder there are rumors in the industry that the Medical University Affiliated Hospital wants to compete with the People's Hospital and Qiaobang Hospital.

It does not appear to be groundless.

The competition among these large hospitals is becoming increasingly fierce.

Jiangli City is just a microcosm of the whole country.

Basically, the competition among major hospitals is becoming more and more intense. Needless to say, the annual ranking of world-famous hospitals is even more popular than the Forbes rich list.

The annual comprehensive ranking of domestic hospitals and individual rankings of departments also attract much attention.

Which department of a hospital is strong will be rated based on three major items: scientific research projects, medical quality, and patient ratings.

Although some departments are powerful, they have low patient ratings and a poor reputation.

The most common reaction is poor service attitude.

There is really no way.

Those departments that are better at treating patients basically have the same attitude.

Doctors don't let patients' wounds touch water. Some patients insist on being pretentious and feel uncomfortable if they don't take a shower for a day.Then the wound was exposed to water. Did the nurse look good?

A very good department must be extremely busy.

The patient did not cooperate and caused trouble for the nurses and doctors. It would be strange if the nurses didn't scold them.

"Dr. Li, look at your answer."

Hu Jia is very motivated to study, and his relationship with Li Jingsheng is becoming more and more familiar.

He is also a colleague in the same department.

At this moment, he was particularly curious to see that Li Jingsheng actually got extra points.At the same time, he also looked at Li Jingsheng more highly.

After all, Chen Anchen was a professor, a veteran of orthopedic surgery, and a chief physician. After all, he couldn't lose face.

At this time, I could only listen to the conversation between the two with my ears open.

He was extremely confident in the surgical plan he submitted. There were obviously no problems, so why didn't he get extra points?
On the contrary, it was Li Jingsheng, a young doctor who was half-assed, who once again made a great contribution.

Not to mention him, Hu Jia was also very puzzled.

When it comes to surgical treatment of bone trauma, my level is not bad.

Where is the problem?
"Hold the grass! It turned out to be the risk of local anesthesia. I thought about it at the time, but I didn't think so deeply."

After Hu Jia read Li Jingsheng's answer, he couldn't help but slap his thigh.

"Risk of local anesthesia? Let me take a look."

Professor Chen Anchen can no longer pretend. When pursuing the truth of medicine, every doctor who wants to make progress is similar.

When encountering something that went wrong, we will always try our best to understand it clearly and avoid making it again next time.

He also came over to see Li Jingsheng's answer.

"This, this... I was really pissed off. I thought the examiner was going to test on how to repair knee joint trauma, but I didn't expect the test would be this! I said my surgical plan was close to perfect, why not give me extra points. "

After Chen Anchen saw it, he was also very upset.

In terms of level, he is no worse than Li Jingsheng.As for whether the prescription level can reach Li Jingsheng's current level, it's hard to say.

After all, it is very difficult to improve prescriptions.

Doctors need to constantly observe the effects of medication during clinical use, summarize it, and then improve it.

Finally, we will be able to know the efficacy and pharmacodynamics of various commonly used drugs.

Because modern medicine is highly developed and there are more and more types of drugs, it is almost impossible for doctors to understand all the drugs clearly.

It is already very good to know some commonly used drugs.

His and Hu Jia's answers were all wrong.

The examiners were testing medication safety, but they focused on the surgical plan. No matter how brilliant the answers were, they were in vain.

In their hearts, both of them cursed the examiner for being treacherous.

Too badass.

"At the end of the answer, a total of 23 hospital teams have successfully obtained extra points, which are all very good. Teams that have not obtained extra points should not be discouraged. The focus of this question is still the word safety. The given The patient's auxiliary examination data suggest that the patient has liver cirrhosis and low liver function. In this case, injecting the patient with the local anesthetic procaine can easily cause a poisoning reaction because the patient's metabolism slows down.

In fact, during the patient's surgery, the doctor only incised the cortex and subcutaneous tissue. Before the patient had time to reduce the fracture of the knee joint, the patient had symptoms of turning his eyes upward and staring immobile.

The nurse immediately measured the patient's blood pressure, but the blood pressure could no longer be measured.

The patient's breathing also stopped.

The large arteries of the neck are pulseless.

The surgeon immediately performed first aid on the patient, injecting 1 mg of epinephrine, performing artificial respiration with tracheal intubation, and performing external chest cardiac compressions.The patient was then placed on a heart monitor, and the electrocardiogram showed premature ventricular contractions and ventricular fibrillation.

The doctor immediately gave the patient electric shock and defibrillation, but it was ineffective.

The patient was immediately given repeated injections of epinephrine, and treated with sodium bicarbonate, atropine and other drugs, including lidocaine.

In the end, despite multiple rescue measures, the patient's life could not be saved.

Taking out this case as a bonus point, the examiners of the judging panel had good intentions, just to sound the alarm for every doctor and nurse present.Safety is no small matter, and you must be alert to various potential risks. "

The host probably didn't read from the script in his hand.

It is estimated that she does not have any medical knowledge in this area.

After all, people need to be good-looking and eloquent, and they don’t have to rely on doctors.

Any adult can make a living as long as he has one skill that he is good at.

At most, it's just bad luck, encountering an unpopular industry or a sunset industry, and not making much money.More seriously, you may lose your job.

"The formal competition begins now. There are ten cases in total. Please submit your respective surgical plans. After comprehensive evaluation, the jury will give priority to the team with the highest score to perform surgery on the patient. Each team can only choose one case to answer. , a total of twenty surgical opportunities will be released, please cherish every opportunity."

It was almost the same as yesterday’s digestive surgery competition.

Those who fail the theoretical part are not even qualified to enter the operating room.

If nothing else happens, it will definitely be another round that determines the outcome.

Li Jingsheng is not good at surgical plans for bone trauma. This round, he basically focused on participating.

Fortunately, Chen Anchen and Hu Jia were both very strong. After discussion, they chose the sixth question.

Captain Chen Anchen submitted the surgical plan.

After the results came out, teams from seven hospitals answered the sixth question, including the team from Qiaobang Hospital.

It can only be said that the Second Hospital is really a bit lacking.

The final result can be imagined with your toes. The orthopedic surgery team of Qiaobang Hospital got priority for surgery and happily went into the operating room to perform surgery on the patient.

"It's really depressing. Why did it collide with the giant Qiaobang Hospital?"

Chen Anchen was originally full of confidence.

As a result, my qualification for surgery was taken away by the team from Qiaobang Hospital. I would be lying if I said I was not depressed.

In a skill competition, the stronger one wins.

Not being able to get the chance for surgery is also a sign of weakness.

(End of this chapter)