Gou is practicing medicine in the clinic

Chapter 286 One knife determines success or failure, neuropathy

Chapter 286 One stroke determines success or failure, neurosis
After taking the scalpel, Li Jingsheng looked very calm and calm.

On the contrary, Director Chen Anchen, who was standing by, had his heart in his throat, and his eyes were fixed on the knife in Li Jingsheng's hand.

It seemed that what Li Jingsheng was about to cut was not the patient's foot, but a piece of raw jade.

One knife is poor and one knife is rich.

Now, Li Jingsheng controls whether the knife will succeed or fail.

He first cut from the deformed point of the ankle. The incision was about three centimeters long.He was very precise, and he skillfully avoided the distorted veins.

It seems like a simple knife, but it reveals a wonderful level of incision.

Just a little bit more and it's possible to cut this blood vessel.

Although the incision will not have a great impact on the operation, it can be repaired by anastomosis after the arthrodesis is completed.But at this moment in the game, any mistake may lead to loss of points.

Under normal circumstances, this knife needs to be cut from three to four centimeters above the ankle joint along the lateral side of the tibialis anterior tendon to the base of the third and fourth metatarsals.

It is equivalent to making a longitudinal incision.

The total length of the wound is about ten centimeters.

Li Jingsheng now chose the distortion point and cut upwards towards the ankle joint first.

Then cut downward from the incision position of the distortion point.

This wound was made twice.

The trouble is a little more troublesome, but a lot of unnecessary risks can be avoided.

The best thing is that after the four-joint fusion is completed, the distortion will basically disappear, and the wound can be sutured in one go.

You can see that his movements are like flowing clouds and still water, and his movements reveal the calmness and confidence that only a senior surgeon can have.

The cuts made are even more impeccable.

If I have to describe it, it is just right.

Regardless of the depth, length, and neatness of the wounds, they are all amazing.

The proficient cutting method is indeed powerful.

He should be able to challenge extremely difficult surgical procedures.

In terms of the degree of refinement, Shen Wai is actually superior to Heart Wai.However, the complexity of extracardiac surgery is even more complicated than that of cardiac surgery.

For example, the more famous tetralogy of Fallot.

Li Jingsheng has now mastered such a powerful incision method and is fully qualified to participate in some top surgical operations and become the chief surgeon's right-hand assistant.

As for him being the chief surgeon, he doesn't have the ability yet.

Doctors who can perform surgeries of level [-] or above must be at least senior deputy chief physicians.

This kind of existence is actually no different from that of a senior chief physician.

They may end up stuck because their academic qualifications are a little inferior, or their papers are weak and there is less scientific research.There are a lot of such deputy chief physicians in many larger hospitals.

They have rich practical experience and have at least one or two categories that they are good at.

For example, he is great at taking medicine, or he is great at diagnosing a certain disease, or he is good at surgery.

Compared with this kind of existence, Li Jingsheng still lacks experience.

Then other surgical skills must continue to be improved.

For a major surgery, just making a severe incision is definitely not enough.

Hemostasis, anastomosis, knotting, suturing, and separation all have to be followed up, so there is no need to ask for help.You can also handle problems yourself.

"Okay, now that the patient's joints have been exposed, let's ask the two directors to complete the key operations of the surgery."

Not only was Li Jingsheng not arrogant, he also took good care of the two directors.

Try to say something that makes people feel comfortable.

"Thank you Dr. Li! The cut was very good! The surgical thinking is also very innovative."

Chen Anchen was full of praise for him.

Fortunately, Li Jingsheng was brought in for this operation. Whether it was the crucial extra point when trying to qualify for the operation or the incision at this moment, their team had hope of winning the award.

"The amount of bleeding was so small, it opened my eyes." Hu Jia, who was standing next to him, also looked full of admiration.

The more skillful the incision technique, the less surgical bleeding.

Some surgeons get off to a good start by cutting blood directly onto their face and body.

This is a sign of poor skill and lack of experience.

In all likelihood, the arteries and blood vessels were cut.

The more mature the doctor, the more cautious he will be when operating.

The next operation was basically performed by Director Chen Anchen and Deputy Director Hu Jia, with Li Jingsheng playing with his assistant and learning this aspect of surgical knowledge.

I saw Director Chen Anchen carefully cutting off the joint capsule and ligaments around the talus, and then extremely plantar flexing the forefoot.

At this time, you can see the talus protruding posteriorly.

After cutting off the attached ligaments, use a periosteal screwdriver to pry out the talus more violently.

Hu Jia clamped it with cloth forceps at the side, and then Director Chen Anchen removed all the cartilage surface of the talus.

……

The entire operation was very bloody and violent.

There is a reason why orthopedic surgeons have always been looked down upon and called rude.

Li Jingsheng learned a lot of practical surgical knowledge and methods of dealing with joint trauma, lesions, and necrosis.

For example, when the surgery proceeds to the back part, the patient's talus is not so closely aligned with the surrounding bone.

At this time, Director Hu Jia chose to fill in the cancellous bone chip.

This skill was learned by Li Jingsheng.

He also gained deeper insights into the healing of bone wounds.

"Dr. Li, I'll leave the rest of the suturing to you."

Director Chen Anchen also left the finishing work to him out of his trust in Li Jingsheng.

"no problem."

Li Jingsheng's suturing skills are in the second group of orthopedic surgery, which is considered to be very high.

But in this kind of provincial and municipal skill competition, Xiaocheng-level suturing skills are simply not enough.

Gritting his teeth, he sharpened his skills before the battle and improved the continuous stitching to a great level.

I originally wanted to upgrade Knotting to Dacheng, but I only had 31 health points left, which was far from enough.

Winning a gold medal will reward you with 500 health points.

Now it's a team battle, I wonder how much can be given to him?

Yesterday, he helped Director Xiao Linlin win the silver medal, and the health reward he received was 100 points.

Team fighting can take advantage of the strength of many people.

But the health bonus will also be reduced a lot.

Under normal circumstances, if he wins the silver medal alone, he should be able to get at least 200 health points as a reward.

After suturing the patient, he checked it over.

Not to mention extra points, at least it is unlikely to be deducted.The suturing part itself is not too tricky, and the suturing at the ends of the limbs is a very easy part to suture.At most, some parts have a little more tension.

This can be done with thicker sutures and some tension-reducing suture methods.

After the operation, the patient is handed over directly to the organizer's staff.

Professional judges will evaluate and score the entire surgery.

The five people returned to the rest area of ​​the Second Hospital, all anxious and waiting for the results to come out.

After about ten minutes, a nurse reminded Chen Anchen.

"Director Chen, Director Chen, look, our team is on the list."

Chen Anchen looked carefully, his face suddenly filled with excitement and smile.

"Haha, I didn't expect to be ranked third in the overall score. It's really good! Now let's see if we can hold on."

The top two teams were from People's Hospital and Qiaobang Hospital.

tied first.

These two hospitals are really strong.

Other hospitals basically have one or two departments that are strong, but all of their departments are extremely strong.

If the second hospital's score can be stabilized and not blown away by others, it should be able to get a silver medal.

"Old Chen, it's okay!"

Zhong Hu was very envious of this achievement.

"Haha, I'm lucky! I almost didn't get the qualification for surgery at first, and there were many obstacles during the surgery. Dr. Li is a capable person, and he is the lucky star of our team."

Director Chen Anchen was all smiles.

At this moment, he was also speaking out of emotion.

Without Li Jingsheng's help, they might not even be able to get the qualifications for surgery.

This year’s competition has added a lot of fun.

When competing for surgery qualifications, even though there are twenty patients to choose from, it is a bit like opening a blind box.

A team of doctors like them who are strong but not yet at the top will basically be doomed if they come across strong hospitals like Qiao Bang, People's Hospital, and Medical University Affiliated Hospital.

Theoretically, there is Qiaobang and People's Hospital, and the second hospital is answering the same question in the first round at the same time.

Then one company wins.

Definitely not the second hospital.

Immediately afterwards, in the second round and the last opportunity to compete for surgery, the Second Hospital and People's Hospital or Qiaobang Hospital competed to answer a question at the same time.

It is conceivable that when this happened, the Second Hospital could only cry and fainted in the toilet.

Luck is also part of strength.

After waiting for nearly half an hour, twenty surgical teams completed all operations.

The surgical cases encountered by some teams may be more complex, so the operation time is very long.In some surgical teams, the operation time will be significantly extended because the surgeon's operating speed is slow or the finishing doctor's suturing is slow.There are no hard and fast rules on this.

If it's not a competition, as long as the operation can be done well, it won't be a problem even if the operation time is extended for a few hours.

Of course, if the operation is ridiculously slow, there will be many problems.

For example, the effectiveness time of local anesthetics. If it is a short-acting anesthetic, it will expire in only about 10 minutes.

At that time, the patient will be so painful that he screams.

There is also the issue of income generation. If you only perform one operation a day, even if it is a minor operation, neither the hospital nor the department will agree.

It’s impossible to raise a living person, right?
Any hospital, whether public or private, will pursue efficiency.

In public hospitals, at least 70% of the expenses need to be paid by the hospital itself.The maximum financial support is 30%.

Not to mention the financial difficulties in some places.

Therefore, doctors whose surgical efficiency is too slow will be eliminated.But there are also other types of survivors.

For example, Li Jingsheng knew a deputy chief physician who worked in the general surgery department of the First Hospital.This person is known to be slow in performing surgeries.

Almost no doctors or nurses were willing to share the stage with him for surgery.

Because his operation speed is too slow.

An operation that others can complete in two hours takes him five hours or even longer.It is also called euphemistically, slow work produces careful work.

It is undeniable that the deputy chief physician of the general surgery department is indeed very strong.

The surgeries performed by him have been error-free so far.Then the patient recovered quickly after surgery and the lesions were cleaned very well.

When it comes to tumor removal, many people line up to see him.

Why?

Because he cuts cleanly, the recurrence rate is very low.

But the doctors and nurses who were on stage with him were not happy!Because the operation time is too long, I often have to work overtime, and my meals are not on time.

Some female doctors and nurses cannot endure such a long operation due to physiological reasons.

Because I can’t go to the toilet easily at work.

Many people had to carry wet diapers into the operating room.

This has also led to many people being reluctant to operate on the same stage as the deputy chief physician.But people just survived.

He performs a tumor surgery, and some of the more expensive ones cost [-] to [-] yuan.

Other general surgeons may only charge a few hundred yuan, or even 2000 yuan, for a minor operation.

The higher one is only five or six thousand at most.

His income from one operation is more than that of dozens of other operations.

And as he gradually became famous, more and more patients came to him for tumor removal.There is no shortage of owners who are not short of money.

So he survived well in the First Hospital.

Slowly, he also recruited several medical assistants and nurses who were willing to endure hardships with him, forming a stable surgical team.

That is, the now very famous Yin Shixian team of the First Hospital.

When Li Jingsheng was working at the First Hospital, he dreamed of joining this team.

It's a pity that Deputy Director Yin Shixian doesn't like him at all.

The selection of medical assistants must be doctors with strong surgical skills or talents.

Deputy Director Yin Shixian did not come to participate in today's competition.

It may be that you are too busy at work and simply can’t get away.After all, there is a long queue of patients who want to have his surgery.

It may also be that his surgery is too slow and he is not suitable for this kind of competition.

It's impossible to ask thousands of people to wait for him to slowly perform surgery alone, right?

If deputy director Yin Shixian comes, he may still remember Li Jingsheng.

Li Jingsheng even tried to give him gifts and wanted to join his surgical team.was ruthlessly rejected.

Now, even if Deputy Director Yin asks him to join, he will not agree.

"Yeah! No. 2, we really got the overall score of No. 2."

Nurse girls are always so lively and cute.

Both surgical nurses were extremely happy.

"Haha, I actually won the silver medal, which is really unexpected! What happens in this world is really amazing!"

Director Chen Anchen was so happy that he fell ill.

Deputy Director Hu Jia also smiled.

Look at him busy chatting with people on his mobile phone, with a touch of warmth on his face. It is obvious that he is not chatting with friends, classmates or the like.

Li Jingsheng glanced casually.

I immediately admired the character of Deputy Director Hu Jia.

He was chatting with his wife, and he should have told her the good news about winning the award as soon as possible.

Behind every successful man is a devoted and supportive wife.

After Li Jingsheng won the award, he did not share it with Ou Qinglan in time. Instead, he waited until dinner in the evening to tell her.

This is where he should examine himself.

"Come on, let's go on stage to receive the award together!"

Chen Anchen said to Li Jingsheng and others in high spirits.

Other winning teams also went on stage to receive their awards.

Li Jingsheng didn't want to go on this stage, but he didn't want to ruin Chen Anchen's enthusiasm either.

Followed on stage together.

Many people were very impressed by him. When they saw him on stage, they couldn't help but point at him and cast all kinds of looks at him.

There are those who admire, there are those who are envious, there are those who are jealous, and there are those who are dissatisfied.

Because Li Jingsheng receives awards too frequently.

No doctor has ever done this.

At most, I can only participate in two competition events.

Li Jingsheng has participated in many competitions and won awards every time he participated.

What kind of monster is this!

He himself is extremely low-key, standing in the back is just a formality.

This award does not belong to Chen Anchen alone, but to the entire team.

Therefore, every team member should have the same sense of honor.

"Dr. Li, I didn't expect that we would have the opportunity to receive the award on the same stage again!" Dean Jiang Yue chatted enthusiastically with him with a smile on his face.

"Haha, this shows that I have a deep relationship with Director Jiang, and it also proves the strength of Jiang's Orthopedic Hospital. Congratulations to Director Jiang for winning another silver medal."

Li Jingsheng responded with a smile.

The strength of Jiangshi Orthopedic Hospital cannot be overemphasized.

In the bone trauma diagnosis and treatment competition where there are many strong people, he once again won a big prize.

Only two hospitals won the silver medal this time, namely the Chen Anchen team of the Second Hospital and the Jiang Qi Department team of Jiangshi Orthopedic Hospital.

Teams from three hospitals received bronze medals, including the Medical University Hospital.

After receiving the awards, competitions in the fields of bone disease and bone joints began in full swing.

Li Jingsheng also worked hard when he was able, and once again became a medical assistant to Director Zhong Hu.

"I have just experienced a wonderful orthopedic trauma surgery competition, and many excellent surgical teams have emerged. It is said that one flower blooming alone is not spring, but a hundred flowers blooming and the garden is full of spring. The vigorous development of national orthopedic medicine cannot be separated from the selflessness of every doctor Share and give.

The following competition events are bone disease and bone and joint surgery.

Bone diseases mainly focus on answering questions, while bone and joint surgery mainly focuses on surgery.

Doctors from each hospital can pool their wisdom and power as a team to answer questions and operate together.The final ranking is calculated based on the total score. "

As soon as the host finished speaking, the patient's information appeared on the big screen.

Patient, male, 27 years old, car mechanic.

One day, I suddenly developed severe pain in my left upper arm at work. At first I thought it was a sprain at work, but after two days of rest, my condition worsened.

Especially at night, the pain was unbearable and prevented him from sleeping.

Three days later, he found that his wrist could not be straightened, his fingers could not be straightened either, and his thumb could only maintain its natural flexion.

He took medicine at a local clinic and the pain subsided after ten days of treatment.

But the wrist and fingers of my left hand still cannot be straightened.

On admission examination, it was found that the patient had complete paralysis of the muscles innervated by the radial nerve below the brachioradialis in the left limb.The sensory function of the tiger's mouth area was normal, and the muscle strength of other nerves innervating the left upper limb was normal.

Attached below is the MRI of the patient's cervical spine, which found no abnormalities.

The patient's electromyography showed electrical rest in the muscles innervated by the radial nerve.

Li Jingsheng is already very familiar with the rules of the competition. The test point of this question is the diagnosis of the cause.

Director Zhong Hu had already started diagnosing, writing something on his tablet from time to time.

As an assistant, Li Jingsheng is also qualified to answer questions.

Diagnosis of causes is his forte.

This patient's initial symptoms were very similar to radial nerve palsy.

This disease generally has no trigger and occurs naturally.

The treatment plan is to take Micoba.

However, after careful analysis, Li Jingsheng discovered some doubts.

It feels a bit like radial tunnel syndrome.

(End of this chapter)

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