Gou in the operating room to add some upgrades

Chapter 10 Big harvest! (Please collect and read)

There are no useless skills and knowledge, it just depends on how you apply the knowledge. This is a problem at the application level, and has no direct relationship with the original knowledge and theory.

The Medical Association has long stated that the level of basic medical knowledge represents the breadth of your knowledge of the overall medical community, and the theoretical basis of surgery represents the thickness of surgical knowledge.

Professional basic theoretical knowledge represents the cake shape of the knowledge system you have achieved, and determines the weight of your knowledge.

Generally speaking, in the knowledge system of subspecialty, level 1 means that you have an understanding of this knowledge and know many things that non-subspecialty colleagues do not know. This determines your major, so it is called basic theory of specialty. The first line of defense for professional barriers.

Level 2 of the subspecialty knowledge system means that you have a deep enough understanding of trauma surgery and can skillfully diagnose common diseases and know the diagnostic routines. This is not only an understanding level, but also a skillful mastery. Diagnostic skills.

And level 3 of the sub-specialty knowledge system represents specialization!

Specialization is not a joke, it is just a compliment, but it means that after you have an in-depth understanding of common diseases in trauma surgery, you will gradually form your own system, begin to have your own ideas for understanding the disease, and gradually begin to form your own diagnosis and treatment thinking!

This is what theory brings you.

Getting started means cognition, proficiency means flexible application, and being familiar with various routines. Specialization means that you are able to do it with ease and can have your own understanding and form your own thinking and focus.

Who says theory is useless? The basic theory of trauma surgery is particularly useful when it reaches level 3!
If this still doesn't work, then at least 50.00% of surgeons should stop doing it!

According to incomplete statistics, at present, in the surgical industry, no more than 3% of them have really upgraded the basic theory of the subspecialty to level 60.00, and nearly half of them only pursue the level of skill operation, while ignoring the theoretical basis.

And this is not allowed in a teaching hospital like the Affiliated Hospital of Shonan University, and such a choice is not favored.

Fang Xian is self-aware and knows that he can do it now, and he has a feeling of being able to do it.

This is specialization!
Don’t be afraid, it comes from the confidence at the level of knowledge, cognition and thinking.

Trauma surgery is surgery, and the use of medication must be concise, accurate, appropriate, symptomatic, and pay attention to many details. It can be summarized in four words, the most subtle...

Then the diagnosis needs to be more comprehensive and meticulous, and some detailed factors need to be continuously extracted and brought into the consideration of the diagnosis!
and so--

Fang Xian continued to push slowly.

I don’t have anything else to do, just eat this case.

So she found out her blood test results.

If D-dimer is high, color ultrasound shows thrombosis, anticoagulation must be used, and deep vein color ultrasound must be reviewed to absolutely avoid the inevitable occurrence of thrombus detachment, which is a lower limit.

The white blood cell count is as high as 20+!

Inflammatory indicators such as CRP (C-reactive protein), ESR (erythrocyte sedimentation rate), and interleukins are also high.Infection is definitely present, what is your current body temperature?
Anti-infective treatment cannot be interrupted, and the four Tid tests must be kept up!If the patient doesn't care about it, doctors must pay attention to the serious consequences if the infection spreads to the brain and heart.

Reviewing the inflammatory indicators must be done and done well.

Fang Xian was recording and analyzing the case of this new patient, which Fang Xian did not do so well and was not so proficient in the past.

Look at the liver function test again——

Fuck, why is the albumin so low? 32?

32. The indication for oral protein supplementation has been met, but the indication for intravenous infusion of paclitaxel has not yet been reached.

Let's prescribe some protein powder later, the protein powder in the hospital should be cheaper than the pharmacy outside.Pentagram mark!

Over!
Let’s take a look at other inspection information…

When Fang Xian turned over them one by one.

Suddenly, he flipped through the examination data that he had skimmed over, and finally discovered such a point from the routine examination results at Huai City No. [-] Hospital when he was admitted at the very beginning, that is, for the first time.

"OB+"

"Positive occult blood? A plus sign. It was not found again during the pre-operative re-examination. It was not re-examined after the operation."

Surgery is very practical, and we don’t bother to pick out the minutiae. Because everyone is very busy, forget it if you don’t pick it up, and focus more on surgical operations.

The big deal is that if a problem is found, it will be thrown to the consultation. This is a matter that the superior physician must make a decision when time is limited and there are many patients.

Catch the big and let go of the small!

And this is exactly what Fang Xian can grab.

"High fever, headache, and transient positive fecal occult blood. Are they stress peptic ulcers? Or are they already existing peptic ulcers, usually asymptomatic, but the symptoms worsen under the stress of trauma?"

"That's an issue that needs to be considered."

"Is a stool routine required for routine examination upon admission? We still need to follow up on the results and ask her about her eating habits later..."

"No high blood pressure, no diabetes and other concomitant diseases."

"Then the admission doctor's order only needs to include inflammatory indicators, liver and kidney function electrolytes, urine routine, electrocardiogram, lung plain film, and send a wound exudate bacterial culture and general microscope examination! Let's do another hp, be prepared!"

"In terms of medication, anti-infection, protein powder for nourishment, sugar water..."

"In terms of consultation, what is necessary at the moment is to invite the vascular surgery department and the pharmacy department for consultation. We plan to ask the gastroenterology department for consultation later."

"The details of the signing of the conversation are that the infection may be difficult to control, the hospital stay is long, and the fracture is still difficult to heal after surgery. I will tell the corresponding treatment plan to the patient one by one, mainly explaining when it is suitable for surgery, etc." Fang Xian's mind froze. After flashing through these, it started working.

After work, although he didn't get any substantial gains, Fang Xian still felt a sense of accomplishment.After dealing with her admission-related examinations, Fang Xian immediately went to the skills training room to start suturing practice.

What Fang Xian thought was that if the suturing could be done better, the superior doctor might give him more suturing opportunities.

But if you do this well, level 3 is not enough. You may need level 4. Only in this way can you seize opportunities from other brothers with doctorates and master's degrees and be favored.

But if you want to reach level 4, you don't know when you will have to wait, but this is also an option, you have to take the initiative, you can't passively wait for feeding!

At the end of the day, Fang Xian's suture practice progress did not increase by 1 point. Fang Xian estimated that it would take three to four months for him to upgrade a skill, and 2 skill points for a skill to level 25, which means that it took three days to increase by 1. point.

Don't be in a hurry.

What surprised Fang Xian was that on the next day, during Fang Xian's rounds on Sunday, he actually saw the patient's HP test positive, indicating that she had Helicobacter pylori infection, which may have caused Ulcer damage, but no obvious symptoms.

It was only under the stress of trauma that ulcer bleeding occurred before, and once the occult blood test was positive.

This shows that this is the precursor stage or early stage of ulcer!

Fang Xian then quickly requested a consultation from the Department of Gastroenterology to see how the teachers in the Department of Gastroenterology arranged and planned. On the consultation sheet, Fang Xian specifically emphasized that he had had a positive transient fecal occult blood test in the past.

After Fang Xian asked for a consultation, he felt that the opinion of the Department of Gastroenterology was probably the combined treatment of antibiotics and antacid ppi, and if the patient was taking intravenous medication, he probably only needed to use one kind of ppi for treatment.

Of course, this was just Fang Xian's own thinking and he did not explain it to others.

However, Fang Xian told the attending physician Xue Li, who was conducting ward rounds on Sunday, about such details. Xue Li just said that it would be fine to wait for the consultation opinion. Sensitive antibiotics for germs!

Fang Xian said yes!

Then he continued to drill into the skill training room.

That night, when Fang Xian continued to practice suturing, a bright light flashed, which made him feel refreshed!
"You claim to guide patients in the direction of peptic ulcer diagnosis, the diagnosis of peptic ulcer and Helicobacter pylori infection have been established, you have requested consultation support, and treated the patient accordingly. You have caused harm to peptic ulcer (stage A1) A total of 51 points (55% damage), and 51 skill points!"

"There are currently 53 skill points left."

"Nice!"

Fang Xian is alone in the skills training room, so Fang Xian is not afraid of others hearing that he is happy, because they don't know what he is excited about.

The Affiliated Hospital of Shonan University has the corresponding minimum requirements for doctors and medical students in the hospital to have the right to be the chief surgeon: trauma surgery theory level 3, X-ray film reading level 3, debridement, suture, and incision all reach level 3!
Fang Xian decided to improve suture first.

After adding points, when Fang Xian practiced suturing again in the skills training room, Fang Xian finally understood why the superior doctors were willing to give more suturing opportunities to those with doctorates or master's degrees.

Suture level 3, which is equivalent to the specialization level, specialization level suture, no special time limit and suture method requirements, the operator needs to carefully clarify each layer of subcutaneous tissue and achieve suture level, no need to suture the outer skin, the skin can be zippered, so that the patient wound healing……

Looking at the simulated skin of this suture operating device, the outermost layer of suturing has not been performed, but the surface of the skin is neatly aligned. As long as the matching surface of the skin is fixed and not loosened, the healing standard can definitely be achieved!

And the seam I sewed up before, although quite satisfactory, was a clarification of the hierarchy, far worse than it is now!
And possessing a specialization level of suture is almost equivalent to possessing the level of suture possessed by most surgeons. Most surgeons will feel that the basic skill of suture is enough to practice at level 3, and it is unnecessary. Take the time to go deeper.

Because increasing investment is inefficient and does not have a return on investment.

Therefore, these professors, including Professor Lin and Associate Professor Song Yu, estimate that the level of suturing is only level 3, which is just for use.

Since they are all at the same level, Professor Lin's suturing is not much different from that of other Fang Xian or other Ph.D. brothers and is harmless.

This kind of strength is the foundation for others to trust you and recognize you.

(End of this chapter)