Gou in the operating room to add some upgrades

Chapter 190 I thought I had a younger brother (please subscribe)

Fang Xian was educated.

However, after completing the popularization of science, Fang Xian wisely stopped going in-depth on this issue.

Instead, he asked: "Uncle Yun, isn't it a little inappropriate for you to praise me so much with the other two doctors in the department just now? They are old employees of this hospital after all."

Fang Yun rolled his eyes when he heard this: "Old employees? In a few months, they will no longer be employees of this hospital, and they will also run away."

"You don't know how I got here over the years. I train people one after another, and people run away one after another. Even the chief surgeons in the operating room come one after another. Change."

"If you have enough ability, you will run away, and then you will choose people who are useless."

"Of course, as for the three you saw in the ward today, even if they run away, their foundation will be too weak. It is basically impossible to enter the Department of Xiangnan University, but you have to go to several hospitals in Shashi and Shashi Central Hospital, it’s not that difficult.”

"After all, the requirements and standards of these hospitals are lower than those of the three hospitals of Shonan University."

Fang Xian blinked: "Uncle Yun, I understand that you are complaining about the existence of the Medical Association?"

"But there is no way. If there is an upper limit for the future, there is no lower limit for enthusiasm. Only when there is no upper limit for the future, can the lower limit of enthusiasm be controlled."

"The positioning of prefecture-level hospitals is only to treat diseases. To complete the leap of saving lives, it can only be achieved when medicine is highly developed and medical talents are super abundant."

"Nowadays, many high-end talents are extremely lacking, and they need to be filled before they can be slowly systemized. Of course, the country is also considering solving this problem."

"Let me tell you, it is an operation simulator that can break the time and space constraints at least in China. When the time comes, it can also be used to operate complex cases in various county-level hospitals in Hunan Province, and it may be able to break the boundaries. Such a deadlock.”

"If the accuracy can be controlled very strictly, then even if there is a negligible time difference, there will be no problem." Fang Yun said, looking forward to something.

"Of course, perhaps such technology will appear abroad earlier than in our country."

"In terms of program development, others are at an advanced level, and there is nothing we can do about it..." Fang Yun lamented.

When Fang Xian heard this, his expression changed.

It seems that this is really the case. If it is possible to break the constraints of time and space to rescue patients, then some professors who perform surgeries do not need to be permanently stationed in Chang City.

Changshi only needs to make accurate diagnosis, select and control surgical procedures, and then find suitable assistants to complete the rescue work of some critical cases.

Another point is that the incidence of critical diseases in prefecture-level cities and counties is not that high. It would be a waste of resources to have a big professor stationed there just a few times a month.

The country is currently unable to achieve such a waste rate of talent.

This was the first time Fang Xian heard about this issue.

However, Fang Xian is no longer curious about this and should do his own thing first.

……

When he came out of Fang Yun's office, Fang Yun had already gone to the operating room again.

There is no way, this is the case in prefecture-level city hospitals. Whenever a director is promoted to the level of a fourth-level physician, he will run away and will not stay in a prefecture-level city hospital.

If you restrict level 4 doctors from running away, others may stop learning and rushing forward.So what if I rush out? Why don't I just stay in Chang City?So what is the difference between a level 3 doctor and a level 4 doctor?

It's a bit too overwhelming to rely solely on feelings to make people progress.

Therefore, nowadays, in the operating room of Changshi Trauma Center, there are mostly level 3 doctors, and some level 4 directors have come to study under Fang Yun's name, just like Professor Xu Fengnian, Professor Zhu Guangyu and others who have come to study under Professor Yang Yifeng Same as going to Shonan University Hospital.

They are just regular passers-by.

Prefecture-level municipal hospitals still lack high-level talents like level 4 physicians.Can't keep it either.

That's why Fang Yun is very tired.

When they entered the office, He Donglai and Huang Qian were watching a film and discussing: "With this patient's current diagnosis, can he be sent directly to the General Surgery Department? Will he be scolded by Director Fang?"

"Probably not. The diagnosis is very clear, it is intestinal obstruction. Intestinal obstruction is a common emergency disease in general surgery, and people from general surgery can handle it..."

While the tall man Huang Qian was talking, he saw Fang Xian walking in. He had an idea and waved, "Doctor Fang, would you like to come over and help me watch a film?"

"Look at this patient. In addition to intestinal obstruction, does he have any other problems? Don't go into a specialist operating room then and the result will be unsolvable."

After Fang Xian was taken away, the two checked Fang Xian's resume.

The number of resumes was not full, but the thickness of each one made them feel stunned.

Oh, when he was in Han City, Fang Xian already had five level 5 skills, and they were basic skills. This was already a step up from a monster.

Presumably with this benchmark, Fang Xian's other skills will not be too bad.

Fang Xian was quite modest and did not refuse: "Dr. Huang, Dr. He, let's study together."

"Does this patient have a medical record?"

Clinical practice without medical records is incomplete clinical practice. Simply reading films may not actually give you a comprehensive view, but it can be quite comprehensive.

After all, there are many patients who cannot speak and can only speak through films. And family members who can speak have difficulty understanding the patient's feelings or what happened.

When a comatose patient enters the hospital, the only thing that can talk is the movie.

"The patient complained of severe abdominal pain and was admitted to the hospital for about half an hour. There was no obvious trigger. After admission, the physical examination showed no obvious plate-shaped abdomen! CT showed abdominal intestinal obstruction." Huang Qian said while giving up his position.

"We are currently doing the most basic resuscitation in the emergency department. The results of the film came out only about 3 minutes ago. The emergency department asked whether to send the patient to the general surgery department or the trauma center. Doctors from the general surgery department are also reading the film at the same time."

Fang Xian passed Professor Xu Fengnian and learned that the trauma center only receives super emergencies, and ordinary emergencies are under the management of specialists. The significance of the establishment of the trauma center is to transform super emergencies into general specialist emergencies.

The amount of information brought by the medical records was limited, so Fang Xian sat on it, scanned the CT layers up and down a few times, and asked, "The patient is not comatose? Can he file a private complaint?"

"Only CT?"

Fang Xian asked three questions in a row.

Such a situation must be diagnosed quickly.

"There are also plain films, do you need them? Dr. Fang, I've transferred them here." Although He Donglai was asking, he had already done so.

Fang Xian turned around and saw that the patient's intestines were flatulent.Mechanical intestinal obstruction can be diagnosed.

However, it is difficult to judge how mechanical it is for the time being, and further analysis on CT scans is needed.

Fang Xian, who has a level 5 basic theory of general surgery, knows that there are many types of intestinal obstruction, and the corresponding treatments range from the simplest transient intestinal obstruction to symptomatic ones that can be treated without treatment, as well as various types that can be solved by enema. Manifestations.

Of course, the most dangerous thing is mechanical or strangulating intestinal obstruction.

However, without MRI, it is difficult to read whether there is strangulation with just CT.Because strangulation is a diagnosis of ischemia, whether it is ischemic or not depends on MRI.

At best, CT can only tell whether there are symptoms such as hemangioma. Even if CT is enhanced, the information that can be seen is limited.

Of course, some traces of blood vessels can still be seen on CT.

Fang Xian glanced at the CT again. The kidneys, liver, spleen and pancreas were in normal shape, but there were signs of peritoneal irritation, which should be local inflammation or bleeding.

Looking at the abdominal aorta of the large blood vessel, there is no obvious break or change in shape. The fluid accumulation in the abdomen is not too much. If the blood vessel ruptures, the abdominal cavity will definitely be filled with fluid and form a frog-shaped abdomen.

The enhanced CT results did not show extravasation of contrast enhancement agent, proving a non-hemorrhagic disease.It can be ruled out that there is damage to blood vessels and solid organs. In CT, no extravasation of the contrast agent was seen and it was evenly distributed, proving that it is not a problem with solid organs.

The patient himself is not unconscious, which proves that the current situation is not particularly serious——

Exclude super emergencies——

In the intestinal area, intestinal obstruction was only concentrated in the jejunum segment, and no intestinal wall tumors were seen.

Axial CT scan showed low isovolumetric peritoneal effusion.Axial contrast-enhanced CT scan showed mesenteric exudation and segmental weakening of intestinal wall enhancement.Other normally enhanced intestinal loops serve as in vivo controls. The CT findings of weakened intestinal wall enhancement, mesenteric effusion or infiltration and ascites should be considered suggestive of strangulation, and the patient should undergo prompt surgical treatment.

No need to go into the trauma center.

However, despite reading so much, Fang Xian still asked: "Simple strangulating intestinal obstruction, can the general surgery here handle it? The strangulation distance is about fifty or sixty centimeters, maybe a little longer."

"Only strangulated intestinal obstruction? No vascular damage or intestinal rupture?" He Donglai asked.

"We didn't see it on the CT scan, so it should be ruled out." Fang Xian nodded.

"Then don't worry, I'll call the General Surgery Department and let them handle it."

Huang Qian took the opportunity to ask: "Doctor Fang, can this patient really be sent to the general surgery department? Will nothing happen?"

Fang Xian heard that the general surgery department could handle it. After thinking about it, he thought he could talk a little bit more nonsense: "It should be possible. From a general perspective, the patient's symptoms are mainly concentrated in the abdomen."

"In the scan of the entire abdomen, no rupture of the solid organs was found, and the intestines and blood vessels can be precisely located."

"On the enhanced CT scan, no contrast agent leakage was seen. We have ruled out damage to the aorta and blood vessels for the time being."

"After reading the intestinal interface accurately, first use CT to read the position and find out that it is the small intestine." Fang Xian said this and started clicking on the computer screen again.

Said: "Looking at the anatomy and layers, it should be the middle part of the small intestine, roughly in this area. You can see that the intestine is dilated, and compared with other intestinal walls, it has a certain degree of edema."

"If intestinal rupture is considered, the peritoneal effusion is serious, but this is only a small amount of abdominal fluid and does not squeeze the intestinal organs. Therefore, the possibility of extensive peritonitis caused by intestinal rupture is not considered for the time being."

“Then we look at the intestinal wall and consider edema. Absolute mechanical intestinal obstruction such as volvulus and tumors on the intestinal wall is not seen. Consider functional intestinal obstruction.”

"Functional intestinal obstruction can also be considered as functional intestinal obstruction. Look at the thickness of the intestinal wall here. Compared with the thickness of the normal intestinal wall? Is it much thicker?"

"And it's evenly thickened, evenly thickened." When Fang Xian looked back at the two of them, they were both absolutely confused.

Well, Fang Xian expected that these two people couldn't even see the absolute level of CT, let alone see the theory from above.

Level 4 looks at the level, and level 5 looks at the theory.

However, the surgery is not managed by a trauma center.

Fang Xian began to point at the intestinal wall section with his finger: "This is the small intestine, right? And it is continuous from the right side to the left side, right?"

"There is a gap in the thickness of the intestinal wall at the upper and lower levels, and it is a meaningful gap, and here, you can see some thickness faults..."

Fang Xian said this, and the two of them nodded.

"In such a case, we will definitely give priority to the dysfunctional intestinal obstruction caused by strangulation, and the occurrence time is not long, and we will not consider the arterial embolic intestinal obstruction."

"This kind of emergency should not be fatal in a short period of time. There is no need to go to a trauma center for surgical rescue. A specialist should be able to handle it."

"After all, it's just an intestinal segment resection at most. It's a routine specialist skill in general surgery, but it's just a little more difficult than the basic skills of a specialist." Fang Xian reasoned with reason.

Then he saw the eyes of the other two people looking at him, both full of incredulity.

Fang Xian also realized that it turns out that when the basic skills are great, the plasticity can be so strong.Although CT reading is only a auxiliary diagnostic skill, once it is absolutely combined with the corresponding theory.

The chemical reactions that can be produced by collisions are huge.

If level 5 reading skills are meaningless, then it will not be classified as a basic skill for a specialist.

"Dr. Fang, how do you consider that the patient has non-strangulating intestinal obstruction?"

"In non-strangulating intestinal obstruction, even in the presence of partial mechanical blockage, severe edema will not occur, at least the intestinal wall will not thicken too much."

"Non-surgical treatment for non-strangulating or simple intestinal obstruction can often be successfully relieved, while strangulating intestinal obstruction is a surgical emergency and can progress to infarction and gangrene in as little as 6 hours after onset."

"Of course, from this level, it can be seen that there is still a low amount of enhancement in the intestinal wall of this patient, so it does not mean that the mesenteric artery has not had blood supply blockage. As long as we find ways to relieve the obstruction, ischemic angina can be eliminated. If the narrowing is relieved, this should be done with simple obstruction relief surgery..."

After understanding it more deeply, Fang Xian's choice of treatment method became clearer.

After listening to Fang Xian's analysis, Huang Qian made another call to the General Surgery Department. After almost repeating Fang Xian's diagnosis and treatment suggestions, he said: "This is our reference opinion. Surgery During the process, please take clinical considerations into account.”

"Well, okay, if anything happens, we'll contact you again."

After Huang Qian finished speaking, He Donglai asked: "Dr. Fang, what is your level of radiographic reading skills?"

Fang Xian thought for a while, but he still wasn't lying: "Level 5."

"Hiss!~Awesome." After hearing this, Huang Qian and He Donglai looked at each other and lowered their heads silently.

I thought to myself, 6 level 5 skills, wouldn’t this mean killing people indiscriminately?

What Director Fang said, not to mention that it was not enough for him to become a colleague or a student with Fang Xian, was relatively conservative.

Level 5 skills are the right to talk to subject leaders and communicate with each other.

Five level 5 skills, such a high level, have exceeded their imagination.It was hard for them to imagine which specialty Fang Xian had gone to. Wouldn't the doctors from that specialty have to suffer under Fang Xian's treatment?

Oh no.

Fang Xian is going to the trauma center here.

He Donglai lowered his posture even more and asked with a smile: "Dr. Fang, have you worked in a trauma center for a period of time before? You must have performed very well, right?"

Fang Xian shook his head: "This is my first time entering the specialty of trauma surgery. I used to stay in the operating room to learn basic operations. Before that, I was managing patients in the trauma surgery ward. It has been a long time since I had any contact with clinical medical records and diagnosis. .”

Said quite frankly.

"Ah this?" When the two of them heard this, they were a little bit off guard!

He Donglai asked again: "Dr. Fang, you were a trauma surgeon before. Trauma surgery is an orthopedics department. What about your theory of general surgery?"

"I learned it when I was learning basic operations. Shonan University Affiliated Hospital paid more attention to theoretical learning and mastery during the intensive training at the trauma center."

"Because of my interest, I know a little more about gastrointestinal surgery."

Fang Xian didn't know why these two were so persistent.

This is a simple diagnosis of strangulating intestinal obstruction. How can it be so mysterious?
Of course, this is because Fang Xian does not know much about general surgery and does not know enough about No. 1 Civil Hospital in Chang City.From Fang Xian's perspective, he felt that doing such a thing was just a casual thing.

However, if you stand in front of an ordinary level 1 doctor, Fang Xian's operation would be really amazing.

Can a level 1 general surgeon reach such a high level in terms of film reading and basic theory?
Their basic operations are slightly better than Fang Xian's, but their overall operation and treatment effects may not be as good as Fang Xian's.

In terms of diagnosis, this is even more true, even if Fang Xian has no experience.But his basic skills are solid, and Fang Xian is able to extract key points from a particularly fine level at every step.

Under such circumstances, when making a diagnosis, it is like divine help.

"Dr. Fang, He Donglai, who will learn more from you in the future, clasped his fists slightly.

I thought I had a younger brother.

In the end, a super daddy came, what the hell?

Originally, He Donglai wanted to help Fang Xian withstand the scolding so that he could find a sense of balance in the future.

Good guy, Fang Xian will probably be able to curse in the operating room of the trauma center from now on.

"Doctor Fang, can you show us a few more films? We have been scolded by Director Fang for these films before, especially this one. After being sent to the operating room of the trauma center today, there was a sudden The blood vessel rupture, take a look, can it be diagnosed in advance..." He Donglai asked seriously.

The level 5 film reading teacher is right in front of you, why don’t you ask for help quickly, what are you waiting for?
(End of this chapter)