Gou in the operating room to add some upgrades

Chapter 195 The first specialized basic surgery (please subscribe)

"Go to bed early, Xiao Xiaoqian. You are a high school student now, and you have to go to morning school tomorrow. You should get up at [-]:[-], right?" Fang Xian urged when chatting with his uncle Fang Yun and his parents at [-] o'clock in the evening. Fang prays for peace.

Fang Qi'an replied with a smile: "Brother Xian, you might have gotten up at [-]:[-] when you were in high school. Our first morning class was already at [-] o'clock, and then there were two morning self-study classes and breakfast. ."

"When you wake up at [-]:[-], our head teacher will go crazy."

After saying that, he rubbed his hands and blew on the peanut shell, then threw it into his mouth.

Fang Xian was slightly surprised: "Uncle Yun, are Fang Qi'an and the others going to start doing this in high school now?"

Fang Yun touched his earlobe at this moment and looked at Fang Qi'an fondly: "Actually, they don't have much pressure to go to college. Now the enrollment rates of high school students and universities across the country are almost equal."

"I just want to say that today's parents are paying more and more attention to education. If they want to get into a better college, they will take more and more exams."

"In last year's college entrance examination, in Hunan Province, there were dozens of people in a 5-point score band with scores above 670. In the 5-point score band below, there were hundreds of cases, with a total of more than 600 people in the 2-point score band. people……"

“It is already different from our era when educational resources were extremely scarce.”

Fang Qian is the youngest and is in a critical period of high school, so the focus of discussion is on him.

"Why don't you go and have a rest quickly? Brother You, I can't run. You will have a day off tomorrow afternoon. If I have time, I will take you out to play."

"Go to bed quickly. Ensuring sleep is the prerequisite for learning."

The back of Fang Qi'an's head seemed to be protruding. He rubbed another peanut and looked at Fang Xian: "My mother said that Brother Xian, you go to bed later than me and sleep less..."

"You are already a master's student." Fang Qian blinked.

"Me!" Fang Xian raised his hand and wanted to hit someone.

Fang Qian stood up with a smile and sat on the sofa opposite.

When Fang Qian and Chen Hui heard this, they turned to look at Fang Xian. Yes, although their son has achieved some results now, his efforts are rarely reported to his family.

According to Fang Qi'an's calculation, Fang Xian was probably overtaxing his body and studying.

The eyes of the two people changed slightly.Chen Hui even touched Fang Xian's arm, as if checking whether Fang Xian had lost weight.

"Go to bed. Children still have to grow. Boys' epiphyses don't close until they are 20 years old. If you want to be as tall as your Xian brother in the future, you have to make sure you get enough sleep."

"Otherwise you, a short man like you now, can't compare to your brother Xian." Fang Yun was worthy of being Fang Qi'an's father, and he immediately found his trump card.

Fang Qi'an immediately got up and went to brush his teeth and wash himself.

Without him, there is an empty room among these four rooms and one living room, which is Fang Qi'an's usual residence. It is estimated that he will rest here today.

"This child has been close to Fang Xian since he was a child." Fang Yun didn't know whether to laugh or cry.

Fang Qian and Chen Hui laughed apologetically.

Fang Xian smiled and replied: "Uncle Yun, are you still jealous?"

Fang Yun shook his head and said in a low tone: "The main reason is that I spent too little time with him. After your aunt went to work in Shashi, the only person who could play with him all the time in his childhood was you..."

The topic suddenly seemed to get into something fishy.

Fang Xian quickly changed the subject: "When I was a child, I often only played with you, Uncle Yun. You were a great professor at that time..."

……

Silent all night.

The next morning, when Fang Xian woke up, it was already [-]:[-].

Fang Qi'an left long ago. The family had put milk, bread, etc. in the refrigerator in advance, as well as cooked porridge. After heating it in the microwave, he ate it with the milk and so on as breakfast.

Today is Sunday, and both Fang Qian and Chen Hui are still asleep.

Fang Xian sent a message to his parents and went out to make friends.

The rice noodles in Shashi are flat noodles, while the rice noodles in Changshi are round noodles. Each has its own taste. But Fang Xian grew up in Changcheng. The beef jerky mixed with rice noodles here and shredded potatoes seem to be engraved in his bones.

Still thinking.

However, the parents didn't seem to be very sleepy. After Fang Xian sent the message, his mother came out in pajamas: "Why are you up so early? I thought you went to work after eight o'clock."

She rubbed her eyes.

"Mom, those are the working hours of the specialist. In the operating room of the trauma center, it will be earlier. It doesn't matter. You and Dad will continue to catch up on sleep. It's finally the weekend."

"I'm here to learn from Uncle Yun. Naturally, I should start earlier. It would be beneficial to learn more."

"Didn't I say it last night? The stronger my ability is, the more money I can earn every year, and my life will definitely be more comfortable in the future." Fang Xian replied.

Chen Hui looked a little hesitant and said, "Xianzi, pay attention to your health. Although your parents are not very capable, they have prepared some money for you."

Fang Xian was no longer in middle school or high school this morning. He turned his head in a circle and replied: "Keke, that's what you said. When I went back to my hometown for the New Year this year, I also said the same thing at my grandma's house."

"The child of a graduate student is not capable yet. He bought a house in Chang City and is not capable either."

"Look, uncle, whether he's going to complain about you or not..."

"My mother is so capable. The glory of the old Chen family depends on her!"

Fang Xian said and immediately shut up, because Chen Hui had already picked up the soles of the shoes.Fang Xian went out immediately.

"Mom, I'm going out to have breakfast."

"You and my dad are very capable. At least you can train me to be so good."

"gone."

"This child..." When Fang Xian closed the door, he could only hear Chen Hui muttering like this.

Fang Xian touched his chin and started waiting for the elevator.

At the same time, he took out his mobile phone and asked: "Uncle Yun, do you prefer soup noodles or dry mixed noodles like me? I can ask the boss to pack the seasonings and soup base separately..."

Fang Xian knew that his workaholic Uncle Fang Yun must have grown up at this point.

"Mix it with dry powder and add some beef. I'm about to ask the boss to bring it to the department. But if you happen to be on your way, just bring it."

"You came just in time. I went to the general surgery department to order an appendectomy for you. Such emergency operations are quite rare in our hospital nowadays. If you intend to enter the gastrointestinal surgery department, starting from this small operation will be quite difficult. good."

"First, let's understand the normal deformation of the patient's intestines under non-destructive injury conditions..."

"Hoe Cloud transfers 30 yuan to you."

Hoe Yun is Fang Yun’s WeChat name. Fang Xian asked Fang Yun before why he chose this name. Fang Yun said that when he was in junior high school, when he went to work in the fields, what he most wanted to see was clouds covering the sun, so that the day would be better. .

"Uncle Yun, you are too unreasonable. Your eldest nephew's annual salary is quite high now. I put it in Yu'e Bao and almost all the breakfast money came out." Fang Xian showed off and returned the money. Went back.

Fang Xian does not have many investment channels. Although the current income from Yu'e Bao is less than one ten thousandth, Fang Xian cannot bear to invest too much.

Before signing the contract, it was 50+. Now after signing the contract, I am nervous and it is almost 50+, which is more than 100 yuan a day.

Fang Xian clicked on the transfer to return it.

"Forgot. Okay." Fang Yun was also more casual.

"Come here early after eating. Don't make the patient wait. The operation will be on time at 07:30. If you can't get to the operating room at [-]:[-], I won't arrange for the patient to wait for you." Fang Yun transformed into Director Fang with his next words. and Professor Amplification.

"We'll definitely be there at [-]:[-]!" Fang Xian also replied solemnly.

It is impossible to make patients wait.

Although an appendectomy is relatively simple, it hurts.Although pain can be relieved after anesthesia, prolonging the anesthesia time is also a kind of harm to the patient.

Fang Xian quickened his pace and ate breakfast faster.

It was really at [-]:[-] that the powder was finished, and the boss also packed the powder into packages.

Fang Xian immediately rushed to the hospital and arrived at the trauma center ward.

After sending it off, Fang Xian said, "Uncle Yun, I won't waste any more time."

"Where is the operating room where the patient is? Is it the operating room in Building 1?"

"No, the patient is in the operating room of our trauma center. I arranged for the patient to come directly. After you complete the operation, remember to have someone take the patient to the general surgery ward."

"You only have an assistant today, Huang Qian."

"If something unexpected happens to you, Huang Qian can still give you assurance." Fang Yun took the powder that Fang Yun brought and explained it while opening it.

Fang Xian was stunned when he heard this and said, "Uncle Yun, it should be fine."

Fang Yun buried his head and went to eat the noodles first.

Fang Xian asked again about the operating room where the patient was, and immediately rushed towards the operating room.

Appendicectomy, this operation is too simple, and you don’t need Brother Huang Qian to take care of yourself——

Fang Xian looked at his skill panel.

Appendectomy level 3.This is pure specialist basic skills, a fusion of incision and appendicitis theory.Then there are figure-eight sutures, packing and the like, which are also closely related to sutures.

Even though Fang Xian had never performed an appendectomy before, he was able to perform it to level 3 thanks to his strong basic theory and high-level basic medical skills.

Level 3 appendectomy, Huang Qian is almost at this level.

This appendectomy, if you add a little more to it, it won't mean much.

While walking, Fang Xian was studying the disease of appendicitis.

Appendicitis is not fatal. No matter how poorly the operation is performed, at most the incision will become infected again, leading to secondary peritonitis and reinflammation or perforation of the appendix stump.

The sutured surgical wound just turned ugly and scary.

Such complications are actually acceptable.

Appendectomy, even if it involves cutting out flowers, is not very beneficial to the patient.

After the onset of appendicitis, the main purpose of treatment is to relieve pain, eliminate inflammation and prevent recurrence of infection.

The treatment fate of this disease is just like this, and it is also related to the symptoms and disease outcome of this disease and the original development of the disease.

As Fang Xian walked, he was still thinking, does this appendectomy need to be done laparoscopically?

Or how about making a small incision?
Let’s wait until we enter the operating room and see the relative age of the patient before talking about this.

If a patient is 70 or [-] years old and has appendicitis, laparoscopy is of little significance. Originally, appendicitis does not require a large incision, which is about two centimeters.

At 24:9, Fang Xian arrived at the [-] operating rooms of the trauma center.

The patient has been anesthetized, using epidural anesthesia.

However, Fang Xian can actually do it by himself through local anesthesia. His current puncture technique requires a particularly precise local anesthesia, which is enough to complete the operation. The standard of level 5 puncture technique is not Covered.

However, the choice of anesthesia method is the job of the anesthesiologist, and you should not put your finger on it.

The patient had a preoperative CT examination and emergency medical records.

After Fang Xian looked at it, he determined that this was a 63-year-old man who suddenly suffered from metastatic pain in the right lower abdomen this morning. He was rushed to the hospital by his family members and was admitted to the hospital for emergency treatment of acute abdomen.

Although the tenderness and rebound tenderness at Maxwell's point were taken into consideration during the physical examination, at such an old age, who could guarantee that he would not develop intestinal obstruction on the basis of appendicitis?
In fact, having a color ultrasound is a relatively good choice.

However, the patient had a history of gallbladder stones before. In order to facilitate the examination together, the patient’s family chose CT, which can also be reimbursed...

In the operating room, Huang Qian is already in place, has seen other medical records, and is now reading the films.

"Dr. Fang, it's simple appendicitis, which is relatively simple. The appendix is ​​located at the back. The appendix is ​​medial to the cecum, and the tip points to 1 o'clock on the hour hand, in front of the ileum. Although the location is uncommon, it is not difficult to treat."

"Do you want laparoscopy?" Huang Qian asked.

The chief surgeon assigned by Fang Yun was Fang Xian, so the choice also rested with Fang Xian.

"What is the procedure for talking to the patient's family before surgery?" Fang Xian asked, and then took out the informed consent form for the surgery.

Huang Qian is very professional and knows that the diagnosis of appendicitis requires classification first, such as simple appendicitis and peri-appendiceal abscess.

The location of the appendix is ​​also beneficial to the choice of surgery and the smoothness of the surgical process.

"His son says it's okay. Doctor Fang, just watch and come." Huang Qian replied while confirming that this patient's surgery was relatively simple.

"Just do a traditional incision, I'm too lazy to make two incisions." Fang Xian said, taking a look at the informed consent form for surgery, which said appendectomy (preparation for laparoscopic appendectomy).

It is still more rigorous, that is, giving more choices to the hospital.

Laparoscopy requires an operating hole and a visual field hole, and each hole also needs about one centimeter.Fang Xian was too lazy to extend the operation time.

Laparoscopic operations will be slower to a certain extent.

Before officially taking the stage, Fang Xian took another look at the CT.To personally guarantee the correctness of the operation——

Ok?
here is?
At this sight, Fang Xian stopped moving when he was about to go out to wash his hands.

"Brother Qian, have you talked to the patient's family? Who?" Fang Xian asked.

"His son and daughter-in-law!~" Huang Qian replied without any doubt.

Fang Xian squinted his eyes and looked at the CT carefully again. But after reading it carefully, Fang Xian felt emotional again and said nothing more.

Klinefelter syndrome is also called congenital seminiferous tubule agenesis syndrome! 47, XXY syndrome!
Can he have children?
However, Fang Xian would not eat such a big melon, or the patient himself knew about it.Or maybe not, who knows!

However, the real clinic is still much more interesting than the operating room.

The patient came here for the treatment of appendicitis, not for 47,XXY syndrome, nor for a paternity test.

Fang Xian feels that sometimes the level is too high, especially the level of film reading is too high, which is not a good thing.

Soon, Fang Xian and Huang Qian were fully armed——

"Teacher of equipment, prepare a round knife and an electric knife!" Fang Xian was quite polite.

The operation was not difficult, so he would no longer be humble to Huang Qian.

Completely completing an operation is the only way for every surgeon.He has now obtained the title of first-level physician. After being recognized by the Medical Association, Fang Xian can perform all first-level operations on a routine basis without deciding on a specialty.

This is an operation authorized by the Medical Association.

"Here! Doctor Fang." The instrument nurse was not very old, and handed the back of the knife to Fang Xian in a standard posture.

It's just that the voice he speaks is slightly abnormal.

After Fang Xian caught this, he looked up and found that the equipment nurse's eyebrows were painted very clearly, and she applied light makeup near her eyes. Moreover, she painted the silkworm so well that it was difficult to tell the real thing from the fake one.

Fang Xian didn't worry too much.

A traditional McLean incision, transverse incision, or low midline incision is made on the right lower quadrant, the skin and subcutaneous tissue are incised layer by layer, and the external oblique muscles are separated...

This part of the operation, so far, is still within the scope of basic medical operations such as incision.

However, the slight difference is that incision and appendectomy need to be organically integrated with related anatomy.

However, although Fang Xian called the equipment nurse to prepare an electric knife, he did not use the electric knife. Instead, he used a round knife to make an incision without breaking the superficial fascial layer under the skin.

However, Fang Xian used the blunt force of incision to penetrate directly to the muscle layer, which was a kind of belief in his own incision.

Fang Xian quickly separated the internal oblique muscle and transversus abdominis aponeurosis through the muscle gap and exposed the peritoneum!

After the two hemostats were clamped at the same time, while Huang Qian was still using a retractor to expose the field of vision, Fang Xian had already used a sharp knife to break open the peritoneum again. He had just used the hemostats to clamp the peritoneum, which was actually a small skill in the flexible application of hemostasis.

Didn't mention it much.

There was no teaching given to Huang Qian, just to advance the operation smoothly.

However, even if it was a simple appendectomy, Huang Qian was still stunned by Fang Xian's operation of directly breaking open the peritoneum in less than a minute.

This speed is simply too fast. Isn't Fang Xian's level 5 incision technique very useful?

Fang Xian used two retractors to pull up the middle part of the incision and handed it to Huang Qian's hand.

Insert your fingers into the 2cm incision and explore the abdominal cavity.

At this time, the level 5 basic medical examination skills are reflected.

Physical examination actually focuses on probing, touching, touching and pressing.

Level 1 medical routine physical examination is the basic physical examination content that can complete the undergraduate requirements.

Level 2 medical routine examination requires some more professional content. For example, when auscultating the lungs and heart, you need to hear some unconventional sounds, such as galloping rhythm, heart rub and other subtle content.

In various specialist fields, specialist physical examination content can be completed relatively completely, such as the visual and tactile volume of orthopedics...

Level 3 medical routine physical examination takes into account a person's hard work.

By pressing the body surface, exploring the fingertips, and basic medical theories, and even touching the fingertips, you can know whether there is infection inside, or what kind of tissue is touched, and what different tissues feel like.

Fang Xian also confirmed these one by one when he performed an autopsy on the corpse of old Professor Gui Yuanping.

Level 4 medical routine physical examination can even detect subtle changes in arterial and venous blood flow. For example, if there is blood turbulence in the arteries at certain locations on the body surface, and the impact on the artery wall emits different frequencies, subtle changes can be detected. .

This is the foundation of many professors of internal medicine.

As for the level 5 medical routine examination, the mystery is even more difficult to describe.

Using your fingertips to find the colon band and colon bag can only be regarded as the most basic operation.

Without having to look, Fang Xian just slid his hand down to find the location of the appendix and took it out...

"Hey!~" Huang Qian only had time to pronounce the syllable of one word.

Fang Xian didn't even give himself a chance to show off, so he continued to operate.

(End of this chapter)