Gou in the operating room to add some upgrades

Chapter 198: Did Dr. Fang say that?Then I will learn more (please subscribe)
Fang Xian really didn't know much about this before.

But we also know that Shonan University Hospital was a hospital directly under the Ministry of Health decades ago.But after the Ministry of Health was changed into the Health Commission, the word subordinate was no longer mentioned in particular.

But one thing is that the Provincial Health Commission really plays a management and restrictive role in the Shonan University Affiliated Hospital.

It means that if there is no management or restriction, then the resources will not be concentrated on you?
A child belonging to someone else’s family?

Fang Xian heard this: "Thank you, Professor Gong. This arrangement may be troublesome, Professor Gong. I am still in Chang City on weekends. There are also some minor surgeries there, so just take your time."

"I can skip some exercises of basic professional skills first and start with professional skills."

"Pelvic peritoneal adhesions lysis, abdominal adhesions lysis, peritoneal adhesions lysis, these local operations..."

Specialist basic skills are a further derivative of basic medical skills.

For example, local resection of rectal lesions or tissues is the specialty basic skill of gastrointestinal surgery. It is the specialized application of incision and debridement in gastrointestinal surgery. This operation mode is more suitable for other than gastrointestinal surgery. In addition, you may be in other places and it will not be useful.

Can bone debridement and intestinal debridement be the same concept?
However, for example, the release of peritoneal adhesions and the release of abdominal adhesions are two different diseases, and they are further sub-specialty operating skills.

The performance of adhesiolysis surgery may not be fatal, but the stimulation and impact on the patient's postoperative digestive function are also relatively different.

Professor Gong Ziye was easy to talk to: "Xiao Fang, if you think so, that's great."

"Actually, when I first learned that you were coming to our general surgery department, I was both surprised and happy."

"I'm surprised. I'm afraid I won't be able to take care of you. I'm happy that our General Surgery Department finally has a super-seeded player. I guess after you come, you can develop together with our General Surgery Department and create something more."

"But it is a pity that even the peritoneal adhesion lysis and intra-abdominal adhesion lysis you just mentioned have now been classified as specialized emergencies in general surgery and are not in our trauma center."

"So, you may have to start with big operations such as repair and replacement, and then dismantle these operations to a certain extent yourself."

"But it doesn't matter. I have already discussed it with the director of the department. If we have the opportunity, we will definitely let you have a more comprehensive understanding of the corresponding diseases in our general surgery department."

“Decades ago, most of the common emergency diseases in our general surgery were single-organ diseases such as gastric perforation, gallbladder rupture, intestinal perforation, and pancreatitis. However, in recent years, the incidence of combined multiple organ injuries has increased. .”

"You should know that the more serious the development of technology, once a trauma occurs, it cannot be a simple injury, including large-scale damage, etc."

"However, in our general surgery department, there have been cases of closed injuries such as pancreatic rupture due to impact. Naturally, this is also accompanied by vertebral fractures, liver contusions and lacerations, etc."

"During Xiaofang's intensive training, you were exposed to the final stages of these diseases, such as suturing and simple local debridement. The key surgical procedures have been completed by our surgeons. This will leave you with some opportunities to develop basic operating skills."

"Of course, if you are talented, you may be able to achieve better processing results with these basic skills..."

While drinking tea, Professor Gong Ziye chatted with Fang about some common diseases in the general surgery department of the trauma center. Fang Xian couldn't help but sigh as he listened.

Indeed, with the development of science and technology, once a trauma occurs, it is not just a simple injury to the muscles and bones.

Twenty years ago, the final destination for patients with injuries caused by rapid car accidents was death.

After the improvement of on-site first aid capabilities, more and more injured people are now able to reach the hospital alive, but the remaining diseases are becoming more and more complex, forcing trauma centers to deal with such highly violent traumatic diseases.

And these diseases are still discussed in the medical development content of from death to life, from life to life.

Large areas of damage are just a few of them.

Under the damage, there are also some "string injuries" on the abdomen, which are not uncommon nowadays.

What is a skewer injury? It means that people are strung together by objects such as steel and concrete. If the chest is broken, the head is exploded, the legs are broken, or the abdomen is strung together, it is impossible to have the previous push. , but don’t fall into such deception.

The reason why Fang Xian had never been exposed to such "string injuries" before was because at that time, almost no one dared to leave such diseases to ordinary students to deal with. That is to say, after joining the debridement team, he Have a chance to get in touch.

In the suturing group, the diseases are smaller and simpler, such as simple intestinal obstruction, then you can cut the skin, it doesn't matter.

For example, if bile duct stones require cholecystectomy, it doesn't matter if you cut the skin.

He may die in four to five minutes here, and then let your intern slowly do the exposure and incision. How is that possible?

Shonan University Hospital, which is committed to reducing the mortality rate in the operating room of the trauma center to less than one per thousand, will not let you fool around like this.

That's why Fang Xian didn't know there were so many things before.

Now that he has grown up, all twelve basic skills have reached a very high level. Naturally, everyone welcomes Fang Xian to pursue professional development, right?

Because everyone knows that if Fang Xian performs a level 5 incision and level 5 hemostasis under absolutely violent conditions, he may be able to directly reach any cavity, any organ, or any joint in the human body within 3 minutes. Blood vessel.

This is the charm of basic medical skills.

Maybe Fang Xian can't deal with specialist diseases, but he can find them.

For example, Fang Xian can diagnose some subtle diseases that are difficult for mature specialists to diagnose, but Fang Xian may not be able to deal with them.

But it doesn't matter, Fang Xian can grow, and the junior college welcomes Fang Xian to grow and lead the junior college to new areas.

After Fang Xian entered the general surgery department, he was able to send more general surgery diseases to specialists, allowing patients to form a standardized treatment process, which can be downgraded. After dimensionality reduction of the disease types, this is where the hospital team suffered. , I can take it out and say, bragging.

You still have to accept it.

If you don't accept it, you hit me.

Although, Fang Xian may think that with such a disease, if he can survive but cannot move, it is a disability, and he feels that he has committed a sin.

But this is a milestone in the development of medicine. For the corresponding patients, as long as a few percent of them can survive, it is salvation.

You can save what others can't save, and that's awesome.

Something to shut you up.

As he spoke, Gong Ziye's message rang: "Here, here comes a picture of a series of injuries. Do you want to take a look? This is a picture of the bumper inserted directly into the navel, hitting the posterior column of the lumbar spine, causing the lumbar spine to burst. "

"It is relatively simple. There is only damage to hollow organs, that is, the intestines and bladder. There is no direct damage to solid organs. It is considered a contusion at most."

Gong Ziye showed Fang Xian the general picture.

Fang Xian took a look and saw a young man, tied to the car seat, dripping with blood.

However, the second picture shows that the team from the fire department and the 120 ambulance removed the front end of the bumper, and performed a temporary hemostasis operation on the incision in the 120 ambulance. Now it has been transferred to the emergency room. surgical.

Preparation before proceeding to the operating room.

For example, temporary packing to stop bleeding, temporary assessment of vital signs, etc.

The reduction in the mortality rate in the trauma center is not only due to the excellence of the surgeon, but also the excellence of the emergency team, which also greatly helps the survival rate of the patients.

Fang Xian looked at it and said, "Look at these hemostatic techniques. These 120 follow-up doctors have at least level 4 hemostatic skills, right?"

"That's natural. The more life-saving operations are involved, the more basic they are and don't require too many bells and whistles."

"If you can stop the bleeding and maintain the heart rate well, the patient will have a chance to go to emergency surgery."

"In emergency surgery, if we can bring shock patients back from the Palace of Hell, then the patients will have the ability to enter the operating room."

"Currently, the entry requirement for many 120 and emergency departments is level 4 in hemostasis. It is a hard-core indicator and is for saving lives."

"It doesn't even require so many specialized skills. As long as the hemostasis skill reaches level 4, you can come if you want, no matter what age you are or what education you have."

"Of course, our hospital's emergency surgery requires a relatively more in-depth approach..." Gong Ziye reported the case to Professor Wang Huan as he spoke.

Then he spoke into his cell phone: "Professor Wang, this is a patient with a penetrating abdominal injury. The diagnosis has been made to the backend of the trauma center. Just contact the professor who is the surgeon and arrange an assistant."

"Fang Xian will go over and become his assistant!" After Gong Ziye finished sending his message, he dimmed the phone screen without waiting for Professor Wang Huan's reply.

"Let's go, I'm in charge of this operation. Let's go and have a look together. We'll wait for an assistant and we can do it." Professor Gong Ziye's tone was serious, as if such an injury was a piece of cake for him.

Fang Xian nodded and said yes.

This patient's injuries were not as severe as extensive damage.

Fang Xian followed and asked, "Professor Gong, to what category would such a patient fall into the classification of diseases classified by the Medical Association?"

"Penetrating injuries without substantial organ damage are classified into Category 3. If blood vessels are injured or there is substantial organ damage, it will be classified into Category 4. Currently, the mortality rate for similar diseases nationwide is from 30.00% to [-]%. Ten times, it soared to about [-]%.”

"The large-scale damage you did before was directly classified into Category 5, with a mortality rate of over 50.00%. Only a very small number of teams can guarantee the patient's survival." Professor Gong Ziye said what Fang Xian had done before. , also understand something.

"What is the mortality rate in our hospital for such penetrating injuries?" Fang Xian asked again.

Gong Ziye tilted his head and smiled: "Xiao Fang, our hospital has actually been one of the few hospitals that has lowered the mortality rate. But even so, here, we still have [-] to [-] percent of such patients. Mortality rate of around [-]%.”

"It's just that accidents happen during the operation."

"The diagnosis I just showed you is the diagnosis made by members of our team 2 in the trauma center ward. There may be some omissions."

"But such an omission cannot be a big mistake. For example, if the damage to a large blood vessel cannot be seen, it would be a big joke."

"Of course, I looked at it and found that this patient had no major blood vessel damage and just avoided the abdominal aorta."

Fang Xian actually saw the diagnosis, glanced at the previous MRI scan, and asked again: "Professor Gong, what about the bilateral ureteral arteries?"

Gong Ziye's fat body suddenly paused and turned his head to look——

His eyes flickered on Fang Xian.

His face changed greatly.

When Fang Xian asked a question, it was natural that he would not ask it in vain.

What is the mortality rate in our hospital?
Professor Gong, on the other hand, chose Fang Xian's absolute trust, because Fang Xian's current film reading skills were level 5, which was known to everyone at the professor level in the trauma center.

"Professor Wang, there is an emergency. The patient I just sent you is suspected of having bilateral ureteral artery injuries. Please be sure to arrange for someone from the vascular surgery department to go to the emergency surgery department for consultation, and arrange for a professor from the vascular surgery department to come to the operating room." Gong Ziye. The professor felt uneasy and his tone changed slightly.

When Fang Xian heard this, the corners of his mouth moved, but he didn't say much after all.

This patient did have damage to both ureteral arteries, but the opening was not that big, and there was also embolism at the proximal end of the artery, so the amount of bleeding was not actually large.

The reason why he mentioned this point was that he hoped that Professor Gong Ziye could understand this point and avoid sending her to a specialist, discovering ureteral artery embolism, and then having to enter the uterus for the second time later.

During the operation, they can perform a simple blood vessel incision and thrombus removal together, which is not difficult for Fang Xian.

But, Professor Gong Ziye’s performance is a little bit?
However, Fang Xian also understands that most doctors nowadays still specialize in specialties. Only a few doctors who do not have specific specialties can be more versatile and full-time, and can handle multiple specialties and subspecialties.

Be aware of it.

Hearing this, Gong Ziye touched his thick earlobe with some embarrassment: "Xiao Fang, your basic skills are solid enough, but also scary enough."

"If this patient had a ureteral injury and it was not discovered in time, and there would be sudden bleeding during the operation, wouldn't it be a big trouble?"

Sometimes ignorance is a source of strength for boldness.

Fang Xian said: "Professor Gong, that's not the case. This patient has a thrombus in the proximal ureteral artery. If you look carefully, there are other small arteries with embolism."

"Therefore, after thrombectomy, the patient needs to undergo thrombolytic treatment. During the operation, whether the blood vessels should be sutured or other methods, such as gaskets, should be used to deal with the breach. , we have to discuss it carefully."

"This injury is not fatal, and there will be no sudden massive bleeding. It's just that I discovered it, so I mentioned it."

Fang Xian's answer was quite pertinent.

But Gong Ziye's eyes became quite resentful.

The scene where he was distracted just now, as if he was a funny old child, made Gong Ziye feel very complicated.

Originally, he wanted to establish a mature, steady, calm and talented image in front of Fang Xian.However, in front of Fang Xian, it didn't take long for him to completely lose his appearance.

Forget it, just live back to your old boy image.

Gong Ziye sighed: "Level 5 skills, the more basic they are, the easier they are to use. The more I have been a doctor for many years, the more I know this result."

"However, now that I have been a specialist for many years, it is already difficult to go back and consolidate my basic skills. After all, there are so many clinical tasks, and some surgeries cannot be performed by others."

"I just have to keep making do."

"Xiao Fang, you are the envy of many people. Hexagon Warrior."

"I seem to understand a little bit again what regrets Professor Zhou and Professor Yang have been talking about before."

Fang Xian said: "Professor Gong, the description of the hexagonal warrior is flattering. I have just laid the foundation for the hexagon. I will learn more from you later, Professor Gong."

"We learn from each other. In fact, I have a lot of questions. I hope that Dr. Fang, if you come, can give me answers and confirm them."

Gong Ziye said, first blocking Fang Xian's mouth.

"Don't refuse. Half of you now belong to me. No one else can do what I want to prove except you. Don't refuse me."

"We are friends." Gong Ziye raised his chin and said it beyond doubt.

……

After entering the operating room, the chief surgeon of the vascular surgery department read the films carefully, but still had doubts. He turned around and said, "Professor Gong, are you sure you saw that this patient has damage to the ureteral artery?"

"Why do I look so different?"

Gong Ziye is now fully armed and ready to take the stage at any time.

Fang Xian and his assistant have already started disinfecting and spreading towels.

Gong Ziye shook his head: "Professor Tu, if you ask me this, I can't give you a direct answer. This is what Dr. Xiao Fang said, and I didn't realize it?"

"The most important thing in our general surgery department is not MRI reading."

General surgery, based on the basic skills of MRI, is also debridement.

MRI reading is a core skill in surgery such as interventional surgery, imaging, hand surgery, and sports medicine. Just like suturing, it is fundamental to hand surgery.

There are actually two core skills of vascular surgery, one is incision and exposure of blood vessels, and the second is hemostasis.

Many operations in vascular surgery are based on these two points.

The requirements for puncture are actually not high, and vascular surgical intervention is a relatively simple operation.

"Dr. Fang said that? Then I'll take a look." Upon hearing this, the man named Professor Tu hurriedly ran to study again.

Can you not listen to what Dr. Fang, a master of level 5 MRI reading technology, said?
Just kidding.

Even though Fang Xian is just a small resident doctor, he is now a 'Ruyi' surgeon. He is like an iron bucket and his basic skills are so solid that he is completely different from an individual.

A tall building has risen from the ground. Fang Xian's foundation can now support him to walk at least a hundred thousand feet. Professor is not his end. The prospect of taking the lead in the subject is Fang Xian's starting point. Going up is not impossible, as long as there is no An accident happened……

(End of this chapter)