Gou in the operating room to add some upgrades

Chapter 199 The source of difficult and complicated diseases (please subscribe)
I saw Professor Tu from the Department of Vascular Surgery going to read the films honestly again. Although Gong Ziye was also a professor, his mood was quite messy at the moment.

This Fang Xian is full of treasures everywhere. Many basic skills have reached level 5. Are they really so useful?
But soon, Gong Ziye suddenly realized that if he had not reached level 5 in debridement, he was still operating and working in general surgery with level 4 skills, which was enough. Why should he pursue level 5 skills?
As a meal?
After reaching this state, Gong Ziye will always feel that it is so delicious.

Entering in at the beginning may not improve a person's ability much, but as you go further, such basic skills are like fermenting old wine, allowing you to widen the gap between you and others, and this gap is not that you have more skills. Learning some fancy technical skills can make up for it.

The more basic it is, the more it is a person’s foundation.

"Professor Gong, I'm going out to wash my hands and change clothes. You and Teacher Zheng can start the show first." Fang Xian took the initiative to take on the work of the most junior doctor.

Teacher Zheng is an assistant attending, not Professor Zheng Baiyan.

After hearing this, Zheng Mohan corrected me again: "Doctor Fang, please call me Brother Zheng or Brother Han. Don't call me teacher."

Fang Xian nodded after listening: "Okay, Brother Zheng, you have corrected the title you gave me, and I feel relieved."

After Zheng Mohan entered the operating room, he was greeted by Teacher Gong and Teacher Fang. Can Fang Xian endure it?

I didn't feel comfortable with it, so I treated him the same way as others.

In the end, Zheng Mohan refused first.

When Fang Xian washed his hands again and entered the operating room, Professor Tu from the Department of Vascular Surgery was by his side, so he was not afraid of arterial damage. Therefore, Professor Gong Ziye and Zheng Mohan had already started working on the bumper in the abdomen. anatomically separated.

Want to take it out first.

This is a kind of belief and foundation.

Professor Tu is a professor of vascular surgery. Even if he ruptures the abdominal aorta, he has the ability to fix such an intraoperative breach, which will make Professor Gong Ziye of the general surgery department feel confident and bold when performing general surgery operations.

Just like you, the professor of anesthesiology in the operating room of the trauma center, any surgeon does not have to worry about their anesthesia level. They often reconcile patients between life and death, and control vital signs to the edge of shock during surgery.

Fang Xian didn't know so much in the past, but Fang Xian didn't know until he went to the No. 1 Civil Hospital in Chang City.

The reason why the trauma center operating room of Shonan University Affiliated Hospital has reached this stage is not only due to Professor Zhou, Professor Yang and others, but also the formation of a super large team.

There are awesome professors by your side.

I am not afraid of having my blood vessels broken when I open my abdomen.

You don’t have to worry about the patient dying during surgery, and you don’t have to worry about splitting the heart when opening a chest. In this way, you can safely and boldly only deal with specialist matters.

When I perform pelvic surgery in trauma surgery, I am not afraid of accidentally poking the intestines in general surgery.Such confidence and boldness are the result of strict standardization.

It's like, as long as he can enter the operating room and be an assistant, he has the ability to be an assistant.

There are at least a bunch of level 2 skills there to ensure the lower limit of surgical quality.

However, at this moment, Professor Gong Ziye and Zheng Mohan were exposed relatively slowly.

Without him.

Because their incision level is all level 3 or 4, not level 5.

If this was a standard surgical, non-traumatic, random wound machine, maybe they could reach the desired surgical field quickly and calmly.

But trauma can never be described in detail in textbooks. Once the bumper is inserted into the belly, it is full of randomness and randomness. It doesn't care where it is inserted and the person will die, and where it is rubbed will not die.

Fang Xian instinctively dislikes such speed of exposure.

Moreover, Fang Xian had an operation with Uncle Fang Yun yesterday, which was also a traumatic operation. Uncle Fang Yun's level of incision and violent sophistication opened Fang Yun's eyes again.

The perfect level of incision technique, his uncle Fang Yun definitely has it in his hands...

However, after receiving Professor Zhou Cheng's guidance, Fang Yun did not envy such a level of incision. Instead, he discovered that his Uncle Fang Yun's skill in operation had now become instinctive.

No matter how much surgery is performed, the changes he can make are not big. In fact, the upper limit of surgery without too many changes is set at this moment.

It was also here that Fang Xian learned a very cruel fact. Generally, for people who are at a certain peak, the possibility of reaching another peak is very small. On the contrary, it is some people who are not afraid of tigers as newborn calves who will find another way out. A new path, bringing forth the new from the old...

Maybe Fang Xian's observation time for a few seconds made Professor Gong Ziye feel Fang Xian's emotions.

"Xiao Fang, how about you expose me and let's buy some time." Gong Ziye sniffed, his tone was quite helpless.

Fang Xian's level 5 incision may not be as applicable once it leaves the operating room of the trauma center and goes to a specialist department.

Specialized surgical approaches have become very sophisticated. For each disease, as long as the approximate location of the lesion is known, there are decades or even more than a hundred years of surgical experience as a basis, allowing Gong Ziye to follow these standards accurately, quickly and Perfectly exposes lesions.

The only exception is uncontrollable wounds caused by trauma. This is a very basic thing.

On the contrary, due to the uncertainty of such wounds, people like Fang Xian, who do not have a deep understanding of the specialty and rely on basic skills to fight hard, will be more comfortable.

Because there are only two things to ensure.

First, it does not damage important tissues such as nerves and blood vessels.

Second, just expose the lesion so that they can take out the foreign object, regardless of where it got in.

For such an undefined disease, it is impossible to have a standard surgical approach as a demonstration, and everything is unknown.

Fang Xian didn't refuse. There was surgery, which was also a skill point. Fang Xian currently needed a lot of skill points.

Although many professional basic skills are driven by the level 5 basic medical skills, when they reach level 3, Fang Xian naturally looks down upon the level 3 level.

However, for current emergency diseases, if Gong Ziye cannot come up with a better corresponding approach for exposure, then his simple incision and hemostasis are the best surgical guarantees that can be provided to patients.

It is not a tyrannical situation, but it does not violate the doctor's true intention to perform better surgery on the patient.

Fang Xian took the scalpel, just looked at the position where the bumper went in, and started to operate from the position where Professor Gong Ziye had already arrived.

However, Fang Xian only used a round knife to slightly expand the surface of the skin. After further widening the incision, he switched to using a vascular forceps for blunt puncture.

It is correct that incision is an operation.

But incision is actually a concept. This is from Fang Xian's perspective and understanding.

Incision is not just cutting with a knife, all suitable operations that can expose the approach are all part of the incision.

This is why, at level 4, the basic medical skill of incision has evolved into many different concepts and development directions.

With someone as an assistant, Fang Xian can use his hands as much as he can.

The left hand is holding the hemostatic forceps. The tips of the hemostatic forceps are like flying dragons and phoenixes. The right hand is holding the electrocoagulation knife. Before blunt breaking, if the small arteries may be damaged, electrocoagulation is performed in advance to stop the bleeding, and then the hemostasis is stopped. Clamp open.

However, in just over 40 seconds, Fang Yun had already opened up the peritoneal layer that had been scratched, and slightly expanded the breach, without allowing the sharp edge of the bumper to cause secondary cutting damage to the peritoneum. .

After breaking through the peritoneal layer, the experienced professors Gong Ziye and Zheng Mohan also pushed the retractor further under the peritoneal layer and slightly opened a distance to both sides.

Before the incision is opened, it is in the shape of vertical lines.

After being pulled apart, the upper and lower edges of the incision will actually narrow further.

At this time, Professor Gong Ziye and Zheng Mohan discovered that after the hole that Fang Xian had opened in advance had been opened and shortened just right, there was still about 0.5cm left from the sharp edge of the bumper, which was just right for easy vision. Transparent, so that the peritoneum will not be cut by sharp edges.

This was obviously designed in advance.

Three years of studying surgery is a lifetime of exposure.

Surgeons spend most of their time studying how to expose the lesions, accurately find the location, and then use appropriate methods to remove or dispose of the lesions.

This is the nature of surgery.

When Gong Ziye realized something, Zheng Mohan asked: "Dr. Fang, did you predict this incision in advance? After the retractor is opened, is it in the right left, right, and right position?"

"I've almost calculated it, but it's not that accurate. If you want to be absolutely accurate, you have to use a ruler to measure it, but this will delay a certain amount of time." "Abdominal expander——" A nurse who also has professional knowledge of the equipment moved the abdomen He opened the clip and handed it over.

When Zheng Mohan heard this, he carefully opened the abdomen clamp, started from the lower abdomen, and inserted it into the incision made by the retractor. After the clamp was closed and stretched, it was fixed on the fourth gear, which could properly open the retractor. The opening after removal.

At this time, everyone was able to see clearly what was going on inside.

It was a mess.

The unique 'charming' taste of gastrointestinal surgery in general surgery is overwhelming.

But the good thing is that the suction device is powerful enough and will absorb part of the smell. Moreover, this is a laminar flow operating room with very good ventilation.

The intestines must have been broken. How much was broken is unknown at the moment.

Everyone is carefully looking at whether the bumper may be inserted into the abdominal aorta.

Fang Xian said: "Nowadays, bumper materials are getting better and better. You can even do MRI even with the bumper on."

Traditionally, metals cannot be used for nuclear magnetic resonance. Otherwise, during the process of nuclear magnetic resonance, the metal will fly out of the body, and the consequences will be unpredictable.

However, after scientific development, many internal fixation materials have been changed to magnetically passive metals, which can be used for nuclear magnetic resonance.

"Well, whether the metal material is suitable for nuclear magnetic resonance, the current fire fighters will verify the material at the accident site and record it, so that our doctors can conduct corresponding examinations after admission." Gong Ziye replied.

Professor Tu saw it at this moment. Sure enough, there were relatively small holes in the ureteral arteries on both sides, but no blood spurted out.

And this breach is not a rolled opening, but a standard sharp breach.

The Juan Lankou is made by bluntly punching the flesh and then incising it. The irregular shape and sharp break are relatively standard surgical incisions, and the incisions are in good condition.

"Dr. Fang, can you tell by such a mouthful?"

"I asked why it was not found on the MRI when I just read the film." Professor Tu suddenly realized.

If it was a blunt mouth, it was a lump. He couldn't possibly not notice it. He could definitely tell it by distinguishing the layers.

In the Vascular Surgery Department of Shonan University Affiliated Hospital, new employees must be hired as attending physicians, and the requirement for MRI reading is Level 4.

Looking at the level at level 4, even slight changes will not escape the eyes of the judge.

"There is local inflammatory edema, and the blood in this patient's ureteral artery is cut off. Under such circumstances, if there is a sign of contusive edema on the blood vessel wall, it should be considered as a breach."

"This patient's trauma was a sharp edge, possibly a scrape."

"We probably have to look for free foreign objects later..." Fang Xian returned at this time.

The level 4 level of nuclear magnetic resonance looks at different levels, and can more accurately detail the structural deformation at different levels.

But level 5 MRI reading requires a theoretical component.If he didn't know how to understand theory, Fang Xian would probably become blind very quickly if he asked Fang Xian to do the set of questions that Professor Zhou and Professor Yang Yifeng asked him to do.

There are very few serious doctors who will only let you look at the MRI images of the lesions.

Professor Tu felt enlightened upon hearing this: "No wonder Professor Yang Yifeng said such a thing before when he was a specialist in vascular surgery."

"The difficulty lies in diagnosis of difficult and complicated diseases. The reason why diagnosis is difficult is that the details are not controlled enough. Medicine is too vast. If you only use professional knowledge to pry into it, you can always only see what you want to see. "

“What you don’t want to see is very likely to be ignored.”

"This is the cognitive domain."

Having said this, Professor Tu looked at Professor Gong Ziye: "Professor Gong, this patient does not need our vascular surgery to participate. We only need to come over and do a thrombus removal operation at the end of the operation, plus a vascular surgery." Just sew it up and it’ll be fine.”

Professor Tu immediately attacked Gong Ziye, activating the atmosphere in the operating room.

There is no need for our vascular surgery department to get involved so early. Why did you ask me to come here?For such a simple operation, do I still need to make a trip?
Gong Ziye replied kindly, and while continuing to cooperate with Fang Xian in debriding and aspirating the inner intestinal tract and intestinal contents, he said: "Professor Tu, I was wrong. Next time I will go for a neurosurgery consultation..."

When Fang Xian heard this, he glanced at the old hermaphrodite.

Gong Ziye is emphasizing that he is a doctor of general surgery, not a doctor of vascular surgery. Even you old man can't understand the diagnosis. Why do you want my doctor of general surgery to see it in such detail?Do you also need to be able to evaluate surgical methods?
It’s an old connotation.

Professor Tu rolled his eyes.

Everyone was here, but he didn't bother to leave and continued to watch Fang Xian's operations.

To be honest, Professor Tu, who is used to doing vascular surgery, can't stand some disgusting scenes. Even the scenes of dripping blood, dark blood, hematoma removal, and blood-stained hands have been seen by Professor Tu.

But Professor Tu really didn’t see much of the operation of turning shit.

But there was no way, it seemed that Fang Xian and Gong Ziye were still doing it with gusto.

Fang Xian's understanding of general surgery was not very deep, so he asked: "Professor Gong, judging from these, does this patient have poor digestive function or poor absorption function? Or is he not in the corresponding position?"

Fang Xian still asked this while cleaning up the food storage.

The gastrointestinal tract is absorbed in stages, and digestion and peristalsis are also continuous. It is not immediately digested and then absorbed as soon as it enters the stomach. It is an intermittent process.

"This is the jejunal loop. It should be both. The stomach is not well adapted to digestion. As for the absorption function, we have to check the specific nutrients before we can judge."

"This patient is not particular about what he eats. It's too rough and he doesn't chew it carefully. After it goes into his stomach, it becomes like this..."

"Actually, it's not bad. It's not completely digested and the taste isn't that big. What if it's the colon segment or the terminal ileum?" Professor Gong Ziye was seriously educating Fang Xian.

Fang Xian opened another group and asked:
"Is it these?"

Learning is not a shabby thing.

Gong Ziye nodded: "The shape is right. It is not completely formed, but the degree of decay is good. In the colon segment, water will be absorbed and formed, and then emptied, except when it becomes thin..."

"This section should be the ileum..."

"Tour, give me a marker and I'll mark it."

In abdominal injuries, the intestinal segments must be distinguished carefully.

After all, the human intestine is very long, and there are no absolute gaps or anatomical landmarks between the jejunum and ileum.Therefore, when multiple sections of intestinal tubes rupture, it is necessary to mark them slightly and record the type of intestinal tubes through the contents, so as to facilitate the control of digestion and hand-washing ability during subsequent resection and anastomosis, so as to avoid the formation of short bowel syndrome.

Only when he reached this point did Gong Ziye react: "Xiao Fang, you can't say that you are completely new to intestinal segment resection, right?"

"When I was doing abdominal injuries with Professor Xu, I occasionally saw other teachers doing it. I didn't have a high level, so I had a little understanding of it."

"Occasionally, I have performed intestinal anastomosis, but at that time, my superiors only asked me to suture the intestinal segments that needed to be anastomosed after they were put together."

"It's like chewing it up and feeding it." Fang Xian now has a deeper understanding of professional skills and basic professional skills than before.

Therefore, it is easier to understand what such difficult and complicated diseases mean.

How to deal with it? Only then did I know how difficult it was for the previous superior teachers to build a training platform for students like them, and how much time and cost and preliminary knowledge and skills preparation they would have to pay.

Doctors grow up step by step.

Of course, I have grown too fast, and it is actually normal for me to have a little bit of drift in the past.

In fact, I can float now.

Not pursuing high-quality surgery, just following the crowd and making do with it.Fang Xian went to a municipal hospital. With this basic medical skill, he was able to create a situation on his own.

However, this is not what Fang Xian wants.

(End of this chapter)