The road to the rise of great doctors

Chapter 111 Meticulous
Needless to say about the former, Liu Dong has performed it countless times in real operations, and he is familiar with all kinds of knotting techniques.However, in this assessment, he still followed the requirements and skillfully repeated the most basic knotting techniques.The assessment score is based on the number of knots tied within the specified time, and they cannot be slippery knots.

Liu Dong did not hide his strength, his technique was textbook level, and his super speed shocked all three examiners.

"Has he been rotated through your department? Has he always been so outstanding?"

The only female doctor among the three people turned to look at Zhu Guoliang and asked.

Zhu Guoliang was also shocked. After hearing the question, he was silent for two seconds and said, "I was relatively good at that time, but I haven't reached this point yet. The main thing is that I was the first to lead him and laid a solid foundation."

As soon as he finished speaking, another surgeon looked disgusted and said, "Lao Zhu, stop bragging. Don't we know what your level is? At that time, I wanted you to help perform a circumcision on a patient. When we came on stage, You are closing the abdomen. We have finished, and you are still sewing the skin. At that time, we were all thinking, Lao Zhu, if you are so slow, could it be that you have prostatic hyperplasia in middle age? The ticking will never end. "

"Pfft." The female doctor couldn't hold back and laughed.After realizing it, he glanced at Liu Dong first, but he was not affected.Then he said to Zhu Guoliang and the two of them, "Go ahead, I just thought of something happy."

When the time was up, Liu Dong stopped his movements. Sure enough, compared to other people, his operation was really outstanding.

Perform the second step, abdominal puncture.

Liu Dong walked to the dummy and took a look at the puncture bag on the operating table and the status of the dummy.

Hand the assessment form for this assessment item to the examiner, and then wait for the announcement to start, and then get ready to operate.

Abdominal puncture is mainly used in three scenarios.

First, it is often used to check the nature of abdominal effusion and help determine the cause.For example, closed abdominal trauma, peritonitis, and peritoneal effusion.

Second, because of certain diseases, intraperitoneal administration is required.Common types of intraperitoneal infusion administration include antibiotics, anti-tumor drugs, or diuretics.In cases of severe pancreatitis, abdominal lavage and drainage are sometimes performed after abdominal puncture to reduce the absorption of harmful substances.

Third, when there is a large amount of abdominal fluid that causes difficulty breathing or abdominal pain and discomfort, the symptoms can be relieved by puncture and drainage.

Before the operation, Liu Dong verbally described the indications for abdominal puncture and drainage, and briefly introduced the contraindications of this operation.These are also assessment points, or points where questions may be asked.

Then, check whether the operating items are complete, and after confirming that they are complete, describe them verbally.This is a combination of movement and speech.

Afterwards, Liu Dong, who was wearing a mask and hat, opened the dummy's clothes to reveal the location to be punctured.

"The patient is placed in a supine position, and the most commonly used puncture point is selected as the puncture point - the left lower abdomen, the intersection of the middle and outer 1/3 of the line connecting the umbilicus and the anterior superior iliac spine. This place is not likely to damage the epigastric artery."

While describing, put on sterile gloves, then hold a sterilizing bowl in one hand and a curved forceps holding a cotton ball soaked in iodophor in the other hand. Sterilize based on the puncture point as the center, and then lay out a sterile drape.

Pick up the syringe and apply lidocaine local anesthesia to the puncture site.

I saw Liu Dong fixing the skin at the puncture site with his left hand, and holding a syringe in his right hand to inject a cortical area. There was no blood drawn out. He inserted the needle vertically and drew back the needle, completing the anesthesia.Replace the special puncture needle and enter it layer by layer. When you feel that the resistance of the skin and other tissues at the needle tip disappears, it means you have entered the abdominal cavity. At this time, you can see that there is abdominal effusion flowing into the rubber tube connected to the puncture needle.Temporarily clamped and fixed.The bag is then drained, and the abdominal fluid is introduced into it.

"It should be noted that the fluid should not be released too fast or too much. The first release of abdominal fluid should not exceed 1000-2000ml, and the subsequent releases should not exceed 3000-4000ml each time to prevent the diaphragm from moving downward and affecting breathing and circulation. For patients with liver cirrhosis, once The amount of liquid released during sex should not exceed 3000ml. Excessive release may induce hepatic encephalopathy and electrolyte imbalance."

After the operation was completed, Liu Dong continued to explain the release amount and precautions.Then it went on to explain the posture and precautions after abdominal puncture.

This operation is complete.He smiled and said goodbye to the three examiners.

Continue to the next level, physical examination, auscultation and image reading.

Auscultation during physical examination is mainly performed on the heart and lungs, and is all audio. Different audios correspond to different diseases.If you haven't contacted many times about the sound of that segment, you may be able to guess [-]% based on the question bank and exam syllabus. However, in clinical practice, when encountering this kind of thing, many tests may not be perfect. If you master it, it will be very easy. Diagnose early for the most part.Therefore, Liu Dong himself listens to it every day.

When he puts on the earphones, and the familiar sound clip sounds, he can quickly choose the correct one, and he can also simply write a few sentences based on the judgment.He thought to himself, "Although you can't add points for writing the basis, it is also very important to ask the teachers after the test to solve your past shortcomings. The things memorized by 'cheating' such as brushing the question bank, It may not necessarily be useful in clinical practice, but the acquired knowledge with independent thinking and verification of theory and practice may be remembered for a lifetime.”

He quickly completed the inspection and handed the test paper to the invigilator at this level.

Then, move on to the image assessment link.

This is not a model for Liu Dong. He has learned this knowledge in the basic course of his undergraduate course - the superficial knowledge has also been transferred to the third department in clinical practice - common chest X-rays, chest, The computerized tomography scan of the abdomen and pelvis also accumulated some experience, and unexpectedly acquired the skills of ultrasound imaging-ultrasound helped him better understand the anatomical structure of the abdomen and pelvis, normal and abnormal, different abnormalities, etc. .

Compared with his classmates at the same level, he has information and is ahead.

"Dang, Dang, Dang," Liu Dong walked to the room where the imaging assessment point was held and knocked on the door three times.After hearing the voice of "please come in" from inside, he opened the door and walked in.

Sure enough, after the lottery, the very common combination of "chest X-ray + abdominal CT" was chosen.

The imaging examiner selected one according to the respective numbers of the chest X-ray and abdominal CT.

Chest X-rays include normal chest X-rays, as well as chest X-rays for various lung diseases, and some may be mixed with effusion, cardiac abnormalities, etc., which are still somewhat difficult.

Abdominal CT shows more possible diseases!The abdomen includes the upper and lower abdomen, and the organs covered include the stomach, intestines, liver, gallbladder, etc. of the digestive system, as well as the kidneys and ureters of the urinary system, as well as other diseases of the retroperitoneal cavity.

Normally, in the assessment of medical students or the qualification assessment of practicing physicians, imaging examination is a multiple-choice question.

However, in this assessment, in order to widen the gap, the question bank was expanded, and the multiple-choice questions were changed into question and answer questions, and the difficulty was also significantly increased.

"The test is really detailed and open-ended!"

(End of this chapter)