medical simulator

"You have to be steady in doing things."

Immediately, Du Yanjun sent two messages to Luo Yun.

One is a message of admitting mistakes, and the other is a message of apology.

Admitting mistakes and apologizing are two aspects. Du Yanjun did not confuse them. After sending out, Du Yanjun walked out of the stairwell, and then greeted Zhou Cheng who was coming out of the second room of the operation room with a smile, and said, "Brother Zhou Cheng, Have you finished restoring your manipulations?"

"I wanted to help, but a phone call happened to come, so I answered the phone."

Zhou Cheng didn't think much about who Du Yanjun was on the phone with, he just said: "When Mr. Luo Yun took me to do the manual reset this morning, he thought my performance was okay, so he authorized me to do this reset alone. .”

"No special report is required. Teacher Cai also granted me the operation authority before."

Zhou Cheng wanted to explain the matter clearly so as not to be misunderstood by Du Yanjun.

Du Yanjun immediately said, "Damn!"

"Brother Zhou Cheng, I don't mean that. We are all brothers."

Then Du Yanjun lowered his voice and asked, "It's just Brother Zhou Cheng, I have a question that I don't understand?"

"Director Yan clearly stated that the basic assessment for the number of hospital stays is open reduction and internal fixation of fractures."

"Now everyone is mostly leaning in this direction."

"Why are you interested in manipulative reduction of dislocated joints? Could it be? Did you get some gossip?"

Chapter 42 With sai joints!

"Gossip? No!"

"It just happened to meet me, and I thought I could give it a try. I didn't have any special ideas." Zhou Cheng blinked and looked at Du Yanjun innocently and sincerely.

In fact, Zhou Cheng didn't want to tell him what Luo Yun told him, and told the general development direction of the department in the future.

The main reason is that Zhou Cheng was afraid that speaking out would affect Du Yanjun's own direction and goals.

This is a fact.

Director Yan has made it clear that one of the basic requirements for staying in the hospital is to complete open reduction and internal fixation of a fracture, which is at least a grade II operation.

Logically speaking, Zhupei is not qualified to obtain such an authorization for surgery!

This kind of surgery, the general postgraduates can't master it right after graduation, because it is difficult for them to get the permission and opportunity of surgery.

To some extent, the conditions for staying in the hospital are higher than the requirements for recruiting graduate students.

But, this is a tertiary hospital, and I just hope that all the regular trainees can show their talents, find a way to find a way to give a chance to a superior doctor and learn this basic skill.

After entering the department, similar operations can be carried out normally.

Zhou Cheng doesn't need to bother with this step, because he has already reached the perfect level in open reduction and internal fixation of fractures.This is a level that no one in the department can reach and touch at present.

As long as he performed a little bit in the daily surgical operation and had the slightest chance to give Zhou Cheng, Zhou Cheng could be recognized quickly.

But Du Yanjun couldn't do it. It was extremely difficult for him to perform closed reduction and Kirschner wire fixation for a fibula fracture, let alone plate and screw fixation.

Although Zhou Cheng thinks that Du Yan's army can be used to reset joint dislocations and fractures, which can directly abolish a competitor, but people still don't want to be so shameless.

Du Yanjun smiled back and said, "Brother Zhou Cheng is worthy of being Brother Zhou Cheng, he has hidden it really deep enough."

"Manual reduction of fractures, manual reduction of joint dislocations."

"My decision to come to study with you seems to be the right one."

Hearing this, Zhou Cheng went to the operating room again. He had to explain to the patient and his companion that he would have to take another look at the results of the reexamination later before leaving the hospital. go home.

Du Yanjun followed all the way, and the two of them arrived in the duty room together. Du Yanjun asked again: "Brother Zhou Cheng, does Mr. Cai know about the joint dislocation manipulation?"

"After all, our department didn't accept similar patients before."

Du Yanjun naturally didn't mention that Luo Yun was dealing with this kind of patients in the department, and he had followed him many times.

"I don't know if Teacher Cai knows. I told Teacher Luo Yun. I don't know whether Teacher Luo told Teacher Cai." Of course Zhou Cheng could only push this matter to Luo Yun.

He wants to get the appreciation value as soon as possible. If Du Yanjun really thinks that Cai Dongfan needs to know, then he will tell Cai Dongfan himself.

However, Zhou Cheng felt that Du Yanjun would not do this either. Several directors in the department were not involved in the field of joints, and what they said was nonsense.

He treats patients whose manipulations have been reset, and at least he can generate income for the department.

Du Yanjun frowned slightly, but didn't say much, just changed the subject and said, "Brother Zhou Cheng, what do you have for lunch, a De Tianshun rice bowl?"

"Okay, let me call." Zhou Cheng took advantage of the situation and turned on the phone.

Detianshun rice bowls are quite good, especially the lean pork strips with green peppers.

Apart from being a bit pricey, there is basically nothing wrong with it.

A rice bowl costs more than 30 yuan, and the delivery fee is [-] yuan, which is an unshakable price tag.

"No, I'll come."

"I've already ordered and paid, Brother Zhou Cheng, don't repeat it." Du Yanjun mentioned it first, so he placed the order with quick eyesight and quick hands.

Zhou Cheng also simply searched for coffee, so AA had lunch and coffee.

Until the meal and coffee were delivered almost at the same time, no patients came to disturb him, so Du Yanjun immediately signed up to pick up the meal.

Zhou Cheng carefully checked the daily ward round records he had written. After he felt that there was no problem, he clicked Save and washed his hands before heading towards the duty room.

In the office, under normal circumstances, one does not eat, otherwise, the mixed smell left by the meal is really not conducive to the afternoon work.

After Du Yanjun brought the coffee and rice bowl to the duty room, he immediately distributed a portion to Zhou Cheng.

Just as he was about to open it, a nurse called from outside, "Zhou Cheng, a patient is here in the emergency department. Come and have a look."

"I'll go! Brother Zhou Cheng, you eat first." Du Yanjun immediately stood up, and then hurriedly ran outside the duty room.

Zhou Cheng looked at Du Yanjun's back, twitched the corner of his mouth, and then took off the mask.

This is Du Yanjun.

When the lid of the rice bowl is opened, a scent of pepper and rice hits instantly, awakening the taste buds on the tongue, and the salivary glands immediately secrete to the maximum.

Moisturizing.

However, Zhou Chengcai didn't eat two mouthfuls, and just when he felt that the cured lean meat strips mixed with chili juice were blooming in his mouth, Du Yanjun came to the door of the duty room and said with a little embarrassment: "It's another patient with dislocated joints. But it’s just written in the report, I didn’t see it.”

"Brother Zhou Cheng, come and take a look."

Another patient with joint dislocation, but Du Yanjun was a little disappointed.

He couldn't handle this kind of patient, so he was too excited.

"What kind of joint dislocation is written in the report?" Zhou Cheng immediately picked up a tissue to wipe his mouth, then hung the mask on his face, stood up, picked up his white coat, and walked outside the duty room.

"It seems to be something with the sai joint, anyway, it's the part of the foot. It's very difficult." Du Yanjun recalled, and then said.

"I think it's okay to send patients directly to the Second Hospital. It's been done this way before." Du Yanjun's face was full of boredom.

Dislocated with sai joint?

Heel the dice joint, bro?

Anyway, it's orthopedics.

Zhou Cheng frowned slightly: "Let's go and have a look first."

I just don't know if this patient can be reset manually.

Today Luo Yun asked if such a patient would be treated. Unexpectedly, such a patient really appeared.

However, simple dislocation of the calcaneus joint is relatively rare. It depends on whether there is a fracture.

"Has the patient had a CT scan?" Zhou Cheng asked Du Yanjun.

The bones of the foot are many and short, and they overlap together. It is difficult to read the fractures on ordinary plain films. Generally, CT [-]D and reconstruction are used to better judge whether there are occult fractures.

If there is an occult fracture, an MRI should be taken to see how the ligament is damaged.

Surgical contraindications and surgical indications.

The indications and contraindications of manipulative reduction must be clearly and clearly grasped to ensure effective treatment.I didn't come rashly.

Even if it is a redefined manipulation reduction, it cannot be treated with manipulation on the indications of non-manipulation reduction...

Chapter 43 I want to become a beast!

Zhou Cheng currently has three perfect-level skills, and the manual reset of fractures is even more redefining-level.

Therefore, he felt more and more that in the clinical process, it is extremely necessary to distinguish the levels clearly.

Define first, diagnose later.

After diagnosis, classification is required.

Only by strictly classifying various diseases such as dislocations can we better grasp how to treat them.

Be adaptable.

If you don't even understand the clinical definition and classification, but simply format and apply it, you will definitely not be able to do well in clinical practice.

Clinical medicine is an evidence-based medicine and an empirical medicine.

Evidence-based, as the name suggests, is to find out the evidence, grasp the current scale of the disease, and then find out the point of treatment according to the type of the disease, so that it can be called perfect.

This is especially true in surgery.

If a surgeon can't even grasp the surgical indications and contraindications clearly, and can't grasp the size well.

There are definitely two situations.

[-]. Excessive medical treatment is like seeing a fracture and operating directly. It is simple and mindless, but it is actually a waste of medical resources and increases the financial burden of patients.

Second, reckless treatment.If patients who should not undergo manual reduction have undergone manual reduction, or patients who should have undergone internal fixation with plates and screws, they will be fixed with Kirschner wires or intramedullary nails, and the results will naturally be unexpected. outside.

As a clinician, I myself have to believe in all kinds of accidents that exist in the clinic.

The accident, how did it happen?

It was unexpected, but if we can better grasp the situation in the process of diagnosis and treatment, we can minimize the occurrence of such accidents.

Just like a foot fracture, on a simple X-ray, there will be overlap of bone development, which hides the obvious fracture line.

If the occult fracture is not discovered in time, it will cause sequelae that cannot be ignored.

However, if fractures can be completely ruled out on X-rays, or through comprehensive means such as physical examination, then there is no need for CT!

"It's been taken, here are the pictures." Du Yanjun quickly took out the patient's examination bag, and sorted out the different planes of the CT scans for Zhou Cheng one by one.

Then he handed it over and said, "There is no fracture in the CT report."

"I'll see. Professional orthopedic surgeons can't fully trust CT reports." Zhou Cheng had already entered the role at this moment, completely unaware that what he said to Du Yanjun now should actually be what the superior doctor should say.

"Let's look at the coronal plane. This is the talus, here is the calcaneus, and here is the tou (two tone) bone level."

"From these bone planes, we can see that the continuity of the bone is intact, the integrity has not been damaged, and the fracture line has not been seen. Fractures can basically be ruled out."

"Also, Yan Jun, look, from this sagittal plane, we can still see that the heel joint plane is staggered by about 2cm."

"There is a ruler here, 2cm is equivalent to the real 0.4cm, and the direction of dislocation is the cuboid upward."

"In this case, according to the treatment principles of calcanoid joint dislocation, manipulative reduction can be performed, which is within the indications of manipulative reduction, right?"

Du Yanjun blinked his eyes, completely numb.

How the hell do I know?

What are the indications for manipulative reduction of calcanoid joint dislocation?Is there still this thing?

Zhou Cheng remembered Du Yanjun's expression when he saw it!

Ok.

This is Du Yanjun, not the students he taught in the mock copy, forget it, don't embarrass others...

The patient next to him heard Zhou Cheng's calm and composed manner of teaching, and asked with a smile: "Doctor Zhou? Is my condition serious?"

"In your situation, as I just said, there is a dislocation, but no fracture!"

"Manipulative reset is possible."

"However, manipulative reduction also has its inherent risks. If you are unwilling to accept such risks, you can alternatively choose a safer surgical treatment."