medical simulator

Zhou Cheng looked at Ning Ling, who smirked along with him.

Zhou Cheng looked at Ding Changle again, and found that Ding Changle's eyes were slightly closed, and after feeling Zhou Cheng's imposing gaze, he quickly said, "Xiao Zhou, you've done a good job, and you've spoken very well."

"There are many diabetic foot patients, and the research is relatively in-depth and thorough. We must build a diabetic foot treatment center in Central China, and make exemplary case treatment points."

Ding Changle spoke with full of air and a tough voice.

Zhou Cheng sniffed and said, "Professor Ding, I think we can be bolder and stop focusing on the Central China area."

"Professor Ding, Professor Ning, I only have one person now, and there is a student Wang Huan, and at most I can add Professor Cai's student Du Yanjun here and a junior, so I hope that if you are interested in this topic , classmates or brothers, if you are willing to come, you can come and help."

"After all, the project is to be done by a group, one or two people, such a big project must not be done."

As soon as Zhou Cheng finished speaking, someone immediately took a step forward.

He looked at Ding Changle with both eyes, but didn't find Ding Changle speaking, so he backed away.

Zhou Cheng also looked at Ding Changle.

After Ding Changle took a deep breath, he pondered: "Xiao Zhou, don't worry about this, you have already made so many theoretical reserves here, let's apply for the project first."

"After the application is received, whether it's a manpower shortage, a funding gap, or something else, I will work with Dean Lei to help you find a solution."

"If you are more courageous, then you will be more courageous." Ding Changle didn't keep Zhou Cheng last time because he suffered from a lack of courage.

Didn't Chapter 441 say that debridement can't do tricks?

"Professor Qin, you have worked hard." Ning Ling and Zhou Cheng went down to the operating room together, and Ning Ling confessed to Professor Qin Dingmo to complete the patient's anesthesia.

Since there are difficulties in the treatment of this patient, Ning Ling didn't simply call Zhou Cheng over for a meeting. With enough time, Ning Ling also hoped that Zhou Cheng could do the debridement of this operation. up.

Qin Dingmo had met Zhou Cheng once before, and it was for a just battle to send the patient named Luo Sangen in.

Therefore, when he learned that Zhou Cheng was going to be the chief surgeon and let him be given anesthesia, he was willing, but regretted: "It's not hard work, but I heard from Yang Yifeng from your department some time ago that Dr. Zhou's anesthesia skills are even better. for the top."

"It's a pity. Dr. Zhou's surgical skills are good. If he comes to our department, he will bury his talents. I just hope that Dr. Zhou can give me some advice."

Zhou Cheng looked at Qin Dingmo: "Professor Qin is too famous, it's all Yang Yifeng's flattery."

But Qin Dingmo couldn't be fooled by these words, and his tone was sour: "Doctor Zhou, this, Xiao Yang also said, the new topic of lacunar anesthesia in the Ninth Hospital of Shanghai..."

Qin Dingmo didn't finish his sentence, he probably got the meaning.Sour.

Now Zhou Cheng is a member of the Affiliated Hospital of Shonan University, but all the good projects before were given to his wife, who took him to the 'brother' hospital.

Ning Ling didn't pick up the slack, and directly led his subordinates to do the disinfection and draping operation before the operation.

Now Zhou Cheng is well-known in the hospital, but he is even more famous in the department and group.

Diabetic foot, which was rarely touched by trauma surgery before, has now become a special feature. Although it has just started, the cure rate is very high, and even many patients from the second and third hospitals come here admiringly.

The cure rate is also quite good. When such diseases were snatched from the burn department before, there were many criticisms, but now they are all extinct.

And all of this is a standard treatment plan that Zhou Cheng and Ning Ling "discussed". It is said to be a discussion, but they are all internal students of the orthopedics department. Who doesn't know that Ning Ling was in hand surgery before.

Ning Ling doesn't say he doesn't understand the treatment of diabetic foot, but he's definitely a layman, and it's not even as deep as the burn department.

Just one plan can achieve such an effect. Can Zhou Cheng's name not impress and convince them...

Even people who originally thought that Wang Huan's apprenticeship was a bit Meng Lang, now they are very envious of Wang Huan.

It's a pity that Wang Huan was not taken directly to the emergency trauma center by Zhou Cheng, but stayed in the trauma surgery department as a long-term intern in the Ningling group.

"Professor Qin, you are blaming me for not being sensible. But there will always be opportunities in the future. We can discuss with each other."

"Time is still a bit tight now. I am the general hospitalization, so I have to do a good job in clinical work first, and then I will find time to ask Professor Qin for advice." Zhou Cheng said.

Hearing this, Qin Dingmo seemed to be waiting for Zhou Cheng to say: "Doctor Zhou is in the emergency room now?"

"It's okay, I can transfer there?" Qin Dingmo probably knew that the application of lacunar anesthesia in Shanghai Ninth Hospital was also honed in the operating room of the emergency department.

Qin Dingmo is now the deputy director and professor of the anesthesiology department. Where do you want to go? Isn't it a matter of telling the director yourself?

Qin Dingmo had thought of this a long time ago, so he confessed to Ning Ling that if Zhou Cheng came to the operating room anytime, he must tell him.

Zhou Chengcheng didn't know how to answer, so he could only say, "Thank you Professor Qin for your trust."

How should I put it, Qin Dingmo's skills in the anesthesiology department are top-notch. If he can go to the operating room of the emergency department, it will be very useful for carrying out major operations in the operating room of the emergency department in the future.

Qin Dingmo had achieved his goal, so he stopped being obedient and went back to the anesthesia machine honestly.

……

While waiting for the disinfection, Zhou Cheng and Wang Huan stood side by side.

Zhou Cheng started his own teaching mode and said: "Diabetic foot is essentially a kind of ulcer, and ulcer needs a suitable healing environment. In addition to controlling blood sugar, this suitable healing environment also has the following environmental preparations."

"Debridement should be performed under appropriate circumstances, including controlling diabetes, keeping the foot clean and dry, avoiding friction and pressure, etc., to promote healing."

"Debridement is to build a sterile environment and remove the cavity environment."

"Dressing is to ensure a dry and clean environment: Appropriate dressings need to be applied after debridement, including antibacterial dressings, penetrating dressings, absorbent dressings, etc. Dressings need to be changed regularly to keep the wound dry and clean."

"More than drying."

Wang Huan nodded and raised his little paw to express his opinion: "Master, I have also checked some corresponding content."

Learning is an active process, so Wang Huan had to express his attitude to Zhou Cheng.

Zhou Cheng frowned slightly, and after more than ten seconds, he asked, "What is the main point of debridement during the treatment of diabetic feet?"

When Zhou Cheng asked this question, Ning Ling just came in, slightly surprised: "Xiao Zhou, isn't it a bit too difficult for you to ask Xiao Wang with such a question?"

"The main points of debridement are only for intermediate or even sub-high students to master in detail. After all, this is not debridement of ordinary trauma."

It is difficult to study medicine. Debridement is the easiest operation to get started, but at different times, there are different requirements. Clarifying the requirements of different diseases is the standard and profound.

Wang Huan said with a puzzled look: "Infection control, careful and thorough debridement, postoperative drainage. The principle of asepsis, the principle of small cavities, and nutritional support."

With Wang Huan's current knowledge reserve, she can only work so hard to understand the treatment principles, and it is a bit embarrassing for her to be more detailed.

The big frame exists, which Zhou Cheng taught her.

Ning Ling smiled a little, Wang Huan's foundation is good, otherwise Zhou Cheng would not value him.

Zhou Cheng nodded: "Infection control is divided into two steps. The first step is the application of drugs, which are divided into two categories, the application of systemic drugs and local drugs. The second step is to control the source of infection, that is, thorough debridement and removal of necrotic tissue."

"Postoperative drainage is the way to control infection. It washes away free bacteria. The principle of small cavity is also the same, so that there is no cavity for bacteria to lurk and block the way of infection."

"The principle of sterility is to avoid new bacterial infections, and nutritional support is to strengthen one's own resistance."

"What can I say that corresponds to?" Zhou Cheng continued to help Wang Huan sort out the knowledge structure.

Wang Huan immediately straightened his body, his face was full of astonishment, and his tone was dull: "Prevention and treatment of infectious diseases."

Prevention and control of infectious diseases, management of the source of infection, cutting off the transmission route, and protecting the susceptible population!

Zhou Cheng shook his head: "It's not comprehensive enough. To accurately describe and understand it, it should be that the prevention and control process of unpredictable and transmissible pathogens is not necessarily an infectious disease, but everything that you can't see with the naked eye is the root of prevention and control. "

With such a small change, Wang Huan's knowledge structure began to be reshaped continuously.

It is taken from the textbook, but it is beyond the scope of the textbook.

"Professor Ning, shall I wash my hands first?" Zhou Cheng walked out of the operating room with a smile.

Wang Huan still stood where he was, motionless.

Ning Ling didn't answer, thoughtful, and after half a minute, he told all the onlookers: "This is the reading to a certain level, logical, transparent, and you can draw inferences at will. Make it clear. "

"Knowledge means you know it, but you can say it. If you can't say it, it proves that you haven't read it well."

Everyone was thoughtful, but of course they hadn't reached the level that Ning Ling said so far.

Zhou Cheng washed his hands and came in, put on the sterile surgical gown, and everyone was waiting for him, having made all the preoperative preparations.

Wang Huan was also called out to wash her hands, disinfect her clothes and go on stage, and gave her the second assistant's position, that is, Zhou Cheng's starting position.

"Wait a little bit, Xiao Wang." Ning Ling said when he saw that Zhou Cheng was going to have an operation.

Ning Ling is mainly thorough. With Wang Huan around, Zhou Cheng's teaching process will increase. He needs this, so he does what he likes.

Zhou Cheng joked: "Mr. Ning, are you talking about my old bastard?"

"Or the old king next door?"

Ning Ling's eyes widened, and he pointed at Zhou Cheng, looking annoyed.

But this is the normal operating atmosphere of surgery!

When Wang Huan came to the stage, Zhou Cheng immediately picked up the scalpel and got the sterile toothed forceps: "Before the operation on the diabetic foot, we must first clarify the level of the foot."

"Skin layer: The outermost layer of tissue covering the plantar surface of the foot and having protective and sensory functions."

"This circle!" Zhou Cheng collected materials on the spot and started teaching anatomy.

"Subcutaneous Fat Layer: Located below the skin layer, it is mainly composed of fatty tissue and has the function of absorbing shock and relieving pressure."

"Subcutaneous fascia layer: Wrapped around the superficial muscles and ligaments of the plantar, it has a supporting and protective effect."

"Superficial Plantar Fascia: Consists of a thin film that covers the superficial muscles and ligaments of the plantar, providing protection and stabilization."

"Deep fascia, muscle layer, bone layer..."

Zhou Cheng said this, and then said: "The ulcer we can see now is basically the deep fascia layer, which is the content inside. It looks very messy and complicated. When debridement, it is mostly There is no way to start."

"But!" Zhou Cheng deliberately raised his voice.

"Deep plantar fascia: This membrane is the main component of the deep plantar fascia layer. It is a dense layer of connective tissue film that covers the deep muscles and ligaments of the plantar and has a supporting and protective effect."

"Contains tendons, nerves, blood vessels and fatty tissue, which is the inner layer of fatty tissue. Right!"

"So if you figure this out, you can go straight to the operation?"

"Yes, but no."

When Zhou Cheng said this, everyone looked up at Zhou Cheng, but Zhou Cheng placed the surgical field at the deep fascia level: "The blood vessels in the deep fascia layer: the branches of the plantar artery and plantar vein. These blood vessels enter the plantar muscles through the deep plantar fascia layer, supplying them with oxygen and nutrients."

While talking, Zhou Cheng took out these things from the 'shit pit' and rotting meat, and picked them up on the tweezers.

Ning Ling was taken aback: "Xiao Zhou, this branch? It wasn't introduced in the anatomy book, right? How did you separate it?"

"The out of shape is very casual, isn't it?" Ning Ling's scalp was really numb.

You should know that the branches of such plantar artery and plantar vein are random, not fixed, and have no deliberate anatomical level.

"It can be seen on the NMR." Zhou Cheng replied.

"Then there are nerves. The deep plantar fascia contains many nerve endings and branches, mainly from the plantar nerve and the posterior tibial nerve. The plantar nerve is the main nerve in the deep plantar fascia. Its The branches are responsible for most of the sensory and motor control of the plantar muscles."

"Hey, did you see it?" Zhou Cheng picked it up.

Ning Ling felt numb again, afraid that Zhou Cheng would break it.

However, after Zhou Cheng showed it to everyone, he said: "After we know these structures, we will be able to do the rest of the debridement. Regardless of these places, wash them first, wash them in large quantities, and wash away the carrion and necrotic tissue first." .”

"This is the second time to build a sterile environment. The first flush is before disinfection. Right?"

As Zhou Cheng said, Ning Ling immediately brought over the washing gun knowingly. The washing gun is connected to a large saline bag, a bag of 3000ml, which can be washed for a long time, and the water pressure is sufficient, so it can be rinsed thoroughly, which is convenient and quick, and can save a lot of time. .

There was nothing bright about washing, so Zhou Cheng finished washing step by step.

Then, the wound surface on the sole of the patient's foot will be as white as the flesh after washing.

And at this moment, Zhou Cheng stopped making a sound, and started debridement, but Zhou Cheng had only done it for half a minute.

Ning Ling's first aid was a little unreliable, and he shook his hand.

Zhou Cheng raised his head, looked at him, and gave him a death stare. Ning Ling, you are an associate professor, and you make such a fuss as an assistant. Are you not responsible?

He didn't speak, but he had already given him a questioning look.

Ning Ling's expression covered by the mask was very exciting, his eyes were particularly astonished, and his voice trembled slightly: "Xiao Zhou, you. You."

"Didn't you say that debridement has nothing to do?"

Ning Ling asked this question, and answered in his heart, you didn't fart at all before, you are just making a fuss about debridement now, don't think I don't know!

"Professor Ning, this is the combination of basic anatomical theory and debridement. In addition to delamination, there are still some fascial cavities on the sole of the foot before delamination."

"It's easier to find in normal structures, but after infection, most of these cavities are semi-closed, so we need to find them." Zhou Cheng explained in a low voice, and did not scold Ning Ling like a student. scold.

I just sighed in my heart, alas, Ning Ling is not Yang Yifeng after all, if Yang Yifeng saw such a fuss, he would definitely frown.

Zhou Cheng passed on the basic anatomical theory through certain means, but Zhou Cheng did not pass on the combined application of the basic anatomical theory and some operations he knew.

Although the application of basic anatomical theory is the prospect of the development of surgery, many people are making a fuss about it, but Zhou Cheng himself is the most capable of making a fuss.