Great doctor starts with adding points

"Xiao Wu, did your former unit perform fracture operations like today's procedure? Then how many operations can you routinely complete in a day?" Wu Longshan finished the plaster external fixation in Wu Xie, and ordered Cao Zhiyuan to treat the patient After being sent back to the ward, I asked like this.

There is a transit time for the operation, and no one expected Wu Xie to complete this operation so quickly in advance. Therefore, the next patient did not call to let the ward prepare to take over the operating room.

It takes a long time to send the patient here, to ask the patient to go to the operating room there, to reassess the anesthesia indications and choose the anesthesia method before the operation.

Wu Xie felt a little strange when he heard the words "former unit", but he also replied: "Uncle Long Shan, the fracture surgery in our original hospital was only performed routinely after my senior brother came."

"The surgical procedure is similar, but the number of surgical patients in the town is relatively small. There are only 13 or 4 surgeries in a week. After a month, there are only 40 or 50 surgeries in total."

Wu Longshan and Wu Guonan are of the same generation, so in informal operations or medical activities such as ward rounds, the family must be called the family.

"Forty or fifty, that's the amount of surgeries in our group in a month. Then your hospital's surgeries are okay? Brother Yaolong, are you right?" Wu Longshan was amazed.

Huang Yaolong nodded and asked the key point: "Then what time will your surgery end for the day?"

"According to your current speed, no more than three o'clock at most?"

"Thirty at twelve o'clock in the three stations, and one or two in the four stations." Wu Xie recalled Longyuan's usual time for the main knife, so back.

"It saves a lot of time on airs." Huang Yaolong said this to Wu Longshan.

Wu Longshan suddenly said: "Professor Zhu dug a hole for Xiao Wu, but he didn't think about making a hole for himself in the end, did he?"

Guan Yun nodded fiercely, expressing his agreement.

Wu Xie also instantly understood what Wu Longshan meant.

Generally speaking, if intramedullary nailing is to be performed, a traction frame is required for the fracture of the middle tibia, and intramedullary nailing is performed while continuous traction is performed.

When Professor Zhu Leiming instructed Director Fu Jinjin to prepare for the operation, he did not take such preparations, did not put the traction frame on, and disinfected and spread the drape in advance, but asked Wu Xie to use open reduction, plate and screw internal fixation. Such a basic surgical procedure increases Wu Xie's workload to a certain extent.

But who knows, Wu Xie didn't go to the step of open surgery at all, and finished the treatment directly in the closed operation.

Wu Xie was secretly happy, but he didn't want to be too proud and complacent: "Senior Brother Huang, Uncle Shan, our hospital was too small before and didn't have so many high-end things, so I didn't think about it in this direction."

"Under normal circumstances, the internal fixation of fractures performed more often in our hospital should be internal fixation with intramedullary nails?"

Intramedullary nails and plate screws are both methods of internal fixation, but the fixation devices are different, and the principles of fracture treatment have not been changed. Of course, the plaster of plaster external fixation is also a way of fixation.

Wu Xie's words can be regarded as reluctantly humbled himself to take the initiative to deeply plow the fracture and reset it, and it can be regarded as being forced by lack of equipment. It's hard for a clever woman to cook without rice, but it means you have to find an extra way by yourself.

Can think of a way, this is the embodiment of ability and adaptability.

"It's already very good, Guan Yun, you need to learn more from Wu Xie in the future."

"Wu Xie's manipulative reduction technique is very rare in trauma surgery. Many of our large hospitals now use traction racks instead. The real manipulative reduction, except for simple fractures, is used by most doctors. , did not pay special attention and practice.”

"But in fact, the simple operation method of manipulative reset is an extremely solid and hard-core basic skill of orthopedics."

Guan Yun touched his big ears, and pushed the upper edge of the mask on the bridge of the nose, and fixed it again: "Brother Yaolong, the relationship between manual reset and that traction frame, is it normal sutures and skin nails in joint surgery? The relationship between?"

Guan Yun went to the joint surgery department, and knew that there could be an alternative method for suturing there.

"One is the operation, and the other is the use of the equipment?"

"It's almost the same, but not exactly the same." Huang Yaolong nodded, stroking his belly, and said, "Using leather nails instead of sutures is to save time, and the orthopedic traction frame is actually just to save labor and facilitate operation, but it is more time-consuming. "

"The purpose of the two is different."

"In trauma surgery, as you have just seen, if the manual reduction is done well, the progress of the operation can be accelerated very quickly. The turnover of the operation will be very fast, and the quality of the operation will be greatly improved."

"Professor Zhu Leiming didn't let Xiao Wu use the traction frame, that's actually the intention."

Wu Xie made a joke when he heard the words: "Senior brother, are you serious? You are my senior brother."

"Haha, let's pretend it's true. We need to be good at trying to figure out what the superior doctor thinks, and think in a higher direction..." Huang Yaolong laughed.

The atmosphere instantly became more relaxed and harmonious.

...

However, Guan Yun, Huang Yaolong and others didn't say a word about what the next surgery would be.

After Wu Xie casually mentioned a few words, he didn't continue to ask, probably Professor Zhu Leiming made the confession on purpose.

I just complained in my heart, this Professor Zhu Leiming looks so kind-hearted and has no airs, but as an examiner, he is simply not a human being. It is not as simple as it looks at all, with more than ten thousand eyes.

Of course, Wu Xie ended the previous operation ahead of time, which increased the turnaround time of the operation, and he himself had more time to review the medical records before the next operation started.

The patient did not enter the pre-anesthesia room, but was directly pushed into the operating room.

Huang Yaolong and others conscientiously began to prepare the preoperative disinfection and laying sheets, and Wu Xie immediately picked up the patient's corresponding medical records and read them.

The medical history is relatively simple but not simple!

A middle-aged male, 48 years old, had a history of rheumatic heart disease surgery and was treated with long-term oral warfarin anticoagulation.

Because there was no special situation in the previous continuous review, I did not adjust the amount of warfarin for three years. As a result, the overdose of warfarin seven days ago caused a localized active hematoma on the front of the thigh, and I was admitted to the hospital in an emergency.

At the time of admission, the INR (National Normalized Coagulation Time) was as high as 6.34!

And because of oral warfarin, INR value is too high, non-fatal surgery, warfarin must be routinely stopped for more than a week before surgery.

The corresponding preoperative examinations are not particularly special, and now the prefemoral 'active' hematoma must be evacuated, and warfarin has been stopped for a long time, and the surgery is scheduled for today.

The electrocardiogram is not too special. I have consulted with the Department of Cardiology and Cardiac Surgery. At present, there is no absolute contraindication to surgery, and surgical treatment is possible. The opinion of the Vascular Surgery Department is that after the postoperative low molecular weight sodium anticoagulation, oral warfarin anticoagulation is sequentially administered. treat.

Because warfarin takes some time to produce anticoagulant effect after oral administration.

Therefore, the key to today's surgery is hematoma evacuation + blood vessel exploration + hemostasis.

The preoperative examinations included MRI and CTA (angiography), and the results showed that the perforator of the deep femoral artery ruptured to a huge hematoma in the prefemoral area.

The preoperative examination results were quite perfect.

After Wu Xie examined it carefully, he probably had an idea for surgery.

The deep femoral artery is the largest branch of the femoral artery, and the branches of the deep femoral artery include the medial circumflex femoral artery, the lateral circumflex femoral artery, and three to four perforating arteries.

The key to this operation is to detect the perforating artery. The anatomical shape of the perforating artery is from the deep femoral artery, which goes around the femur to the posterior femur and nourishes the posterior thigh muscles.

After reading the relevant case information, Wu Xie stood up and made an inspection by himself.

It can be seen that the patient is lying on the bed at the moment, the diameter of the right thigh is 1.5 times the size of the left thigh, and it can be seen that the upper part penetrates to the lesser tubercle of the femur, and the lower part reaches the skin between the medial and lateral femoral condyles They were all extremely swollen, and there were obviously a large number of huge hematomas wrapped inside.

According to the re-examination of the MRI data, the muscle space of the quadriceps anterior is almost filled.

Now in the process of disinfection, the anterior femoral area is bulging, flicking and flicking, showing the degree of internal hematoma.

Seeing this scene, Wu Xie continued to close his eyes and think hard.

Began to continue to ponder such a case.

The more traditional solution to the hematoma evacuation of this patient is to directly incision, then explore the perforating artery branches of the deep femoral artery, and ligate to stop bleeding.

The hamstrings have other nutritional blood vessels, and it is not necessary to supply blood through the arteries. However, the opening will be very large, at least eight to ten centimeters of incision.

This is the conventional solution for general hematoma evacuation, but this is not the only solution for Wu Xie who has expert-level hematoma evacuation——

To be more simple, according to the shape of the deep femoral artery, it is the thickest branch of the femoral artery, which originates from the posterolateral wall of the femoral artery about 3-5 cm below the inguinal ligament. First on the outer side of the femoral artery, then on the deep surface of the femoral artery and femoral vein, to the back of the adductor longus muscle and continue to descend, and finally to the lower 1/3 of the thigh.

There are mostly 3 perforating arteries, which are called the first, second and third perforating arteries from bottom to top. They are located above, in front of and below the adductor brevis, respectively. It starts from the deep femoral artery, closes to the medial side of the femur, and passes through the adductor magnus to the posterior part of the thigh to nourish the posterior femoral group.

If the terminal branch of the deep femoral artery passes under the adductor longus muscle to the posterior part of the thigh, it is called the fourth perforating artery.

It can be seen that the main openings of these piercing arteries are inseparable from the adductor brevis.

Slightly triangular-shaped flat muscle located above the inner thigh, deep to the pectineus and adductor longus. It starts from the front of the inferior ramus of the pubic bone and ends at the upper 1/3 of the thick line of the femur.

In this way, isn't it all right?

However, the concept of blood-pushing school of hematoma removal surgery is a particularly good minimally invasive concept, and there is no need to open a large opening at all.

Wu Xie had his own set of ideas.

Before the technology was immature, Wu Xie definitely didn't dare to think and design his own ideas, but the reason why expert-level skills are awesome is that everyone can have their own understanding, and they can do it well. Otherwise, why is it called an expert instead of a specialized repeater?

When Director Fu Jinjin and others re-entered the operating room, Wu Xie had already put on his shirt and sterile gloves.

Then, he confirmed the start time of the operation and the corresponding equipment with the equipment nurse, Huang Yaolong and others in advance.

The authorization assessment of surgery is not standardized, it is to focus on the surgeon, and then test your comprehensive ability to deal with surgery!

Wu Xie and the others took their positions.

Zhu Leiming and the others stood at various angles of the operating table, ready to observe the progress of the operation at any time. As the chief examiner, Zhu Leiming naturally stood at the best viewing angle, which was opposite to Wu Xie.

The exploration through the artery generally takes away the medial femoral approach, which corresponds to the opposite side of the femur, which is the best viewing field of view.

Wu Xie stood in the main position, and after seeing that several examiners were no longer active, he ordered: "Teacher Tour, press the operation timer. At 14:01 in the afternoon, the operation will officially start."

Wu Xie was already holding the round knife in his hand, and the electric knife and hemostat beside him were all prepared in the curved plate.

After giving the order, Wu Xie made a slit about 4cm long without hesitation!

After finishing, Wu Xie put down the round knife, and then used the electric knife to break open and go deep inside.

Seeing this scene, Zhu Leiming's eyes flashed instantly!

You must know that the exploration of the internal femoral artery requires a large incision, usually ten to fifteen centimeters or even longer, and such an incision is most suitable from the anterior femoral area!

Wu Xie made an incision from the medial thigh area for the first time, what is he going to do?

If Wu Xie is such a reckless person, then today's operation authorization will be meaningless!

However, now that Wu Xie has taken the position of chief surgeon, it is not easy for him to criticize too much.

Zhu Leiming's mood was disturbed, so Xiong Kaikai, Agricultural Xuequan from the State People's Hospital and others became a little flustered.

Wu Xie didn't use a scalpel in the last operation. They can still accept such an accident, but now Wu Xie is doing hematoma removal surgery, and he doesn't follow the routine. How do they comment?

But Wu Xie has Wu Xie's ideas.

From the anatomical structure, it can be found that when making the incision on the medial side of the hip joint, there is a jingle that refers to the adductor brevis!

First feel the pubic tubercle, and move it down three centimeters;

The inner iliac enters from this cut and descends along the adductor longus muscle.

The length of the incision is determined according to the sample, and the length of the two gracilis muscles is divided;

Short retraction and large retraction gap are deep, and the obturator nerve should be careful.

This is the medial approach to the hip, and the last one is for you to avoid the obturator nerve.

Of course, Wu Xie definitely didn't go into the hip joint, but took the same position, after bluntly separating the gap between the adductor longus muscle and the gracilis muscle!

"Prepare the attractor!" Wu Xie ordered to Huang Yaolong who was on the opposite side.

Huang Yaolong didn't take the suction device, but Guan Yun has already aligned the suction device to the lower edge of the opening! Very decisive and precise, which means that he also has a certain foundation and is not afraid.

After reading it, Wu Xie decisively opened it inside.

I know in my heart that the first, second and third branches of the artery are located above, in front of and below the adductor brevis!

Therefore, after the adductor brevis was broken, a large amount of blood gushed out immediately, and some fresh blood pushed the blood clot outward like a red bean curd brain!

Seeing this, Wu Xie directly snatched the suction device from Guan Yun's hand. Seeing that Guan Yun was reluctant to stuff it in, he did it himself.

"Shhhhhhhhhhhhhhhhh!"

After the sound of drinking milk tea and sucking jelly sounded for a while, most of the blood and blood clots inside were sucked away by the negative pressure, and Wu Xie handed over the hook that he was in charge of to Wu Longshan, who was in charge.

Then hold the suction device in the left hand and the vascular forceps in the right hand. After a very quick push inward, the opened vascular forceps will be clamped immediately.

Moreover, from the best viewing position where Zhu Leiming stood, it can be seen that Wu Xie actually clipped the perforating artery with the breach! This perforating artery is exactly the perforating artery in front of the adductor brevis.

After clamping, the blood oozing was reduced by half immediately, and it started to flow out from the more oozing.

At this time, because it is known that the first and third perforating arteries come from the upper and lower parts of the adductor brevis respectively, it can be absolutely confirmed which one of the perforating arteries corresponding to the blood source is ruptured.

Blood flows from bottom to top, not down.

There was a problem with the third perforating artery, Wu Xie directly pushed the suction device further down the adductor brevis, and picked up the vascular forceps again.

After the suction volume is greater than the bleeding volume to a certain extent!

Repeating the same trick, Wu Xie immediately clamped it down!

There was a click, crisp and decisive.

After clamping, Wu Xie decisively used the suction device to patrol around the inside of the incision, sucking up the remaining blood and the blood clot, and then observed the operative field, but no blood leaked out.

That is to say, among the first, second and third perforating arteries, only the second and third perforating arteries ooze blood, and their positions are located in front and below the adductor brevis.

Active bleeding has been dealt with!

Of course, to be on the safe side, Wu Xie pulled the suction device out for a full ten seconds, and then continued to observe the dryness of the wound.

There is almost no fresh blood gushing inside!

Arterial hemorrhage is either rushing, spraying or bursting, it cannot be seeping slowly, this is the meaning of the word arterial!

"Doctor Huang, help me prick the blood vessel!" Wu Xie exercised his authority as the chief surgeon.

After the main operation is completed, the redundant operation is handed over to the assistant.

Piercing an artery is not what I should do as a surgeon.

It was not the first time for Huang Yaolong to be an assistant, but it was the first time for Wu Xie to be an assistant, so Wu Xie's tone of voice made him a little stunned.

A full five seconds passed, and Wu Xie had already reached the lower edge of the femur before he realized it.

"Silk thread, tie it up!"

The equipment nurse handed over the silk thread, Huang Yaolong took it in his hand, and then followed the vascular forceps that Wu Xie used to clamp the blood vessels before, and sent them directly into it, completing the vascular ligation, which is the basic operation of all doctors in trauma surgery and hand surgery , which is actually a variant operation of knotting.

Wu Xie came to the upper part of the medial femoral condyle, and after carefully closing his eyes for a few seconds, he made up his mind about his operation and made a 3cm incision about 4cm above the upper edge of the medial femoral condyle!

After the skin was cut through the incision, it went directly to the surface of the muscle layer. After breaking the deep fascia, Wu Xie paused for a while, and then made two pathways, one leading to the surface of the muscle, and continuing to receive the tendon rupture.

Going down is the inner part of the muscle gap leading to the hamstrings!

As soon as the two openings were made, a small amount of blood clots slowly seeped down along the two openings.

Because this is a relatively low position, and it is the lowermost edge of the thigh muscle gap.

After doing this, Wu Xie handed the negative pressure suction device to Guan Yun, and then confessed: "Remember to suck blood at any time."

"Teacher Equipment, give me another basin." Wu Xie turned around and reached out to ask the equipment nurse for another basin.

The equipment nurse handed over the letter suspiciously.

Wu Xie placed the basin under the inner edge of the inner incision.

Just when everyone didn't know what Wu Xie was about to do, Wu Xie's left hand began to slide down slowly with the hypothenar muscle along the outside of the patient's thigh!

And just as Wu Xie was sliding like this, a weird scene appeared.

It can be seen that at the position of Guan Yun's suction device, above the iron basin in Wu Xie's hand, lumps of tofu brain-shaped blood clots are constantly sprayed out from this position, puff puff puff puff.

Confidentially drop and slip in the basin!

This scene directly broke the defense of Director Ding of the Orthopedics Department of Yan City People's Hospital: "Damn!~~~~"

He even took two steps back, and in an instant, all his thoughts became clear, and he suddenly realized.

Guan Yun's hands trembled.

While sliding, Wu Xie pursed his throat with a "hmm!", and scratched Guan Yun's body with his eyes, signaling him not to move.

Only then did Guan Yun stabilize his hand near the opening, allowing part of the blood clot and black blood to enter the negative pressure suction device, and part of it continued to fall into the stainless steel iron basin.

Soon, Wu Xie took half a pot, which was no less than the size of a serving of duck blood in a hot pot restaurant.

At the same time, Wu Xie's hand just slipped to the lateral condyle of the femur.

At the same time, it can be seen that the patient's thigh has become significantly smaller!

"Change another basin!" Wu Xie gave the equipment nurse the steel basin filled with blood clots, and then ordered.

"Oh, good!" She was stunned for a few seconds, and then she took the steel basin and gave Wu Xie a bigger one at the same time.

Wu Xie was not flustered or nervous at all, and continued to repeat the old tricks.

Because of the large basin, Wu Xie quickly slid twice from the anterior thigh area and the medial thigh area in the same way. After the big basin was received halfway, there were almost no blood clots in it, and the diameter of the thigh also returned to approximately normal size.

But it is not exactly the same size as the healthy side, and this is not supported by the hematoma, but the inflammation after the hematoma stimulates the swelling of the affected limb!

Harmless!

After most of the blood clots inside were removed, Wu Xie extended the suction device into the two gaps, and after sliding it two more times, the operation ended.

Then stop the operation of the negative pressure suction device, and continue to observe whether there is fresh bright-colored blood. This is to judge whether there is rupture and bleeding in the fourth perforator. The branch was also found, and then ligated to stop the bleeding.

The patient's luck was relatively good. Wu Xie did not see fresh blood flowing down, so this meant that the fourth perforating vessel did not lack anatomical levels!

However, just when everyone thought the operation was coming to an end.

From the opening of the medial condyle, Wu Xie used the hemostatic forceps to move slightly upwards, and even passed through the adductor tendon hiatus and found the popliteal artery.

The terminal branch of the deep femoral artery is sometimes called the fourth perforating artery, which anastomoses posteriorly with the branch of the popliteal artery through the adductor magnus muscle. If no such anastomosis is found, then there is no 4th perforating artery.

This is pure anatomical knowledge, and it is also a kind of common sense, but it is not widely known common sense.

Seeing this, Professor Zhu Leiming walked away silently.

The remaining operations are suturing and washing, which are not within the scope of the chief surgeon's assessment.

Seeing Zhu Leiming walk away, Xiong Kaikai, Nong Xuequan and others also left the operating table without saying a word, but everyone looked a little exciting.

this?

They didn't understand this operation until the end, how could it be done?

Wu Xie's operation is not authorizing them to take school exams, but performing for them.

Soon, Professor Zhu Leiming left the operating room with Xiong Kai and the others.

Agricultural Xuequan asked with a guilty conscience: "Professor Zhu, this hematoma removal operation is not a conventional operation, should it be counted?"

"Actually, this is not the first time that Dr. Wu Xie performed hematoma removal surgery. He performed it once before." Nong Xuequan was afraid that Zhu Leiming would feel that Wu Xie was out of control, so he explained it this way.

"How to say?" Zhu Leiming's tone was very heavy.

Because it seems that in this assessment, he didn't see what he wanted to see in the end, and this was the operation authorization of trauma surgery, but he didn't see what he wanted to see, and he had to be responsible!

Agricultural Xuequan then told the story of Li Cong before.

"Dr. Wu Xie was able to complete the active complex hematoma in the pelvis under the guidance of Professor Zeng. I think he has no problem with the routine hematoma removal."

"Today's surgery only involves two or three arteries." Agricultural Xuequan added a lot of historical achievements to Wu Xie.

Active hematoma in the pelvis, that is to face thirty or forty different blood vessels at the same time, the difficulty is completely incomparable with this!

Zhu Leiming's eyes flickered a few times when he heard the words: "This is a blood pushing operation. It is a type of hemostasis technique. The bleeding is stopped first, and the hematoma is treated later."

"It's generally rare to see. It's a kind of operation done by doctors of traditional Chinese medicine combined with modern medicine and massage technology. It looks very ornamental and has strong applicability."

"Compared with the precise hemostasis methods such as exploration and incision that we usually use, it is similar in purpose."

"Is Dr. Wu close to a surgeon from a traditional Chinese medicine hospital?" Zhu Leiming asked Xiong Kaikai.

Xiong Kaifang is the director of orthopedics at Minda Hospital.

Xiong Kai shook his head: "I've never heard of it! Why did Professor Zhu say that?"

"Traditional Chinese medicine makes good use of reset and massage in the process of treating bruises. Dr. Wu's two operations have a lot to do with traditional Chinese medicine. I thought it was Enzhou and everyone in the orthopedic surgery department of traditional Chinese medicine." Zhu Leiming Did not discuss in depth.

When Wu Xie was in Han City, he probably didn’t have this opportunity. He was taught by Professor Duan Hong, so he didn’t need to go to a professor of orthopedic surgery in traditional Chinese medicine. Other than that, the rest are very average.

Nongxue Quan said, "Professor Zhu, Dr. Wu Xie is not very close to a Chinese orthopedic surgeon, but he is very close to an old Chinese doctor."

"Who is it?" Zhu Leiming tilted his head curiously.

"Old Doctor Xiong." Agricultural Science Quan replied.

But he was afraid that everyone would have no idea about this, so he explained: "The Huaguo Association of Traditional Chinese Medicine is the first national-level vice chairman after its establishment."

When Zhu Leiming heard this, he staggered instantly and almost fell down.

After a while, he regained his calm expression. When he went downstairs to the locker room, he took off his mask, exposing his nose and big mouth, as if this would make the air fresher and easier to breathe.

"I shouldn't have asked him to take the first surgery assessment and diagnosis. This kid doesn't follow the routine at all." Zhu Leiming grinned.

Originally, his mouth was big, but now it's even bigger!

"Then this surgery?" Agricultural Xuequan continued to ask.

"Let's see how he explains it later, Director Fu, let Xiao Wu come out for dinner later..." Zhu Leiming didn't care about avoiding suspicion at all.

"Okay!" Fu Qianjin, who was following behind the crowd, nodded quickly.

...

In the operating room.

After Director Fu Jinjin and others left, everyone including Huang Yaolong felt that the atmosphere had completely returned to normal.

"Awesome, Xiao Wu!"

"You didn't see it just now, that Professor Zhu's face turned green." Huang Yaolong is the deputy director and the first assistant, standing directly opposite Zhu Leiming, he smiled happily.

Although he is the deputy chief physician, he is not yet a professor, not that kind of boss, or the object of oppression, standing on the same front as Wu Xie.

Wu Longshan also said: "Dr. Wu didn't play cards according to the routine. The two patients already had their own ideas about the diagnosis and treatment, and they both handled them very well. Naturally, Professor Zhu found it difficult to deal with."

"Can't say it's bad, but he didn't see what he wanted to see."

Guan Yun felt particularly relieved, and interjected: "Anyway, it's still the same sentence, for the sake of the patient, you must maximize your ability, right?"

"When I was talking to the patient before, the cut was at least fifteen centimeters!"

"Now?" Guan Yun made two gestures, and finally superimposed them.

Huang Yaolong joked instantly: "It's longer than yours, isn't it?"

Guan Yun turned his head abruptly, his eyes flashed a little and he said, "Brother Long, haven't you tried it?"

Huang Yao immediately hit his radius with the hemostat, and her face changed slightly: "You have the right to joke with me, right?"

"I was wrong, Brother Long." Guan Yun immediately apologized.

Apparently, the superior and subordinate atmosphere of Minda Hospital is better than that of Xuan County Hospital of Traditional Chinese and Western Medicine. There, Guo Lixiang and Zhong Yusheng dare not flirt with the superior doctors, they are all serious.

But here, Guan Yun is much more generous and casual!

After washing, Wu Xie and Huang Yaolong stepped off the stage. It was Wu Longshan who led Guan Yun and Cao Zhiyuan to complete the aftermath.

This is the last operation.

However, when he picked up his phone and left, Wu Xie still said, "Uncle Shan, thank you for your hard work, let's have dinner together this weekend."

Wu Longshan said without hesitation, holding back the second half of Wu Xie's words: "At that time, I will invite you when I am free. Who made me your uncle?"

Wu Xie blinked his eyes, and Wu Longshan said, "Go, Professor Zhu must be looking for you."

If you are outside, you will feel close if you meet your own family. If you can meet someone from your own family who is of the same generation, Wu Longshan will naturally get closer, and if this junior is more talented and awesome, then he will be very happy to get closer to him.

This is a natural advantage, who made the rest of you not have the surname Wu, and you are not from the dragon generation?

"Thank you uncle."

"After this patient goes back, he can use a little bit of tranexamic acid. Don't be afraid that he will cause blood clots." Wu Xie felt that he still had to confess.

Although tranexamic acid is a hemostatic drug that may cause thrombosis, and such patients cannot cause thrombosis, its hemostatic effect and its use during the postoperative recovery period of bleeding patients are excellent and can withstand scrutiny.

The expert level of hematoma removal surgery is not just as simple as pushing the blood faction, but a comprehensive concept improvement.

"Okay!" Wu Longshan nodded.

Wu Xie and Huang Yaolong went out together.

After Huang Yaolong went out, he asked directly: "Xiao Wu, can this move be passed on to the outside world? If possible, teach me later."

"Yes, senior brother." Wu Xie nodded quickly.

"Call me Brother Long in the future. You can discuss formally in the division, there is no need to be so official in private, Brother Long is very good. Haha!" Huang Yaolong was very happy, and after speaking, he quickened his pace and walked downstairs to the dressing room .

...

In the evening, no wine.

But there is no meal, only a large table of dishes and drinks.

After Wu Xie toasted all the examiners with drinks instead of wine, they were so full that they even hiccupped!

But at this time, that big mouth with deep scheming returned to normal, with a smile on his whole face: "Xiao Wu, you can't do this, you can't even hold a drink. If you have to drink, don't you have to lie down?"

Seeing the old hermaphrodite laughing, Wu Xie couldn't help laughing: "Professor Zhu, I can't drink very well, thank you for letting me go."

Wu Xie made a pun.

Wu Xie already knew that his surgical authorization for trauma surgery had passed, at least he had obtained the authorization for trauma surgery.

"Who did you hear that you can have your own ideas in the process of authorization of surgery? Did Professor Duan Hong teach you?" Zhu Leiming asked with a smile, and at the same time picked up a piece of food with chopsticks.

"Mr. Zhu, what my teachers taught me is to do my best in the clinic. It's not just to complete tasks or other things." Wu Xie said very seriously.

This sentence is contained in the Hippocratic Oath.

Although Wu Xie didn't remember whether he had made the oath, but he was a medical student, so he definitely did.

Zhu Leiming said: "If you think so, I will give you a level 2 and level 3 surgical authorization, so I can rest assured."

"However, I still want to remind you one sentence. After doing your best, there is one more sentence, don't appear similar, take a gamble, once!"

"If you can't do what you want, then absolutely don't contribute!~"

"The most feared thing in surgery is the moral knife!"

"Poor medical skills are more destructive than moral incompetence!"

"Of course, I'm not emphasizing that you should not pay attention to medical ethics." Zhu Leiming added another sentence on purpose.

"I don't know about your medical ethics, but your performance today is indeed a bit disrespectful to martial arts!"

"Hahaha!~" Hearing Zhu Leiming's words, Xiong Kaikai and the others laughed.

Wu Xie didn't just talk about martial arts today, he was simply not a human being, he put the knife on Zhu Leiming's neck, and even hung the moral knife on his head.

Everything is good for the patient, so I am unconventional.

Zhu Leiming didn't even dare to fart.

Wu Xie knew that Zhu Leiming was acting strangely, and he was also warning him, so he nodded and didn't reply!

When Fu Jin heard the words, he hurriedly said: "Professor Zhu, thank you for giving the little brothers in our department a chance. You have really worked hard this time."

"You can't drink alcohol today. Tomorrow, we, Dr. Wu, will definitely drink with you."

"I'll also replace the wine with a drink, and I propose a toast to you."

Hearing this, Zhu Leiming clinked glasses with Fu Jinjin, and said: "Tomorrow, you guys can't fight me one-on-one. I want to fight against Xiao Wu. Do you still want to talk about martial arts?"

Then he grinned, and said that he was going to eat alone with Wu Xie in a high-sounding way.

"Don't dare, then don't dare." Fu Qianjin's eyes flickered, and his heart began to wander. He was also wondering what Zhu Leiming meant by these words.

...

After the guests enjoyed themselves, Fu Jinjin sent Professor Zhu Leiming and others to the hotel, while Xiong Kaikai and Agricultural Xuequan went back to their respective homes.

Wu Xie had nothing to do, so he returned to Tang Yuewei's house ahead of schedule.

Then the chat with Tang Yuewei started.

When Wu Xie told Tang Yuewei what happened today.

Tang Yuewei directly poked Wu Xie with the pen in his hand, and his eyes widened: "You are too bold, aren't you? At this time, do you still want to be independent? Can't you just follow the conventional route?" ?”

"Of course you can just follow the conventional technique, but the effect of the treatment is as good as it can be, and it will be better if it can be better. You need to do your best."

"My operation did not violate the principle."

"Professor Zhu didn't hit you?" Tang Yuewei continued to ask.

"I didn't hit it, but I was poured a lot of water. No, I have to go to the bathroom again. Wait for me." Wu Xie got up and went to the bathroom.

When sitting back again, Tang Yuewei said: "Then you can now, you can already design individualized treatment and surgery plans for patients according to your own ideas and understanding."

"Very good, come on!"

"Well, that's what I think, Yuewei, please give me a detailed look."

"It's like this. In the process of reading some literature and some materials recently, I found that the current indications and contraindications for some fracture operations seem to be a bit incomplete. I think that some operations In fact, it does not need to be included in the scope of surgical indications, but can be solved by manual reduction.”

"At present, the classification of these fractures is within the indications for surgery, and not included in the indications for manual reduction. You said that my first project is so big, is it good or bad?" Wu Xie hurriedly Change the topic to something related to yourself.

I am about to step into a Ph.D., so I have to start doing projects!

Everyone is doing it, Tang Yuewei is doing it, Longyuan is doing it, even Professor Ding Mulin is doing it, I must do it myself, and I have to do my own stuff. This is the only feeling Wu Xie has in his clinical experience. to something different from the mainstream.

"It's a bit too big. If you're doing a project for the first time, you need to narrow the scope a little bit. It's not suitable for you to go against the guide from the beginning. You can think about the direction of reduction..." Tang Yuewei knew that Wu Xie was right Theories related to scientific research are a little weak.

After all, Wu Xie spent most of her time on professional skills, so she started laying the groundwork and giving advice to Wu Xie...

Wu Xie listened with a smile all over her face, and seeing Tang Yuewei's serious analysis, she instantly felt extremely fulfilled.