medical simulator

When he entered the operating room, he saw Zhou Cheng alone, and asked, "Xiao Zhou, where is Du Yanjun? Has he slipped away?"

He thought that Du Yanjun ran back secretly to be lazy.

The tone and mood are a bit off.

Zhou Chengdao: "I'll let Yan Jun go down to rest for a while, and then go back to the operating room after the patient comes in. I guess he's only in the waiting room. Mr. Cai, are you looking for Yan Jun?"

Cai Dongfan's preparation before was that Du Yanjun followed Zhou Cheng, he took him to the beach, and then Luo Yun took Zhang Zhengquan.

But now that Luo Yun went to the outpatient clinic, the operation arrangement had to be readjusted.

"Well, he can't go to rest! Luo Yun has to go to the outpatient clinic, and he has to go to the 19th room to be the surgeon. At that time, I will ask Zhang Zhengquan to come to your place to help."

"Damn it. What's going on every day." Cai Dongfan walked out of the operating room cursing, took out his cell phone, and called Du Yanjun.

Du Yanjun just lay down, and when he heard this, he quickly stood up again, dragged his tired body, and fought vigorously again.

Moreover, because there was no one to help, he had no choice but to go to the Seventeenth Room first, and then called Zhou Cheng to the Nineteenth Room to help lift his legs, disinfect and spread the towels.

In the absence of people, one person can only serve a few people.

After doing all this, Du Yanjun had time to look at the patient.

This is an open injury of the knee joint with exposed blood vessels, which belongs to that kind of rather complicated debridement operation!

Du Yanjun's scalp was throbbing, looking at the patient, he was at a loss.

However, both the anesthetist and the itinerant nurse looked at him.

There is no hand-washing nurse in this operation. Yesterday’s hand-washing nurses were all tired and went back to rest. Most of the shifts today are patrolling!

Although I can wash my hands, when I am on stage, there is no one to take things and help off stage.

Zhou Cheng walked out the door, saw that the operating room in the seventeenth room was still empty, then turned his head again, and gave instructions to the tour operator in the nineteenth room: "After the patients in the seventeenth room are anesthetized, call me to come on stage."

"I'll take the stage here first."

Debridement and suture are also very particular. Strictly speaking, simple debridement and complex debridement should not belong to the same level of surgery, but when the surgery is graded, they are all divided into debridement and suture. It's just surgery.

Zhou Cheng knew that such a third-degree open knee injury was not something Du Yanjun could handle.

This kind of open injury of the knee joint is a small case at the emergency scene, because the task of the emergency scene is to transfer the patient to the hospital and save his life.

When it comes to the emergency department, it is just quite tricky. The purpose of the emergency doctor is to bandage, stop the bleeding, and then transfer to a specialist.

After entering a specialist, the real treatment actually begins!

It is the most basic principle to save lives first and then treat diseases.

However, saving lives is obviously not the ultimate goal of medicine, it is only the most basic goal.

It's like an open trauma to a joint.

Open bones and joints can be divided into three degrees according to the severity of the injury:

The first degree: the skin is punctured from the fracture end from the inside to the outside, the soft tissue is slightly injured or the joint capsule is punctured by a sharp instrument, the wound is small, and the articular cartilage and bone road are not damaged.

Second degree: the skin is cut or crushed, the subcutaneous tissue and muscular tissue are moderately injured, or the soft tissue around the joint is extensively damaged, the articular cartilage and bone are partially destroyed, and there are foreign bodies in the wound.

Third degree: Extensive and severe damage to the skin, subcutaneous tissue, and muscles, or soft tissue damage around the joints, rupture of ligaments, severe damage to articular cartilage and bones, foreign bodies in the wound, combined with blood vessel, nerve damage, or joint dislocation.

If it is a first-degree injury, it can be treated as septic arthritis, even without excessive debridement.

Du Yanjun gritted his teeth, he could try debridement of the second degree open joint injury, but the debridement and suture of the third degree joint injury requires not only the removal of necrotic tissue, but also the reconstruction of muscles and ligaments.

There may even be an anastomosis of blood vessels and nerves. Such debridement is not easy.

And this kind of patients, in the first aid scene, in the open trauma, are relatively mild!

Hearing Zhou Cheng's words, Du Yanjun felt as if he had received an amnesty, as if he had met a savior. Just now, when Cai Dongfan asked him to take the stage, he was a little happy. surgery.

But after entering the operating room and seeing the patient's condition, I immediately felt at a loss.

Zhou Cheng washes hands, dresses, and wears gloves!

"Teacher Tour, put on the tourniquet, the pressure of the tourniquet should not be too high!" Zhou Cheng ordered.

Open joint injury, accompanied by vascular injury, if the pressure of the tourniquet is too high, the open vascular injury may not be found, making the debridement operation incomplete, or the vascular injury that should have been discovered may not be found.

This is bullshit.

"Open another lower extremity fracture package." Zhou Cheng gave another order after glancing at it for a while.

The instruments in the lower extremity debridement pack and the fracture pack are different. Although there are some duplicates inside, if there are some instruments in the fracture pack, the operation can be carried out more smoothly!

"Yan Jun, let's investigate together, you look for foreign objects, I'll look for blood vessels!"

For destructive injuries, the blood supply must be found first, which is the first prerequisite for judging whether the limb can be saved.

If the blood vessel damage is serious, don't even think about it, either blood vessel transplantation or amputation!

For simple things, he handed them over to Du Yanjun, so there must be no problem.

If it was complicated and Du Yanjun couldn't handle it, Zhou Chengcheng picked it up by himself.

Otherwise, if you always procrastinate, you will waste a lot of time loving you.

"Okay! Brother Zhou Cheng." Zhou Cheng came to the side, so decisive and straightforward, which gave Du Yanjun the backbone!

There was even a feeling of tears welling up in his eyes. Just now, he was scurrying around like an ant without a leader, but he quickly organized his thoughts——

He immediately used a suction device to suck up the blood clots on the surface one by one, and then used the thyroid retractor to slowly pull the inner layer.

During the on-site first aid, although most of the sundries or foreign objects will be cleaned up, it is impossible to clean them up after all. It is necessary to carefully explore during the operation to ensure that there is no residue.

And while Du Yanjun was looking for foreign objects, Zhou Cheng's side had already begun to judge the anatomy out of shape quickly.

The arteries at the knee joint take shape, mostly focusing near the popliteal fossa.

Fortunately, it is the patient's open joint, which is in front.So the popliteal fossa may be protected and not involved, but the blood vessels below the popliteal fossa, that is, below the tibial plateau, need to be carefully explored.

Moreover, it is necessary to straighten out the shape of the muscles at the starting and ending points of the tibial plateau, identify the tendons and muscles one by one, and then rebuild the bone defect and muscle insertion points...

The treatment of simple bone defects is very simple, and Zhou Cheng can also do a good job of simple tendon insertion reconstruction.

But when the two exist at the same time, then the difficulty is not as simple as one plus one, or even a simple exponential increase!

Instead, it directly increased the difficulty to several or even hundreds of times!

Do you want to rebuild the bone, do you want to rebuild the tendon, and how?

Can muscle grow without rebuilding bone?What to do if the muscles atrophy without rebuilding the tendons?

What if the tendon is rebuilt and the rebuilt bone is strained?

The reason why surgery is complicated, or the reason why some diseases are complicated, is that there is no very logical one-to-one correspondence.

It is not even possible to find a perfect counterpart that is very perfect and fit.

However, this issue should be considered later.

While Du Yanjun was sorting out stones, broken gravel, glass fragments and blood clots, he also sneaked a look at Zhou Cheng, and found that Zhou Cheng had exposed the corresponding blood vessels and nerves at some point. out!

The nerves were contained by Zhou Cheng with the cut off rubber gloves, and the blood vessels were fixed by him with silk threads.

Moreover, Zhou Cheng's fixation was not the kind of fixation that was tied off, but a dead knot.

The dead knot is above the blood vessel, and the blood vessel has not been punctured, but the blood vessel can be pulled out.At the same time, he also classified the broken muscles and clamped the tendons with vascular forceps.

Vascular forceps cannot clamp the muscle, because it will dissolve the muscle tissue and cause death similar to rhabdomyolysis.But the tendon can be clamped, there are no blood vessels in the tendon, and the clamp will not dissolve!

However, after Zhou Cheng finished these, the [-]th and [-]th tours came to remind him.

Said: "The anesthesia in Shiqijian has been administered, and Dr. Zhang over there has been sterilized. I asked Dr. Zhou if you want to go there?"

"I'll be right over!" Seeing this, Zhou Cheng stepped off the stage immediately!

While unfastening the gloves, untie the clothes at the same time!

"Brother Zhou Cheng, what?" Du Yanjun panicked when he heard that Zhou Cheng was about to step down.

If this operation is completely entrusted to him, he will not be able to take it.

Now it is no longer a matter of mobile phone opportunities, but the situation encountered is beyond the scope of ability, and Du Yanjun can't handle it.

Although he really didn't want to admit that he was much worse than Zhou Cheng, in fact, he had already recognized the fact that Zhou Cheng was the junior superior in the group.When Zhou Cheng was here, he felt very at ease, as long as he did things well.

Everything can be handed over to Zhou Cheng. Before Zhou Cheng took the stage, he panicked a lot!

Now that Zhou Cheng was about to leave, he was still in a panic.

When there are many opportunities, if you can't grasp them, this is a sense of powerlessness!

"Debride the wound first, don't worry!" Zhou Cheng comforted Du Yanjun calmly.

Zhou Cheng must step down.

Seventeen is his main battlefield, this is one of the reasons!

The second is that he has already investigated the patient clearly, so Du Yanjun can slowly remove the foreign body, and then clean up the necrotic tissue.At least in this way, the patient's life will not be in danger!

But next door, he hasn't seen what's going on, he still has to take a look first, so he can know for sure!

If this kind of third-degree open knee injury is a small debridement, then the situation next door will definitely not be too small. If Zhang Zhengquan is alone there, if something happens, it will be troublesome up.

Still not enough staff.

Teacher Luo.

"Yan Jun, don't throw away these bone fragments. Put them in a dish later and soak them in complex iodine. I'll go over and see the situation," Zhou Cheng ordered.

Luo Yun had no choice but to go to the outpatient clinic, but when he left, the patient still had to be taken care of, and there was no way he could run around!

He only hoped that the 21 rooms at Cai Dongfan's side could be completed sooner, and then an operating room would be taken over in the gap.

Otherwise, Zhou Cheng really felt a little unfocused if he ran on both sides.

You have to be specific in surgery.

"Okay, Brother Zhou Cheng." Du Yanjun was a little panicked when he saw Zhou Cheng leave, and also a little afraid that the patient would suddenly disappear after Zhou Cheng left.

However, after Zhou Cheng has sorted out the muscles, blood vessels and nerves, the operation is actually not that difficult, and he can start to walk step by step.

Zhou Cheng went out, washed his hands, and entered the Seventeenth Room.

While putting on his clothes, he directly asked, "Quanzi, what's the condition of this patient?"

"Arterial embolism, plantar injury, lower leg amputation!" Zhang Zhengquan hurriedly replied, he also knew the patient's situation clearly in advance!

Zhang Zhengquan knew.

Luo Yun left suddenly, and Du Yanjun next door couldn't bear it alone. Before that, Zhou Cheng was helping next door. He wasn't in the hospital yesterday, and he didn't make rounds in the morning. He definitely didn't have time to understand so many things.

"How long has it been tied?" Zhou Cheng asked again.

"Are you wearing a tourniquet?"

Zhou Cheng looked at the patient's foot and removed the bloody damaged sole. It should be a girl's foot, and she should not be very old.

Then, as he walked towards the operating table, he looked around quickly, his mind racing wildly.

If the embolism time is not long, this amputation can still be salvaged!

Amputation is the last step in orthopedics, and he doesn't want patients to go to this step unless it happens.

"The tourniquet is on." Zhang Zhengquan hurriedly replied.

"I don't know how long it's been tied."

"Little sister, do you know when you were admitted to the hospital?"

"Boom!~"

"Bah!~" Lying on the operating table was a young girl, who was under spinal anesthesia at the moment, sobbing while sucking her nose.

"Boom!~"

"Bah!~"

The sound of air hitting the nasal cavity and the sound of snot piercing through the nose sounded one after another, and so on.

"Little girl?" Zhang Zhengquan asked again.

"I was admitted to the hospital after four o'clock. Doctor!"

"呲呲呲!"

"Woo! Uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu" As she spoke, her body trembled slightly.