medical simulator

In order to avoid misunderstandings and oolongs due to information errors between myself and Mao Yuxuan.

Looking at his words, Xue Xiude has practiced much better than the others.

"Yes. There are two sets, Master. The 5 beds and 8 beds are scheduled for surgery today." Mao Yuxuan replied seriously and carefully.

After Mao Yuxuan spoke, Chen Shengwu said: "I have checked the preoperative examinations and preoperative doctor's orders of the two patients undergoing surgery today, and there is no special problem."

"Should be able to operate on time."

Xue Xiude nodded: "Well, let's do a simple report on the condition first."

"1-4 beds, whose is it?"

A person stood up: "Brother Zhang and I will take care of one to four beds together."

The speaker is Gu Zhongliang's student.

Then he said in detail: "The first bed was after debridement of multiple bone tuberculosis. Now it is complicated by bacterial infection, the wound does not heal, the patient is thin, and there is bone defect before the operation. At present, there are multiple thrombus in both lower limbs. After consultation with vascular surgery It is decided to suspend the next operation."

"Continue to continue to drain at present, and prepare for the third debridement and suture."

"A 2-bed patient with suppurative osteomyelitis had multi-resistant bacteria infection before operation, high blood pressure, and mild diabetes, but it has fluctuated greatly in recent days. The endocrinology department came to consult and said that it was perioperative. Blood sugar fluctuations must be adjusted, and early surgery is not suitable."

"And the results of the recent bacterial cultures are also that the bacteria are not fixed."

"Three beds. Infected after open reduction and internal fixation of fractures in the local hospital, fracture nonunion and sinus tract admission. Currently there are three sinus tracts, and sinus tract resection has been performed, but the infection is still not under control. The current level of antibiotics It has been mentioned that it is very high, and the pharmacy department is invited to the department for consultation every day."

"Bacterial cultures are carried out every day. The results are clear, but the antibiotics are not effective. The patient and his family are making a lot of noise. From the time of admission, they say that the hospital's diagnosis and treatment were wrong before, and now they start to blame us again. .”

"..."

At the beginning of listening, what this person said directly stunned Zhou Cheng.

What's the situation?

these patients?

However, after a full 30 seconds, Zhou Cheng stabilized his mentality before reacting.

The department I re-entered now is the Ninth Hospital of Shanghai, not the Eighth Hospital of Shashi.

In the Shashi No. [-] Hospital, there are basic departments, which only do trauma, and there are no patients such as sports medicine.

As for the Shanghai Ninth Hospital, there are not many simple trauma surgeries here.

I came here just for debridement and sutures. I might not be able to reach the emergency department, so I was sent out and sutured.

For simple fractures, unless the residents live nearby, they will come to the Ninth Hospital. Other patients who are not in this area will not come to the Ninth Hospital of Shanghai.

Those who can come to Shanghai No. [-] Hospital, trauma surgery patients, how can there be simple patients?

Maybe all of them were rejected by hospitals in various provinces and cities. The condition is very complicated. After many operations, it can't be cured, so I came here to try my luck.

This place is simply a hodgepodge. There are only one to four beds. If you say a bad word, there is no good product.

Compared with them, open fractures and comminuted fractures are too simple.

A simple pelvic fracture is very simple.

However, such patients who have been treated by others and are not treated well, and then sent to the trauma surgery patients in the Ninth Hospital of Shanghai City, have a particularly headache.

Zhou Cheng continued to listen and concluded.

For the patients here, infection is the basic operation!

Bone defects are not uncommon.

Don’t be surprised that there may be large and multiple infections, and don’t even be surprised that some deformed patients are treated for osteotomy.

Another one, lying on the hospital bed, asked Professor Xue Xiude to perform height-enhancing surgery. Professor Xue Xiude refused his request sternly, and reported the case to the hospital and the public security agency, saying that such an operation could not be performed.

But the patient did not agree to other operations.

Because he was really sick and had a broken bone.

He broke the bone himself, because he heard that the operation to grow taller is to break the bone and then re-operate to grow taller.This buddy, less than 20 years old, did not know where the obsession came from, and knocked his leg bone.

The problem is, both his father and his mother still know about it!

I just froze here and quarreled every day, but Xue Xiude definitely couldn't agree to this kind of non-therapeutic surgery, and he also filed a record. Xue Xiude performed an illegal operation.

Without surgery, the patient does not want to, and he cannot be driven away, only psychological work can be done.

And the patient and his family members, as if admitting to death, set their eyes on Xue Xiude.

Seeing so many patients, Zhou Chengcheng felt that maybe he chose to come to Shanghai No. [-] Hospital as his first stop, which meant that he chose the wrong place.

Isn't there that kind of relatively simple fracture in the Ninth Hospital of Shanghai?

When Zhou Chengcai asked himself this question, reality told him the answer...

Chapter 243

The process of rounds did not slow down or stop because Zhou Cheng was new here today.

Only Zhou Chengyin is a newcomer, and he is not familiar with the patient's past and current conditions, so he can only analyze it based on the report of the doctor in charge of the bed, which is equivalent to looking at the flowers on horseback.

Although I roughly remembered the general situation of the patient, but for some detailed problems, even if the subordinate doctor made a report, there was no way to restore all the details one by one at once.

Because the doctor in charge of the bed tacitly knew some details for Yu Qiuhua and others, naturally he would not report more things just because Zhou Cheng was a newcomer.

If there is only one variable factor, then it is a very small number of variable factors to adapt to most stable factors.

Without the overall control over the patient's condition, even Zhou Cheng couldn't make up for it so easily.

Of course, Zhou Cheng didn't have the opportunity to work hard to understand the other patients, but Zhou Cheng was very impressed with the two patients who were going to be operated on today.Because he deliberately spent an extra 10 minutes to read the medical records of the two beds.

After reading it, I was a little worried.

Zhou Cheng had just arrived, although junior doctors could ignore him, but Professor Xue Xiude still gave Zhou Cheng a lot of face. After he got out of the operating room, he asked Mao Yuxuan to accompany Zhou Cheng and arrange things in the department first.

Mao Yuxuan had almost figured out Zhou Cheng's current state, and felt sorry for Zhou Chengdao: "Xiao Zhou, according to what you said, then you are not making any money as the general inpatient now."

At first, Mao Yuxuan thought that Zhou Cheng was an employee of the hospital who came by airborne. Because of his relationship with Academician Zeng, he was hospitalized for a symbolic few months, and then he was promoted to attending.

He wanted to make way for Zhou Cheng, so he moved away.

But now that I think about it, things are not as I imagined. Zhou Chengcheng hasn't worked yet, so the work of the general hospital is equivalent to doing it for nothing, and both himself and Zhou Cheng are at a loss.

Naturally, Zhou Cheng would not tell Mao Yuxuan the main purpose of his visit, this had to be infiltrated slowly, otherwise he would be regarded as a fool.

"It's okay, the main reason is that Mr. Zeng wants to exercise well, and I also feel that I need more clinical polishing now."

Then Zhou Chengcheng brought the topic back to the main topic: "Brother Xuan, the two operations today are not easy to do."

Zhou Cheng said while flipping through the medical records.

The first thing to be operated on is a 5-bed tuberculosis patient. The patient's lower limb skin has sinus tracts, and the sinus tracts have pus, which is extremely difficult to treat.

What is the concept of sinus drainage? It means that Mycobacterium tuberculosis has eroded and broken the bone marrow cavity, cortical bone, and even the soft tissue layer outside the bone, eroding a channel.

Then the pus inside slowly oozes out.

Originally, according to the principle, patients with special infections like tuberculosis are definitely arranged in the last one in an operating room, so as not to increase the infection rate of patients in the latter operation room.

However, another 8-bed situation is more dangerous than this 5-bed one. In addition to tuberculosis bacteria, there are also bacteria infected.It's equivalent to a mixed infection, it sucks...

Bacteria and Bacteria are not the same thing.Therefore, 5 beds were assigned to the first station, and 8 beds were assigned to the second station.

The situation is roughly like this.

The skills that Zhou Cheng currently knows are all simple skills written in textbooks.These skills are definitely the foundation. With so many Level I-IV skills, one can basically deal with all orthopedic diseases.

Especially in the face of textbook-like fractures or diseases that require surgery, these perfect level skills are extremely lethal.

But there is another critical issue, that is, the patients encountered may not be sick according to the textbook, which requires slowly dismantling and analyzing the mechanism of the disease.

The grades of surgeries are strictly graded as I-IV. However, in Zhou Cheng’s understanding, some surgeries should not be classified as Grade IV surgeries, but should be beyond Grade IV surgeries, and can even be classified as Grade V surgeries…

Zhou Cheng's own experience is limited. Even in the process of using the simulator, he only honed his skills one by one according to the orthopedic surgery grading list announced by the state.

Zhou Cheng definitely has the ability to perform treatments and surgeries. However, it seems that the patients in Professor Yu Qiuhua's group simply use one or two simple surgeries, so it is difficult to deal with them.

It is necessary to analyze its pathogenesis in more detail in order to achieve a better therapeutic effect.

Mao Yuxuan smiled and asked, "Xiao Zhou, didn't you say that you are a trauma surgery major? Have you never seen such a patient before?"

Mao Yuxuan has been trying to figure out Zhou Cheng's origin, and finally determined that it should not be the inheritance of the Ninth Hospital of Shanghai, but may belong to Shanghai.But now that Zhou Cheng looks like he has never seen the world, it seems that he is not the inheritance of the devil city.

Of course, Mao Yuxuan's question did not mean looking down on Zhou Cheng, but rather.

If the unit Zhou Cheng stayed in before was on the same level as the current No. [-] Hospital of Shanghai, such patients should not be uncommon.

How many hospitals are there in the country?

Even if a hospital has two difficult patients a year on average, if they cannot handle them, the number will be thousands or even tens of thousands after they are gathered in Shanghai, Kyoto, Guangdong Province and other places.

China is too big.

Both Zhou Cheng and Mao Yuxuan felt that it was a bit too ostentatious for Mao Yuxuan to call Mr. Zhou Cheng Zhou or Mr. Xiao Zhou. In the end, it was absolutely that Mao Yuxuan called Zhou Cheng Xiao Zhou, and Zhou Cheng called Brother Mao Yuxuanxuan.

Mao Yuxuan also didn't like Zhou Cheng calling him a teacher in the friendship of young people.

"I haven't seen it much before. Patients with simple infection after surgery are rare." Zhou Cheng didn't care. Anyway, he was young, so what if he admitted his short-sightedness?

At most, you will be laughed at. If you pretend to know everything, in case you are told, since you have more knowledge, then you don’t want to learn. How can Zhou Cheng get started and gain trust?

Mao Yuxuan probably understood that Zhou Cheng's previous unit was the one that only dealt with the simple fracture and trauma patients he encountered.

Don't solve problems for others, and don't solve units that others have solved but can't solve.

It cannot be said that their technology is not good, but that the positioning of each place is different.

This also just shows that in Zhou Cheng's previous unit, because there were many patients with simple fractures, there were enough patients to support him to practice the magical technique of closed reduction and external fixation of fractures.

"After that, we can learn more." Mao Yuxuan's mentality was slightly adjusted.

Because I saw Zhou Cheng's shortcomings, and then I felt that Zhou Cheng was more real.Although Zhou Cheng has such strong skills, he also has his own shortcomings, which is normal and like a human being.

"We don't have to worry about other things. The main thing is to manage subordinate doctors and review their medical orders."

"But these things are now being done by the attendants in the hospital, and these doctors also have things to do..."

"All we have to do now is to review the operation that is scheduled for tomorrow, if."

After Mao Yuxuan told Zhou Cheng some common-sense questions, he led Zhou Cheng to the operating room.

Prior to this, Professor Xue Xiude, Gu Zhongliang and others had already gone down first.

In addition to the general hospitalization, there are still three people who are attending and above, and there are two attendant chiefs, so whether the chief doctor on duty is in the hospital or not, the operation can be carried out normally.

The general inpatient can go into the operating room and assume his role after doing his own thing well.

Zhou Cheng then asked: "Brother Xuan, in our hospital, on weekdays, do patients with this kind of infection be routinely treated and treated?"

Somewhat curious, if the 5 beds and 8 beds are routine treatment and treatment, then he feels that he has to rethink and recognize the perfect level skills he thinks.

Mao Yuxuan also shook his head and smiled wryly.

He replied: "Xiao Zhou, how can you be so magical as you think? In fact, in clinical medicine, there are only a bunch of dead principles. Surgery is surgery and medication, but the process and details of the surgery are slightly different."

"The reason why there are more patients now is because it is winter vacation. Generally, patients with this kind of infection rarely come in summer, and the summer is hot and dry. It is possible that such patients will be admitted to the ICU before they can turn around..."

Speaking of this, Mao Yuxuan hesitated to speak, probably meaning that when it is cold, there are more patients like this, and in other seasons, they may not be able to carry them to Shanghai.

But this kind of thing is not something that Mao Yuxuan can control, so he continued: "Complicated infection is better. Kyoto and Shanghai are one, but the other is Xinjiang Province."

"There are a lot of infected patients there, and the reimbursement ratio is very high, so the patients hardly need to spend money."

"But no matter how you say it, it also falls into the category of complete debridement. It's not good. If the debridement operation is done well, the number of operations can be reduced."

"If the dosage and type of antibiotics used are well selected, the course of anti-infection treatment can be reduced. But these are issues that professors should consider. We junior doctors can only slowly ponder based on experience."

Zhou Cheng had heard Luo Yun say such a conclusion before.

"What is the prognosis of such a patient on weekdays?" Zhou Cheng continued to ask.

"Not necessarily. 90.00% of the patients can still get a relatively good prognosis."

"Of course, there are still about [-]% of patients with complicated infections, and the prognosis is not very good due to various reasons." Mao Yuxuan did not hide or brag about his department's awesomeness, and admitted that there were also some patients with complicated infections. A small group of patients has a poor prognosis.

But in fact, this is Mao Yuxuan's confidence.

I was able to treat so many patients that other provinces could not handle until the cure rate reached 90.00%. This is where I am awesome.

As for why it is not 100%, there are many factors.