medical simulator

"Now in our group, there are only four patients with diabetic foot. Our operation day will be next Thursday. During this period, we must first control the blood sugar of the patients."

"And we must try our best to control the emotions of patients and family members."

"Master, I'm thinking about one thing now. If we take care of all these patients, will they go to the burn department instead? Or to the hospital!" Zhou Cheng didn't think much about it.

But the matter of Li Keke made Zhou Cheng think a little more.

"Trouble with the burn department, trouble with the hospital, what does it have to do with us, we are cured, it is our ability, the past of the burn department and the orthopedics department, then let Dean Lei and Director Liu of the burn department to break up Shit, let's do our own thing." Cai Dongfan said indifferently.

"Then master, let's do it well?" Zhou Cheng became interested immediately when he heard Cai Dongfan's words.

"Go, go to the ward rounds, let's see the specific situation first." Although Cai Dongfan spoke a little harshly, in fact, he was a little timid when he really had to do something to deal with these patients.

Chapter 389 Someone Will Come

"Today is Saturday?" Zhou Cheng glanced at the time before his ward rounds, and felt that the time was a little out of order, and he didn't know the meaning of day and night.

Zhou Cheng hasn't been home for three days, and he sleeps when he finds time to squeeze.

"Oh, so it's shift shift." Zhou Cheng followed Cai Dongfan's footsteps, followed by Du Yanjun and Li Chongyue.

Originally, there was nothing special about the patients in the ward. The only thing that was special was the two hospital beds that had just undergone surgery the day before yesterday. They secretly said to Cai Dongfan, "Director Cai, my cub's activities are very good, but I dare not let him mess around."

"I'm afraid that other people will be jealous. He does functional exercises secretly at night. He is very happy."

It is probably Li Keke's business, let them know that the patients in the ward also have lemon essence.

Cai Dongfan smiled and said: "It's okay, you have to exercise on time, don't overdo it. Functional exercise is your own, there is no need not to do it because of other people's ideas and opinions."

"The operation has been done, and the best opportunity has been laid out for you, but what you will do in the future depends on your own efforts."

"If I don't cooperate with functional training, no matter how good the surgery is, it will actually be useless."

Cai Dongfan was in a pretty good mood when he heard this.

Even without the interns, the residents in charge of the beds also felt a little relieved.

I thought that in Cai Dongfan, the most junior professor group, there would be a lot of things.After the superior doctor has completed the operation, he will take care of the bed doctor's ability to communicate with the patient.

But in fact, there are very few things. The patients and their families see that their functions have recovered very well. Under Zhou Cheng's strict principle of painless medication, the patients are willing to cooperate with exercise after their pain is well controlled.

There are also some children who are spoiled by the family, or people who are very afraid. Then there is no way, this cannot be forced.

Soon, the ward round team arrived at the ward where the first diabetic foot patient was located.

As soon as Cai Dongfan entered, a family member came up and said, "Professor Cai, you are here. My husband has caught a cold for the past two days, and the air conditioner in this ward is not good."

"I went to the nurse to change the bed, but they said they want Professor Cai to talk to them. Professor Cai, look, can you be considerate and think of a way for us?" The speaker was a woman in her thirties, dressed Quite delicate and polite in speech.

Those who have been in the hospital will know that she is lying.

Cai Dongfan hurriedly said: "You are wrong. All the bed allocation and bed replacement in our hospital are coordinated by the Nursing Department. Don't blame me."

"The head nurse disagrees, and Director Ding is useless."

This is true. The Nursing Department and the Medical Department are two parallel departments. In the hospital, there are clear regulations on the assignment of responsibilities.

The reason why it is called the head nurse housekeeper is that all the beds and wards are in charge of the head nurse.

"But, Professor Cai, my husband has caught a cold. I'm afraid that he will catch a serious cough. It will tear the wound again. It will affect the recovery." As she said, her eyes kept rolling.

The young man lying on the bed also coughed a few times very cooperatively, as if to prove that he really had a cold.

"There is really no way around this. As you know, the beds in our department are very tight. When one is discharged from the hospital, one will be vacated, and then new patients will come in immediately." Cai Dongfan also continued to explain.

"Professor Cai, is anyone discharged from the hospital today? Can you transfer?" The woman asked again.

"Yes, it's bed 23." Cai Dongfan pouted towards the back of the room. This patient has bed 21 and is in the same room.

"That?"

"Then we are discharged from the hospital too? Can we be discharged from the hospital?" The woman asked again with an idea.

Du Yanjun hurriedly said: "Master, this patient had an operation last Friday, and it is already the eighth day after the operation. He is not willing to let him be discharged from the hospital on Monday."

"It's ok. Your husband is recovering quite well. I also saw that this young man's usual activities are also good. After he was discharged from the hospital, be careful of his wounds. It's not a big deal." Cai Dongfan knew that Professor Wang and Professor Ding wanted to take care of him. Fractured patients.

It is a high-quality disease that is well managed and basically does not have too many sequelae, so he can do it smoothly.

"Then we'll be discharged from the hospital too..." the woman said immediately.

There was disgust in his tone.

No way, to be honest, no one wants to live in such a ward except family members or people with similar diseases, especially now it is winter.

The air conditioner here is cold, and they turned it off. I just feel that the smell is roasted again, absolutely amazing!

But there is no way, this is a gay man, and the other two diabetic foot patients are lesbians. In principle, men and women do not live in the same ward for fear of inconvenience.

The Department of Orthopedics of the Affiliated Hospital of Shonan University basically has no vacant beds for turnover.

After confirming that he was discharged from the hospital, Cai Dongfan took him to bed 22. He was a man in his 40s. He was very thin and dark. His feet were very black. They were wrapped in a thick layer of gauze, but they still couldn't cover them. The taste of ecstasy.

Even though Zhou Cheng and the others put on masks, they could still smell the smell, mixed with the smell of complex iodine.

The accompanying family member was his wife, with a blank expression, helping him to sit up, not impatient, but not very happy either.I didn't have any complaints about the family members in bed 21, so I showed special displeasure or irritability.

"Hi, how are you feeling today? How much is your blood sugar in the morning?" Cai Dongfan asked.

Diabetic foot patients are all diabetics, and blood sugar must be asked.

"Tested in the morning, 8.8, the blood sugar is under control, but this foot is still the same. When I sleep at night, it is very painful again." The family member replied.

The man got used to being tortured, shook his head and said: "Doctor, if my foot is really bad, it should be amputated, I can't bear it myself."

As he spoke, he straightened his body slowly.

Xie Wenhua is the doctor in charge of the bed, and hurriedly said: "Professor Cai, the patient's current treatment plan is still the same as that of the burn department, and he has been consulted by the endocrinology department for many times. He is currently waiting for surgery, and his blood sugar control is better now. .”

"What are the drugs used to promote microcirculation?" Zhou Cheng asked Xie Wenhua. He didn't have time to look at these carefully. He was too busy yesterday to organize them.

"Alprostadil is currently used for treatment." Xie Wenhua also worked hard.

"What about anti-oxidation?" Zhou Cheng continued to ask, anti-oxidation is the most commonly used, and there should be no mistake, but Zhou Cheng was also afraid of missing it.

"Lipoic acid." Xie Wenhua answered fluently.

"Add gabapentin to relieve pain and let the patient rest better at night. Then add mecobalamin, a neurotrophic drug, and diabetic foot will damage the nerves to a certain extent." Zhou Cheng added.

"Methylcobalamin has already been prescribed in the burn department." Xie Wenhua memorized the arm machine and wrote gabapentin in his notebook.

"Pay attention to protecting the stomach. Alpha lipoic acid and alprostadil both have certain gastrointestinal irritation. Remember to use preventive anticoagulant drugs, low molecular weight heparin sodium, and do not use naqu." Zhou Cheng specifically explained.

Low molecular weight heparin sodium is the most classic anticoagulant drug, and nadroparin calcium is rumored to be a better anticoagulant drug, which is also written in the guidelines.

However, Naqu is more expensive, and low-molecular-weight heparin sodium has been used for many years, and its safety factor is very good.

The most important thing is that Zhou Chengyou discovered that low molecular weight heparin sodium can promote the recanalization of the internal microcirculation of the diabetic foot to a certain extent, and it happens to prevent venous thrombosis.

"Okay!" Xie Wenhua wrote.

"Half the amount before the operation. The most important thing is to pay attention to the pain response of the patient. Strict analgesia must be used to allow the patient to rest well." Zhou Cheng explained again.

Diabetic foot has developed to the stage of ulcer, and there is no shortage of accompanying nerve and blood vessel damage, and the pain is particularly unbearable.

Without a good rest, it will definitely be very painful before the next surgery.

For such a disease, surgery and medication need to be very delicate. If the medication is used properly, the rotten smell can disappear.

"Okay!" Xie Wenhua nodded.

During this process, Cai Dongfan didn't say a word, and he wasn't even very clear about how to use the medicine mentioned by Zhou Cheng and the others.

He himself is a trauma surgeon, and suddenly he has a diabetic foot, and the progress is still slow.

Then the 23rd bed was originally agreed in advance to be discharged from the hospital, especially after the 22nd bed was transferred in, his idea of ​​transferring out became more urgent.

After the ward rounds, Zhou Chengcai said to Du Yanjun: "Yan Jun, please remember to remind me in the future that all diabetic patients in our group must use low molecular weight heparin from the beginning of admission, stop the night before the operation, and stop on the second day after the operation." Days will start to be used again."

"On the day of the operation!" Zhou Cheng ordered.

He is now the attending physician and has the absolute right to prescribe. As long as Cai Dongfan doesn't stop him, he can change the patient's treatment plan at any time.

"We will talk about other drugs according to the specific situation. You can check the information and literature by yourself. Our team will formulate a general treatment framework for residents to know."

"They will be able to use it in their work and study in the future."

"We try our best to focus on medication and supplement it with surgery. If some cases can be solved without surgery, the pressure on a large part of the hospital bed can be relieved." Zhou Cheng In the simulated world, half of the patients can be treated with surgery, and half of the patients can be treated with medication. Can be solved.

He has yet to work out which patients can be managed surgically and which can be managed medically.

He has to deal with the classification slowly. If he can figure out the type of diabetic foot and come up with a treatment plan, that alone will be enough for Zhou Cheng to firmly bring this disease to the title of a national key medical center!

Because no one did it, and Zhou Cheng did a good job, the patient is huge!

"Okay, Brother Cheng, I'll check as soon as I get back." Du Yanjun's heartbeat also started to speed up.

Zhou Cheng is working now, and finally he is going to start teaching projects at his own place, and he just made such a big living room, and some soup is enough for him to stay in the hospital!

Cai Dongfan left the ward, turned around and asked, "This diabetic foot can be treated with simple medicine?"

"It can be cured, at least a rate of 40.00% or more, and it will take about five days to see results!" Zhou Cheng conservatively estimated that he didn't want to give too high hopes.

"That's enough for a large batch, let's go, let's continue to make ward rounds."

……

Half an hour later, Li Chongyue came up immediately and asked Zhou Cheng: "Senior brother, why are the three patients with diabetic feet taking different medications?"

"Of course the medication is different, and everyone's situation is different." Zhou Cheng said.

"I haven't figured out the difference myself. You can also check the literature for me."

"Oh, yes, senior brother." Li Chongyue's mood became mixed with disappointment and excitement.

Zhou Cheng couldn't even figure out what kind of disease it was?In Li Chongyue's vision, Zhou Cheng was almost invincible in orthopedics.

Of course, Zhou Cheng himself has never thought about it this way, he just has a cheat, but he is not able to control all orthopedic diseases.

This type of disease, after he solves it, requires someone to open up a separate department, so I don't know who is willing to take over.

"That's it, I have to take a nap for a while. I'm too sleepy." Zhou Cheng said.

"Okay, brother, you go to rest first." Li Chongyue saw Zhou Cheng's green wash clothes, and hurried away.

Zhou Cheng fell asleep right away.

Wang Huan and others came back from the ward rounds with the teacher and wanted to report to Zhou Cheng, but they were also stopped by Du Yanjun.

Then several interns from Peng Lingli got together and were analyzing several diseases that the teacher had conducted ward rounds today, looking for similarities and differences and exchanging opinions.

The learning motivation and learning methods among the top students, and even the way to find happiness, are different from ordinary people.

When Zhou Cheng was in the Eighth Hospital before, there was no such a test.

……

Zhou Cheng was woken up, it was Cai Dongfan who knocked on the door and knocked him out.

"Xiao Zhou, get up quickly! Come and meet Professor Ning." Cai Dongfan shouted loudly after banging on the door.

Zhou Cheng was in a sleepy sleep. Hearing this, he rubbed his eyes and opened the door. His eye circles were very red.

Then he saw two people standing at the door. Needless to say Cai Dongfan, Zhou Cheng was surprised that the other person was Ning Ling from the first orthopedic ward.

"Xiao Zhou, we meet again." Ning Ling's figure was upright, his whole person looked very kind, and his voice was softer. It sounded like a spring breeze, with an indescribable taste.

"Professor Ning, Master! I'm sorry, I fell asleep." Zhou Cheng hurriedly explained.

"Understandable, I told Professor Cai, and we will talk about it tomorrow, but Professor Cai insisted that we meet now." Ning Ling said helplessly.

"Xiao Zhou, Professor Ning transferred to our group after applying with Professor Chen Tingye on purpose, and we will all be part of it from now on."

"Tonight, let's cleanse up Professor Ning." Cai Dongfan warmly invited the banquet.

Before Zhou Cheng could speak, Ning Ling said, "Professor Cai, this won't work. Let's make an agreement. I will treat you today, and I will definitely not refuse Professor Cai's treats in the future."

"This time, I have to thank Dr. Zhou for his help. My sister-in-law is recovering well. In today's game, I have to compete with Professor Cai. You can't refuse." Ning Ling was full of momentum and could not refuse.

"What else?" Cai Dongfan turned to look at Zhou Cheng, he hadn't heard of it.

Zhou Chengcheng said: "Master, Professor Ning and I performed two operations together, and learned from each other. It was an emergency operation, so I didn't bother you."

"What time is it now, oh, master, I have to go for a consultation, and then I need to improve the record of the intern's teaching rounds, master, why don't you and Professor Ning chat more?"

The total hospitalization time is all squeezed out, there is no emergency consultation, and there are regular consultations.