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Now, Zhou Can's level of plaster casting is no worse than Dr. He's.
If he spends a year in orthopedic surgery, the level of plaster casting will definitely be better than most attending doctors.
Fracture joint surgery, the improvement of this medical skill is also extremely gratifying. It also reached the lower level of resident medicine.
After all, this is a specialty of orthopedic surgery, and there are too many opportunities to join broken bones.
During these two months, Zhou Can followed Dr. Shan and Director Shen, and got a total of 117 chances of splicing broken bones.
He could feel a marked improvement in the level of articulation of the broken bones.
In the past, severed fingers were the most frequently received, and the superior doctor basically only let him do this kind of less risky and less difficult bone joint.
Now he has a resident doctor's level of osteosynthesis, and he can also perform one or two operations on the articulation of broken bones such as arm bones and tibias.
It's just that the ones who came out were not as good as Dr. Shan and Dr. Chi.
The improvement of the above three orthopedic medical skills is not bad. Only osteopathy, after learning it, has been at the unqualified level of interns, without any improvement.
Mainly because there is no chance to get started.
The vast majority of patients who need bone-setting reduction are directly treated in the manual reduction room, and it is impossible to enter the operating room.
Occasionally, because the dislocated or displaced joints are more complicated, it is difficult to perform surgical reduction, and an invasive operation is required to perform a surgical reduction on it.
This kind of operation is usually performed by the bone and joint group, and the bone trauma group they belong to has never done it.
Orthopedics has been unable to improve for a long time, and he can't help it.
You can only wait until later to find opportunities for further study.
The main purpose of the regular training is to standardize the training of diagnosis and treatment operations. During this period, it is enough to learn the basic operation methods, diagnosis and treatment procedures.
It is not necessary to master every medical skill.
No one can learn all the medical skills that have been trained in a short period of three years.
It's all about getting started, learning the methods, and then slowly tempering and improving your medical skills during the next resident practice.
In the more than two months of orthopedic surgery, in addition to the improvement of orthopedic medical skills, his suture, ligation, hemostasis, debridement, separation and other medical skills have been greatly improved.
Hemostasis is currently close to the middle level of attending physicians.
Suturing and ligation have more opportunities to use mobile phones, and the experience value increases quickly. In addition, it is already close to the excellent level of attending.
As early as last month, he had reached the excellent level of attending, and was about to reach the level of deputy chief physician.
He is looking forward to it.
Director-level medical skills, what kind of experience would that be?
On this day, Zhou Can arrived at the orthopedic surgery department early as usual.
Arrive at the doctor's office of their group at least half an hour in advance, for no other reason than to check the surgical cases in the group. Knowing the information of the patients who are about to undergo surgery in the group in advance can help you know what to expect during the surgery.
In addition, by paying attention to the conditions of those postoperative patients and the surgical plan, you can clearly know the therapeutic effect of the operation.
Accumulate rich experience for him to practice medicine in the future.
When he found a talus fracture case that was about to be scheduled for surgery today, Zhou Can checked the various inspection reports and films of this person, but the condition of that patient during the ward round appeared in his mind.
Judging from the film taken by the patient, the talus was severely fractured.
Surgery is required to cut open the ankle joint, reset the fractured talus, drill holes, and use screws for internal fixation.
Don't look at the surgical site is only on the limbs, and it doesn't look complicated, but the level of this surgery is level four.
The deputy director can't preside over it.
It can only be performed by the chief physician himself.
There is a strict standard for the classification of surgery. Ratings will be given based on various factors such as difficulty and risk.
There is nothing easy to do if you can reach level 4 surgery.
Director Shen will perform the operation himself at nine o'clock this morning.
Director Shen must have seen the inspection report and the film. The pre-operative talk may be done by him personally, or by his subordinate attending physician.
Zhou Can repeatedly zoomed in on the patient's film and checked it carefully.
The patient's injured left foot, he saw, was swollen and flooded. It has been two days since he was admitted to the hospital, and the operation plan was only formulated yesterday.
"What is Doctor Zhou looking at?"
Dr. He walked into the office and found that Zhou Can was the first to arrive. He greeted him with a smile.
"Check the patient information in the group. Come and help me see if there is any problem with this patient's film?"
Zhou Can's intuition has always been stronger than a woman's sixth sense.
When checking the patient's information, he always felt that something was wrong.
Dr. He Zhang came over to carefully examine the film taken by the patient.
"No problem, it is indeed a severe fracture of the talus."
After looking at it, he found no problem.
"Maybe I'm worrying too much! I'll go to the ward to see the patient again."
Zhou Can got up and walked towards the ward.
Here are rows of open beds.
There are too many patients in large hospitals. In order to save management costs and space to the greatest extent, they like to have this kind of open bed area.
Along the way, family members or patients continued to greet him.
Smarter patients or family members basically know that Zhou Can's status is quite high.
In the morning rounds, although Zhou Can was in fourth place, Dr. Shan would take the initiative to discuss some important cases with him.
This is the treatment that Dr. Tang and Dr. He did not have.
The reason is very simple.
Zhou Can's level of pathological diagnosis is not bad, and his knowledge of medical cases is quite profound.
Often able to give very constructive diagnostic advice.
Sometimes, Zhou Can can find problems that others can't find in time.
This is a kind of dependence and trust.
Doctor Shan asked him to consult with him, feeling at ease.
Patients and families are savvy.
Knowing that Zhou Can's status in orthopedic surgery is quite high, he naturally scrambled to curry favor. In order to get more attention in the stage of surgery and hospitalization.
Zhou Can went straight to bed 77.
"Mr. Zhao, I plan to arrange surgery for you today, do you understand?"
"The nurse notified me yesterday evening, and told me to fast from water and food."
The patient responded enthusiastically.
As Zhou Can's hidden status in orthopedic surgery continues to rise, now that he comes here for rounds, he is rarely treated coldly by family members and patients.
Like now, he personally came over to inquire about Mr. Zhao's condition, and the family members and patients were a little flattered.
"How many days has it been since your foot was injured?"
Zhou Can asked.
The patient's eyes flickered twice, and after thinking about it, he said, "It seems to be three days!"
The family member next to him should be his father, who seemed unclear about his son's injury. He rushed here when his son needed to be accompanied when he went through the hospital admission procedures.
When a hospital handles inpatient admissions, it generally makes an implicit request.
The hospital will not accept you without an accompanying person.
Because after entering the hospital, the hospital will be responsible for the patient. Inconvenient mobility, going to the toilet, eating, pre-operative preparation, and post-operative care are all very real problems.
It is impossible for the hospital to get a nurse to wait on it.
Many people think that it is only natural for nurses to serve them when they are hospitalized and spend hundreds of thousands of hospitalization fees every day.
Hehe, I can only say that such a person is too 'young'.
Nurses are responsible for changing dressings, drips, injections, monitoring blood pressure and so on. It's really overthinking to let someone serve you, eat and drink.
Some pretentious male patients thought about the sweet smile and gentle attitude of the nurse girl. Should I take this opportunity to have an affair with her?
Patients with superior conditions, such as the second-generation rich, second-generation officials, young corporate executives, etc., are indeed likely to succeed.
For the general public, it is better to keep one's law and order.
Don't think too much, get angry.
Zhou Can stared at the patient's left foot carefully. The ankle and instep were all swollen.
However, the surface of the skin is somewhat gray and wrinkles are looming.
"Are you sure the time of injury is three days?" Zhou Can's tone became a little more serious.
It is really difficult for doctors now.
If you speak to a patient with a slightly worse tone, they will become hostile and even complain to you.
Zhou Can suspected that the patient had not told the truth, so he could not blame the other party.
I can only ask again in this reminding tone.
Some patients will lie to doctors and nurses for various reasons.
This is very frustrating.
There are many kinds of purposes for patients to lie, and some are to cover up their ugliness. For example, when Zhou Can was in the emergency department, he received a patient with a foreign object embedded in his anus. They said that when he sat down, he accidentally inserted it into the anus.
Do you have the nerve to keep asking?
This kind of lie has no effect on treatment. As long as the doctor knows it well, he won't reveal it.
When an accident happened, not only the patient was unlucky, but the doctor was also wronged.
After this Mr. Zhao was questioned by Zhou Can for the second time, his eyes were still flickering.
"If you misremember the time of injury, it's only a few hours difference, that's not a big problem. If it's several days or even longer, it's very detrimental to your surgery."
Zhou Can really wasn't trying to scare the patient.
The surgery itself carries high risks.
The preoperative understanding of the situation is very different, which will lead to double the risk of surgery.
"It should be three days. I drank alcohol at that time, so I really can't remember clearly."
The patient's insistence on the purpose of lying is very confusing.
According to common sense, there is no need to lie about the time of injury.
What is the purpose of this person's repeated concealment?
Seeing that there was nothing to ask, Zhou Can carefully observed his feet for a while, and then went back to the doctor's office.
Just in time, Doctor Shan came.
"Doctor Shan, there is a very strange patient in our group."
Zhou Can didn't want to meddle in this kind of nosy at first.
It was about the safety of the operation, so he had to bring it up.
"Which patient?"
Dr. Shan is very familiar with him now, and his tone of voice is also extremely easy-going.
"Mr. Zhao from bed 77."
"Director Shen is going to operate on him this morning! What's the matter?"
Doctor Shan knew that Zhou Can would never say useless words.
She has always attached great importance to Zhou Can's opinion.
Immediately start to understand what's going on.
"When I checked the patient's information in the morning, I always felt that something was wrong, but I couldn't find the reason. So I ran to the bed area to check the actual condition of the patient. Judging from the hematoma on his foot and the gray and wrinkled skin, I think he might be injured for more than three days."
Zhou Can said seriously.
"Sometimes the patient's memory is not so accurate. It's a few hours away, but it's not a big deal. It's not a replantation of a severed limb anyway."
After hearing this, Doctor Shan didn't take it seriously.
"But I asked the patient twice, and he insisted that he remembered the time of injury correctly. But his eyes were obviously lying. I was very puzzled, why did he deliberately lie about the time of injury?"
Zhou Can asked.
Dr. Shan thought for a while, and couldn't help blurting out, "Could it be the same as the forensic TV series I watched recently, the patient is trying to hide the crime?" She didn't expect her to have this hobby.
Most young women like to watch romantic dramas, soap operas.
She may have something to do with her profession, and the TV series she likes to watch turned out to be forensic reasoning.
"If you deliberately postpone the injury time, you can get rid of the criminal suspicion!"
Dr. Shan saw that Zhou Can was puzzled, so he added another sentence.
One word awakens the dreamer.
Zhou Can thought about it, and there was really such a possibility.
Otherwise, why would the patient lie?
"Should we report the patient's information to the police station for investigation?"
Zhou Can asked her for instructions.
Hospitals have this obligation.
When encountering patients with drug abuse, gunshot wounds, knife wounds, and beating injuries, it is necessary to report to the police in time to help the police maintain social order.
Some criminals were injured and did not dare to enter a large hospital. They only dared to go to a small clinic to buy some medicine and treat the wound by themselves.
It is precisely because he is afraid that the doctor will secretly call the police after discovering an abnormality.
"It's always right to report to the police station and check. You can call the police directly instead of calling 110. There is a phone number for the local police station here."
She pointed to a business card in an inconspicuous place in the office, pressed on the desk.
Zhou Can immediately called the police to report the patient's condition.
The rest will naturally be checked by the police.
He continued to think about the patient's surgery.
While thinking hard, his eyes light up when he saw the date on the film.
This is a picture taken two days ago.
Will the patient's bones change over the course of two days?
"Doctor Shan, do you think the patient needs another X-ray examination before the operation?"
"In consideration of the patient's treatment costs, the hospital usually does it when they are admitted to the hospital, and will not do the same examination within three days. After the operation, you need to take another photo when you leave the hospital to check the healing of the fracture."
She is looking down at the medical records and inspection reports of patients who need surgery today.
Zhou Can could only review the patient's X-ray taken two days ago.
Looking at it, he suddenly thought of something.
Immediately call up an X-ray film of femoral head necrosis for comparison.
In this comparison, there is really a little discovery.
Mr. Zhao's talus seems to have a sign of necrosis.
Without careful comparison with other necrotic bone slices, it is difficult to find this slight abnormality.
There are several surgical contraindications for open reduction and internal fixation of talus fractures, and if one of them occurs, it is not suitable for surgery.
The first type is those whose local skin conditions are not suitable for surgery. The second type is old fracture malunion. The third type is those with aseptic necrosis of the talus. The fourth type is those with severe comminuted fractures.
Zhou Can seriously suspected that the patient's talus had begun to show aseptic necrosis.
This is a major discovery.
It must be reported immediately.
Preoperative discovery and postoperative discovery are two completely different concepts.
"Doctor Shan, can you see if there are signs of aseptic necrosis in this patient's talus?"
Zhou Can is just a regular trainee, and he should have reported to Dr. Tang or Dr. He.
However, his status is quite special, after all, his ability lies there.
Coupled with the presence of Doctor Shan, he jumped directly to report.
In fact, this is not the first time this has been done.
"No way? Both the teacher and I have seen the film, and Dr. Chi has also seen it, and there is no problem."
Doctor Shan didn't quite believe it.
Go to Zhou Can's computer and check it carefully.
"My level is limited, so I can't tell. But this is a big deal. I'll call Director Shen."
She called Director Shen on the spot.
"Teacher, I'm Shan Dan, please excuse me."
"Dr. Zhou Can in our group checked the patient's information and suspected that the patient who was going to undergo internal fixation of the talus this morning had aseptic necrosis of the talus. I looked at the film carefully, but I'm not sure, so I can only ask you to take another look."
After hanging up the phone, Director Shen rushed to the hospital not long after.
directly into the office.
"Xiao Zhou's eyes are really sharp. So many of us didn't notice the problem, but you discovered it. No matter what the result is, this meticulousness and prudence is worthy of recognition."
Director Shen smiled and praised him as soon as he entered the door.
Then carefully review the patient's film.
After a few minutes, his face became serious little by little.
"There are indeed signs of aseptic necrosis, but the symptoms are extremely mild. Give the patient another X-ray~www.mtlnovel.com~I'll see the situation and make a conclusion."
Because the patient will enter the operating room at 9 am.
The inspection can only be expedited.
Director Shen personally issued an application for an urgent inspection, and the Medical Technology Department dared not refuse to accept it.
Soon, the film taken by the patient came out.
It can be seen that the signs of sterile necrosis are already more obvious.
"My god, it's really sterile necrosis. Fortunately, it was discovered in time, otherwise, even if the operation is completed, it will still be a failure."
Director Shen broke out in a cold sweat.
"Xiao Zhou, you performed very well."
Director Shen praised him, and then gave him a solution.
"Tell the patient the situation first, so that the patient and his family members have a psychological preparation. Judging from the current situation, the osteonecrosis of the talus has just occurred and is still in the early stage. The operation can be evaluated according to the actual situation. It is possible to directly fix the foot with plaster after the operation. Ankle can be solved. No matter how serious it is, transplantation of bone marrow stem cells can also cure it.”
When Director Shen said this, he frowned and couldn't figure it out.
"Strange, logically speaking, the injury only lasted three days, so it's impossible for necrosis to occur so quickly!"
After hearing this, Dr. Shan laughed and said, "Dr. Zhou is really good. He told me early in the morning that the patient may have concealed the time of injury. I suspected that the patient was trying to cover up the crime, so I asked Dr. Zhou to report the situation to the jurisdiction. The police station responded."
After listening to Director Shen, he suddenly realized.
Patted his forehead.
"No wonder, I said, the injury is less than three days old, how could talus necrosis occur so quickly? The current doctors are really tired! In addition to treating diseases, they also need to learn some detective skills. Who would have thought that such a trivial matter, How can a patient lie!"
In a word, everyone smiled.