I don’t know how the patient was treated yesterday?
Later, he was not even transferred back to his original bed. I felt that the matter might be serious.
"Today, we were supposed to arrange for three of you to help in another operating room. There are two important surgeries that need to be taught, so let me lead you for a day. My last name is Shan. I am currently able to independently perform level 1 and level 2 orthopedic surgeries. I have participated in many level 3 orthopedic surgeries and completed the most difficult parts of them."
It seems that all successful doctors have one skill in common.
That's 'bragging'.
Nowadays, you have to brag. Once the patient hears how good you are and how many difficult surgeries you have performed, he will trust you and let you perform the surgery with confidence.
"The principle I follow is that the capable are promoted and the mediocre are demoted. If you have the ability, you can always strive for opportunities to practice. As long as you perform well, I will give you high scores. Let me be frank, do what you are capable of. If you don't have the ability, you are not allowed to rush to practice on patients. If you do too badly, I won't give you another opportunity to practice next time."
Dr. Shan first explained the rules of the competition to the six people.
That sounds good, fair and just.
"Now, please look at the X-ray of the first patient who underwent surgery today. I will give you five minutes to watch it, and then you will give your diagnosis and treatment plan. Learning how to read the film is the first thing you need to do. You are allowed to answer quickly."
As soon as she finished speaking, the assistant turned on the light sheet amplifier.
A light curtain appeared on the wall.
Four X-ray images were displayed.
It looks like the right foot bone.
Taken from multiple angles.
The patient's big toe phalanx was significantly deformed.
While Zhou Can was amazed at the advanced hardware facilities in the orthopedic surgery operating room, he was also carefully observing the patient's foot bone X-ray.
The severe inward varus deformity of the big toe bone may be congenital or caused by some special acquired reasons.
No healing line can be seen after the fracture.
It is almost certain to be a congenital malformation.
Then it is very likely that this is not where the patient needs treatment.
Zhou Can continued to watch carefully.
At this time, some people have already started to answer.
"These four X-rays should be of the patient's right foot. It can be clearly seen that the phalanx of the right big toe is severely deformed. This will affect the patient's walking. I think it can be corrected with surgery."
This person's face was full of excitement when he answered the question.
Thought I won first place.
After he finished speaking, Dr. Shan did not make any comment.
Zhou Can received a lot of guidance from Dr. He yesterday, and his ability to read films has improved a lot.
He found a slight fracture of the first calcaneal bone of the patient's right foot, near the navicular bone.
“It should be…”
"I think..."
Zhou Can and another trainee student spoke at the same time.
Finally, Zhou Can magnanimously made a gesture of humility and said, "You answer first!" The trainee was not polite either.
After all, it concerns the next three months of orthopedic surgery training and whether I can stay in the operating room.
This has a great impact on future career development.
"I think it's a slight fracture of the first tibia of the right foot! No surgery is needed, just a cast and rest for about 42 days."
If the fracture is not serious, it is fully capable of healing on its own.
The younger you are, the shorter the healing time.
Children's bones heal fastest and are most stable after healing. Older people heal the slowest.
Judging from the picture, this is the foot bone of an adult.
I had to rest in a plaster cast for 42 days, and the treatment recommendations were very reasonable.
"Zhou Can, you can speak now."
Dr. Shan actually remembered his name.
And they were very fair to him and didn't suppress him.
This surprised Zhou Can a little.
Many women are petty. I offended her badly yesterday, but I didn't expect that she didn't care.
"My previous opinion is the same as what he said, including the treatment suggestions. I would like to add that the big toe bone is a congenital deformity. The patient is already an adult, so his willingness to receive treatment should be very low. Moreover, the patient should have adapted to this deformity when walking. I do not recommend surgical correction."
The advice Zhou Can gave was obviously more comprehensive than that given by the previous gentleman.
It is also more comprehensive and in-depth.
"Well, both of your answers are correct. Zhou Can's answer is more comprehensive, and he considered the treatment plan from the patient's perspective, which is very good."
Dr. Shan probably didn't want to praise him.
But the other person's performance was indeed excellent, and she had to praise him.
"Is there anyone who can put a cast on this patient?"
"I can!"
"I can!"
All six of them can do it.
Applying plaster is relatively simple and easy to learn. Even if they didn't learn it before entering the orthopedic surgery department, they must have learned it after spending a day in the orthopedic surgery inpatient ward yesterday.
However, with only one day, I only learned the most basic operation methods.
Only some simple operations can be performed.
"You are the first person to answer correctly, so you can do it! Doctor He, you take him there and make sure you keep a close eye on him."
Doctor Shan said to one of the assistant doctors.
Zhou Can knows this Doctor He.
This was the doctor who taught the eighteen of them how to fill out the registration form in the office yesterday.
"Let's look at the second patient's information!"
As soon as Dr. Shan finished speaking, the smile on the face of the intern who had been assigned the task of applying the plaster froze instantly.
He must have missed a lot of opportunities during the time he was out applying plaster to patients.
Just as Dr. Shan said, everyone has equal opportunities.
Two new films appeared on the screen.
This time it was not an X-ray, but an ultrasound.
Judging from the situation, it seems to be the knee.
Zhou Can got a lot of training in the emergency department by reading B-ultrasound images. He was taught by a master like Dr. Xu.
Naturally, his abilities as a disciple are quite good.
You can tell where the problem is at a glance.
"The patient should have fluid accumulation in the right knee joint cavity, and it is quite serious. It is recommended to puncture and draw out the fluid, and then inject medicine into the joint for treatment. The preferred medicine is hyaluronic acid, such as sodium hyaluronate."
At this moment, Zhou Can finally understood what it meant to accumulate strength for a great success.
The practical experience he gained in the emergency department, coupled with the medical knowledge he learned from reading medical books, became the weight that allowed him to lead other interns.
The other four trainees looked at him, all dumbfounded.
Shit! Is this really a trainee?
Why does it feel like this person's ability to read films is better than that of the attending physician?
It was really unlucky for their group to encounter such a "monster".
In today's competition for the operating room, there is a high probability that they will be beaten by Zhou Can.
"That's correct."
When Dr. Shan looked at Zhou Can, the surprise in her eyes could not be hidden even by her black-framed glasses.
This resident trainee in the emergency department is indeed worthy of his reputation.
She now seemed to understand why Director Shen had that expression when he heard Zhou Chan's name.
Director Shen must know Zhou Can's abilities.
"This patient's treatment is a bit special. It requires bone puncture, which is extremely difficult to operate. Not to mention you, even I need to be very careful to puncture successfully. You just need to watch carefully and learn the operation steps later."
The patient was brought in quickly.
This is a white-haired old lady whose left knee is swollen as thick as her thigh.
It looks scary.
When it was pushed in, he kept shouting "ah ah ah ah".
This kind of joint pain is very torturous.
It's not the kind of pain that kills people instantly. Rather, it's like a blunt knife cutting flesh, slowly torturing people until their will collapses.
"Grandma, we will treat you right away. Please sit still and keep this position."
When puncturing the knee joint cavity, it is best to treat the patient in a sitting position.
This makes it easier to select the puncture point.
"Here, all of you come and take a look. The puncture point is chosen at this location."
Doctor Shan took a pen and drew the puncture point.
"This puncture point is not the only one. Depending on the patient's actual situation, the puncture point can be taken on the inner or outer side below the patella. If the puncture is from the outside, it should be this position."
She taught very carefully.
The assistant, who looked to be about 28 or 29 years old, should be a resident doctor. It seemed that he had already mastered the task of puncturing the knee joint cavity. He just watched from a distance.
Didn't come close.
"Once you have found the puncture point, use a 5mL syringe to pierce the joint cavity from this location. Until you feel a breakthrough, it means... uh, only a breakthrough feeling means the puncture is successful."
Her expression froze for a moment, and the syringe in her hand seemed to encounter an obstacle in the puncture.
"Oh... girl, be gentle..."
The patient cried out in pain.
Doctor Shan couldn't help but blush.
When is Kuang Piao not good? It has to be when she is teaching the trainees.
Isn't this intentional to embarrass her?
The resident seemed to see Dr. Shan’s predicament and hurried forward to help.
"Doctor Shan, we men are stronger, let me try!"
He said this obviously to save Dr. Shan's face.
Help her out.
"It is not easy to successfully puncture the knee joint cavity. It is a secondary surgery. Please be careful and don't do it recklessly."
She was very grateful to the male doctor for helping her out.
I also took the opportunity to step aside.
The male doctor took the syringe, changed the needle and punctured again.
"Um……"
The veins on the male doctor's hands were exposed, and he must have been very strong. The old lady screamed in pain, and even her voice changed.
“It hurts, it hurts…”
She slapped the armrests of her wheelchair.
It might have really hurt her.
If the needle missed the target but hit the periosteum, the pain would be so intense that no one could bear it.
"Doctor Tang, you take a break first, let me do it!"
Dr. Shan didn't dare to let his residents perform the operation anymore.
She looked at the patient's film again and said with a little embarrassment, "Perhaps the patient's joint disease is more serious, and the difficulty of puncture is also doubled. But it doesn't matter, we can switch to the outside below the patella for puncture."
She changed the needle, and while comforting the patient, she found the puncture point on the outside and then performed the puncture.
“Hmm…”
Judging from her expression, she must be cursing in her heart, "Damn it, why is it stuck again?"
Zhou Can stood by and watched.
He also looked at the X-rays taken by the patient.
Just an ultrasound cannot clearly show the knee bones.
As Dr. Shan said, the patient's joints may have serious lesions, so the normal puncture points are useless during puncture.
After Dr. Shan tried twice more, his face turned red and sweat broke out.
When teaching, one mistake is enough to embarrass her.
Who would have thought that even after changing to the outside for puncture, it still failed.
This is just a preliminary puncture.
It's so embarrassing.
"Doctor Shan, I've practiced puncture before, why don't you let me try it?"
Zhou Can's injection skills are as high as level four, and his attending physicians are at a medium level.
When I first learned the injection technique, I thought this medical skill might not be of much use.
Now I understand.
In addition to injections, it can also be used for punctures.
Lumbar puncture, thoracic puncture, spinal puncture...all kinds of puncture work are what the interns in the operating room should master.
When I was in school, teachers often persuaded students to learn physics and chemistry so that they would not be afraid of traveling around the world.
Now, Zhou Can wants to tell all doctors that if they practice injection techniques well, all kinds of punctures can be done with just one needle.
Doctors who require two, three, or even more injections to successfully perform a puncture have not practiced the injection technique well.
Doctor Shan didn't know how to step down at this moment.
After multiple failures, if you try again, you may succeed. But you will most likely fail.
It will be even uglier then.
She was considering whether to ask someone to come over to help.
Zhou Can volunteered. Although she didn't hold out much hope, it was always a good thing to have someone to help her out.
Otherwise, if the first surgical patient made her lose face, how would she teach this group of interns later?
They didn't dare laugh at her in front of her.
Who knows what people will criticize behind your back.
"Be careful. If I tell you to stop, you must stop immediately."
She warned with some concern.
"OK!"
Zhou Can took the syringe and replaced the needle.
It must be said here that if the needle puncture fails, it is best to replace it with a new one.
The main purpose is to avoid introducing bacteria that could cause infection in the originally sterile joint cavity. If the puncture causes infection, the consequences will be serious.
A needle doesn't cost much.
Anyway, it is counted as consumables.
Zhou Can just touched the patient's joint and then inserted a needle into it.
"laugh!"
After the needle of the syringe penetrated the cortex, it encountered resistance and then punctured it quickly.
The puncture was successful with one needle.
"Is this a successful puncture?"
The several interns who were watching, including the nurses and resident doctor Tang, were all silent.
Hold your breath.
Wait and see the results.
Doctor Shan's eyes widened instantly until she saw the needle deeply embedded in the skin. Only then did she confirm that Zhou Can had hit the target with one shot. He easily completed the puncture of the knee joint cavity.
“So cool!”
Someone murmured in admiration.
Several trainees were feeling desperate. How could they compete when their competitors were so strong?
Fortunately, there are six spots in the operating room.
What they hope most is that among the eighteen trainees, there is only one genius like Zhou Can.
"Don't move, let me check it out!"
She squatted down , examined it carefully, and showed an expression of disbelief.
The needle actually hit the spot and the puncture was successful.
"Well, you did a great job. After puncturing into the knee joint cavity, we need to drain the joint fluid first."
She demonstrated the operation herself.
"After draining the joint effusion, inject about 10 ml of 0.25% lidocaine."
The purpose of injecting anesthetic is to facilitate subsequent treatment.
"This liquid medicine contains about 5 mg of triamcinolone acetonide. It is mainly injected into the patient's pain point. Then the patient is helped to move the knee joint so that the drug can take full effect."
Doctor Shan kept observing the patient's reaction.
The effect of the medicine should have taken effect and the patient should no longer cry out in pain.
"Grandma, your treatment needs to be divided into five sessions. Come back to the hospital in a week for the second session."
She said to the old man.
The old woman seems very happy now that she doesn't feel any pain in her knees.
"Thank you, thank you!"
The old lady thanked Dr. Shan and Zhou Can repeatedly.
Although she was old, she could tell who had cured her.
"Girl, I'm old and my memory is not good. Can you tell my son again later?"
"Okay! We'll tell your son later!"
After treatment, the patient was pushed out of the operating room.
Doctor Shan glanced at Zhou Can, then swept his eyes over the other interns.
"This treatment is usually carried out in five sessions. The first two sessions are injections of the liquid medicine mentioned earlier. Starting from the third session, the sodium hyaluronate mentioned by Dr. Zhou Can is injected. The difficulty in the treatment should be the puncture of the joint cavity. You need to read more, think more, and practice more."
Thinking of the joint puncture just now, she still felt a little embarrassed.
Until now, she still doesn't know why the punctures always fail.
This situation rarely occurs.
Just ask Zhou Can directly. I would be too embarrassed to ask her even if I kill her.
But this does not pose a problem for the smart girl.
"Doctor Zhou, please share with us your successful puncture experience just now."
"OK!"
Zhou Can glanced at Dr. Shan meaningfully.
Zhou Can naturally knew her little tricks.
I secretly admired Dr. Shan's speaking skills.
Director Shen's speech yesterday was very artful in leadership. Naturally, the apprentices brought up by Director Shen are not much worse.
"I was able to successfully puncture, first of all, it was definitely a lot of luck. Then, as Dr. Shan mentioned, the patient's joints were diseased, which might cause some changes in the bones, or even serious deformities. So I touched it and found that her joint cavity was narrowed. When puncturing, I deliberately chose a position that was close to the median line and slightly above it."
Zhou Can rolled up his trouser legs and demonstrated it to everyone.
After listening to this, Dr. Shan suddenly realized.
I see.
No wonder punctures failed several times when we encountered patients with severe joint diseases.
Every patient's joint disease is different.
The old lady just now should be one of the rarer types.
Zhou Can spoke modestly, saying that it was mostly due to luck.
In fact, she knew in her heart that people were subtly taking care of her face.
Her liking for Zhou Can also increased significantly because of this.
"Okay! Thank you, Dr. Zhou Can, for sharing. Let's look at the third patient's examination report."
The patient examination images displayed on the screen are two types of examinations: MRI and X-ray of the hand bones.
Generally speaking, MRI examinations are not cheap, and doctors with a little professional ethics will not prescribe this examination to patients casually.
This test will only be prescribed when the cause of the disease is unclear or the doctor believes that further examination is necessary.
And when prescribing a medicine, we will discuss it with the patient.
Ask the patient for their opinion.
The inspection report showed that after four or five minutes, no one responded.
Because the patient's condition is very complicated.
After two rounds of quick answers, everyone understood one thing: it is better to answer well than to answer early.
"No one can understand?"
Dr. Shan seemed very happy.
Finally, she had the chance to reestablish her authority and position as the lead surgeon.
This group of trainees can’t understand it, so she will explain it later, which will further demonstrate her high level.
There was a nasty mistake during the puncture just now, which is somewhat embarrassing.
"I only see that the patient's extensor tendon is ruptured, and the patient's joints also seem to have rheumatoid arthritis?"
Zhou Can was also a little unsure.
This involves knowledge of orthopedics, and it is really difficult for a trainee like him to answer it.
"I also think it was the extensor tendon rupture caused by rheumatoid arthritis."
Another trainee agreed with Zhou Can's opinion.
I guess he is just like Zhou Can and can't see it clearly.
Rheumatoid arthritis in the hands is very harmful and can easily cause rupture of the extensor tendon.
Many patients do not lift heavy objects or make violent movements in their daily lives.
Then I heard a "crackling" sound, like a rag being torn apart.
Then there was severe pain in the hand and loss of grip.
How painful can this pain be? It's like taking too big a step and pulling your crotch, the kind of tearing pain. And it's a continuous and severe pain that is unbearable.
In this case, it is most likely a tendon rupture.