Chapter 129 Lying Patient, Aseptic Necrosis
Now, Zhou Can’s plaster-casting skills are no worse than Dr. He’s.
If he were to spend a year in orthopedic surgery, his ability to apply plaster casts would definitely be better than that of most attending physicians.
The improvement in broken bone joining technique was also very encouraging. It also reached the lower level of resident doctors.
After all, this is an orthopedic surgery department, and there are many opportunities to connect broken bones.
During the past two months, Zhou Can followed Dr. Shan and Director Shen and got a total of 117 opportunities to reconnect broken bones.
He could feel a significant improvement in the level of broken bone healing.
In the past, the most common bone reconnection was of severed fingers, and senior doctors would basically only let him perform this type of bone reconnection, which had lower risks and was less difficult.
Now that he has reached the level of an osteopathic resident, he can also perform some operations on the connection of broken bones such as arm bones and tibias.
But the results he received were not as good as those of Dr. Dan and Dr. Chi.
The above three orthopedic medical skills have all improved quite well. However, the bone setting skill is still at the level of an intern after learning it, and there is no improvement at all.
The main reason is that there is no opportunity to get started.
The vast majority of patients who need orthopedic reduction are treated directly in the manual reduction room and are simply not able to enter the operating room.
Occasionally, because the dislocated or displaced joint is complex and difficult to reduce surgically, it needs to be reduced through invasive surgery.
This type of surgery is usually performed by the bone and joint team, and their bone trauma team has never performed it before.
There was nothing he could do as his bone-setting skills had not improved.
I can only wait and find opportunities for further study in the future.
The main purpose of regular training is to standardize diagnosis and treatment operation training. During this period, you only need to learn the basic operation methods, reception and treatment procedures.
It is not necessary to master every medical skill.
No one can master all the medical skills received in just three years.
They all start by getting started, learning the methods, and then slowly honing and improving their medical skills during the subsequent residency and medical practice.
In the more than two months in orthopedics, in addition to the improvement of his orthopedic medical skills, his suturing, ligation, hemostasis, debridement, separation and other medical skills have also been greatly improved.
The hemostasis technique has now reached the mid-level level of attending physicians.
Suturing and ligation can be done more often, so the experience points increase quickly. In addition, it is already close to the excellent level of attending physician.
As early as last month, he had reached the level of excellent attending physician and was almost reaching the level of associate chief physician.
He is particularly looking forward to it.
What would it be like to have director-level medical skills?
On this day, Zhou Canru arrived at the orthopedic surgery department early as usual.
Arrive at their group's doctor's office at least half an hour early, if for no other reason than to review the group's surgical cases. Knowing the information of the patients who are about to undergo surgery in advance can help them have a clear idea of what to expect during the surgery.
In addition, by observing the condition of patients after surgery and the surgical plan, you can clearly understand the therapeutic effect of the surgery.
To accumulate rich experience for his future medical practice.
When Zhou Can saw a case of talus fracture that was about to be scheduled for surgery today, while checking the various examination reports and films of the patient, the condition of the patient during the ward rounds emerged in his mind.
Judging from the X-rays taken of the patient, the talus was severely fractured.
Surgery is required to make an incision at the ankle joint, reposition the fractured talus, drill holes, and use screws for internal fixation.
Although the surgery is only performed on the limbs and does not seem complicated, this surgery is of level four.
Even the deputy director couldn’t preside over it.
Only the chief physician can perform the operation personally.
There is a strict standard for grading surgeries, and ratings are given based on a variety of factors, including difficulty and risk.
There is no easy surgery if it reaches level four.
Director Shen will personally perform this operation at 9 o'clock this morning.
Director Shen must have reviewed the examination reports and films. He may have conducted the preoperative interview himself or asked his attending physician to do so.
Zhou Can repeatedly enlarged the films taken of the patient and examined them carefully.
He had seen the patient's injured left foot, which was swollen and shiny. He had been hospitalized for two days, and the surgical plan was only formulated yesterday.
"What is Dr. Zhou looking at?"
Dr. He walked into the office and found Zhou Can was the first to arrive. He smiled and took the initiative to greet him.
"Check the patient information in the group. Can you help me check if there is any problem with this film of the patient?"
Zhou Can's intuition has always been sharper than a woman's sixth sense.
When he checked the patient's information, he always felt that something was wrong.
Doctor He Zhang came over and carefully examined the patient's X-rays.
"No problem, it's indeed a serious fracture of the talus."
After he looked at it, he found no problems.
"Maybe I'm worrying too much! I'll go to the ward to check on the patients."
Zhou Can stood up and walked towards the ward.
There are rows of open beds here.
There are too many patients seeking treatment in large hospitals. In order to save management costs and space to the greatest extent, they prefer to have open bed areas.
Along the way, family members and patients kept greeting him.
Smarter patients or family members basically know that Zhou Can has a very high status.
During the morning ward rounds, although Zhou Can was the fourth in line, Dr. Shan would take the initiative to discuss some important cases with him.
This is a treatment that Dr. Tang and Dr. He do not have.
The reason is very simple.
Zhou Can's pathological diagnosis skills are pretty good, and his knowledge of medical cases is quite profound.
Often able to give very constructive diagnostic advice.
Sometimes, Zhou Can can discover problems in time that others cannot.
This is a kind of dependence and trust.
Doctor Shan sought advice from him and felt at ease.
Patients and their families are very savvy.
Knowing that Zhou Can has a high status in the Department of Orthopedics, they naturally scrambled to curry favor with him in order to get more attention during the surgery and hospitalization.
Zhou Can went straight to bed 77.
"Mr. Zhao, we are going to arrange surgery for you today. Do you understand?"
"The nurse informed me yesterday evening and told me not to drink or eat anything."
The patient responded enthusiastically.
As Zhou Can's hidden status in orthopedics continues to improve, he is rarely treated coldly by family members or patients when he comes to make rounds.
Like now, he came personally to inquire about Mr. Zhao's condition, and both his family members and the patient were flattered.
"How many days have you been injured since your foot was injured?"
Zhou Can asked.
The patient's eyes flickered twice, and after thinking for a while, he said, "It seems to be three days!"
The family member next to him should be his father, who seemed to be unaware of his son's injury. He rushed over when his son was going through the hospital admission procedures and needed to be accompanied.
When you are hospitalized, the hospital usually makes an implicit requirement.
The hospital will not admit you if you don’t have someone to accompany you.
Because once admitted to the hospital, the hospital is responsible for the patient. Inconvenience in movement, going to the toilet, eating, preoperative preparation, and postoperative care are all very real problems.
It is impossible for the hospital to hire a nurse to serve here specifically.
Many people think that after being hospitalized and spending hundreds or thousands of dollars a day on hospital fees, it is only natural for them to be served by a nurse.
Hehe, I can only say that such people are too 'young'.
The duties of a nurse are to change the dressing, give IV drips, injections, monitor blood pressure, etc. Asking them to take care of your eating, drinking, defecating, and urinating is really too much to ask.
Some conceited male patients thought that the nurse had a sweet smile and a gentle attitude. Should they take this opportunity to date her and have a romantic encounter with her?
Patients with superior conditions, such as second-generation rich people, second-generation officials, young corporate executives, etc., do have a chance of success.
For the general public, it is better to keep to one's own business.
Don't think too much and get angry.
Zhou Can stared at the patient's left foot carefully and found that his ankle and instep were all swollen.
However, the skin surface is a little gray and wrinkles are visible.
"Are you sure you were injured three days ago?" Zhou Can's tone became a little more serious.
Being a doctor nowadays
If you speak to patients in a slightly harsh tone, they will become hostile and may even complain about you.
Zhou Can suspected that the patient was not telling the truth, but he could not blame him.
I can only ask again in this reminder tone.
Some patients lie to doctors and nurses for various reasons.
This makes people feel very helpless.
There are many reasons why patients lie, some of which are to cover up shame. For example, when Zhou Can was in the emergency department, he received a patient with a foreign body embedded in his anus. The patient said that he accidentally put it into his anus when he sat down.
Do you have the nerve to keep asking?
This kind of lie will not have any impact on the treatment. The doctor just needs to know it and will not point it out.
However, some patients' lies may lead doctors to misdiagnose and misjudge, which can have very serious consequences.
When an accident happens, not only the patient is unlucky, but the doctor is also wronged.
After being questioned twice by Zhou Can, Mr. Zhao's eyes were still flickering.
"If you misremember the time of the injury, it's not a big deal if it's only a few hours off. But if it's a few days or even longer off, it's very detrimental to your surgery."
Zhou Can really wasn't trying to scare the patient.
This operation itself is very .
There are huge differences in the information known before surgery, which can double the risk of surgery.
"It should be three days. I was drunk at the time, so I can't remember clearly."
The patient's insistence on lying is puzzling.
According to common sense, there is no need to lie about the time of injury.
What is the purpose of this person deliberately concealing the truth again and again?
Seeing that he couldn't get any information out of him, Zhou Can carefully observed his feet for a while and then returned to the doctor's office.
Coincidentally, Dr. Shan came at this time.
"Doctor Shan, there is a very strange patient in our group."
Zhou Can didn't want to get involved in this kind of business.
Since it involved surgical safety, he had to bring it up.
"Which patient?"
Dr. Shan is now very familiar with him and speaks to him in a very casual tone.
"Mr. Zhao, the one in bed No. 77."
"Director Shen was going to perform surgery on him this morning! What's the matter?"
Dr. Shan knew that Zhou Can would never say useless words.
She has always attached great importance to Zhou Can's opinions.
Immediately start to understand what is going on.
"When I checked the patient's information this morning, I felt something was wrong, but I couldn't find the reason. So I ran to the bed area to check the patient's actual condition. Judging from the hematoma on his foot and the gray and wrinkled epidermis, I think his injury may have lasted more than three days."
Zhou Can said seriously.
"Sometimes patients' memories are not so accurate, and a few hours' difference is not a big deal. It's not a limb replantation surgery anyway."
After hearing this, Dr. Shan didn't take it seriously.
"But I asked the patient twice, and he insisted that he had remembered the time of injury correctly. But his eyes clearly showed that he was lying. I was very puzzled, why would he deliberately lie about the time of injury?"
Zhou Can asked.
Doctor Shan thought about it and couldn't help but blurt out, "Could it be like the forensic TV series I watched recently, where the patient is trying to hide the crime?" He didn't expect that she had this hobby.
Most young women like to watch romance dramas and soap operas.
Maybe it has something to do with her profession, as her favorite TV series are actually forensic mystery dramas.
"If you deliberately postpone the time of injury, you can get rid of the suspicion of crime!"
Seeing that Zhou Can was puzzled, Dr. Shan added another sentence.
A word can wake a dreamer up.
Zhou Can thought about it and realized that this was indeed possible.
Otherwise, why would the patient lie?
"Should we report the patient's information to the police for investigation?"
Zhou Can asked her for instructions.
The hospital has this obligation.
If you encounter patients who are taking drugs, have gunshot wounds, have knife wounds, or have been beaten, you need to call the police in time to help them maintain public order.
When some criminals are injured, they dare not go to big hospitals and only go to small clinics to buy some medicine and treat their wounds themselves.
It is because they are afraid that the doctor will secretly call the police after discovering something abnormal.
"It's always a good idea to report it to the police station for investigation. Just call the police directly, don't call 110. Here is the phone number of the local police station."
She pointed to a business card pressed on the desk in an inconspicuous place in the office.
Zhou Can immediately called the police and reported the patient's condition.
The rest of the matter will naturally be investigated by the police.
He continued to think about his patient's surgery.
While thinking hard, he saw the date on the film and his eyes lit up.
This was filmed two days ago.
After two days, will there be any changes in the patient's bones?
"Doctor Shan, do you think the patient needs another X-ray before surgery?"
"The hospital takes the cost of treatment into consideration and usually does the same examination when the patient is admitted to the hospital. It will not be repeated within three days. After the operation, another examination is required when the patient is discharged to check the healing of the fracture site."
She was looking down at the medical records and examination reports of patients who needed surgery today.
Zhou Can could only look again at the patient's X-ray film that he had taken two days ago.
As he watched, he suddenly thought of something.
An X-ray of femoral head necrosis was immediately retrieved for comparison.
This comparison did lead to some discoveries.
Mr. Zhao's talus seems to have shown signs of necrosis.
Without careful comparison with other necrotic bone fragments, it is difficult to detect this extremely slight abnormality.
There are several contraindications for open reduction and internal fixation of talus fractures. If one of them occurs, the surgery is not suitable.
The first type is patients whose local skin conditions are not suitable for surgery. The second type is patients with malformed healing of old fractures. The third type is patients with aseptic necrosis of the talus. The fourth type is patients with severe comminuted fractures.
Zhou Can seriously suspected that the patient's talus had begun to show aseptic necrosis.
This is a major discovery.
Must report immediately.
Preoperative discovery and postoperative discovery are two completely different concepts.
"Doctor Shan, can you please take a look at this patient's talus and see if it shows any signs of aseptic necrosis?"
Zhou Can is just a resident intern and should have reported to Dr. Tang or Dr. He.
However, his position is quite special since his abilities are there after all.
In addition, Doctor Shan was present, so he reported the case directly to his superiors.
In fact, this is not the first time this has happened.
"No way? My teacher and I have looked at the film, and so has Doctor Chi, but they didn't find any problems."
Doctor Shan was a little skeptical.
Walk to Zhou Can's computer and check it carefully.
"My level is limited, so I can't tell. But this matter is very serious. I'll call Director Shen."
She called Director Shen on the spot.
"Teacher, I'm Shan Dan, sorry to bother you."
"When Dr. Zhou Can from our group reviewed the patient's information, he suspected that the patient who was going to have talus internal fixation surgery this morning had aseptic necrosis of the talus. I looked at the film carefully, but I'm not sure. I can only ask you to take another look."
Not long after hanging up the phone, Director Shen rushed to the hospital.
Went straight into the office.
"Xiao Zhou has a really sharp eye. So many of us didn't notice the problem, but you did. Regardless of the outcome, your meticulousness and prudence are worthy of recognition."
Director Shen smiled and praised him as soon as he entered the room.
Then carefully review the patient's films.
After a few minutes, his expression gradually became solemn.
"There are indeed signs of aseptic necrosis, but the symptoms are extremely mild. Let me take another X-ray of the patient and see the situation before making a final conclusion."
Because the patient will enter the operating room at 9 am.
The inspection can only be expedited.
Director Shen personally requested an expedited examination, and the Medical Technology Department dared not refuse it.
Soon, the patient's X-rays came out.
It can be seen that signs of aseptic necrosis are already quite obvious.
"Oh my god, it really is aseptic necrosis. Fortunately, it was discovered in time, otherwise even if the operation was completed, it would still be a failure."
Director Shen was so frightened that he broke out in a cold sweat.
"Xiao Zhou, you did a great job."
Director Shen praised him and then gave a solution.
"Tell the patient the situation first so that the patient and his family can be mentally prepared. Judging from the current situation, the talar necrosis has just occurred and is still in the early stages. The surgery can be evaluated based on the actual situation. It may be able to be solved by directly fixing the ankle with plaster after the surgery. For more serious cases, bone marrow stem cell transplantation can also cure it."
Director Shen said this with a frown, puzzled.
"That's weird. Logically speaking, it's only been three days since the injury, so it's impossible for necrosis to occur so quickly!"
After hearing this, Dr. Shan next to him laughed and said, "Dr. Zhou is really amazing. He told me early in the morning that the patient might have concealed the time of injury. I suspected that the patient was trying to cover up the suspicion of a crime, so I asked Dr. Zhou to report the situation to the local police station."
After listening to this, Director Shen suddenly realized.
Patted his forehead.
"No wonder. I was wondering how it was possible for the talus to become necrotic so quickly after being injured for less than three days. Doctors today are so exhausted! In addition to treating illnesses, they also have to learn some detective skills. Who would have thought that a patient would lie about such a trivial matter?"
One sentence made everyone smile.
