medical simulator

"Since the current drainage tube is unobstructed, we will observe it for a few more days. If bacteria can still be cultured in the subsequent drainage tube, we may have to do a debridement. However, the current strains of bacteria are changeable, and may not be the real focus of infection .”

Quan Zhuolin said: "At present, patients have great opinions, saying that our hospital has not even figured out the diagnosis. Several surgeries have been done in vain, and so much time and money have been wasted. In fact, we are already I tried my best, it’s hard to explain this situation.”

Infection is a big taboo in surgery.

Lu Bin asked: "Quan Zhuolin, I just heard that this patient was operated on by another hospital. How did such a patient come in?"

"Why didn't he go back to the previous hospital, or Shashi?"

This patient had a first visit to the hospital and was transferred after infection. Then they were wiping other people's buttocks, and Lu Bin was a little unhappy.

They are all prefecture-level city hospitals. Why don’t you let them deal with such troublesome patients by themselves?

The key is that the patient still doesn't understand, thinking that the disease cannot be cured after spending money, and they only come to you, which is a thankless type.

Before Quan Zhuolin could speak, Xie Limin said, "This patient was admitted by the head nurse. I don't know what's going on. When I was on duty, I was admitted to the hospital through regular consultation."

Generally speaking, the director accepts the patients, and then the bed doctor takes over. Therefore, Xie Limin first shirked his responsibility.

Quan Zhuolin pondered for a while, glanced at Xie Limin, and said, "Director Lu, this patient was called by the head nurse. I didn't know the situation at first. The head nurse originally planned to take you there. But because of this The month is special."

"So I will take care of it for the time being. You should know about this." Quan Zhuolin's tone was meaningful.

Lu Bin's expression changed slightly, and he glanced at Zhou Cheng who was sitting next to him, and found that Zhou Cheng's expression had not changed, so he knocked on the table: "The key thing we are discussing now is how to treat this patient in the future. It is recommended to transfer to a higher-level hospital, and other matters will be discussed later."

Quan Zhuolin found that Lu Bin was making fun of him, he tilted his head, and then turned serious again.

"Director Tong, what do you think?" Lu Bin asked.

Tong Xunjin, the Chief Physician, is relatively late and has the lowest qualifications at present. He said with a cheerful smile: "I think this kind of patient should be debrided several times and find sensitive antibiotics before we can make a conclusion. Otherwise, , There is no way to rely on empirical anti-infection treatment alone."

"It's not easy to do. It's very troublesome." Tong Xun kept shaking his head, saying that it was equivalent to not saying anything.

In fact, infection, it is easy to say, is a bacterial infection, but it is very troublesome to treat it.Laymen think that hospitals are fooling around, but people who really come into contact with this industry.will find out.

But any infection caused by surgery, such a patient, the dog will shake his head when he sees it.

Anyway, if there is no cure, there is only one sentence, good medicine is not a good commodity.This kind of person is very smart, smarter than people in the whole world. He regards medical practitioners all over the world as unscrupulous people, belonging to the level of saints. As long as there are poor people in the world, they are inseparable from him. !

Lu Bin then turned around and asked, "Doctor Zhou, what do you think of this patient?"

"Let's debride the wound. At present, the drainage tube is unobstructed, but no bacteria can be cultured, but the infection cannot be controlled. I think it is possible that the current continuous irrigation and drainage has not reached the place where the infection focus is concentrated. Debride the wound, and then during the operation, Then send the bacteria for culture."

"Strive to be able to find the focus of infection."

"A large-scale infection. From below the greater trochanter of the femur to above the ankle joint, a huge abscess cavity appeared, but there was no bone destruction. Moreover, the patient's blood sugar level was also fluctuating, so, in this case, must It is necessary to thoroughly debride the wound, otherwise, if it continues to develop, there may be a risk of amputation."

"Director Quan, when will you arrange the debridement of this patient?" Zhou Cheng didn't say much before, but now, he still thinks this case is more interesting.

It's very rare. Zhou Cheng had never seen such a strange case in the Ninth Hospital of Shanghai.

"It's just this afternoon, and there's only one for today. Doctor Zhou, didn't you have a small lecture in the morning." Quan Zhuolin said flatteringly.

Next month, Zhou Chengcheng will come to him, and he can finally relax a little bit, and introduce the biggest reassurance in the department to his own group.

Quan Zhuolin is still looking forward to it.

Zhou Chengcheng said: "Then let's go to the operating room to have a look later. I just think this case is very interesting. I don't know if it's convenient for you, Director Quan?"

To be honest, up to now, there are very few cases that Zhou Cheng finds interesting.The two surgeries I performed before, one for osteotomy and correction, and one for muscle necrosis, were both slightly interesting, not that interesting type of disease.

"It must be convenient, Dr. Zhou, you can come to the stage in person, we can only wish for it."

"Dr. Zhou, you have been in contact with many infection cases before, right? By the way, Dr. Zhou, you are in trauma surgery, how could you not have contact with such patients?" Quan Zhuolin laughed at himself.

Trauma surgery covers a wide range and is the foundation of the entire orthopedics department, with a wide range of contacts.

Zhou Chengcheng said: "Director Quan, that's not true. I don't have any experience in receiving patients with similar diseases. That is to gain knowledge. Let's learn from each other."

The more in-depth study, Zhou Chengcheng will find that the current types of orthopedic diseases are more complicated and complicated. The current types of diseases are known and unknown, which means that the level is not enough.

If you jump out 100 years and look at people 100 years ago, people at that time were much healthier, free from illness and pain, and they would be considered old if they were 60 years old.

If you skip 1000 years, there will be no concept of diabetes, high blood pressure, etc. At that time, sixty will be rare in ancient times.

Looking back after a few hundred years, it was still a doom for a woman to give birth to a child at that time, with a [-]% to [-]% mortality rate, even the imperial physicians in the palace were helpless...

At that time, there was no cancer at all, no terminal illness, and no infection. It was all wind-cold and hot air, and death from wind-cold meant bad luck.

Therefore, Zhou Cheng has always been in awe of medicine. He has never denied a certain medical concept and its ability to cure diseases, but in the same way, Zhou Cheng will deny all the more reasonable cognitions he now thinks.

Because only by constantly denying can we get closer to the truth.

"Doctor Zhou, you're joking." Quan Zhuolin smiled and didn't say anything more.

In this case, the troublesome points and difficulties have been clearly explained. What is needed is time to explore. Just holding a meeting here to discuss it will definitely not have much effect on the condition.

Then, it was time for Zhou Cheng's lecture.

Everyone knew the content of Zhou Cheng's lecture, so Lu Bin and Tong Xun soon called in everyone from their respective groups.

Limb transplantation is based on the concept of replantation of severed limbs. Combining amputation with amputation is very novel and bold. However, they all have their own basic concepts and are not particularly advanced thinking.

It's just that following Zhou Cheng's explanation, everyone would feel that it was Zhou Cheng who dared to be so skilled and bold enough to reinstall the legs of an amputee patient.

In this process, I gained a lot, but most of these gains belonged to gaining knowledge. If it is really necessary to implement it in the clinic, no matter whether it is Lu Bin, Quan Zhuolin, or Tong Xun, they dare not do so.

Fear of failure, and then the patient will make trouble, and now the patient's family will make trouble, and there will be money and death!

Zhou Cheng saw that everyone was listening seriously, but after he finished speaking, except for Qin Ming who asked two questions, everyone else remained silent.

This is far from Zhou Cheng's idea of ​​teaching.

However, teaching is like this, only those who want to learn will want to teach, and those who don’t want to learn, no matter how much they can be taught, they can’t be taught. We are all adults and independent individuals. Everyone only needs to be responsible for themselves .

At noon, everyone had a fast food together, a packed box lunch.

Then, all the talents left the operating room.

Tong Xun and Lu Bin were also there, hoping to see how Zhou Cheng did the basic operation of debridement, and whether he could do tricks.

Chapter 337 From Zhou Cheng's Crushing!

In the operating room, the patient has been anesthetized by the anesthesiologist on the operating table. Because the scope of the operation is relatively wide, general anesthesia is given.

However, when Zhou Cheng went to the operating table, he saw that the patient's right lower limb, from the thigh to the ankle above the calf, had surgical scars and incisions, like a graceful dragon swimming, and the water inlet and outlet pipes of the drainage tube were buried in the skin. .

This is a fresh surgical incision, and there are old surgical scars, black, like a few huge centipedes clinging to it, it is a little shocking to see.

At this time, several other tube bed doctors and subordinate doctors were preparing to pull out the drainage tube and complete the disinfection operation before debridement.

"Director Quan, you said earlier, where are the patient's drainage tubes placed?" Zhou Cheng couldn't remember clearly, or maybe Quan Zhuolin didn't describe clearly before.

"The side of the thigh and calf. The thigh is through the quadriceps gap, and the calf is through the tibia gap." Quan Zhuolin still gave a professional reply.

"Doctor Zhou, is there a problem?"

Zhou Cheng shook his head: "I'll just ask casually."

In front of so many people, Zhou Cheng naturally wouldn't tell the truth in his heart. There is a problem, but there is no problem. It's just that their cognitive levels are different.

Someone finished the preoperative preparations, and Zhou Cheng, Quan Zhuolin, and Lu Bin all washed their hands, and because of the participation of Tong Xun and Lu Bin, the deputy chief physician of Quan Zhuolin's group, after washing their hands and taking the stage, all He could only stand on the edge of the operating table and wander.

Zhou Cheng stood at the main operator's seat, and after putting on double-layer gloves, he said: "Teacher Tour, our hospital should have a large saline bag for sports medicine. This patient needs a lot of water for washing. Do you want to use it?" Go get a few bags, so that you don't hurt your hands when you open the normal saline solution for flushing."

The small bottle of normal saline is only [-]ml, and the large one is [-]ml. It is very convenient to connect multiple bags at the same time.

In severe infection surgery, thorough debridement and thorough lacuna flushing are particularly important.

Quan Zhuolin immediately said: "Xuan, go get the flushing gun and flushing tube, I didn't think of it before."

Tour responded quickly.

During the tour to prepare these things, Zhou Cheng had already led people to start the exposure work, and the wound was a bit big. This can be said to be the biggest wound since Zhou Cheng's surgery.

From the proximal end of the femur to the distal end of the tibia, the surgical incision is as long as the entire lower limb. It is estimated that it will take two hours to suture...

There was a surgical incision before, so Zhou Cheng didn't make any other incisions, but went down along the original surgical approach.

There is nothing special about this process at all. The original incision is opened, that is, the sutures are cut, and the exposure process is quite satisfactory, and no tricks can be made.

Seeing this, Quan Zhuolin and Tong Xun glanced at each other, seeming to say that Dr. Zhou Cheng is not as good at dealing with infection as he is at performing fracture surgery.

During the fracture operation, from the very beginning, Zhou Cheng would give people a sense of surprise, which brought a sense of surprise, and even if he watched it many times, he could still see the difference.

This makes them slightly disappointed.

Moreover, after the opening was exposed, Zhou Cheng still completed the debridement operation step by step. Debridement is nothing more than cutting the necrotic tissue and the rotten tissue on the surface of the infected muscle, scraping it off, and completely removing it. This is the most basic. In principle, there is nothing to see.

Coupled with the washing of the washing gun and the soaking of multiple dilutions of complex iodine, the re-exposed wound is not surprising. Zhou Cheng's operation is not fast. It took about an hour to complete the superficial debridement , a normal surgical rhythm.

Seeing this, Lu Bin said, "Doctor Zhou, can the incision be closed now? I think the parts that should be debrided have been cleaned up."

Zhou Cheng shook his head: "Director Lu, don't rush to close it for the time being. This is just the most basic debridement, and there are still some latent cavities that we haven't opened. If they are left untreated, the patient's postoperative The chances of re-infection will still be higher.”

"This operation has just begun." Zhou Cheng said helplessly, but at the same time he was a little excited.

Cases are the best teacher and the best subject undertaker. Infection cases are the best materials for him to explore his basic anatomical theory in actual clinical practice. He has an in-depth understanding of the needs of patients, which is perfect!

Lu Bin was a little embarrassed when he heard this, but still chose to respect Zhou Cheng's choice.

Just curious, what Zhou Cheng will do next.

However, immediately after, Lu Bin discovered that Zhou Cheng began to move the quadriceps muscles in strips starting from the proximal side of his thigh, carelessly pulled them apart, and, using blunt hemostatic forceps, continuously Provoking something.

This is an operation on a single muscle. What is it for?

But soon, Zhou Cheng's manipulator gave Lu Bin an answer, and saw that Zhou Cheng inadvertently exposed a milky white liquid the size of a grain of rice, which appeared in everyone's eyes. In front of the field of vision.

In the normal structure of the human body, there is no milky white color.

Muscle is red, even if it is rotten muscle, it is mostly dead milt, not milky white, fat is light yellow, and necrotic fat tissue is that kind of dry white.

Milky white is usually formed by emulsification after the infected tissue destroys the structure of normal tissue.

Can Zhou Cheng also find it this week?

"Doctor Zhou, there are still abscess cavities in this place, under normal circumstances, it is difficult to find it?" Quan Zhuolin's expression became serious.

Don't underestimate the existence of this rice-grain-sized infection focus. With its existence, it will take another five days to refill all the infection focus that has been cleaned up before. This is not alarmist talk!

There was already a slight sweat oozing from Quan Zhuolin's back. If Zhou Cheng hadn't discovered such an infection focus, I am afraid that the debridement effect this time after the operation?

"It's hard to find, but I have carefully read the patient's MRI before the operation, and I think there is almost an edema signal in this place." Zhou Cheng gave a reasonable explanation.

Yes, on the NMR, there is a lot of information, so much that the average person may have a brain explosion if they have to fully accept it. An ordinary doctor can read one-tenth of the information above, and he is already at the level of a professor with profound skills. .

"Ah!~~~" Quan Zhuolin felt a little embarrassed.

It was found on the NMR, why didn't I see it?This was the first time that Quan Zhuolin felt that Zhou Cheng could be so terrifying.

However, it wasn't over yet. Immediately afterwards, Zhou Cheng moved a little further down and used the hemostatic forceps again to peel off the second milky thing, which was the size of a little fingernail.

Although it is milky white, it is like red, with white sticky substance hidden inside, and even scabs.

Zhou Cheng took it out and observed it in front of his eyes for a while: "This thing still has a capsule? Send it to a bacterial culture. I guess, this patient has multiple bacterial infections, and there are different bacterial sources."

At this moment, the scalps of Lu Bin and the others began to go numb.

Before that, they all felt that the operation of this operation should have been completely completed.

Zhou Cheng was also able to find the first infection focus, which may have been due to luck and strength, but the existence of this infection focus sounded a wake-up call on their heads.

Perhaps, the reason why the infection will repeat is not an accidental event, but an inevitable event due to lack of strength!

However, how did Zhou Cheng discover such a hidden focus of infection?

The eyes of Lu Bin and Tong Xun intertwined, and they could see doubt and shock from each other's eyes.Quan Zhuolin is the chief physician in charge of the patient. He doesn't have the time to question, but is afraid and reflective.

What I thought before was that I had done my best, but was it really my best?

So many infections, could it be because of my own ability?

However, how to find such a hidden focus of infection?

"Doctor Zhou, is this also seen through MRI?" Ask if you don't understand, the big deal is to strip yourself more thoroughly and admit your shortcomings, which is not a shameful thing.

Because Quan Zhuolin knows very well that if he is still ignorant in the field of orthopedic trauma surgery, then at least 90.00% of the doctors in the country are laymen.

It can only be that Zhou Cheng is too outrageous.

"Yes. There are actually a lot of information we can read on the MRI. If Director Quan is interested, we can discuss it next time, or after the operation is over, we can do a review of the scans." Zhou Cheng did not reply proudly.

The first state of film reading is not to watch the film, but only to read the report, which is what most residents do.

The second state is to be able to see the problems of specialists. It belongs to the state that doctors in the imaging department cannot see it, but specialists can see it. It is separated from the report and only looks at plain films.This is the beginning of not being a film doctor.