Chapter 306： Third

Chapter 306

In the first twenty-four hours, Zhang Fan also fought directly in order to knock on the mountain. Sometimes, at the technical level of surgery, there is really no way to do comparison, especially for conventional surgery. You say you did a good job, and I also said that I did a good job. Difficult surgery, after all, is a minority, not every day. Therefore, Zhang Fan's 24-hour continuous operation is also a way to show the card, and I will tell you directly: I am here!

Doctors can also be regarded as literati. There is rarely a bayonet in the department or the hospital. Unless it is a critical moment, such as changing the director and director, the competition under normal circumstances is relatively mild. But Zhang Fan couldn't wait. He didn't want to waste time on such things, so he directly declared in a rude way: I'm here!

For seven operations, Zhang Fan performed seven consecutive operations, and the anesthesiologist, surgical nurse, and itinerant nurse changed three crops. The assistants were Wang Yanan and Xue Fei. By the end of the last operation, Xue Fei was exhausted and couldn't get up directly lying on the floor in the operating room!

"Dr. Zhang, you are also exhausted, lie down for a while! Seven operations are really amazing!" The older nurse in the operating room said to Zhang Fan. Zhang Fan waited for this sentence. After Wang Yanan and Xue Fei both had surgery, they fell on the ground like dead pigs, and their mouths were unwilling to open, let alone other things.

"It's okay, where is this? I haven't had surgery for a long time. I haven't enjoyed it!" Zhang Fan said cheerfully, and then helped the nurses to pack things. Isn't Zhang Fan tired? Pull, absolutely tired, this time he is also bracing himself!

"Yo! Dr. Zhang, you dare not move anymore, let's clean it up ourselves." Another nurse quickly took away Zhang Fan's hands.

"I'm not tired." Zhang Fan said with a smile.

"If you are not tired, take a rest, drink some water, go to the bathroom or something!"

Zhang Fan really wanted to say one more thing, there wasn't one who could fight, but no one held up. The nurse finished packing and left, Xue Fei and Wang Yanan were asleep!

Although Zhang Fan felt that the pretend effect was not very good, the next day, the surgical system already knew, especially the three orthopedic doctors, "Know no, yesterday, Zhang Fan performed seven consecutive operations, and the last operation came down. In the future, I said directly, there is no more, this is the event! "

"real or fake?"

"Have you heard?"

"what?"

"Zhang is about to dominate the operating room!"

"How can I do? Hi! You said this thing, not high technology, physical strength is as good as a large animal. Let others not live!" This is two orthopedics doctors chatting.

In the morning, have a morning meeting. Zhang Fan and his team work in shifts. In the department, they usually work on duty. Zhang Fan started to work: 43 original patients, 11 were discharged, 12 were newly admitted, and 10 were operated yesterday. Among them ~~~~, these newly admitted patients and surgical patients are discharged and the patient numbers are to be explained, what surgery was performed, what was the operation, what was the case at night, what was the case in the morning.

At night, the patient has no pain, no fever, what is the treatment of the pain and fever, what medicine is used, is there any bleeding, and whether the gauze has been infiltrated? These must be explained because these are the daily work of the doctor. Most people think that doctors may have surgery all year round. They do surgery every day and do nothing else.

In fact, except for some senior surgeons, ordinary surgeons, surgery during work hours, observation of patient numbers and writing of medical records during work hours, these things do not take much less time than the operation time, so the doctors are busy and have to Busy, such as this medical record, all have time requirements, and now all electronic medical records, a new patient number, how many hours must complete the large medical record, beyond this time, well, can not write, just can't play directly Open this big medical record, and then wait to be criticized and fined. The leader doesn't care how many operations you had yesterday.

Zhang Fan explained the situation of the patients one by one. The doctor in the orthopedics department opened his mouth in surprise. Others did three, and the rest of the operations were performed by Zhang Fan. A voice sounded in the heart of the department doctor: Is this still human?

Generally, in this case, the doctor will divert the patients and do it for the other groups of doctors, but Zhang Fan's group just finished the operation without saying a word. Can't you be shocked!

After Zhang Fan finished the class, Lao Gao said: "In the future, when there are many surgical patients, you can call others, don't get tired."

"Good director!"

After the handover of the patients was clear yesterday, the discussion on tomorrow's surgery will follow. In general, especially for non-emergency surgery, it must be discussed in the department before surgery. What kind of surgery method and which fixed instrument are used must be planned.

"Tomorrow, patients in our group of sixteen beds will be admitted due to oblique fractures of the femur. After completing the relevant examinations, it is planned to perform internal fixation of the femoral fracture plate tomorrow. Selecting a titanium alloy locking plate ~~" Zhou Chengfu's patient number Take it out at this time to start the discussion.

Zhang Fan frowned a little while listening. What did you say? Especially for this kind of femoral fracture surgery, the medical community is particularly disputed, two schools. They are divided into two groups based on the characteristics of the bones. Because bone nourishment and blood supply are also divided into two sets, one is the tiny capillaries crawling on the periosteal bone surface, and the other is the blood supply inside the bone marrow.

Surgery is for the purpose of treating illnesses and saving people, but because it is an open treatment, there must be injuries. Doctors continue to improve the surgery to reduce injuries. For example, for this femur fracture, there are two conventional methods and two internal fixation methods.

One is the steel plate, which fixes the fracture end, the advantage is simple and straightforward. The disadvantages are also obvious, a large number of periosteum are damaged, and the form of fixation is a little too strong. The bones are not wood. The stronger the fixation, the better. In fact, how can the fracture heal fast and heal well? It is that under the fixed precursor, the fracture end can have a slight mobility, not less than two millimeters. Activity. It sounds very contradictory, but this is the biological characteristic of bone healing.

Another type of fixation is intramedullary fixation. Make a mouth from the proximal end of the femur, drive the intramedullary needle into the cavity of the femur, pass the broken end, and then fix it at the distal end. The advantage is that the axis is fixed, which not only hardly damages the periosteum, but also conforms to the biological characteristics of bone growth. The disadvantages are also obvious, and the blood supply system in the medullary cavity must be damaged.

Zhang Fan is not an admirer of any kind of technique. He is more inclined to choose the most suitable surgical method based on the situation and patient conditions.

After Zhou Chengfu introduced the condition and the surgical plan, he turned to Lao Gao. In the department, how a patient performs surgery and in what way, the doctor in charge makes a plan first, and the director just decides whether to perform the operation, when, and who will do it. He is the last person to approve the gatekeeper before the operation.

Lao Gao, looking at the X film on the viewer, said to everyone: "Discussion. Everyone talk about their ideas." In the hospital, especially the surgical department, everyone usually talked and laughed, and worked together during the operation. Together to fight against the disease and pain, but often during the pre-operative discussion, often blushing and thick neck. Especially when this kind of academic has not been conclusive, and there are many such conclusive ones.

"Let me talk about it. I think it is better to choose intramedullary fixation for this operation. The first patient is a woman in her sixties. The periosteal damage caused by steel plate fixation is too serious. It is difficult for the patient to recover in the later stage. Damage. "A deputy senior from the other group spoke. At this time, the residents of Zhou Chengfu's group were recording that this discussion was to be recorded, and everyone's speech would be reflected in the medical record.

"Yes, it will cause periosteum damage, but the secondary damage is not necessary. This patient is already in his sixties. The titanium alloy steel plate is now antibacterial. It is not necessary to take the steel plate at such an age. The second intramedullary fixation Isn't there any damage? The patient is not old anymore, and the bone blood supply is mainly bone marrow blood supply, so plate internal fixation is definitely superior to internal fixation. "

Doctors began to express their opinions one by one, and not all surgeries will have such discussions, but once they encounter such an operation that is not academically conclusive, the debate is very fierce. This is an academic argument, an interest argument, and a right of speech argument.

When it is the attending doctor's and resident's turn to speak, they immediately become a standing team. The doctors at the deputy or positive level have already shown the advantages and disadvantages very clearly. Without the resident doctor talking nonsense, the standing team becomes! At this kind of moment, once the director can't suppress, and technically can't suppress the crushing, the department over time becomes a battlefield without cohesion.

Of the five groups, two groups supported plate internal fixation and two groups supported intramedullary fixation. In the end, Zhang Fan and their newly formed team members left their opinions.

"Xue Fei." Lao Gao named.

"I think it's all right! ~" This thing is heartless and heartless, but what it says is impeccable. Yes, both are suitable. And there is no evidence-based medicine to prove which is better!

"Zhang Fan." Lao Gao glanced at Xue Fei and continued to call.

Everyone unexpectedly looked at Zhang Fan. The old doctor who had seen Zhang Fan's record now also wanted to hear Zhang Fan's opinion, knowing that he couldn't jump out of this trance, but looked over. Young doctors, especially the new Xu Xian, also want to see Zhang Fan's vision. He thinks that intramedullary fixation is absolutely advantageous, and it depends on whether Zhang Fan has this vision.

"I don't think both surgical methods are appropriate!" Zhang Fan really said something amazing.

"Why? I want to go outside and fix it. Isn't this a joke!" Zhou Chengfu's deputy high school was anxious when they heard it. The outside fixation is also a fixation method. To put it simply, it is like building a building outside the building Like the steel frame, fractures can also be fixed this way. The benefits are obvious, the damage is small, but the disadvantages are also obvious, the applicability is too narrow, and it is easy to be infected, and the later care is too troublesome.

This femoral fracture is not suitable for external fixation, and this fracture is even more difficult to use external fixation. Therefore, this acute sub-sub-high directly interrupted Zhang Fan's speech. Although a little impolite, his mood was understandable.

Zhang Fan did not care, but said with a smile, "Director Chen, do you think this surgery can be fixed externally?" Now Zhang Fan is going to set up a banner, especially this academic discussion, not humble If you can persuade others, you need to come up with something. Since you can interrupt me, I will ask you, when you discuss it later, you have thoughts when talking, and think about interrupting later. I!

"Eh! No." Dr. Chen's momentum was gone. Zhang Fan asked the other question, and asked Dr. Chen cold sweat directly, Zhang Fan did not say it was external fixation. "Hi! Coarse." Lao Chen scolded himself!

"Continue! Surgery." Lao Gao interrupted Zhang Fan's question. Lao Gao's face was colorless, unhappy or sad, and embraced with his hands. He also wanted to hear Zhang Fan's thoughts. In this operation, Lao Gao also tended to intramedullary fixation.

At this time, Zhang Fan stood up and gently swayed the hem of the white gown, just as an ancient master threw the hem of the gown before going on stage, and he was imposing. "Ka! ~" Zhang Fan opened the folding plastic ruler that is usually used for measuring bones, took it in his hand, and walked towards the film viewer.

"Look at everyone! The broken end of the fracture is broken in the femur, and it is an oblique fracture, an unstable fracture. But the plane displacement of the port is not very severe, and it is still a non-open fracture, combined with the patient's age, so my Opinion is intramedullary fixation. "

As soon as Zhang Fan finished speaking, he heard a lot of doctors' disdainful snoring noises. Lao Gao also frowned, but after a moment's thinking, he became expressionless. Xu Xian was also slightly disappointed when listening, Zhang Fan was full of momentum, but his words were out of stock. "That's it!" He thought secretly.

Everyone ignored it. Zhang Fan said that the two surgical methods were not suitable. Lao Gao understood, but the operation was too difficult.

"Closed intramedullary fixation!"

"Closed intramedullary fixation?" Many words, but the difficulty is increased in magnitude! Some people couldn't help asking their voices, and they couldn't help but be produced by the doctors of the senior level. Doctors below the senior level couldn't realize the difficulty of this operation. Several deputies looked at each other, not shocked but confused. The faces of some attending and resident doctors who are not learning well are all confused, yes, confused. What is closed intramedullary fixation? Such as Xue Fei!

Closed intramedullary fixation is actually simple, that is, it does not cut the skin and soft tissues, and directly fixes without exposing the fractured ends. Simply speaking, it is blind-tapping, which is too technically demanding, and this surgical method is generally A fairly stable fracture is the only surgical method. Even stable fractures, ordinary hospitals and doctors will not choose.

Yes, this surgical method is the least damage to the patient, but it is too dangerous for the doctor, because it is a blind stroke, the possibility of accidents and deviations is too great. The fracture error is two centimeters or even millimeters. of. Once the fixation is not good, or the fracture will cause the fracture to shift and form an angle after the fixation, and then it will lead to fracture healing deformity. This becomes a medical accident. Once a medical accident occurs, no one cares whether you are considering it for the patient. Therefore, let alone this kind of operation in a basic hospital, even in a large hospital, is not a director-level doctor, and generally will not be easily done.

"This is an oblique unstable fracture, not a stable fracture, my brother! Can you guarantee that the stump reaches the physiological anatomic position?" The other vice high said to Zhang Fan with a bit of regret or helplessness. This is the helplessness of doctors, who dare not try and never step forward unless they are skilled.

"I can!" Zhang Fan stood in front of the light watching machine, holding a ruler, and said with a straight face.

"Um! He can." The doctor of the first senior rank, who didn't want to speak anymore. Because Zhang Fan's record is terrible! They doubt and doubt, they are tangled!

The original secret discussion was gone, quiet! Just like the appearance of the Net Street Tiger, everyone didn't even have eye contact. They looked at the director quietly, but the director looked at Zhang Fan.

Finally, Lao Gao said, "Have you ever done this?" This is the grassroots hospital. No matter how high your surgical technique is, if you encounter a special operation, the first question you ask is whether you have done it or have experience! Large hospitals also have various guarantees for you to innovate, and primary hospitals are first and foremost safe. What are grass-roots hospitals? Except for the top 30 hospitals in China, all are grass-roots hospitals!

The difference between these grassroots hospitals is the advanced level of equipment, the level of doctors' education, and the speed of learning new treatments in higher hospitals. Do scientific research! Which is a floating cloud, that is, spinning around the corners of the disease.

Want to take risks to innovate? Not to mention the patient's family, the hospital can break your leg! This matter is good or bad, there is no way to discuss it, but one thing is very clear. Although the development of technology is progressing slowly, all the heavy research tasks have been delegated to higher-level hospitals, but the medical accidents have indeed decreased significantly, and they are responsible for patients. It seems irresponsible, anyway, very awkward.

"Have done it!" Zhang Fan's face is not red. Although he has not done it in reality, Zhang Fan has no white liver in the system. The surgery in other departments is difficult to say, but orthopedic surgery. Know how many times. This is his guarantee, this is his confidence!

"determine?"

"determine!"

Lao Gao thought, hesitated! It seems to have passed for centuries, but it is actually more than ten seconds. Then he turned around, "Director Chen, what do you think?" Lao Gao asked, in fact this is to give Chen face, Lao Gao has already tended to Zhang Fan, now is to give Lao Chen a step!

They are all clever people. It would be useless if Lao Chen held his neck to disagree, and Lao Gao directly gave Zhang Fan the sick number. If Zhang Fan's operation was successful, Lao Chen would have a hard time doing it! This is the power of the director, which most doctors aspire to.

"The difficulty is too high! I don't have any grasp on the director!" Lao Chen was able to tone up or sternly to Zhang Fan, but he was very low-key to Lao Gao.

"Will I take Dr. Zhang for this operation?" Lao Gao asked again. This is where the steps have been put on each other. Lao Gao is coming to the surgery alive, the risk? The risks are not small. Once Zhang Fan couldn't do it or there was a medical accident, it was Lao Gao's turn to do it. If he couldn't make it, his director couldn't do it.

But Lao Gao was willing to trust Zhang Fan and was willing to carry Zhang Fan. This is the technical dog who engages in technology, not a politician. In the technology industry, once you can show your excellence, there will definitely be someone who will carry you, that is, the difference in carrying strength.

Lao Gao really wholeheartedly carried Zhang Fan. What is a great doctor, this is what Lao Gao is! At his own risk, let the younger generations move forward, there are so many doctors in this place of life and death! They are the cornerstone of Huaguo's medical industry!

"Okay, I can help!" Lao Chen did not fall into the rock or be a bystander. Academics can argue, once determined, the rest is to work together, this is an excellent department!

"Okay! Non-emergency surgery tomorrow, all stopped, watch this operation!" Lao Gao finally smiled, with a smile, since it is all this way, simply raise the table a little higher, maybe Zhang Fan can take off sooner!

At this time, the doctors turned to look at Zhang Fan. Zhang Fan was like Lao Gao with a smile, and slowly closed the ruler in his hand, "click!"

No more tickets?

(End of this chapter)