Medical road

In the first twenty-four hours, Zhang Fan also fought so hard that he could knock the mountain and shake the tiger.Sometimes, at the level of surgical techniques, there is really no way to compare, especially for conventional surgery. You said you did it well, and I said I did it well.After all, difficult operations are still rare, and they cannot be encountered every day.Therefore, Zhang Fan's 24-hour continuous operation is also a way to show his cards, and he will directly tell everyone: I am here!

Doctors can be regarded as literati. In departments or hospitals, there is rarely a tit-for-tat against a bayonet, unless it is a critical juncture, such as changing the dean or director. Under normal circumstances, the competition is relatively mild.But Zhang Fan couldn't wait. He didn't want to waste time on this kind of thing, so he directly declared in a rough way: I'm here!

In the seven operations, Zhang Fan performed seven consecutive operations, and the anesthesiologist, surgical nurse, and itinerant nurse changed three times.The assistants were Wang Yanan and Xue Fei. By the end of the last operation, Xue Fei was already exhausted and was lying directly on the floor of the operating room, unable to get up!

"Doctor 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 just waited for this sentence. Wang Yanan and Xue Fei were both put on the ground after the operation, just like a dead pig. They didn't want to open their mouths, nothing else.

"It's okay, where is this? It's been a long time since I had an operation, I haven't enjoyed it yet!" Zhang Fan said cheerfully, and then helped the nurses pack their things.Isn't Zhang Fan tired?Tugging, absolutely tired, he will also be pretending to be forced!

"Yo! Doctor Zhang, don't you dare to move anymore, let's clean up by ourselves." Another nurse hurriedly picked up what Zhang Fan was holding.

"I'm really 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 is no one who can fight, but no one praises it.The nurse finished packing and left, Xue Fei and Wang Yanan were already asleep!

Although Zhang Fan felt that the effect of pretending was not very good, but the next day, the surgical system already knew, especially the three orthopedic doctors, "You know, yesterday Zhang Fan performed seven consecutive operations, and the last operation came down. From now on, just say, if there are any more, then the activity will start!"

"real or fake?"

"Have you heard?"

"what?"

"Person Zhang is about to dominate the operating room!"

"How can I do? Hey! You said this thing, not to mention high technology, good physical strength like a big animal. Let others live!" This is a chat between two orthopedic doctors.

In the morning, we have a morning meeting.Zhang Fan and the others handed over in groups. In the department, it was usually whoever was on duty.Zhang Fan started to hand over: 43 original patients, 11 discharged, 12 new admissions, and 10 surgeries yesterday.Among them~~~~, these newly admitted patients and surgical patients and discharged patients are all required to explain, what kind of operation was performed, what was going on, what was going on at night, and what was going on in the morning.

Does the patient have any pain or fever at night? How to deal with the pain or fever? What kind of medicine is used, whether the bleeding has been bleeding, whether the gauze has been penetrated, these have to be explained, because these are the daily work of the doctor. Most people think that doctors may be doing operations all year round, but doing operations every day and not doing other things.

In fact, with the exception of some senior surgeons and ordinary surgeons who perform operations during work hours, observe patient numbers and write medical records during work hours, these things take no less time than the operation time, so the doctors are busy and have to Busy, for example, this medical record requires time, and now it’s all electronic medical records. For a new patient number, a major medical record must be completed within a few hours. If this time is exceeded, it’s OK. I can’t write it. I just can’t type it. Open this big medical record, and then wait to be criticized and fined. The leader does not care how many operations you had yesterday.

Zhang Fan explained the situation of the patients one by one, and the doctors of the orthopedics department opened their mouths in surprise.The others did three, and Zhang Fan did all the remaining operations.The doctors in the department heard a voice in unison: Is this still a human!

Normally, in this situation, the doctor would shed the patient and give it to the doctors in other groups to do it, but Zhang Fan and his group just finished the operation without saying a word.Can you not be shocked!

After Zhang Fan handed over the shift, Lao Gao said: "From now on, when there are many cases of surgery, you can call people and don't get tired."

"Good director!"

After yesterday's patient handover is clear, the discussion of tomorrow's surgery will follow.In general, especially for non-emergency surgery, the preoperative discussion must be conducted in the department. What kind of operation method and what kind of fixed equipment are used must be predetermined.

"Tomorrow, 16-bed patients in our group will be admitted to oblique femoral fractures. After completing relevant examinations, we plan to undergo internal fixation of femoral fractures with steel plates tomorrow. Titanium alloy locking steel plates will be selected." Zhou Chengfu and his group's patient.Take it out at this time and start the discussion.

Zhang Fan frowned as he listened, what should I say.Especially for this kind of femoral fracture surgery, there are many controversies in the medical field, two schools.Both are divided into two groups due to the characteristics of bones.Because bone nourishment and blood supply are also divided into two sets, one is the tiny capillaries crawling on the bony surface of the periosteum, and the other is the blood supply inside the bone marrow.

Surgery is to treat diseases and save people, but because it is an open treatment, there must be damage. Doctors continue to improve the operation method to reduce the damage.For example, for this femoral fracture, there are two conventional methods, two internal fixation methods.

One is the steel plate, which fixes the broken end of the fracture. The advantage is simple and direct.The shortcomings are also obvious, a lot of periosteum is damaged, and the fixed form is somewhat too strong.The bones are not wood. The firmer the fixation, the better. In fact, how can fractures heal faster and heal well? That is, under the fixed and solid precursor, the fracture end can have a slight mobility, not less than two millimeters. Activity.It sounds very contradictory, but this is the biological nature of bone healing.

Another fixation method is intramedullary fixation.Make a mouth from the proximal end of the femur, drive the intramedullary needle into the femoral cavity, 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 disadvantage is also obvious, it will damage the blood supply system in the medullary cavity.

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

After Zhou Chengfu introduced his condition and surgery plan, he looked at Lao Gao.In the department, the doctor in charge makes a plan for how a patient performs an operation and what method is used, and the director decides whether or not to perform the operation, when and who will do it. He is the last approval gate before the operation.

Lao Gao, looking at the X-film on the viewer, said to everyone: "Discussion and discussion. Everyone talks about their ideas." The hospital, especially the surgical department, usually talks and laughs, and works together during surgery. Work together to resist disease and pain, but when discussing before surgery, I often blush and have a thick neck.Especially when this kind of academic is not yet finalized, and there are still many such uncertain times.

"Well, 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 60s. The plate fixation damages the periosteum too severely. It is difficult for the patient to recover later. If the plate is taken later, it will be a second time. Injury." A deputy high in the other group spoke.At this time, the resident doctors in Zhou Chengfu's group were recording that this discussion was for the record, and everyone's speech would be reflected in the medical record.

"Yes, it will cause damage to the periosteum, but secondary damage may not be necessary. This patient is already more than sixty years old. The titanium alloy steel plate is now antibacterial. There is no need to remove the plate at such an age. The second intramedullary fixation Is there no injury? The patient is already quite young. The blood supply of bone is mainly the bone marrow, so plate internal fixation definitely has advantages over intramedullary fixation."

The doctors started to express their opinions one by one according to their ranks. Not all surgeries will have this kind of discussion, but once they encounter this kind of academically inconclusive surgery, the debate will be very fierce.This is an academic controversy, a controversy over interests, and a controversy over the right to speak.

When it is the turn of the attending doctor and resident doctor to speak, they are directly standing in line. Doctors at the sub-high or positive level have already expressed their advantages and disadvantages very well. There is no need for resident doctors to talk nonsense and stand in line!At this kind of moment, once the director cannot be suppressed, he cannot be suppressed technically, and the department becomes a battlefield over time, without cohesion.

Of the five groups, two groups support plate internal fixation and two groups support intramedullary fixation.Finally, Zhang Fan and the newly formed team members are left to express their opinions.

"Xue Fei." Lao Gao called his name.

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

"Zhang Fan." After taking a look at Xue Fei, Lao Gao continued to roll his name.

Everyone unanimously looked at Zhang Fan. The old doctor who had seen Zhang Fan's previous record also wanted to hear Zhang Fan's opinion. Knowing that he could not escape the shackles, he still looked over.Young doctors, especially the newcomer Xu Xian, also want to see Zhang Fan's vision. He believes that intramedullary fixation definitely has an advantage, and it depends on Zhang Fan's vision.

"I don't think the two methods of surgery are appropriate!" Zhang Fan really didn't stop talking.

"Why? I want to fix it externally. Isn't this a silly thing!" Zhou Chengfu and his group's vice-president was anxious when he heard it. Like the steel frame, fractures can also be fixed in this way.The advantages 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 post-care is too troublesome.

This femoral fracture is not suitable for external fixation, and this fracture is even more incapable of external fixation. Therefore, the acute subordinate high directly interrupted Zhang Fan's speech. Although it was a bit impolite, his mood was understandable.

Zhang Fan didn't care, but after smiling, he said, "Dr. Chen, do you think external fixation can be used for this operation?" Now Zhang Fan is going to raise the flag, especially for this kind of academic discussion, not just humility. If you can persuade others, you have to take out things realistically. Since you can interrupt me, I will ask you so that you can think about it when you discuss it later, and then interrupt when you think about it. I!

"Uh! No." Dr. Chen's momentum disappeared immediately.Zhang Fan asked Dr. Chen in a cold sweat. Zhang Fan didn't say it was external fixation."Hi! Rough." Old Chen scolded himself in his heart!

"Go on! Talk about surgery." Lao Gao interrupted Zhang Fan's questioning.Lao Gao has no color on his face, neither happy nor sad, embracing his arms.He also wanted to hear Zhang Fan's thoughts.In this operation, Lao Gao also prefers intramedullary fixation.

At this moment, Zhang Fan got up and gently swung the hem of the white coat with his hands, just like an ancient master shaking the hem of his coat before going on stage, with an aura."Crack!~" Zhang Fan opened the folding plastic ruler used to measure bones, held it in his hand, and walked to the film viewer.

"Look, everyone! The fracture end is interrupted in the femur, and it is an oblique fracture, an unstable fracture. However, the port plane shift is not very severe, and it is still a non-open fracture, depending on the age of the patient, so my The opinion is intramedullary fixation."

As soon as Zhang Fan finished speaking, he heard the disdain of many doctors below, and Lao Gao frowned, but after a little thought, he became expressionless.Xu Xian was also a little disappointed when he heard that, Zhang Fan was full of momentum, but his words were out of stock."That's it!" he thought to himself inwardly.

Everyone has overlooked one point. The two surgical methods Zhang Fan mentioned earlier are not appropriate. Lao Gao understands, but the operation is too difficult.

"Closed intramedullary fixation!"

"Closed intramedullary fixation?" More than two words, but the difficulty is increased in magnitude!Someone can't help but ask. This can't be helped by doctors at the sub-high level. Doctors below the sub-high level still don't realize the difficulty of this operation.Several sub-highs looked at each other, their faces were not shocked but confused.And some attending doctors and a group of resident doctors who have not studied well are all confused. Yes, they are confused. What is closed intramedullary fixation?Such as Xue Fei!

Closed intramedullary fixation is actually simple, that is, the skin and soft tissues are not cut, and the fracture ends are not exposed but directly fixed. Simply put, it is blind beat. This requires too high technical requirements, and this surgical method is generally for Surgery is the only option for a fairly stable fracture, even if it is a stable fracture, ordinary hospitals and doctors would not choose it.

Yes, this surgical method is the smallest injury to the patient, but it is too dangerous for the doctor. Because it is a blind type, the possibility of accidents and deviations is too great. The error of this kind of fracture is two centimeters or even millimeters. of.Once the fixation is not good, or after the fixation, the fracture end shifts to form an angle, and then the fracture heals 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 such operations in primary hospitals, even in large hospitals, doctors who are not at the director level will generally never do it easily.

"This is an oblique unstable fracture, not a stable fracture, my little brother! Can you ensure that the fracture reaches the physiological anatomical position?" The other subtropical height said to Zhang Fan with a little regret or helpless tone.This is the helplessness of doctors, who dare not try and take a step forward if the technology is not enough.

"I can!" Zhang Fan said with a straight face while standing in front of the viewing machine, holding a ruler.

"Uh! He can." The doctor who was one level higher than the deputy said no longer.Because Zhang Fan's record is terrible!They doubted and did not doubt, very tangled!

The original voice of secretly discussing is gone, quiet!As if the street-cleaning tiger appeared, everyone had no eye contact, and looked at the director quietly, while the director looked at Zhang Fan.

Finally, Lao Gao said: "Have you ever done it?" This is the primary hospital. No matter how high your surgical technique is, or if you encounter a special operation, the first thing to ask is whether you have done it before and if you have any experience!The big hospitals still have the conditions to have various guarantees for you to innovate, and the primary hospitals are safety.What is a primary hospital? Except for the top 30 hospitals in China, all are primary hospitals!

The difference between these primary hospitals is the advanced level of equipment, the level of doctor's education, and the speed of learning new treatment methods in higher-level hospitals.Do scientific research!Where is the floating cloud, that is, it is spinning around the corners of the disease.

Want to take risks to innovate?Let alone the patient’s family, the hospital can break your leg!There are good and bad things, and there is no way to discuss it, but one thing is very clear. Although technological development has been slow, and all the research tasks have been assigned to higher-level hospitals, medical accidents have indeed been significantly reduced, and it is said that the patient is responsible. It seems irresponsible, anyway, very awkward.

"Did it!" Zhang Fan's face didn't blush. Although he hadn't done it in reality, Zhang Fan didn't have a white liver in the system. It's hard to say the operation in other departments, but it's impossible for Zhang Fan to do this kind of surgery for orthopedics. Know how many times.This is his guarantee, this is his confidence!

"determine?"

"determine!"

Old Gao thought, hesitated!It seems that several centuries have passed, but it is actually more than ten seconds.Then he turned his head and said, "Director Chen, what do you think?" Lao Gao asked. In fact, this is to give Lao Chen face. Lao Gao is already inclined to Zhang Fan. Now he is giving Lao Chen a step!

They are all smart people. It is useless if Old Chen stretches his neck and disagrees. Old Gao will directly give Zhang Fan the number of the patient. If Zhang Fan succeeds in the operation, it will be difficult for Old Chen to do it!This is the power of the director, the power that most doctors yearn for.

"The difficulty is too high! I'm not sure at all, Director!" Lao Chen can still speak harshly or ridicule Zhang Fan, but he is very low-key to Lao Gao.

"Why do I take Dr. Zhang for this operation?" Lao Gao asked again.This is that each other has set up the steps.Lao Gao is asking for the operation alive, risk?The risk is not small. Once Zhang Fan can't do it, or has a medical accident, it will be Lao Gao's turn to do it, and if he can't do it, the director can't do it.

But Lao Gao is willing to believe in Zhang Fan and is willing to support Zhang Fan.This is a technical dog, not a politician.In the technology industry, once you can show your excellence, someone will definitely support you, which is just a difference in the strength of the support.

And Lao Gao really helped Zhang Fan wholeheartedly.What is a great doctor? This is what Lao Gao is!Take the risk and let the younger generation move forward. There are too many such doctors in this place of life and death!They are the cornerstone of China's medical industry!

"Okay, I'll help!" Old Chen didn't fall into trouble or be a bystander.Academics can be debated. Once determined, the rest is a concerted effort. This is an excellent department!

"Okay! Tomorrow is not an emergency surgery, all will be stopped, watch this operation!" Lao Gao finally smiled, with a smile on his face, now that it is all like this, simply raise the table a little higher, perhaps let Zhang Fan take off earlier!

At this time, the doctors turned their heads and looked at Zhang Fan. Zhang Fan, like Lao Gao, with a smile on his face, slowly closed the ruler in his hand, "Ka!"