In the first twenty-four hours, Zhang Fan also fought directly in order to knock on the mountain and shake the tiger. Sometimes, at the level of surgical technology, there is really no way to make a comparison, especially in conventional surgery, you say you are doing well, and I also say that I am doing well. Difficult surgeries, after all, are still a minority, and they are not encountered every day. Therefore, Zhang Fan's 24-hour continuous operation is also a way to show off his cards, and he directly told everyone rudely: I'm here!

Doctors are also considered literati, and there are few bayonets in departments or hospitals, unless it is a critical moment, such as changing the president or director, and the competition under normal circumstances is relatively mild. But Zhang Fan couldn't wait, he didn't want to waste time on this kind of thing, so he directly announced in a rough way: I'm here!

Of the seven surgeries, Zhang Fan performed seven surgeries in a row, and the anesthesiologist, surgical nurse, and itinerant nurse were replaced three times. The assistants were Wang Yanan and Xue Fei, and by the time the last operation was over, Xue Fei was already exhausted, and he couldn't get up directly on the ground in the operating room!

"Doctor Zhang, you're tired too, lie down for a while! Seven surgeries are really amazing!" said the slightly older nurse in the operating room to Zhang Fan. Zhang Fan was waiting for this sentence, Wang Yanan and Xue Fei were both left on the ground like dead pigs after surgery, and they didn't want to open their mouths, let alone anything else.

"It's okay, where is this, I haven't had surgery for a long time, I haven't enjoyed it yet!" Zhang Fanle said happily, and then helped the nurses clean up their things. Isn't Zhang Fan tired? Pull, absolutely tired, this will be him also hard to pretend!

"Yo, Dr. Zhang, you don't dare to move anymore, we'll clean up after ourselves. Another nurse hurriedly took the things in Zhang Fan's hand.

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

"If you're not tired, take a break, drink some water, go to the bathroom or something!"

Zhang Fan really wanted to say it again, there was no one who could fight, but no one praised him. The nurse packed up her things and left, Xue Fei and Wang Yanan were already asleep!

Although Zhang Fan felt that the effect of pretending to be forced was not very good, but the next day, the surgical system already knew, especially the three orthopedic doctors, "Do you know, yesterday Zhang Fan did seven consecutive surgeries, and after the last operation came down, he said directly, is there any more, this is the activity!"

"Really?"

"Did you hear that?"

"What?"

"Zhang is going to dominate the operating room!"

"What can I do? Hey, you say this thing, not to mention the high technology, the physical strength is as good as a big animal. Let no one else live!" This is two doctors from the orthopedic department chatting.

In the morning, a morning meeting is held. Zhang Fan and their group are shifted, and in the department, it is generally who is on duty and who is on duty. Zhang Fan began to hand over shifts: 43 original patients, 11 were discharged, 12 were newly admitted, and 10 were operated on yesterday. Among them~~~~, these new patient numbers and surgical patient numbers and discharge patient numbers are all to be explained, what surgery was done, what was the next operation, what was the situation at night, and what was the situation in the morning.

At night, whether the patient has pain or fever, how to deal with the pain and fever, what medicine is used, whether the bleeding is there, whether the gauze has penetrated, these must be explained, because these are the daily work of doctors, and most people think that doctors may be doing surgery all year round, just doing surgery every day, and not doing other things.

In fact, except for some senior surgeons, ordinary surgeons, do surgery when they go to work, observe the patient number and write medical records when they get off work, these things take much less time than the operation time, so the doctor is busy, and has to be busy, such as this medical record, there are time requirements, and now they are all electronic medical records, a new patient number, how many hours must be completed to complete the big medical record, more than this time, okay, you can't write, you can't open this big medical record directly, and then wait to be criticized, be fined, the leader doesn't care how many surgeries you had yesterday。

Zhang Fan explained the patient's situation one by one, and the doctor in the orthopedic department opened his mouth in surprise when he listened. The others did three, and the rest of the operations were all done by Zhang Fan. A voice sounded in the hearts of the department doctors: Is this still human!

In this case, the doctor will triage the patient and give it to the doctors of other groups to do, but Zhang Fan and their group simply finished the operation without saying a word. Can you not be shocked!

After Zhang Fan finished his shift, Lao Gao spoke: "In the future, when there are many surgical patients, you can call people to call people, don't be tired." ”

"Okay Director!"

After yesterday's patient handover was clear, it was time for tomorrow's surgery to be discussed. In general, especially for non-emergency surgeries, it is necessary to discuss in the department before the operation, and what kind of surgical method to use and what kind of fixation instruments to use should be predetermined.

"Tomorrow, the 16-bed patient in our group will be admitted due to oblique femur fracture, and after completing the relevant examinations, we plan to undergo plate internal fixation of femoral fracture tomorrow. Choose titanium alloy locking steel plate ~~" Zhou Chengfu is a sick number of their group. This is the time to take it out and start the discussion.

Zhang Fan frowned a little when he heard it, how to say it. Especially for this kind of femur fracture surgery, there is a lot of debate in the medical community, and there are two schools. They are divided into two factions because of the characteristics of the bones. Because bone nourishment and blood supply are also in 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 to treat the disease and save people, but because it is an open treatment method, there will be damage, and doctors are constantly improving the surgical method to reduce the damage. For example, for this femur fracture, there are two conventional methods, two internal fixation methods.

One is the steel plate, which fixes the broken end of the fracture, and the advantage is that it is simple and direct. The disadvantages are also obvious, a large amount of periosteum is damaged, and the fixed form is somewhat too strong. In fact, how can the fracture heal quickly and heal well, that is, under the fixed and strong precursor, the fracture can have a slight range of motion, not less than two millimeters of activity. It sounds very contradictory, but that's the biology of bone healing.

Another type of fixation is intramedullary fixation. Making an incision from the proximal end of the femur, inserting the intramedullary needle into the femoral cavity, passing through the broken end, and then fixing at the distal end, has the advantage of axial fixation, which not only barely damages the periosteum, but also conforms to the biological characteristics of bone growth. The disadvantage is also obvious, it is necessary to damage the blood supply system in the medullary cavity.

Zhang Fan is not an admirer of any kind of surgery, he prefers to choose the most suitable surgical method according to the situation and the patient's condition.

After Zhou Chengfu introduced his condition and surgical plan, he looked at Lao Gao. In the department, when a patient does surgery and in what way, the doctor in charge first makes a plan, and the director determines whether to do the operation, when to do it, and who will do it, he is the last approval gatekeeper before the operation.

Lao Gao, looking at the x-film on the viewer, said to everyone: "Discuss and discuss." Everyone has their thoughts. "In hospitals, especially in the surgical department, everyone usually talks and laughs, and during the operation, they work together to resist the pain of the disease, but when they discuss before the operation, they often blush and have a thick neck. Especially when this kind of academic inconclusive conclusion, and there are many such undecided times.

The first patient is a woman in her sixties, the periosteum damage caused by the steel plate is too serious, and it is difficult for the patient to recover in the later stage. A deputy senior from the other group spoke. At this time, the resident doctors in 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 periosteal damage, but the secondary injury may not be, this patient is more than 60 years old, the current titanium alloy steel plate is already antibacterial, there is no need to take the steel plate at such an old age, the second intramedullary fixation is not damaged, the patient is not young, the blood supply of bone is mainly bone marrow blood supply, so the steel plate internal fixation is definitely more advantageous than intramedullary fixation. ”

Doctors began to express their opinions one by one according to their ranks, and not all surgeries have this kind of discussion, but once it comes to such an operation that is not academically conclusive, the debate is very intense. This is an academic debate, a debate on interests, and a debate on the right to speak.

When it is the turn of the attending doctor and the resident doctor to speak, they will directly become in line, and the doctors at the level of deputy senior or senior have already made their advantages and disadvantages very clear, and there is no need for the resident doctor to talk nonsense, and it will become a team! At this moment, once the director cannot be suppressed, and technically cannot be suppressed and crushed, the department will become a battlefield and will have no cohesion over time.

Five groups, two groups supported plate internal fixation and two groups supported intramedullary fixation. In the end, it was left for Zhang Fan and their newly formed team members to express their opinions.

"Xue Fei. "Lao Gao took a roll call.

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

"Zhang Fan. After Lao Gao glanced at Xue Fei, he continued to roll call.

Everyone looked at Zhang Fan in unison, and the old doctor who had seen Zhang Fan's past and present achievements also wanted to hear Zhang Fan's opinion, knowing that he couldn't jump out of this shackle, but he still looked over. Young doctors, especially the newcomer Xu Xian, also want to see Zhang Fan's vision, he thinks that intramedullary fixation is absolutely advantageous, it depends on whether Zhang Fan has this vision.

"I don't think either type of surgery is suitable!" Zhang Fan was really speechless.

"Why? I want to fix it externally. Isn't this nonsense!" Zhou Chengfu and the deputy senior of their group were anxious when they heard it, external fixation is also a way of fixation, to put it simply, just like the steel frame erected outside the building when building a building, fractures can also be fixed in this way. The benefits are obvious, the damage is small, but the disadvantages are also obvious, the applicability is too narrow, and it is also easy to get infected and the aftercare is too troublesome.

This femur fracture is not suitable for external fixation, and this fracture cannot be fixed externally, so this acute sub-deputy Gao directly interrupted Zhang Fan's speech, although it was a little rude, but his mood was understandable.

Zhang Fan didn't care, but smiled and said, "Director Chen, do you think this operation can be fixed externally?" Now Zhang Fan is going to put up a flag, especially this kind of academic discussion, it is not humble to convince others, you have to take out something in a real way, since you can interrupt me, I will ask you, so that when you discuss it in the future, you will have your brain when you speak, and you will interrupt me after you think about it!

"No, I can't. Dr. Chen's momentum immediately disappeared. Zhang Fan asked rhetorically, and directly asked Dr. Chen into a cold sweat, but Zhang Fan didn't say that it was external fixation. "Hey! Lao Chen scolded himself in his heart!

"Go on!" said surgery. Lao Gao interrupted Zhang Fan's questioning. Lao Gao's face is colorless, neither happy nor sad, and his hands are embraced. He also wanted to hear Zhang Fan's thoughts. In this operation, Lao Gao actually prefers intramedullary fixation.

At this time, Zhang Fan got up and gently swung the hem of the white coat with his hand, just like an ancient master shook the hem of the coat before going on stage, and a wave of momentum came out. "Click!~" Zhang Fan opened the folding plastic ruler he usually used to measure bones, held it in his hand, and walked to the viewing lamp.

The fracture is broken in the femur, and it is an oblique fracture, an unstable fracture. However, the displacement of the port plane is not very serious, and it is also a non-open fracture, combined with the age of the patient, so my opinion is intramedullary fixation. ”

As soon as Zhang Fan finished speaking, he heard the disdainful "sigh" of many doctors below, and Lao Gao also frowned, but after thinking about it slightly, his face became expressionless. Xu Xian was also slightly disappointed when he heard it, Zhang Fan was full of momentum, but his words were useless. "That's it!" he thought to himself.

Everyone ignored one point, the two surgical methods mentioned by Zhang Fan earlier were not suitable, Lao Gao understood, but the operation was too difficult.

"Closed intramedullary fixation!"

"Closed intramedullary fixation?" are two words, but the difficulty is an increase of magnitude! Some people can't help but ask their voices, and this can't help but be produced by doctors at the first level of the deputy high school, and doctors below the deputy high level have not yet realized the difficulty of this operation. Several vice-presidents looked at each other, their faces not shocked but confused. And some of the attending doctors and a group of residents who are not solid in their studies are full of confusion, yes, they are confused, what is closed intramedullary fixation? For example, Xue Fei is like this!

Closed intramedullary fixation, in fact, is also simple, that is, it does not cut the skin and soft tissue, does not need to expose the broken end of the fracture and directly fixes, simply put, it is blind typing, which is too demanding on the technical, and this surgical method is generally a surgical method for quite stable fractures, even if the fracture is stable, the general hospital 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 type, the possibility of accidents and deviations is too great, and the error of this fracture is two centimeters or even millimeters. Once the fixation is not good, or the fixation leads to the displacement of the broken end of the fracture to form an angle, and then leads to the fracture healing deformity, this becomes a medical accident, once there is a medical accident, no one cares whether you are considering the patient or not. Therefore, this kind of surgery is not to mention in a grassroots hospital, even in a large hospital, a doctor who is not at the director level will generally not do it easily.

"This is an oblique unstable fracture, not a stable fracture, my little brother, can you guarantee that the broken end reaches the physiological and anatomical position?" said to Zhang Fan with a bit of regret or helplessness. This is the helplessness of doctors, who never dare to try or take a step forward if the technology is not enough.

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

"Uh! "The doctor who was a deputy senior level, who was originally going to speak, stopped talking. Because Zhang Fan's record is so terrible! They doubt it but don't doubt it, they are very entangled!

The voice that had been secretly discussed in private was gone, and as if a street tiger appeared, everyone didn't even make eye contact, and looked at the director quietly, while the director looked at Zhang Fan.

Finally, Lao Gao spoke: "Have you done it?" This is a grassroots hospital, no matter how high your surgical skills are, when you encounter a special operation, the first question you ask is whether you have done it and whether you have any experience! Large hospitals still have the conditions and various guarantees for you to innovate, and the primary thing in grassroots hospitals is safety. What is a primary hospital, except for the top 30 hospitals in China, they are all primary hospitals!

The difference between these grassroots hospitals is the degree of advanced equipment, the level of doctors' academic qualifications, and the speed of learning new treatment methods from higher-level hospitals. Engage in scientific research! What is a floating cloud, that is, spinning around the corners and corners of the disease.

If you want to take a risk to innovate? Let's not talk about the patient's family, and the hospital will be able to break your leg! There is no way to discuss this matter, whether it is good or bad, but one thing is very clear: although the development of technology is very slow, and all the heavy responsibility of research has been handed over to the higher-level hospitals, medical accidents have indeed been significantly reduced, and it seems that they are not responsible for the patients, and it is very awkward anyway.

"I've done it!" Zhang Fan's face is not red, although he has not done it in reality, but Zhang Fan does not have white liver in the system, and the surgeries in other departments are not easy to say, but orthopedic surgery, this kind of surgery Zhang Fan has already done I don't know how many times. This is his security, this is his faith!

"Are you sure?"

"Sure!"

Lao Gao pondered, hesitated! It seemed as if centuries had passed, but in fact it was more than ten seconds. Then he turned his head, "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, and now he is giving Lao Chen steps!

They are all smart people, if Lao Chen cranes his neck and disagrees, it is useless, Lao Gao directly gives Zhang Fan the sick number, if Zhang Fan's operation is successful, it will be difficult for Lao Chen to do it in the future! This is the power of the director, the power that most doctors yearn for.

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

"Why don't I take Dr. Zhang for this surgery?" asked Lao Gao again. That's how the steps have been put together. Lao Gao is going to come over the operation alive, and the risk is not small, once Zhang Fan can't do it, or there is a medical accident, it will be Lao Gao's turn to do it, and his director can't do it.

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

And Lao Gao really wholeheartedly supported Zhang Fan. What is a great doctor, this is, Lao Gao is! Take the risk yourself and let the younger generations move forward, there are too many such doctors in this place of life and death! They are the cornerstone of Huaguo's medical industry!

"Okay, I'll take a hand too!" Lao Chen didn't fall into the well or be a bystander. Academics can be argued, once determined, all that remains is to work together, and this is an excellent department!

"Okay! Tomorrow's non-emergency surgery, all stopped, observe this operation!" Lao Gao finally smiled, with a smile on his face, since this is the case, simply directly build the platform a little higher, maybe let Zhang Fan take off early!

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