Now, Zhou Can's level of plaster is no worse than that of Dr. He.

If he is allowed to mix in orthopedic surgery for a year, the level of plaster cast can definitely be better than that of most attending doctors.

Broken bone joint, this medical technique is also very gratifying. It is also at the inferior level of a resident doctor.

After all, this is an orthopedic surgery specialty, and there are too many opportunities to close broken bones.

In the past two months, Zhou Can has followed Dr. Shan and Director Shen to a total of 117 opportunities for broken bone joints.

He could feel a significant increase in the level of joints of broken bones.

In the past, the most common thing to catch was broken fingers, and senior doctors would basically only let him get started with this kind of broken bone joint with less risk and less difficulty.

Now that he has the level of a resident bone, he can also operate one or two broken bone joints such as arm bones and tibia.

It's just that the ones that came out are not as good as Doctor Shan and Dr. Chi.

The improvement of the above three orthopedic medical skills is not bad. Only osteopathy, after learning it, it has been a failed level of interns, and there is no improvement.

The main thing is that there is no chance to get started.

The vast majority of patients who need orthopedic reduction are directly treated in the manual reduction room, and it is impossible to enter the operating room.

In some cases, it is difficult to reduce the dislocated or displaced joint due to its complexity, and it is necessary to perform a surgical reduction through invasive surgery.

This type of surgery is generally carried out by the bone and joint group, which has never been done by the bone trauma group they are in.

Osteopathy has been slow to improve, and he can't help it.

You can only wait for future training opportunities.

The main purpose of regular training is to standardize the training of diagnosis and treatment operations, during which you only need to learn the basic operation methods, reception, and treatment processes.

You don't need to learn every skill.

No one can learn all the medical skills that have been trained in just three years.

They all enter the door, learn methods, and then slowly temper and improve their medical skills in the next residency practice.

In the two months of orthopedic surgery, in addition to the improvement of orthopedic medical skills, his suture, ligation, hemostasis, debridement, separation and other medical skills have been greatly improved.

Haemostasis is now close to the middle level of the attending doctor.

Suturing and ligation will be more because of the mobile phone, and the experience value will rise quickly. In addition, it is already close to the excellent level of the main treatment.

As early as last month, it reached the excellent level of attending physicians, and it is about to reach the level of deputy chief physicians.

He was looking forward to it.

Director-level medical skills, what will that experience be?

On this day, Zhou Can rushed to work in the orthopedic surgery department early as usual.

Arrive at the doctor's office in their group at least half an hour early, for nothing else, to see the surgical cases in the group. Knowing the information of the patients in the group who are about to undergo surgery in advance can make you aware of the operation at the time of surgery.

In addition, by paying attention to the condition of the postoperative patients and the surgical plan, you can clearly understand the treatment effect of the surgery.

Accumulated rich experience for him to practice medicine in the future.

When looking at a talus fracture case that was about to be operated on today, Zhou Can looked at the person's various examination reports and films, but the situation of the patient during the ward rounds came to his mind.

Judging by the patient's films, there was a severe fracture of the talus.

Surgery is required to make an incision in the ankle joint to reduce the fractured talus, and after drilling, an internal fixation is done using screws.

Don't look at the surgical site is only on the limbs, and it doesn't seem complicated, but the level of this surgery is level four.

The deputy director couldn't preside over it.

It can only be performed by the chief physician himself.

There is a strict standard for the grading of surgery. Ratings are given based on a variety of factors, such as difficulty and risk.

If you can achieve level 4 surgery, there is nothing good to do.

At 9 o'clock this morning, Director Shen will personally perform the surgeon.

Director Shen must have seen the inspection report and film. The preoperative conversation may be done by him himself, or he may let his subordinates talk about it.

Zhou Can repeatedly enlarged the patient's film and examined it carefully.

The patient's injured left foot, which he had seen, was swollen and shiny. It has been two days since I was admitted to the hospital, and the surgery plan was only worked out yesterday.

"What is Dr. Zhou looking at?"

Dr. He walked into the office and found that Zhou Can was the first to arrive, and he smiled and took the initiative to say hello.

"Take a look at the patient profiles in the group. Can you help me see if there is a problem with this film of the patient? ”

Zhou Can's intuition has always been more intelligent than a woman's sixth sense.

When looking at a patient's profile, he always felt that something was wrong.

Dr. He Zhang walked over and carefully examined the patient's film.

"It's no problem, it's a serious fracture of the talus."

After he looked at it, he didn't find a problem.

"Maybe I'm overthinking! I'll go to the ward to see the patient. ”

Zhou Can got up and walked towards the ward.

There are rows of open beds.

There are too many patients in large hospitals, and in order to save management costs and space to the greatest extent, they prefer to make this kind of open bed area.

Along the way, he was constantly greeted by family members or patients.

Smarter patients or family members basically know that Zhou Can's status is quite high.

In the morning, when the attending ward round, although Zhou Can was in fourth place, 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 level of pathological diagnosis is okay, and his knowledge of medical cases is quite profound.

He is often able to give a very constructive diagnosis.

Sometimes, Zhou Can can find problems that others can't find in time.

That's a kind of dependence and trust.

Doctor Shan asked him to work with him on the staff, and he was down-to-earth.

Patients and families are savvy.

Knowing that Zhou Can's status in orthopedic surgery is quite high, he naturally competed to curry favor. In order to get more attention in the stage of surgery and hospitalization.

Zhou Can went straight to bed 77.

"Mr. Zhao, I'm going to arrange surgery for you today, you know?"

"The nurse notified me yesterday evening and told me to fasting water and food."

Patient enthusiastic response.

With the continuous improvement of Zhou Can's hidden status in orthopedic surgery, he is now running over for ward rounds, and he is rarely treated coldly by his family members and patients.

Like now, he personally ran over to inquire about Mr. Zhao's condition, and the family and patients were a little flattered.

"How many days has it been since you injured your foot?"

Zhou Can asked.

The patient's eyes flickered twice, and after thinking for a moment, he said, "It seems like three days!" ”

The family next to him should be his father, and it seems that he is not clear about his son's injury. He rushed over when his son needed to be accompanied when he was admitted to the hospital.

When a hospital is hospitalized, it usually makes an implicit requirement.

If you don't have an escort, the hospital won't accept you.

Because after being admitted to the hospital, the hospital is responsible for the patient. Mobility problems, toileting, eating, preoperative preparation, and postoperative escort are all very real problems.

It's impossible for a hospital to have a nurse to wait.

Many people think that it is natural for nurses to wait for them when they are hospitalized, spending hundreds of thousands of hospitalization fees every day.

Hehe, it can only be said that such a person is too 'young'.

A nurse's duties are to change dressings, administer intravenous drips, give injections, monitor blood pressure, and so on. Asking the family to come and wait for you to eat, drink and Lazar is really thinking too much.

Some pretentious male patients, thinking that the nurse girl's smile is so sweet, and her attitude is gentle. Do you take this opportunity to have an affair with her?

Patients with superior conditions, such as the rich second generation, the second generation of officials, and young business executives, are indeed likely to succeed.

If the general public is concerned, it is better to keep to themselves.

Don't think too much and get angry.

Zhou Can carefully stared at the patient's left foot and observed, and the ankle and instep were all swollen.

However, the surface of the skin is somewhat grayish, and wrinkles are faint.

"Are you sure the time of the injury is three days?" Zhou Can's tone was a little more serious.

Doctors nowadays are really hard.

If you speak to a patient in a slightly worse tone, they will become hostile and even complain about you.

Zhou Can suspected that the patient did not tell the truth, and could not blame the other party.

You can only ask again in this reminder tone.

Some patients lie to doctors and nurses for various reasons.

It's very frustrating.

There are many reasons for patients to lie, and some are to cover up their ugliness. For example, Zhou Can was in the emergency department, and when he received a patient with a foreign body embedded in his anus, he said that when he sat down, he accidentally got into his anus.

Are you embarrassed to keep asking?

This kind of lie will have no effect on the treatment. The doctor just knows it, and he won't break it.

However, some patients' lies will make doctors misdiagnose and misjudge, and the consequences will be very serious.

When there is an accident, it is not only the patient who is unlucky, but also the doctor.

After this Mr. Zhao was questioned by Zhou Can for the second time, his eyes were still flickering.

"If you misremember when you were injured, just a few hours, it's not a big problem. If there is a difference of several days, or even longer, it will be very detrimental to your surgery. ”

Zhou Can really didn't scare patients.

The surgery itself is very risky.

What you know before surgery varies greatly and can multiply the risks of surgery.

"It should have been three days, and I drank at the time, and I really can't remember it clearly."

The patient's insistence on the purpose of lying is very confusing.

Injury time, according to common sense, there is no need to lie at all.

What is the purpose of this person who has repeatedly and deliberately concealed it?

Seeing that he couldn't ask anything, Zhou Can carefully observed his feet for a moment and then went back to the doctor's office.

It just so happened that at this time, Dr. Shan came.

"Doctor Shan, it's very strange to have a patient in our group."

Zhou Can didn't want to care about this idle business.

It was a matter of surgical safety, and he had to bring it up.

"Which patient?"

Dr. Shan is now very familiar with him, and his tone of voice is extremely easy-going.

"Mr. Zhao in bed 77."

"Director Shen is going to operate on him this morning! What's wrong? ”

Doctor Shan knew that Zhou Can would never say useless words.

She has always attached great importance to Zhou Can's opinions.

Start understanding what happened right away.

"When I look at the patient's information in the morning, I always feel that something is wrong, but I can't find the reason. So I went to the bed area to check on the patient's condition. Judging by the hematoma in his foot, as well as the gray, wrinkled epidermis, I think he may have been injured for more than three days. ”

Zhou Can said seriously.

"Sometimes a patient's memory is not so accurate, a few hours away, and it's not a big deal. Anyway, it's not amputated limb replantation surgery. ”

After listening to this, Dr. Shan was unimpressed.

"But I questioned the patient twice, and he insisted that he remembered the time of the injury. But his eyes were clearly lying. I wondered why I was deliberately lying about the time of injury. ”

Zhou Can asked.

Doctor Shan thought about it for a while, and couldn't help blurting out, "Could it be the same as the forensic TV series I watched recently, the patient is here to hide the facts of the crime, right?" "I didn't expect her to have this hobby.

Most young women love to watch romantic dramas, soap operas.

She may have something to do with her profession, and the TV series she likes to watch turns out to be forensic reasoning.

"If the injury time is deliberately postponed, you can get rid of the suspicion of crime!"

Doctor Shan saw that Zhou Can was puzzled, so he added.

A word wakes up the dreamer.

Zhou Can thought about it, there is really such a possibility.

Otherwise, why would the patient lie?

"Shall we report the patient's information to the police station for checking?"

Zhou Can asked her for instructions.

Hospitals have this obligation.

When encountering patients such as drug abuse, gunshot wounds, knife cuts, and assault injuries, it is necessary to report to the police in time to help the police maintain social order.

Some criminals were injured and did not dare to go to the big hospitals, but only dared to go to small clinics to buy some medicine and treat their wounds themselves.

It is precisely because of the fear that the doctor will secretly call the police if he finds out about the abnormality.

"It's always a good idea to report it to the police station and check it out. You can call the police directly, don't call 110, there is the phone number of the police station in the area. ”

She gestured to a business card pressed against her desk in an inconspicuous part of the office.

Zhou Can immediately called the police and took care of the patient's situation.

The rest of the things will naturally be checked by the police.

He continued to think about the patient's surgery.

While thinking about it, he couldn't help but see the date on the film, and his eyes couldn't help but light up.

This was made two days ago.

After two days, will the patient's bones change?

"Doctor Shan, do you say that the patient needs to have another X-ray before the operation?"

"Considering the cost of treatment for patients, the hospital usually does it when it is admitted to the hospital, and will not do the same examination again within three days. After surgery, you will need to take another photo at the time of discharge to see how well the fracture is healing. ”

She was looking down at the medical records and examination reports of patients who needed surgery today.

Zhou Can could only check the X-ray taken by the patient two days ago again.

Looking at it, he suddenly thought of something.

An x-ray of necrosis of the femoral head was immediately called up for comparison.

This comparison really made a little discovery.

Mr. Zhao's talus bone seems to have a hint of necrosis.

Without careful comparison with other necrotic bone fragments, it is difficult to detect this slightest abnormality.

There are several contraindications to open reduction and internal fixation of talus fractures, and if one of them appears, it is not suitable for surgery.

First, local skin conditions are not suitable for surgery. The second type is those who have healed old fractures and malunions. Third, there is aseptic necrosis of the talus. Fourth, severe comminuted fractures.

Zhou Can seriously suspected that the patient's talus bone had begun to develop aseptic necrosis.

This is a major discovery.

It must be reported immediately.

Preoperative discovery and postoperative discovery are two completely different concepts.

"Doctor Shan, can you see if this patient's talus is showing signs of aseptic necrosis?"

Zhou Can was just a regular trainee, and he should have reported to Dr. Tang or Dr. He.

However, his status is quite special, after all, the ability is there.

Coupled with the presence of Dr. Shan, he directly reported to the higher level.

In fact, this is not the first time this kind of thing has been done.

"Wouldn't it? My teacher and I have watched the film, and Dr. Chi has also watched it, but we didn't find any problems. ”

Dr. Shan was a little unconvinced.

Walked over to Zhou Can's computer to take a closer look.

"My level is limited and I can't see it. But this is not a trivial matter, I called Director Shen. ”

She called Director Shen on the spot.

"Teacher, I'm Shan Dan, excuse me."

"When Dr. Zhou Can of this group looked at the patient's information, he suspected that the patient who was going to undergo the internal fixation of the talus this morning had aseptic necrosis of the talus. I watched the film carefully, and I can't be sure, so I can only ask you to watch it again. ”

After hanging up the phone, it didn't take long for Director Shen to rush to the hospital.

Straight into the office.

"Xiao Zhou's eyes are really sharp, so many of us didn't find the problem, and you found out. Regardless of the outcome, this meticulousness and prudence are worthy of recognition. ”

Director Shen smiled and praised him when he entered the door.

Then take a closer look at the patient's film.

After a few minutes, his face became solemn little by little.

"There are indeed signs of aseptic necrosis, but the symptoms are extremely mild, and then take an X-ray of the patient, and I will see the situation before making a conclusion."

Because the patient is going to be in the operating room at 9 a.m.

The test can only be done urgently.

Director Shen personally opened the application for urgent examination, and the medical technology department did not dare not buy it.

Soon, the footage of the patient came out.

Signs of aseptic necrosis can be seen.

"Oh my God, it's really aseptic necrosis. Fortunately, it was discovered in time, otherwise even if the operation was completed, it would have been a failure. ”

Director Shen broke out in a cold sweat.

"Xiao Zhou, the performance is very good."

Director Shen praised him, and then gave a treatment plan.

"Tell the patient about the situation first, so that the patient and his family can be mentally prepared. From the current situation, talar osteonecrosis has just occurred and is still in the early stage, and it can be evaluated according to the actual situation at the time of surgery. It may be possible to fix the ankle directly with a cast after surgery. In more severe cases, transplantation of bone marrow stem cells can be cured. ”

When Director Shen said this, he frowned and couldn't understand.

"It's strange, it stands to reason that it has only been three days since the injury, and it is impossible for necrosis to occur so quickly!"

After hearing this, Doctor Shan next to him smiled and said, "Doctor Zhou is really amazing." He told me early in the morning that the patient might have concealed the time of the 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 police station in the jurisdiction. ”

After listening to this, Director Shen suddenly realized.

He patted his forehead.

"No wonder, I said, less than three days after the injury, how could talar osteonecrosis occur so quickly? The current doctor is so tired! In addition to healing, you also have to learn some detective skills. Who would have thought that such a trivial matter would make a patient lie! ”

In a word, everyone was ridiculed.

(End of chapter)