There are no useless skills and knowledge, just look at how you apply knowledge, which is an application level problem, and is not directly related to the original knowledge and theory.

The Medical Association has long stated that the level of basic knowledge of medicine represents the breadth of your knowledge of the overall medical community, and the theoretical foundation of surgery represents the depth of knowledge in surgery.

The basic theoretical knowledge of the specialty represents the shape of the cake of the knowledge system that you have achieved by yourself, and determines the weight of your knowledge.

Generally speaking, the knowledge system of subspecialties, level 1 means that you have an understanding of these knowledge, know a lot of things that are not known to your peers in this subspecialty, and determine your major, so it is called the basic theory of the specialty, which is the first line of defense of professional barriers.

Level 2 of the subspecialty knowledge system means that you have a deep enough understanding of trauma surgery to be proficient in diagnosing common diseases and know the diagnostic routines, which is not only the level of understanding, but also the skills of diagnosis.

And the level 3 of the subspecialty knowledge system represents specialization!

Specialization is not a joke, just a boast, but it means that after you have an in-depth understanding of the common diseases in trauma surgery, you will gradually form your own system, begin to have your own ideas for the understanding of diseases, and gradually begin to form your own diagnosis and treatment thinking!

That's what theory brings to you.

Entry is cognition, proficiency is flexible application, familiar with various routines, specialization means that you are at ease, you can have your own understanding, form your own thinking and focus.

Who said that the theory is useless, the basic theory of trauma surgery is particularly useful when it reaches level 3!

If it doesn't work, then at least 50 percent of surgeons don't do it!

According to incomplete statistics, at present, in the surgical industry, no more than 60% of the basic theories of subspecialties have been upgraded to level 3, and nearly half of them only pursue the level of skill operation, while ignoring the theoretical basis.

And this, in a teaching hospital like the Shonan University Hospital, is not allowed, and such a choice is not favored.

Fang Xian is self-aware, knowing that he can do it now, and he has a sense of control.

That's mastery!

Don't be afraid, from the level of knowledge, cognition, and thinking.

Trauma surgery belongs to surgery, and the medication should be streamlined, accurate, appropriate, symptomatic, and pay attention to many details, which can be summarized in four words, the most subtle......

Then the diagnosis needs to be more comprehensive and detailed, and some detailed factors need to be continuously extracted and included in the scope of diagnosis!

So—

Fang Xian continued to push slowly.

Nothing else, just eat this case.

So I turned over the results of her blood test again.

D dimer is high, color ultrasound shows thrombosis, anticoagulation must be used, and deep vein color ultrasound must be rechecked to absolutely avoid the inevitable occurrence of thrombus falling off, which is a bottom limit.

White blood cell count up to 20+!

Inflammatory markers such as CRP (C-reactive protein), ESR (erythrocyte sedimentation rate), and interleukin are also high. Infection is definitely there, the current body temperature?

Anti-infective treatment cannot be interrupted, and the four tests of Tid must keep up! In the absence of the patient's own concern, the doctor must be aware of the serious consequences of the infection once it is secondary to the skull or heart.

Retro-examination of inflammation indicators must be done and done well.

Fang Xian recorded and analyzed the case of this new patient, which Fang Xian had not done so well and was not so skilled before.

Let's look at the liver function test again -

Damn, why is this albumin so low? 32？

32, the indication for oral protein supplementation has been met, but the index of intravenous infusion has not yet been reached.

Wait a minute, let's get some protein powder, it should be cheaper in the hospital than in the pharmacy outside. Pentagram marker!

Pass!

Let's take a look at the other test materials......

When Fang Xian flipped through them one by one.

Suddenly, he turned back the examination data that had been skimmed again, and finally found such a point from the routine examination results of the first hospitalization of Huaishi First Hospital, that is, the first hospitalization.

“OB+”

"Occult blood positive? A plus, re-examination before the operation again and again. I haven't had a follow-up examination after the operation. ”

Surgery is practical, and will not pick out some trivial things, because everyone is very busy, just forget if you don't pick it, and focus more on surgical operations.

The big deal is that if a problem is found, it will be thrown to the consultation, which is one thing that senior physicians must choose when they have limited time and a large number of patients.

Catch the big and let go of the small!

And this is exactly what Fang Xian can catch.

"High fever, headache, transient fecal occult blood positive, is it a stress peptic ulcer? Or do you already have a peptic ulcer, usually no symptoms, and the symptoms are aggravated under the stress of trauma? ”

"It's a question to consider."

"The stool routine is something that must be routinely checked when admitted to the hospital, and you still have to chase the results, wait and ask her eating habits......"

"No concomitant diseases such as hypertension and diabetes."

"Then the admission order only needs to include inflammatory indicators, liver and kidney function electrolytes, urine and urine routines, electrocardiograms, lung plain films, and then send a bacterial culture of wound exudate and ordinary microscopic examination! Make another HP and be prepared! ”

"In terms of medication, anti-infection, protein powder cultivation, sugar water ......"

"In terms of consultation, it is necessary to invite the vascular surgery department and the pharmacy department to come for consultation, and we plan to invite the gastroenterology department for consultation."

"The details of the conversation are that the infection may be difficult to control, the hospital stay will be long, and the fracture will still be difficult to heal after surgery, and the corresponding treatment plan will be explained to the patient one by one, mainly explaining when surgery is appropriate." Fang Xian's mind flickered one by one, and after these flickered one by one, he began to work.

After the work, although he didn't get any substantial gains, Fang Xian's sense of accomplishment was still full. After dealing with her admission-related examinations, Fang Xian immediately went to the skills training room to start the practice of suturing.

Fang Xian thought that if the sutures could be done better, maybe the senior doctor would give him more opportunities for sutures.

But if this is done well, level 3 is not enough, it may take level 4, so that it can take the opportunity to be favored from other doctoral and master's brothers.

But if you want to reach level 4, you don't know when you have to wait, but this is also an alternative, you have to take the initiative and can't passively wait to be fed!

At the end of the day, Fang Xian's suturing practice progress did not increase by 1 point, Fang Xian estimated that it would take three or four months to upgrade a skill by himself, and a skill would require 25 skill points to reach level 2, which means that it would only increase by 1 point in three days.

There's no hurry.

What surprised Fang Xian was that the next day, when Fang Xian was doing his rounds on Sunday, he really saw the patient's HP test positive, indicating that she had a Helicobacter pylori infection, which may have caused ulcer damage, but there were no obvious symptoms.

It was only under the stress of trauma that the ulcer bleed, and there was a positive occult blood test.

This means that this is the precursor or early stage of ulcers!

Fang Xian hurriedly invited a consultation in the Department of Gastroenterology to see how the teachers of the Department of Gastroenterology arranged and planned, and on the consultation list, Fang Xian deliberately emphasized that he had a positive transient fecal occult blood test in the past.

After Fang Xian asked for a consultation, he felt that the opinion of the Department of Gastroenterology was estimated to be a combination of antibiotics and antacids and PPI treatment, and if the patient was taking intravenous drugs, it was estimated that only one PPI treatment would be used.

Of course, this was just Fang Xian's own thinking, and he didn't explain it to the outside.

It's just that Fang Xian told Xue Li, the attending physician who took the ward rounds on Sunday, and Xue Li just said that he would just wait for the consultation opinion, and what Fang Xian and the orthopedics department should focus on is whether there are contraindications to surgery and sensitive antibiotics for infectious bacteria!

Fang Xian said okay!

Then he continued to drill into the skills training room.

That night, when Fang Xian was still practicing suturing, a bright light flashed, which made his spirit suddenly lift!

"You advocate that the patient be guided in the direction of peptic ulcer diagnosis, and that the diagnosis of peptic ulcer and Helicobacter pylori infection have been established, and you have requested consultation support and treated the patient accordingly. You deal a total of 51 damage to Peptic Ulcers (A1 stage) (55% damage) and gain 51 skill points! ”

"There are 53 skill points left."

“nice！”

Fang Xian was alone in the skills training room, so Fang Xian was not afraid of others hearing that he was happy, because they didn't know what they were excited about.

The Affiliated Hospital of Shonan University has the right to perform surgery for its physicians and medical students, and the corresponding minimum regulations are: Trauma Surgery Theory Level 3, X-ray Reading Level 3, Debridement, Suture, and Incision All Level 3!

Fang Xian decided to improve the suture technique first.

After adding points, when Fang Xian practiced suturing in the skills training room again, Fang Xian finally understood why the senior physician was willing to give those doctors or masters more opportunities for suturing.

Suture level 3, equivalent to the level of specialization, specialization level suture, no special time limit and suture method requirements, the surgeon needs to carefully clarify the subcutaneous tissues and suture level to achieve, no need to suture the outer skin, through the zipper skin, so that the patient's wound healing......

Looking at the simulated skin of this suture operator, there is no outermost suture, but the surface of the skin is aligned neatly, as long as the opposite surface of the skin is fixed and not loosened, it can definitely reach the standard of healing!

And the opening that I stitched up before, although it was decent, it was a clarification of the level, which was far worse than now!

Most surgeons will feel that the basic skill of suture is enough to practice to level 3, and there is no need to spend time to continue to deepen.

Because it is inefficient to increase investment and does not have a return on investment.

Therefore, these professors, including Professor Lin and Associate Professor Song Yu, estimated that the level of suture surgery was a level 3 specialization, just for use.

Since they are all at the same level, Professor Lin's sutures are not much different from those of other doctors, or the sutures of other doctors and brothers, and they are harmless.

This kind of strength is the foundation that others trust you and recognize you.