Fang Xian avoided his mother's blind date, so he went downstairs to the community for a walk first.

While walking, Fang Xian once again thought back to the current classification of medical skills and the classification of diseases.

The accreditation of medical associations is divided into physician level certification and skill certification.

There are 1-6 levels of doctors, and the classification of diseases is also divided into 1-6 types of diseases according to the mortality and disability rates, and it is not possible to accurately determine whether it is closely related to the 6 levels of doctors.

Fang Xian flipped through the screenshots of some of the information he had searched before.

——

"The first-level specialist doctors certified by the medical association are resident doctors, and after statistical and comprehensive analysis of the top residents in the country, the assessment standards for first-level doctors are set."

"Trauma Surgery Level 1 Physician Certification Assessment Requirements: Medical Routine Theory Level 3, Orthopedic Routine Theory Level 3, Trauma Surgery Medical Routine Theory Level 3...... (Non-skill assessment requirements)"

"Basic skills assessment requirements: incision, suture, hemostasis, puncture, specialist reading, and specialist anatomy all need to reach level 3."

"Specialist basic skills requirements: debridement, vascular exploration, and nerve exploration have reached level 3."

"Level 2 operation skills requirements for trauma surgery: vasotomy, vascular suture, nerve suture, fracture manual closure reduction, joint dislocation manual reduction, arthrotomy, open fracture open reduction external fixation stent external fixation...... (Any 3 of them can pass the certification if they reach level 2)"

"Age Restriction: None."

The Physician level is the Physician level, and the skill level is the proficiency level of the skill. In fact, there are still some gaps and differences between different skills.

For example, basic medical skills or basic medical operations, in the medical association, when the difficulty of the operation is divided, it is classified as level 1, and like some simple basic skills, it belongs to the content that residents can operate.

The basic skills of specialties, such as the basic skills of trauma surgery, vasotomy, vascular suture, etc., are divided into two levels according to their difficulty. This second-level skill may be closely related to second-class diseases.

Further up, for example, fracture incision reduction plate screw fixation, intramedullary nail fixation, arthroscopic anterior cruciate ligament reconstruction in trauma surgery, etc., are trauma surgery specialties that belong to orthopedics.

Such skills are classified as Level 3 in terms of operational difficulty.

It has moved away from the category of basic skills of a specialist and has developed into a real subspecialty. At present, the competency requirements of the Medical Association for Level 2 physicians, that is, formal attending physicians, are to reach a certain number of specialist skills, and the proficiency level of specialist skills can reach Level 3 (specialization level)

On this basis, that is, in terms of mature specialist skills, there are also specialized difficult surgeries and complex surgeries, which are defined as four-level operations in terms of operation difficulty and difficulty, and are diseases that can be accessed by non-ordinary doctors in each subspecialty.

In addition, some operational skills, such as new treatment methods of subspecialties, or innovative new procedures, as well as subspecialties, treatment surgeries or operations for diseases with ultra-high mortality and disability rates, or the reconciliation of protocols, are called the five levels of difficulty.

Operation, there is a difference in the difficulty of operation, and there is also a difference in operation proficiency.

The first-level difficult procedures in gastrointestinal surgery are:

Hemorrhoidal clipping, hemorrhoidal ligation, ultrasound-guided hemorrhoidal ligation, other excision of perianal tissues, perianal abscess excision, anal papillectomy, anal cerclage, anal fistula closure, umbilical incision and drainage......

There are more than 60 kinds of basic skills in general surgery that are difficult to operate at the first level.

Procedures with secondary difficulty include: gastrictotomy, pyloric ring myotomy, pyloroplasty, gastric anastomosis repair, gastric rupture repair, open small bowel biopsy, and infusion flank stomy......

This is even more outrageous, close to two hundred......

"Alas! ~" After reading these lists, Fang Xian couldn't help but feel that his previous thoughts were still too naïve. I think I have some basic skills, and by evolving and evolving, I can be completely comfortable in medicine.

There's a delusion that I'm pretty awesome right now.

In fact, when it is really applied to the specialty, Fang Xian will find that he is still a frog at the bottom of the well.

But that's a process that every doctor has to grow. The better the basic skills, the stronger the plasticity, and the more diseases that can be handled relatively well.

But in fact, the effect of the diseases dealt with by basic skills is not the best, and the specialized treatment is the improvement of the upper limit of treatment.

However, when some diseases have not yet developed corresponding treatment options, drugs, and procedures like natural enemies, it is necessary to carry out alternative treatment through other means.

The therapeutic effect of targeted specialist skills is greater than that of basic skills, and the effect of basic skill processing will be greater than that of appropriation of substitute treatment——

After thinking carefully for a long time, Fang Xian found that he had walked around the periphery of the community several times.

Father had already come back and called himself, so Fang Xian walked in the direction of home.

When I got home, I was taken to the vegetable market by my father, and Uncle Fang Yun and Fang Qi'an would come over for dinner in the evening, planning to buy some more side dishes......

In the afternoon, before the meal, Fang Xian's family was preparing in the kitchen to welcome Uncle Fang Yun.

It was early autumn, just after the National Day, the weather was neither hot nor cold, and the weather was not too hot, some of the big dishes left at noon could still be served, but the side dishes and soup, my mother still planned to boil them now.

Fang Xian and Fang Qian were washing vegetables.

Fang Xian asked: "Dad, does our family always like to take words as names?" Look at Uncle Fang Yun, me, and Dad, you are all words. ”

"Originally, the little money was also called Fang Qian, is there anything special about this?"

Fang Qian turned his head back when he heard this: "What, it's too old-fashioned to dislike the name your father gave you?" ”

"You won't be like your Uncle Yun, you've met a colleague with the same name, right?"

Fang Qian gossiped first.

Fang Xian shook his head: "People with the same name have heard it, but colleagues don't." ”

"Half a year ago, just after the Chinese New Year, a patient named Fang Xian came to our department, who was also a boy, and my classmate, in order to be funny, recorded the preoperative and postoperative operations, especially the time of intubation and removal of urinary catheters, in the morning class."

Fang Xian didn't say the name of Li Qiu's dog's egg, but just replaced it with a classmate.

"Actually, it's not exquisite, it's just taken casually." Fang Qian washed the coriander roots one by one, put them in the palm of his hand and rubbed them, and said.

"In our Fang family, the previous generations, including our generation, have few literate people."

"The reason why your name is Xian is because your aunt hopes that you can be more idle when you grow up, don't be so busy, don't be so 'rolly', in fact, your aunt still has some opinions on your Uncle Yun's dedication."

"Although I can understand your Uncle Yun, in the current crisis, you have the ability to do it. But from your aunt's point of view, the scene at that time was indeed too dangerous, and even if you look back now, it is still very dangerous. ”

"And, I heard that it seems that your Uncle Yun's surgical skills are very powerful, if he is next to your aunt, even if your aunt has an amniotic fluid embolism at that time, he can leave no sequelae......"

When Fang Xian heard this, he drained the red amaranth out of the vegetable basket, and his hands were like blood: "Could it be that my aunt is reluctant to go back to Changshi because of this?" ”

This was a point of doubt in Fang Xian's heart.

It stands to reason that Uncle Yun will either work in Shashi, or it would be better for his aunt Wang Huan to work in Changshi with Uncle Yun.

The two of them work in the same place, and it is much better for the other party to pray for peace.

"That's not it, your Uncle Yun came back to Changshi, in fact, to do something, it seems that he also wants to give it a try, can you cure your aunt's hand."

"Bang la la la ......" Fang Qian turned on the faucet again, picked up the coriander root and put it down.

"The doctor's hands may be different from us ordinary people, if I feel that my movement is not flexible, I will carry things with my fingers when I carry things, but the doctor is definitely different."

"I've heard people say, your aunt used to be very powerful, she was so young at that time, when she just gave birth to a child, she was an associate professor, only twenty-eight or nineteen years old, an associate professor at this age, isn't it amazing?" Fang Qian didn't know much about the affairs of the medical industry.

But I also work in a pharmaceutical company, so I know a little bit about it.

"It's awesome, even in the old days, it's awesome, and if it's now, it's even more powerful." Fang Xian nodded.

Now it is more difficult to evaluate associate professors than before, in the past, only scientific research results were needed, but now what is needed is the number of students who can be taught, and it is very difficult to teach, and it is necessary to bring the resident training into a master's degree graduate.

If you are unlucky and bring a few fairy students, just like your own 'teacher', you may really be angry to death.

Professor is a teaching title, and you can be the chief physician, but in a teaching hospital, at the non-professor level, you will be laughed at.

……

At five o'clock in the afternoon, Fang Yun also came to the house, and he also brought something. It's a bottle of Wuliangye, but looking at the outer packaging, it should be the kind that is worth a lot of money.

"Xiaoyun, why are you still bringing wine here? Is this family still so polite? Fang Qian had already poured wine on the table.

"Second brother, since you have said that it is your own family, then you are not welcome, Xiao Xiaoqian and I are here as if we have two pairs of dishes and chopsticks, right?"

"Isn't it normal to buy something and come back?"

"Second brother has an opinion, so I put on my shoes and go?" Fang Yun had already changed his slippers and joked.

"Don't, Uncle Yun." Fang Xian hurriedly stepped forward and screwed the wine in his hand.

Fang Yun didn't have any document bag, and he only had a keychain, which he put on the entrance easily.

After Fang Yun entered the door, he shouted: "Sister-in-law, I'll wash my hands first, and I won't go into the kitchen to help for the time being." ”

"No help, you can eat." Chen Hui replied.

Fang Yun explained to Fang Xian: "When I first came back, the emergency department received a hemorrhage in the arteries of the lower limbs, I covered it, I went to wash my hands again, and there will definitely be bones to gnaw later." ”

After speaking, Fang Yun also sniffed, it was also relatively casual, and he couldn't see the professor's shelf.

"Uncle Yun, do you want a drink? I bought coffee, oriental leaves, and soft drinks. ”

"Then take a bottle of oriental leaves, you can taste anything." Fang Yun said as he turned on the faucet at the sink, saying:

"Second brother, don't pour me wine, there is another operation tonight, I guess I have to go on stage. The patient who just came in the afternoon estimated that they had a hard time dealing with ......"

Fang Qian poured all the wine, looked up and asked, "Then you don't want to go for surgery now?" ”

"We can wait for you to get off the stage before eating."

Fang Xian helped go to the kitchen to serve the meal.

"Eat when you eat, and the people in the department must also grow, so that they don't go through a few patients who can't be handled, and they can't grow."

"Second brother, I'll drink with you tomorrow." Fang Yun squeezed out a smile.

Fang Qi'an didn't come back for dinner in the afternoon, he estimated that he wouldn't be able to take leave, maybe the afternoon time was too short, and the time to go back and forth was not enough.

"Uncle Yun, when the surgery is going on, should I go with you?" After Fang Xian filled the meal, he suggested this.

After all, if you can go on stage, you can have more skill points and consolidate your skills.

Now that it has been decided to develop in urology and gastrointestinal surgery first, Fang Xian also has to plan carefully how to add points in order to achieve a better state of rebuilding the function of urine and urine.

The more skill points you have, the faster you will definitely improve.

"Your aunt said you worked harder than me, but I didn't believe it at first."

"You just came back, what are you going to drill into the operating room?"

"You're not afraid that my brother and sister-in-law have an opinion about me?" Fang Yun asked back.

Fang Qian and Chen Hui hurriedly shook their heads: "That won't be, that definitely won't, Fang Xian still has to learn more from Xiaoyun, he is very junior now." ”

Fang Yun pursed his lips and said, "Uncle Yun, I'm looking forward to seeing a big professor like you do surgery now." Would love to learn about it. ”

Fang Xian's current vision and insight are not short-sighted, but he also lacks a certain extent, that is, he has never seen a top professor like Fang Yun perform surgery.

And Uncle Fang Yun's strength must be one level higher than that of Professor Xu, Professor Zhu Na and others.

Moreover, Fang Xian also felt that if Fang Yun was doing something related to the functional reconstruction of his aunt's hand in the First People's Hospital of Changshi, he would definitely be doing research on nerve displacement and functional reconstruction, and he would not be able to help him do the reconstruction of urine and urine function.

To have an existing path and a certain foundation will save a lot of time than to slowly start from scratch on your own.

Fang Yun didn't play any scheming and modesty with Fang Xian, and nodded: "Okay, if you are willing to go, then you can go along, but the surgery I am going to do today is probably not the one you want to see." ”

While talking, Fang Qian was giving Fang Yun vegetables, two cured pig's trotters, the best meat quality, and the fat and meat.

"Oh oh oh, enough is enough, don't clip it, brother, I'm not a child anymore, you give me so much."

"Come, Xiaofang, here you go, I'm all fat......"

After eating, Fang Yun and Fang Xian didn't have time to eat, and they didn't even have time to clean up the dishes and chopsticks, so they rushed to the direction of the department.

Fang Yun expected it correctly, there was no accident in the operation, but it was also something that no one else could handle......

When the abdominal aorta is not completely ruptured, the resulting 'arterial dissection' and 'pseudoaneurysm' will stop the entire operation.

If such an operation is performed by Professor Zhu Guangyu of vascular surgery, then the operation will definitely be completed, but Professor Zhu Guangyu is a professor of vascular surgery who is infinitely close to a level 5 physician, how can the directors of the First People's Hospital of Changshi be compared?

The two hurriedly entered the operating room, and Fang Yun walked briskly in the direction of the operating room, and said: "Pseudoaneurysm refers to the tearing or puncture of the arterial wall, and the blood flows out from this hole and is wrapped by the tissues adjacent to the aorta to form a hematoma, which is mostly caused by trauma. ”

"Do you know the principles of management of pseudoaneurysms? It is to think about how to deal with this from the perspective of simplicity and mechanism. ”

When Fang Xian heard this, he replied: "Accurate diagnosis, hemostasis, filling the vascular gap, and debridement." ”

A pseudoaneurysm is a trauma-induced burst in a blood vessel that forms a hematoma with surrounding tissue.

Then it is necessary to make an accurate diagnosis to find the location, size, and number of aneurysms, as well as whether there is an adherent thrombus in the aneurysm artery and the aneurysm.

In the case of angiography, the image of the tumor cavity shown by angiography is often smaller than the actual size of the tumor, but it can provide a basis for diagnosis and differential diagnosis, and provide a reference for the selection of treatment methods.

In addition, CT and MRI examinations also have great reference value for diagnosis, especially MRI can determine whether there is an adherent thrombus in the tumor when examining large aneurysms.

Giant aneurysms often show mixed signals of various components, this patient is a pseudoaneurysm of the more fatal abdominal aorta, such as blood flow and vortex due to the flow of void effect is no signal, calcification is no signal, thrombus is high signal, hemosiderin is low signal, aneurysm is concentric circle stratified mixed signal, thrombus is in the inner surface of the aneurysm wall, can be concentric circles, the aneurysm cavity is thus narrowed, only accounting for a part of the aneurysm......

Fang Xian's theory is now very abundant, and he has made a thorough and detailed analysis of the possible diagnosis at once.

Fang Yun stepped upstairs and continued to ask: "How to stop the bleeding, how to fill the gap?" ”

This is a further question of Fang Xian's corresponding theory.

Fang Xian was subconsciously sure that he would be able to think of hemostasis.

Haemostasis is a basic operation in medicine: "extravascular clamping, balloon intervention to stop bleeding." Then, around the wall of the hemangioma, outside the true artery, the procoagulant is injected with interventional puncture to seal the breach, and the bout can be plugged in advance with a balloon to avoid the procoagulant entering the blood vessel and reshape the blood vessel in advance. ”

For pseudoaneurysm, the treatment must be to stop the bleeding, and the blood bag that breaks out of the blood vessel must also be cleaned up.

If the hematoma is liquid, it is difficult to perform debridement directly, but if a blood clot forms after early treatment with a procoagulant, the blood will not explode even if the hematoma is incised.

But this requires the basic medical skill of very precise puncture.

Pseudoaneurysm of the abdominal aorta is estimated to be below grade 4 puncture, and it is difficult to even think about the operation, and grade 4 puncture can only be barely ......

"It's worthy of being a Ruyi doctor with many level 5 skills, this therapeutic thinking is like a rich man throwing money......" Fang Yun turned his head and looked at Fang Xian.

Then he asked, "What if there is no suitable balloon and no suitable procoagulant?" ”

"This is not the trauma center operating room of Shonan University Hospital!"

(End of chapter)