Regarding this point, Fang Xian really hadn't known much about it before.

But I also know that the Affiliated Hospital of Shonan University, decades ago, was a hospital directly under the Ministry of Health. However, after the Ministry of Health was changed to the Health Commission, the word ministry was not specifically mentioned anymore.

But there is one point, the Provincial Health Commission has really played a role in managing and restraining the Affiliated Hospital of Shonan University.

In other words, if you don't manage and restrict, then the resources will be relatively unconcentrated to you.

A child who belongs to someone else's family?

Fang Xian said: "Thank you, Professor Gong, this arrangement may be more troublesome, Professor Gong." I'm still in Changshi on weekends, and there are some minor surgeries over there, so just take your time. ”

"I can skip some of the basic skills of the specialist and start with the specialist skills."

"Pelvic peritoneal adhesiolysis, peritoneal adhesiolysis, peritoneal adhesiolysis, these local procedures ......"

Specialist basic skills are a further derivative of basic medical skills.

For example, local resection of rectal lesions or tissues is the basic specialty of gastrointestinal surgery, and it is the application of incision and debridement in gastrointestinal surgery.

Can bone debridement and intestinal debridement be the same concept?

However, for example, the release of peritoneal adhesions and the release of abdominal adhesions are two different diseases, which are further subspecialty skills.

The quality of adhesiolysis may not be fatal, but the irritation and impact on the patient's postoperative digestive function are also relatively different.

Professor Gong Ziye is also easy to speak: "Xiao Fang, it's great if you think like this." ”

"Actually, when I first found out that you came to our general surgery department, I was also surprised and delighted."

"I'm surprised, I'm afraid I won't be able to bring you, but I'm glad that our general surgery department finally has a super seed player, and it is estimated that after you come, you will be able to develop with our general surgery department and create something more."

"But it's a pity that even the peritoneal adhesion release and abdominal adhesion release you just mentioned have now been classified as a specialist emergency department of general surgery, not in our trauma center."

"So, you may have to start with the big operations like repair and replacement, and then disassemble these operations yourself to a certain extent."

"But it doesn't matter, I have already discussed it with the director of the specialty, and with the opportunity, we will definitely let you see and understand the corresponding diseases of our general surgery more comprehensively."

"Decades ago, most of the common emergency diseases in our general surgery were single-organ diseases such as gastric perforation, gallbladder rupture, intestinal perforation, and pancreatitis, but in recent years, the incidence of multi-organ combined injury has been increasing."

"You should know that the more serious the development of technology, once the trauma occurs, it cannot be a simple injury, including large-scale damage."

"However, in our general surgery department, there are closed injuries that are caused by impact into a rupture of the pancreas, and naturally, there are also diseases such as vertebrae fractures and liver contusions."

"During Xiaofang's training camp, what you can get in touch with is the finishing stage of these diseases, such as sutures, such as simple local debridement, and the key techniques have been done by our professors who are the chief surgeons, so that they will leave you with some opportunities for basic operation skills."

"Naturally, if you have good talent, you may be able to use these basic skills to achieve a better processing effect......"

Professor Gong Ziye was drinking tea while chatting with Fang about some common diseases in the general surgery department of the trauma center, and Fang Xian couldn't help but sigh as he listened.

Indeed, the development of science and technology has made it possible for trauma to occur more than just a matter of breaking the muscles and bones.

Twenty years ago, death was the ultimate destination for patients injured in a quick car accident.

After experiencing the improvement of on-site first aid capabilities, more and more injured people are now able to go to the hospital alive, but the diseases left behind are becoming more and more complex, so that the trauma center has to meet such a highly violent traumatic disease.

And these diseases are still the discussion of the content of medical development from death to life and from life to life.

Extensive damage is only a small part of it.

Under the damage and injury, there are also some "string injuries" in the abdomen, which is not uncommon at present.

What is a string of injuries, that is, reinforced concrete and other objects, stringing people up, breaking the chest, bursting the head and skull, encountering a broken leg, and encountering the abdomen, it is strung up.

And the reason why Fang Xian had never been in contact with this kind of 'skewer injury' before was because at that time, almost no one dared to throw such a disease to ordinary students to deal with, that is, after entering the debridement group, he had the opportunity to contact it.

The suture group is a smaller, simpler disease, such as simple intestinal obstruction, then you cut the skin, it doesn't matter.

For example, if you need to remove your gallbladder for bile duct stones, then you can cut the skin, and it doesn't matter.

You may die in four or five minutes, and then you will slowly do an exposure incision for your intern, how is that possible?

The Shonan University Hospital, which is committed to reducing the mortality rate in the operating room of the trauma center to less than 1 in 1,000, will not let you mess around like this at all.

That's why Fang Xian didn't know there were so many things before.

Now that he has grown up, the twelve basic skills have reached a super high level, so naturally everyone welcomes Fang Xian to go to the college for development?

Because everyone knows that if Fang Xian is absolutely violent, the 5th level incision and the 5th level hemostasis may directly reach any cavity, any organ, and any blood vessel in the human body within three minutes.

That's the beauty of basic medical skills.

It may be that Fang Xian can't deal with specialized diseases, but he can find them.

For example, Fang Xian can diagnose some subtle diseases that are difficult for mature specialists to diagnose, but Fang Xian may not be able to deal with them.

But it doesn't matter, Fang Xian can grow, and the specialist also welcomes Fang Xian to come and grow and lead the specialist to a new field.

After Fang Xian entered the general surgery department, he was able to send more general surgery diseases to the specialty, so that patients can form a standardized treatment process, be able to downgrade treatment, and reduce the dimensionality of the disease.

You can't disagree yet.

I don't accept you to beat me.

Although Fang Xian may feel that such a disease has come in and lived, he can't move, he is disabled, and he feels that he is doing evil.

But this is a milestone in the development of medicine, and for the corresponding patients, as long as a few percent of them can survive, it is salvation.

What others can't save, you can save, that's.

Something that can shut you up.

As he spoke, Gong Ziye's message rang out: "Oh, here is a picture of a string of injuries, do you want to take a look, this is a picture of the bumper being inserted directly into the umbilicus and reaching the posterior column of the lumbar vertebrae, causing the lumbar vertebrae to burst." ”

"It's relatively simple, only the damage of hollow organs, that is, the intestine and bladder, and there is no direct injury to the substantive organs, at most it is contusion."

Gong Ziye showed Fang Xian the general picture.

As soon as Fang Xian looked, he saw a young man, who was stuck in the car seat, drenched in blood.

However, in the second picture, the team of the fire department and the 120 ambulance removed the front end of the bumper, and in the part of the incision, a temporary hemostasis operation was carried out on the 120 car, and now it has been transferred to the emergency surgery.

Preparation before proceeding to the operating room.

For example, temporary tamponade to stop bleeding, temporary assessment of vital signs, etc.

The reduction in mortality in the trauma center is not only the awesomeness of the surgeon, but also the awesomeness of the emergency team, which is also a great benefit to the survival rate of patients.

Fang Xian looked at it and said: "Look at these methods of stopping bleeding, these 120 doctors with the car, the hemostasis techniques are at least level 4?" ”

"That's natural, the more life-saving operations are, the more basic they are, and they don't need too many bells and whistles."

"If the bleeding can be stopped and the heart rate can be maintained, the patient will have the opportunity to go to the emergency department."

"In emergency surgery, only when a patient in shock can be brought back from the Hades Palace, can the patient have the ability to enter the operating room."

"At present, many entry requirements for 120 and emergency departments are level 4 of hemostasis, which is a hard-core indicator, which is to save lives."

"You don't even need so many specialized skills, as long as the hemostasis reaches level 4, you can come if you want, no matter what age or education you have."

"Of course, the emergency surgery department of our hospital will require a relatively more in-depth ......," Gong Ziye reported the case to Professor Wang Huan as he spoke.

Then he said into his mobile phone: "Professor Wang, this is a patient with a penetrating abdominal injury, and the diagnosis has entered the backstage of the trauma center, you can contact the professor in charge of the surgeon and arrange an assistant." ”

"Fang Xian will go over and become an assistant!"

After Gong Ziye finished posting, he didn't wait for Professor Wang Huan's reply, so he dimmed the screen of his mobile phone.

"Let's go, I'm in charge of this operation, let's go and see it together, wait for an assistant, and we'll be able to do it." Professor Gong Ziye's tone was not small, as if such an injury was a piece of cake for him.

Fang Xian nodded and said okay.

The patient's injury is not as good as a large-scale damage.

Fang Xian followed and asked, "Professor Gong, how many categories can such a patient be classified into in the medical association's disease classification?" ”

"Penetrating injuries without substantial organ damage are 3 categories, if they hurt blood vessels, or if they are incidental to substantial organ damage, then they will be classified as 4 categories, and the mortality rate of similar diseases in the country has soared from 10 percent to about 30 percent."

"The kind of extensive damage you did before was directly classified as category 5, with a mortality rate of more than 50 percent, and only a very small team was able to ensure the survival of patients." Gong Ziye also has an understanding of what he did before he was free.

"What about the mortality rate of such penetrating injuries in our hospital?" Fang Xian asked again.

Gong Ziye tilted his head and smiled: "Xiaofang, our hospital has actually been a handful of hospitals that have lowered the mortality rate. But even so, in our case, such patients still have a mortality rate of about three to four percent. ”

"It's just that there will be an accident during the operation."

"The diagnosis I just showed you is the diagnosis made by the members of our 2 teams in the trauma center ward, and there may be something missing."

"But such an omission, there can't be a big mistake, for example, the damage to the large blood vessels can't be seen, then it's a big joke."

"Of course, I looked, this patient did not have a large vascular injury, and just avoided the abdominal aorta."

Fang Xian actually saw the diagnosis, and also glanced at the previous MRI tomograph, and asked again: "Professor Gong, what about the bilateral ureteral arteries?" ”

Gong Ziye's chubby body suddenly paused, and he turned his head to see-

His eyes flickered on Fang Xian's body.

His face changed dramatically.

Fang Xian asked questions, and naturally he would not ask in vain.

What is the mortality rate in our hospital?

Professor Gong, on the other hand, chose the absolute trust of Fang Xian, because Fang Xian's current reading technique is level 5, which is something that all professor-level people in the trauma center know.

"Professor Wang, in an emergency, the patient I just sent you is suspected of having bilateral ureteral artery damage, please be sure to arrange for someone from the vascular surgery department to go to the emergency surgery department for consultation, and arrange for the professor of vascular surgery to come to the operating room." Professor Gong Ziye's mind was restless, and his tone changed slightly.

When Fang Xian heard this, the corners of his mouth moved, but he didn't say anything after all.

This patient did have bilateral ureteral artery damage, but the incision was not that large, and there was embolism at the proximal end of the artery, so the amount of bleeding was not much.

The reason why he mentioned it was because he hoped that Professor Gong Ziye would understand this, so as not to send him to a specialty, find a ureteral artery embolism, and then enter the palace for the second time later.

During the operation, they can do a simple vasotomy and thrombus removal together, which is not difficult for the other party.

It's just that Professor Gong Ziye's performance is a little?

However, Fang Xian also understands that most doctors are still specialists, and only a small number of doctors in uncertain departments can be more versatile and full-time, picking multiple specialties and subspecialties on one shoulder.

Be informed.

When Gong Ziye heard this, he touched his thick earlobes with some embarrassment: "Xiao Fang, your basic skills are practical enough, but they are also scary enough." ”

"If this patient has a ureteral injury and is not detected in time, if there is sudden bleeding during the operation, wouldn't it be a big trouble?"

Sometimes, ignorance is a source of strength for boldness.

Fang Xian said: "Professor Gong, that's not enough, this patient has a thrombus in the proximal ureteral artery, and it is estimated that if you look closely, there are other small arteries that have embolism." ”

"Therefore, after thrombectomy, it is necessary to consider the need for thrombolytic therapy for the patient, so during the operation, whether to do vascular suturing or use other methods, such as spacers, to deal with the location of the breach, you have to discuss carefully."

"This injury is not fatal, and it will not bleed suddenly, but I found out, so I mentioned it."

Fang Xian's answer was quite pertinent.

But Gong Ziye's eyes were quite resentful.

The scene of his distraction just now seemed to be like a funny old child, which made Gong Ziye's mood very complicated.

Originally, he wanted to erect a mature and stable image in front of Fang Xian, like a spring breeze, Bole. However, in front of Fang Xian, it didn't take long for him to completely break his appearance.

Forget it, then live back to your old boy image.

Gong Ziye sighed: "Level 5 skills, the more basic they are, the easier they are to use, and the more I have been a doctor for many years, the more I know such a result." ”

"However, now, I have been in the junior college for many years, and it is difficult to go back and consolidate my basic skills. After all, there are so many clinical tasks, and some surgeries cannot be done by others. ”

"I can only keep making do."

"Xiao Fang, you are the envy of many people. Hexagonal warriors. ”

"I seem to understand a little bit about what Professor Zhou and Professor Yang have been talking about regret before."

Fang Xian said: "Professor Gong, the description of the hexagonal warrior belongs to the killing, and my hexagonal has only made a foundation." Later, follow Professor Gong to learn more. ”

"We learn from each other, in fact, I have piled up a lot of questions, so I hope that Dr. Fang is here, and you can give me answers and corroboration."

Gong Ziye said, first blocking Fang Xian's mouth.

"Don't refuse, half of your people who belong to me now, what I want to seal, except for you, there is no one else who can do it at present, don't refuse me."

"We're friends." Gong Ziye's chin was raised, and there was no doubt about it.

……

After entering the operating room, the chief surgeon of the Department of Vascular Surgery was still skeptical after carefully reading the film, and turned his head to look: "Professor Gong, are you sure you saw this patient with ureteral artery damage?" ”

"How do I look at it, it doesn't look like it?"

Gong Ziye is fully armed at the moment and ready to come to power at any time.

Fang Xian and his assistant have already begun to disinfect and spread towels.

Gong Ziye shook his head: "Professor Tu, if you ask me this, I can't give you an answer directly, this is what Dr. Xiaofang said, and I didn't see it?" ”

"The most important thing in our general surgery is not MRI reading."

General surgery, based on the basic skills of MRI, is also debridement.

MRI reading is a core skill in interventional surgery, imaging, hand surgery and sports medicine, just as suture is fundamental to hand surgery.

In fact, there are two core skills in vascular surgery, one is to cut open exposed blood vessels, and the second is hemostasis.

Many operations in vascular surgery are based on these two points.

In fact, the requirements for puncture surgery are not high, and the intervention of vascular surgery is a relatively simple operation.

"Did Dr. Fang say that? Then I'll take a look. When the person named Professor Tu heard this, he hurriedly ran to study again.

What Dr. Fang, who has a grade 5 MRI scan, can you not listen to what he said?

Just kidding.

Even though Fang Xian is only a small resident, he is now a 'Ruyi' surgeon, an iron bucket-like existence, and his basic skills are so solid that he is not a person at all.

Thousands of high-rise buildings rise from the ground, Fang Xian's foundation, now at least can support him to walk 100,000 zhang, the professor is not his end, the prospect of the discipline taking the lead, is Fang Xian's start, and then go up, it is not impossible, as long as there are no accidents......

(End of chapter)