Seeing Professor Tu of the vascular surgery department, he honestly went to read the film again, although Gong Ziye is also a professor, and his mood is quite messy at the moment.

This Fang Xian is full of treasures, and many basic skills have reached level 5, is it really so easy to use?

But soon, Gong Ziye also suddenly realized, if he has not reached level 5 before the debridement technique, he also adheres to the level 4 skill in the operation and work of general surgery, which is enough, why pursue level 5 skills?

Eat it as a meal?

When he reached this realm, Gong Ziye always felt that it was really fragrant.

At the beginning, it may not improve a person's ability much, but the further back you go, such basic skills, like fermented old wine, allow you to open up a gap with others, and such a gap is not something that you can make up for by learning more bells and whistles.

The more basic it is, the more it is the foundation of a person's life.

"Professor Gong, I'll go out to wash my hands and change my clothes again, you can start the stage with Teacher Zheng first." Fang Xian took the initiative to take on the work of the lowest doctor.

Mr. Zheng is an assistant and not a professor of Zheng Baiyan.

After listening to this, Zheng Mohan corrected again: "Doctor Fang, call me Brother Zheng or Brother Han, don't call me a teacher." ”

Fang Xian nodded after listening: "Okay, Brother Zheng, the title you gave me has been corrected, and I feel comfortable." ”

After Zheng Mohan entered the operating room, he had a Teacher Gong and a Teacher Fang, and Fang Xian could stand it?

I don't feel very comfortable, so I use the way of others to give back to others.

In the end, Zheng Mohan pushed back first.

When Fang Xian washed his hands again and came into the operating room again, because Professor Tu from the Department of Vascular Surgery was on his side, he was not afraid of arterial damage, so Professor Gong Ziye and Zheng Mohan had already begun to anatomically separate the bumper in the abdomen.

I want to take it out first.

This is a kind of belief and heritage.

Professor Tu is a professor of vascular surgery, and even if the abdominal aorta is broken, he has the ability to deal with such an intraoperative breach, which will make Professor Gong Ziye of the Department of General Surgery feel at ease and bold when he does the surgery of General Surgery.

Just like through you, the anesthesiology professor in the operating room of the trauma center, any surgeon does not have to worry about their anesthesia level, they often reconcile the patient's life and death, and during the operation, regulate the vital signs to the edge of shock.

In the past, Fang Xian would not have so much, but after a trip to the First People's Hospital of Changshi, Fang Xian only knew.

The reason why the operating room of the trauma center of the Shonan University Hospital has been able to get to this point is not only the credit of Professor Zhou and Professor Yang, but also the formation of a super team.

There's a professor on the side.

I'm not afraid of broken blood vessels.

The surgery is not afraid of the patient's death, and the thoracotomy is not afraid of splitting the heart, so you can rest assured and boldly only deal with specialized matters.

I have pelvic surgery in trauma surgery, so I am not afraid of accidentally poking the bowel of general surgery. Such reassuring boldness is the result of strict standardization.

It's like, as long as he can enter the operating room, as long as he is an assistant, he has the strength to be able to take on the assistant.

There's at least a bunch of level 2 skills out there, guaranteeing the lower limit of the quality of the surgery.

However, at this time, the exposure speed of Professor Gong Ziye and Zheng Mohan is relatively slow.

None of them.

Because their incision level is level 3 or 4, and they don't reach level 5.

If this is a standard procedure, non-invasive, random wound, they may be able to get to the desired field quickly and calmly.

But trauma is something that textbooks can never describe in detail, and the bumper is full of randomness and randomness when inserted from the belly.

Fang Xian instinctively disliked this kind of exposure speed slightly.

Moreover, Fang Xian also had an operation with Uncle Fang Yun yesterday, which was also a traumatic operation, and the level of Uncle Fang Yun's incision and the degree of violence and sophistication opened Fang Yun's eyes again.

The perfect-level incision, his uncle Fang Yun, is definitely in his hand......

However, after Fang Yun was instructed by Professor Zhou Cheng, he did not envy such a realm of incision, but found that his Uncle Fang Yun had now become an instinct at this level of operation.

No matter how he cuts, there will not be much change in him, and the surgery without too many changes will actually be set at this moment.

It was also here that Fang Xian knew a very cruel fact, generally people who are at a certain peak, he wants to create the peak again, the possibility is very small, but some newborn calves are not afraid of tigers, so they will find another way to come out of a new way, pushing through the old and bringing forth the new......

Maybe Fang Xian's few seconds of looking at it made Professor Gong Ziye feel Fang Xian's emotions.

"Xiao Fang, if you don't expose it, let's buy a little time." Gong Ziye sniffed, his tone quite helpless.

Fang Xian's level 5 incision, but as long as he leaves the operating room of the trauma center and goes to the specialist, the applicability may not be so great.

The surgical approach of the specialty has been developed very exquisitely, and each disease, as long as the approximate location of the lesion is known, there are decades or even more than 100 years of surgical experience as the foundation, so that Gong Ziye can accurately and quickly and perfectly expose the lesion in accordance with these standards.

The only exception is uncontrollable wounds caused by trauma, which are very basic.

On the contrary, such a wound, because of uncertainty, so people like Fang Xian, who do not have a deep understanding of the specialty and rely on basic skills to fight hard, will be more comfortable.

Because there are only two things that need to be guaranteed.

First, it does not harm important tissues such as nerves and blood vessels.

Second, expose the lesion so that they can take out the foreign body, where did Guan Fangxian get in.

If such a disease is not defined, there can be no standard surgical approach as a demonstration, and everything is unknown.

Fang Xian didn't excuse himself, there was surgery to do, and it was also a skill point, and Fang Xian currently needed a lot of skill points.

Although it is said that many basic skills of specialties are driven by the basic medical skills of level 5, and they have reached level 3, but at the level of level 3, Fang Xian is naturally not eye-catching now.

And, since Gong Ziye can't come up with a better response to the exposure of the current emergency disease, then his simple incision and hemostasis are the best surgical guarantees that can be provided for patients.

It is not a tyrannical situation to do better surgery on the patient, which is not against the doctor's intention.

Fang Xian took the scalpel, just looked at the position where the bumper entered, and started to operate from the position where Professor Gong Ziye had arrived before.

However, Fang Xian only used a round knife to expand the surface of the skin a little, and after further expanding the incision, he switched to using vascular forceps for blunt puncture.

Incision, which is an operation, is right.

But incision, in fact, is also a concept, which is from Fang Xian's perspective and understanding, which is the case.

Incision, not just cutting with a knife, everything that is suitable and can do the operation that exposes the approach, is part of the incision.

As a result, the basic medical skill of incision has evolved into many different concepts and development directions at level 4.

Someone is an assistant, and Fang Xian's hands can be used as much as possible.

Holding a hemostat in the left hand, the tip of the forceps of the hemostat is vividly dancing with a dragon and phoenix, and the right hand is holding an electrocoagulation knife.

However, in just over forty seconds, Fang Yun had already stretched open the peritoneal layer that had been scratched, slightly enlarging the breach, and did not let the sharp edge of the bumper cause a second cut injury to the peritoneum.

After breaking through the peritoneal layer, the experienced Professor Gong Ziye and Zheng Mohan also further penetrated the hook under the peritoneal layer and slightly pulled a distance between the sides.

The incision is a longitudinal line before it is opened.

When it is pulled apart, the upper and lower edges of the incision will be further narrowed.

At this time, Professor Gong Ziye and Zheng Mohan found that the opening that Fang Xian had broken in advance was just right to be stretched and shortened, and there was still a distance of about 0.5cm from the sharp edge of the bumper, which was just convenient for the transparency of the field of vision, so that the peritoneum would not be cut by the sharp edge.

This is clearly designed in advance.

Three years of surgery, a lifetime of exposure.

Surgeons, most of the time, are studying how to expose the lesion, expose the lesion well, accurately find the location, and use appropriate methods to remove or dispose of the lesion.

This is the essence of surgery.

When Gong Ziye had an understanding, Zheng Mohan asked: "Doctor Fang, did you predict this incision in advance, after the hook is opened, the left and right up and down are just right in the right position?" ”

"It's almost done, but it's not that precise, if you want absolute accuracy, you have to use a ruler to measure, but this will delay a certain amount of time."

"Abdominal opener—" The nurse, who also has professional skills, handed over the abdominal stretch clip.

When Zheng Mohan heard this, he carefully opened the abdomen, entered from the lower abdomen, and put it into the incision where the retractor was opened.

Only then was the crowd able to see what was going on inside.

It's a mess.

The 'charming' taste unique to gastrointestinal surgery in general surgery comes out of the stomach.

But fortunately, the suction device is powerful enough to suck out some of the flavor, and this is a laminar flow operating room, and the ventilation is very good.

The intestinal tube must have been broken, and how much it was broken, is unknown for the time being.

Everyone is carefully looking to see if it is possible for the bumper to be inserted into the abdominal aorta.

Fang Xian said: "The current bumper material is getting better and better, and you can still do MRI with the bumper." ”

Traditionally, metals cannot be MRI, otherwise in the process of doing NMR, metals will fly out of the body, and the consequences will be unpredictable.

However, after the development of science, many internal fixation materials have been changed to magnetic blunt metal, which can be used for nuclear magnetic resonance.

"Well, whether the material of metal is suitable for nuclear magnetic resonance, the current fire department will review the material at the accident site and record it, so that our doctors can do the corresponding examination after being admitted to the hospital." Gong Ziye returned.

Professor Tu saw it at this moment, and sure enough, there were relatively small holes in the ureteral arteries on both sides, but no blood spurted out.

And this crack is not a roll rotten mouth, but a standard sharp hole.

The curly mouth is a blunt flesh and then cut, the irregular shape, sharp and broken, is a relatively standard surgical incision, and the fit is intact.

"Doctor Fang, can you see it like this?"

"I said how come when I just read the film, I didn't find it on the MRI." Professor Tu suddenly realized.

If it is a blunt mouth, it is a lump, he can't find it, and he can definitely see it through the hierarchical distinction.

In the Department of Vascular Surgery at the Affiliated Hospital of Shonan University, new employees are required to be hired as attending physicians, and the requirements for MRI reading are level 4.

Level 4 looks at the level, even if it is a subtle change, it will not escape the eyes of the law.

"There is local inflammatory edema, and the blood inside the ureteral artery in this patient is cut off, in this case, there is a signal of abrupt edema in the blood vessel wall, and it should be considered from the rupture."

"This patient's trauma is sharp, and there may be a scratch."

"Later, we probably have to find a free foreign object......" Fang Xian only returned at this time.

The level 4 of NMR is to look at the different levels, and it can more finely detail the structure of different levels of shape.

However, for grade 5 MRI reading, it is necessary to look at the theoretical components. If you don't know how to read the theory, then the set of questions that Professor Zhou and Professor Yang Yifeng asked Fang Xian to do, Fang Xian is estimated to become blind soon.

There are basically few serious MRI images that only let you see the lesion.

Professor Tu was enlightened when he heard this: "No wonder Professor Yang Yifeng said such a sentence when he was in the specialty of vascular surgery before. ”

"Incurable diseases, the difficulty lies in diagnosis. The reason why diagnosis is difficult is that the attention to detail is not enough. Medicine is so vast that if you just use your specialist knowledge to peek into, you can only see what you want to see. ”

"If you don't want to see it, you're likely to be ignored."

"This is the cognitive domain."

Speaking of this, Professor Tu looked at Professor Gong Ziye: "Professor Gong, then this patient doesn't need our vascular surgery to participate, just need to come over at the end of the operation, let's come over for a thrombus removal operation, plus vascular sutures." ”

Professor Tu instantly challenged Gong Ziye and enlivened the atmosphere in the operating room.

We don't need to be mixed with vascular surgery so early, why are you asking me to come over? Do I need to make a trip for such a simple operation?

Gong Ziye replied very generously, while continuing to cooperate with Fang Xian to do the debridement and aspiration of the inner intestinal tube and intestinal contents, and said: "Professor Tu, I was wrong, next time I will go for a consultation in neurosurgery......

Hearing this, Fang Xian glanced at this old yin and yang man.

Gong Ziye is emphasizing that he is a doctor of general surgery, not a doctor of vascular surgery, and you can't even see the diagnosis of the old man, why do you want my general surgery doctor to see it in such detail? Also be able to evaluate the surgical method?

The old connotation is up.

Professor Tu rolled his eyes.

Everyone came, and he didn't bother to leave, and continued to watch Fang Xian's operation.

To be honest, Professor Tu, who is used to vascular surgery, is not unaccustomed to seeing some disgusting scenes, even if it is bloody, dark blood masses, hematoma extraction, and blood stains on his hands, Professor Tu has seen it.

But the operation of turning, Professor Tu really doesn't see much.

But there is no way, it seems that Fang Xian and Gong Ziye are still doing it with relish.

Fang Xian's understanding of general surgery was not particularly in-depth, so he asked: "Professor Gong, from these points, is this patient not good in digestion or absorption?" Still not in the right place? ”

When cleaning up the food accommodation, Fang Xian still inquired about it.

The gastrointestinal tract is absorbed in stages, digestion and peristalsis, and it is also continuous, not digested immediately and then absorbed as soon as it enters the stomach, it is an intermittent process.

"This is the jejunal loop. There should be both, and the run-in digestion of the stomach is not good, and if the absorption function is concerned, you have to check the specific nutrients to make a good judgment. ”

"This patient is not particular enough about eating, it is too rough, he does not chew and swallow slowly, and after entering the stomach, it becomes like this......"

"Actually, it's okay, it's not completely digested, the taste is not so big, if it's a colonic segment, or the end of the ileum?" Professor Gong Ziye was seriously popularizing science for Fang Xian.

Fang Xian opened the ball again and asked:

"Is that all?"

It's not chilling to be a scholar.

Gong Ziye nodded: "This shape is right, it is not fully formed, but the degree of decay is good, in the colon section, it will be formed after water absorption, and then it will be emptied, except when it is thin......"

"This paragraph should be the ileum ......"

"Tour, give me a marker, I'll mark it."

In the case of abdominal damage, the intestinal segment should be well distinguished.

After all, the human intestine is very long, and there are no absolute gaps and anatomical markers in the jejunum and ileum. Therefore, in the case of multi-segment intestinal rupture, it is necessary to mark it slightly, and record the type of intestinal tube through the contents, so as to facilitate the control of digestion and handwashing ability during subsequent resection and anastomosis, so as to avoid the formation of short bowel syndrome.

And when he did this, Gong Ziye reacted: "Xiaofang, your intestinal segment resection should not be said to be completely uninitiated, right?" ”

"It's just that when I followed Professor Xu to do abdominal damage before, I occasionally saw other teachers do it, and the level is not high, so I know a little."

"Occasionally, I have done intestinal anastomosis, but at that time, it was the superior who had aligned the intestinal segment that needed to be anastomosed and asked me to do a suture."

"It's kind of chewed and fed." Fang Xian now has a deeper grasp of specialist skills and basic specialist skills than before.

Therefore, it is better to understand what such an incurable disease means.

How to deal with it, I also know how difficult it is for the previous superior teachers to build a training platform for their students, and how much time cost and early knowledge and skills preparation will be paid.

Doctors grow step by step.

Of course, my growth is too fast, and in the past little time, there is a loss of drift, which is actually a very normal thing.

Actually, I can float now.

I don't want to pursue high-quality surgery, but I just follow the crowd. Fang Xian went to the prefecture-level hospital to drill, and with this basic medical skill, he was able to create a situation alone.

However, this is not what Fang Xian wants.

(End of chapter)