"The overall cost of your operation, if there is no infection, should be around fifteen thousand, but how much can be reimbursed after the specific operation, and how to reimburse, you have to ask."

"You are a car accident injury, how the medical insurance stipulates it, we really don't know much, it seems that if you are responsible, the medical insurance will not reimburse you......"

"If the surgery is scheduled, we will probably have to postpone it a bit. Although the arrangement of hospitalization is in order, the operation schedule is generally the old and young first, and the young will be slightly behind, which is basically the operation arrangement of hospitals across the country in this order. ”

"You were all hospitalized at the same time, and you understand ......"

"Children will cry when they have surgery early, so noisy that the people in the ward can't sleep, and the elderly will lie down in bed for a long time, just these two points, which is why our doctors understand, if you really can't afford to wait, you can go to the surrounding hospitals to have a look, and I will give you a temporary cast later, it's okay."

Fang Ziye was in the office, watching Guo Yunlei and Zhang Jinchuan admit inpatients separately, explaining to them in detail the cost and operation arrangement.

It's as if I saw myself on duty, and basically, when I admit a newly admitted patient, even if they ask a question from a professor in the outpatient clinic, they will ask it again.

However, the fees in the prefecture-level city hospitals seem to be slightly lower than those in Zhongnan Hospital.

There should be a certain difference in the cost of surgery, and the cost of surgery in Zhongnan Hospital will be about two or three thousand higher than that of Enzhong Central Hospital.

Fang Ziye didn't help in the past, although Fang Ziye knew that participating in the admission of patients, or putting on a plaster cast, would definitely have more knowledge points than he got now, but this was to do things for the sake of knowledge.

In the event of a relatively large emergency incident, the chaos will definitely be dissed, the order is prohibited, each doing its own thing, obeying the arrangement of the superior, so that all the patients can be placed one by one with the fastest efficiency.

It was impossible for Fang Ziye to mention these things.

It's just that Fang Ziye only drank two sips of water and went down his stomach, and he saw that outside the office, Wang Zhongxing showed his big stubble, wearing a mask, and walked in the direction of the nurse's station.

Fang Ziye hurriedly followed.

Now that he and Wang Zhongxing belong to the team that deals with small traumatic fractures and puts on a plaster, they can't let Wang Zhongxing wait for him, which can speed up the allocation efficiency.

It's just that Fang Ziye just walked out of the office door, and he didn't see the door on the left, which was temporarily arranged as a plaster operation room, with patients and family members waiting, and then looking at Wang Zhongxing, he was already walking in the other direction of the nurse's station.

was a little puzzled, but Fang Ziye didn't have Wang Zhongxing's contact information, so he didn't catch up.

Wang Zhongxing soon arrived at the door of another operating room for manual reduction and debridement and suturing, which was actually a dressing change room.

If nothing else, Fang Ziye guessed that he was Xue Tao, another deputy chief physician.

When Xue Tao and Wang Zhongxing staggered, they said a few words, and then Xue Tao walked in the direction of Fang Ziye while wrapping his arm.

His right hand was put into his pocket, and his left hand quietly took out the cigarette case, and said with a smile: "Doctor Fang, it's hard work, go order one?" ”

Fang Ziye approached with Xue Tao, and also saw his badge: "Teacher Xue, no need, I don't know how to smoke, can you go and rest?" ”

Xue Tao was not surprised when he heard this, and nodded: "It's a good habit not to smoke, and the fracture here should be almost dealt with." ”

"Let's go to the lounge and take a break? Maybe there will be more patients later. ”

Fang Ziye thought for a moment and nodded: "Okay, Teacher Xue." ”

"Call me Xue Tao or Brother Tao, what kind of teacher am I in front of you. We are all brothers. Xue Tao asked Fang Ziye to change his name.

When he didn't get to the lounge, Xue Tao couldn't help but order one, and then after entering the door, he quickly took a deep breath, as if the pressure and exhaustion had been relieved a lot for a while.

"Brother Tao, are there still a lot of patients over there?" Fang Ziye smiled and asked.

Xue Tao twisted his neck at this time, twisted his arms slowly, and did simple stretching exercises, his expression was painful and enjoyable: "Fortunately, you also know, it is more troublesome to reset, and some may not be able to reset." ”

"Until now, we've only reset six or seven, and there's still a queue outside."

"Just this shoulder dislocation, I reset it with Yuan Hong three times, but I couldn't reset it, so I asked Wang Zhongxing to go over to help, and my hands were out of strength." After Xue Tao returned to normal, he began to slowly wrap around his waist again, and there was a faint clicking sound between the lumbar vertebrae.

Xue Tao's eyebrows are very thick, his nose is also very large, his face is ordinary, full of traces of time and night shifts, and the whole person looks quite mature.

"Brother Tao, then you and Brother Hong have really worked hard." Fang Ziye also took off his white coat unceremoniously, and then sat down first.

Xue Tao smiled: "We are working, work is part of life, Dr. Fang, you are here to help, you are an extra hard worker." ”

"If it weren't for something special today, we would have been at the dinner table by now. Dr. Fang, don't think that we are not hospitable and do not have good etiquette, and we asked you to come over and help with things. ”

As the deputy chief physician, Xue Tao still has a set of speeches.

"No, no, Brother Tao, it's the first time I've seen so many fracture patients, which can be regarded as a boost in knowledge. I have seen everything that is not in the textbooks. Very happy. ”

"No wonder many teachers said before that prefecture-level city hospitals are the most exercised." Fang Ziye also flattered, leaned back slightly, and propped his hands on the lower bunk of the yellow lacquered wood double bed.

The muscles of the shoulders are relieved, and the whole person relaxes.

Xue Tao said: "Maybe this is a different siege, we envy Dr. Fang, you can easily get in touch with high-end surgeries and procedures, but Zhongnan Hospital does not have the opportunity to see the basic diseases of orthopedics, and generally the surgeries you carry out there are all tertiary surgeries." ”

"Fourth-level surgery is also common, innovative surgeries are also very common, severe patients, incurable diseases are even more commonplace, but ordinary debridement sutures, small fractures, K-line injections, rarely seen."

"We're all throwing up."

"This is the difference between platforms, no wonder you are high-achieving students after graduation, and your skills are good, can you be good at technology after you have grown up in such an environment?"

Xue Tao took another sip after speaking, and the atmosphere in which he spoke could be described as quite thoughtful, and he also took care of Fang Ziye's emotions, but he was neither humble nor arrogant, and analyzed objectively.

Fang Ziye shook his head and said a few more greetings.

Unexpectedly, Xue Tao just finished smoking, went to the toilet, drank half a glass of water, and his phone rang.

It was Li Yuanhong's: "Brother Tao, this patient's joint dislocation, does it seem that it can't be reduced, should it be directly transferred to the operating room for incision and reduction, or should it be hospitalized first and reduced at an elective date?" ”

"Have you called Director Zhang and Director Hong?" Xue Tao's tone was calm, although he turned on the amplification and heard the emotions on the other side a little anxious, but Xue Tao was not in a hurry at all.

"Not yet, but Director Zhang called before, saying that he was going to the stage, and when he knew that I was coming, he asked me if I was free. I said manual reset here. Xue Tao explained.

"Then call Director Hong for advice. Director Wu went to the town today for something, and I don't know when I will come back. ”

There are three groups in the department, the administrative director is Zhang Mingcan, and Wu Guonan and Director Hong are both the chief physicians of the group.

"Good!" After listening to this, Li Yuanhong hung up the phone.

Xue Tao frowned tightly, drank all the water in the cup, and then began to wear a mask again, sighed, and stood up again.

Fang Ziye also stood up and said, "Brother Tao, I'll go over and see if there is anything I can help, anyway, I'm idle now." ”

"That's good."

"However, you may be disappointed in the past, after all, whether it is joint dislocation or fracture reduction, the failure rate is a bit high, and the chance of transfer to surgery may be very high." Xue Tao took a preventive shot in advance.

Even though Fang Ziye is only a doctor, Xue Tao has studied in Zhongnan Hospital, and knows that the previous general residents are like cattle, treating manual reduction as eating and drinking, and only a very small number of cases need to go to the operating room to let the old director solve it, and especially extreme cases need to be reduced by surgery.

Such technology and heritage, as well as layers of exhaustion, are not envied by prefecture-level city hospitals.

Fang Ziye didn't answer, and he didn't take it seriously.

After following Xue Tao back and forth into another operation room, because both of them were wearing white coats, no one thought that they were cutting in line, but took the initiative to get out of the way.

At this time, the left lower limb of a young man inside was still externally rotated and valgus deformity, and he was moaning in pain: "I can't do it, doctor, I can't do it, I can't do it, I can't do it, I can't do it, I can't do it, I can't do it, I can't ...... it."

His voice was weak, and it was clearly painful.

Originally, the best suggestion for manual reduction of joint dislocation is to do it under anesthesia, so that the patient does not feel pain.

But in today's environment, how is it possible for an anesthesiologist to specialize in anesthesia? If so many dislocated patients are anesthetized one by one, the reduction will be completed tomorrow morning.

Next to them, Li Yuanhong and Wang Zhongxing were full of depression, constantly looking at the patient's pelvic plain film, helpless.

It looks as if it's just a typical hip dislocation.

But together with the number of times Xue Tao was reset, they all went through four resets, and they were still a little bit worse. The sick were in pain, and their hands were filled with lead.

Manual reduction is not a reduction of the hip joint under anesthesia and muscle relaxation, which is to twist the thigh with the arm, but it does not have so much strength.

Fang Ziye also went over to read the film carefully.

There are only plain films, and there is no MRI, but Fang Ziye estimates that so many manual reductions have not been successful, and an MRI plain film must be done after surgery to see if there is any damage to soft tissues and ligaments.

After reading it, Fang Ziye also found it difficult to understand, this is obviously a simple anterior hip dislocation, why can't it be reduced?

If there is an MRI, you can also see if there is any muscle entrapment, or other soft tissue entrapment into the hip socket, but there is none.

It is very difficult to simply pass the pelvic plain radiograph to see if there is soft tissue entrapment.

At least, Fang Ziye took a very close look and didn't find any clues.

In the case of unclear diagnosis, if you want to rashly go for reduction, this is definitely not feasible, Xue Tao and others have tried four times, and it is impossible to dislocate the joint in a conventional state.

Therefore, should we use up the knowledge points first and add the X-ray reading to level 4 in order to increase the chance of diagnosis?

However, my knowledge points are not abundant, if I rashly add X-ray reading, when I need anything in the future, I will not have the knowledge points to temporarily add some skills to myself.

Fang Ziye's heart groaned.

But I heard the patient beside him, still moaning in a low voice: "Damn, I'll operate, I'll operate, doctor, I'm wrong, I want surgery, I can't stand it......"

Joint dislocation, no more than fractures.

The fracture may be quiet and painless, but as long as the joint is not reduced and the joint is corrected, the pain of entrapment, or a dull pain that pokes the muscle, will persist.

It may also be due to the failure of multiple reductions, which also causes damage to the muscle tissue.

The pain is aggravated, and at this time, what the patient wants most is to do a good job of pain relief, even if it is anesthesia, or to get a strong painkiller injection.

I don't have any other thoughts in my heart, don't let me hurt, please......

Pain, as a fifth vital sign, is quite painful.

After a little hesitation, Fang Ziye still used more than 400 points of knowledge to increase the X-ray reading technique to level 4.

He and this old brother are not related, but since he is here, there is a certain degree of diagnosis and treatment relationship, do your best, lose a little, lose a little, and don't be rational if you are irrational.

Anyway, the knowledge points are still used in the end, and their own skills are ultimately used to solve the patient's pain.

After the X-ray reading technique reached level 4, Fang Ziye instantly felt that there were a lot more things in his mind.

For example, the relationship between X-ray reading level 1 and level 4 seems to be slightly different. In grade 1, as long as you can see the diagnosis, in grade 2, it seems that you can see some subtle changes, such as microfractures and the shape of the fracture line.

But at level 3, you'll be able to see the anatomy and probably guess what kind of muscle layer this shadow is.

And the level 4 X-ray reading can clarify the level very clearly, as if the X-ray photograph was cut by you, and it will be reorganized in your mind and through your knowledge.

It is precisely for this reason that Fang Ziye noticed that the round ligament of the femoral head and the acetabulum of this patient just form an elastic tension band, and the round ligament is like a rubber strip, and after being stretched, there will be a huge retraction force. The femoral head, on the other hand, is just stuck outside the acetabulum.

In this case, if it is simple, the traditional traction in the distal direction of the line of force is precisely offset by the pressure between the femoral head and the acetabulum, and the retraction force of the circular ligament, unless you bring the circular ligament and let the elasticity disappear, so you will not be able to reduce successfully at all.

At this time, what needs to be solved is to move the femoral head from the position of acetabular compression to the side for traction, and then perform continuous traction in the normal direction of force after getting rid of the compression.

The operation is not difficult, and there is no need to add the manual reduction to level 4 by yourself, which is only at the diagnostic level, and there is a lost problem.

As soon as he thought of this, over there, Li Yuanhong just finished calling Director Hong.

"Brother, this, it's really not that our doctors want to embarrass you, it's really that there are no manpower now, and everyone in our department is in the emergency department, operating room, and department."

"If you have to do this surgery, you have to wait."

"Let's try it for you again, if it really doesn't work, we can only give you painkiller injections to deal with it." Li Yuanhong conveyed the meaning of Director Hongdu.

"Okay, okay, you can do it, as long as you can keep me from pain now, you can give me a knife."

"I can't help it...... "The patient already has a lack of energy.

The pain index of joint dislocation during dislocation will be at least twice as severe as the pain of the surgical infusion immediately after surgery, and it is the kind of colic pain in which the muscles are stretched and pulled sideways.

Hearing this, Fang Ziye said: "Brother Hong, why don't you take a break and be a conductor, and I will be a traction and make a lot of effort." ”

What Fang Ziye diagnosed by himself may not be able to explain clearly in the current situation. In addition, Li Yuanhong and others have already decided to reset for the last time, and then Xue Tao and Zhang Jinchuan are already in place.

Fang Ziye didn't waste time, but found a position that was most suitable for himself.

This is to treat the disease, to solve the pain of the patient, the patient over there is so painful that he almost wants you to give him a knife directly, and it will delay a chicken feather time, and I will review it later when I have time.

Li Yuanhong hesitated slightly, but seeing that Fang Ziye's heart to help was more sincere, he nodded and looked at Xue Tao: "Brother Tao, then I'll be lazy." ”

Where does Xue Tao have time to care about this, he and Li Yuanhong have been resetting here, they are tired, and Li Yuanhong is not iron-clad.

Xue Tao is responsible for fixing the position of the pelvis and providing anti-traction, and then Wang Zhongxing, who has used force before, pinched the patient's calf, intending to use his own gravity to move part of the traction.

Fang Ziye is too thin, and the component of gravity is too small.

It just so happened that Fang Ziye could hold the thigh surface.

"Come, one, two, three, start!" Xue Tao did not hesitate.

When the patient heard this, he closed his eyes and teeth, took a deep breath, and said in a deep voice, "Uh-huh~~~~~~~"

But at this time, after Fang Ziye slightly pushed the head towards the direction of Xue Tao's pelvis, he made the patient's whole person shrug slightly towards the head, and then Fang Ziye quickly pushed the patient's thigh out with his right hand, and at this moment, Zhang Jinchuan just began to exert force.

A magical scene appeared, the dislocation that seemed to be immovable, was slowly pulled apart-

"Huh? Oh, alright? Before the reduction went up, the patient's pain was relieved a lot, and the patient, who was ready to die of pain, began to shout.

Fang Ziye exerted another force, parallel to Zhang Jinchuan's strength.

In an instant, the strength of Fang Ziye and Zhang Jinchuan was all bounced out.

Because the normal force of the joint into the nest is not something that one or two people can twist.

It's just that the traction of Fang Ziye and Zhang Jinchuan is just the protective force, and it does not increase the power of the rebound.

After a crisp click, the patient's upper body and legs shrank.

"Eh! ~" sounded.

After the fear of a brief joint dislocation and the pain disappeared, he went limp.

"It's comfortable." The patient closed his eyes, did not want to move, and began to breathe evenly, as if he were a drama spirit.

But no one laughed at him, and no one had time to laugh at him.

The action of resetting just now is very long to describe, but it is only something that happened in four or five seconds, so Xue Tao and the others only had time to look in the direction of Fang Ziye.

This is forced, something is wrong!

(End of chapter)