Outside the operating room, patients and their families still came one after another, and there were muffled complaints.

It was the patient in the queue who asked, 'Why is it so long?' ’

"It's okay, this is a cure and not a grocery store, you didn't see the big brother before, it took more than half an hour to come out. Someone replied more enthusiastically.

"There are so many doctors, and the operation room is only this one, so I can only arrange it slowly, and I think that I didn't hang the lottery, and I think it's a little better luck than others." There are also those who can see and advise......

There are a lot of people, you can't squeeze it, originally everyone is either fractured or dislocated, and then squeezed around, who you bump into, that is, you can't find it comfortable.

Which person here is not a sick person and does not suffer physically?

Zhang Jinchuan's broad shoulders, stocky stature, and a very oppressive sense of an orthopedic surgeon, as soon as he opened the door and stood behind the door, it would naturally make the patients closest to him unconsciously shrink back.

Zhang Jinchuan has a very strong figure, saying that his arms are as thick as some girls' thighs, which is not a joke at all, and he doesn't look bloated at all, and his voice is also raised a few tones at the moment: "Everyone work hard to line up, we have to be responsible for every patient, everyone comes one by one, don't squeeze until you fall." ”

Then the patient who was brought in by Zhang Jinchuan, about forty years old, with weak arms hanging down, was also a local, and copied the local accent at the door: "Hurry up, give the film to the doctor, and I will go in." ”

He wears leather shoes and a formal suit with a shirt underneath.

But at this moment, he himself asked his wife to cut off the sleeves of her shirt, and the suit was half set, and the sleeves hung behind her, and walked in like a robe.

"Director, am I going to lie down or sit?" He immediately looked at the older Xue Tao, and glanced at Fang Ziye next to him.

After all, Xue Tao was still chatting with Fang Ziye at this time, and there was a bit of respect in his words.

When people reach middle age, if they don't even understand such the most basic observation of words and colors, then they will be wasted. The more unfamiliar the field, the more you must know how to watch people cook.

So after leaning on the bedside, he also looked at Fang Ziye, who was wearing a mask.

is not very tall, estimated to be close to one meter eight, the whole person is very energetic, although he is not as big as Zhang Jinchuan looks, but his muscles are also strong......

He looked at Fang Ziye, and Fang Ziye walked up to him and said, "Uncle, what's going on with you here, how did you get hurt?" ”

In an emergency, the examination and reading are done at the same time, and then the physical examination is repeated.

Otherwise, the normal procedure is to ask for a consultation first, then a physical examination, and then read the film. But when necessary, time is the first resource......

The middle-aged man was stunned for a moment, but he also took the initiative to take the conversation-

"I'm this after the car deviated, this hand, tightly grasped the thing, after it deviated, I still held it, the doctor below said that fortunately I held it tightly enough, so there is only dislocation, otherwise it is a hanging lottery." The middle-aged man also joked a little self-deprecatingly.

The history and radiograph reading are consistent with the historical features of anterior dislocation......

But Fang Ziye still didn't dare to skip the step of physical examination, the busier the time, accurate diagnosis is the first priority to speed up.

When Fang Ziye went to do a physical examination for the patient, Xue Tao and Zhang Jinchuan next to him read the film and carefully diagnosed the diagnosis, so as to completely rule out occult fractures.

To confirm the diagnosis of joint dislocation, medical history, physical examination, and auxiliary examinations are all indispensable.

Moreover, in addition to the diagnosis, the diagnosis must also be ruled out, but if the dislocation is accompanied by a fracture, then there is no need for manual reduction, just do a bone traction, and let the patient lie on the hospital bed.

There is a dislocation of a fracture, and you reset a yarn.

After the diagnosis can be made.

Xue Tao said to the patient: "Your condition is anterior dislocation of the shoulder joint. We need to manually reset, and by the way here, we can perform a manual reset on Ling, and put a plaster cast, and then ......"

The situation is urgent, Xue Tao didn't have time to talk nonsense with him, the normal medical treatment process needed to be talked in detail, but there were too many people, so you can do it if you want to, and leave if you don't want to do it.

There are so many general things, and these are the risks, and no matter how you talk about it, it is a waste of time.

When necessary, some links will be omitted.

"Okay, why don't you ask my wife to sign it, I'm a good handwriter, I can't move." The patient pointed to his right arm, and although he felt that it was quite troublesome to sign, at least a professional doctor now took care of him, as if he had met a savior.

This time, he really suffered, from the scene to the emergency department, he waited for a long time, waited in the emergency department for a long time, and then waited for a long time at the door of the orthopedic trauma center.

He wanted to cry without tears, after all, a few people who were anxious and thought they were very related, after looking for a relationship, the troublesome brothers who didn't cut the queue in the hospital were taken away directly by Shu Huang, and they were honest in middle age.

Looking for a relationship, that's an occasional situation in the hospital in normal times.

But in the event of a major emergency, whoever dares to make trouble will directly ask the leaders of Enzhou not to think about it......

"Come with me, we're not in this room to reset." After Fang Ziye saw that the patient's wife had signed at the door, the hands of the physical examination changed to holding the patient's affected limb, and then pointed to the patient in the direction of the door with his mouth.

Fang Ziye was a little caught off guard by this, and the patient nodded without thinking at all: "Okay." Thank! ~”

Naturally, after hearing Fang Ziye's words, Xue Tao next to him was also stunned, where did Fang Ziye take the patient?

Suddenly, the patient turned around halfway.

He suddenly felt a violent force coming from his right arm, which made him subconsciously panic, "Whew!" ~" sounded.

Immediately afterward, his center of gravity was slightly unstable and slightly backward.

"Click!" A sound almost in sequence with a whining.

Two voices rang out at the same time, and everyone in the room was stunned!

The middle-aged uncle seemed to feel a sharp pain in his right shoulder again, and immediately exclaimed in pain.

But the duration of this sharp pain definitely did not last more than two seconds.

A sudden feeling of emptiness, like the feeling that in a short period of time, one's own hand has detached one's own body.

In medical examinations, this is called a phobia sign and can be accompanied by pain.

The sudden pain made him subconsciously deviate the right half of his body down, and the short-term pain immediately made his forehead covered with fine sweat! The muscles are all erected!

But in the next moment, all the pain was relieved, and the rebound of the upper arm muscles made his pain instantly numb, and he didn't realize that the pain was gone.

The left hand covered his right arm very aggrieved and resentful, and looked at Fang Ziye standing on the right side with some anger, as if he wanted to explode with anger.

It's just that although Fang Ziye's son is not high, he can be regarded as a strong level, and his strength is not small at a glance, and he is currently only one hand.

Can't beat it.

can only scold: "You! ”

scolded in my heart: You don't talk about martial arts, didn't you say that you would go this way......

At the same time, Xue Tao and Liang Xueya were both stunned.

I don't know what this is.

Zhang Jinchuan, who was burly, turned his head slowly and stiffly to Xue Tao, who had a big nose and thick eyebrows, with question marks on his face. found that Xue Tao's eyebrows were shrunk like knives at this time, and he was furrowed.

Xue Tao looked at Fang Ziye-

Fang Ziye immediately let go of his hands and explained to the patient: "The reduction is good, you try to move this hand?" ”

"It hurts me!"

"I can't move, I can't move. I'm going to the feathers. The middle-aged uncle's tone was not very good.

While scolding my mother in my heart, I was thinking about what I had reported.

If it weren't for the injury to my hand now, you see me and you are not fighting, where is there a doctor like you? I'm going to have to hit you.

"It's okay, uncle, you move, it was dislocated before, and now it's reset. The intensification and persistence of the pain you have just experienced is a fear sign in the reduction process, which is an academic term that disappears immediately after a short period of time, and the original pain will be relieved immediately. ”

"Am I right?"

"The reason why I'm letting you go somewhere else is to divert your attention and speed up the reset. If I tell you I'm going to lie to you and get you off guard, you're going to have to beat me up. Fang Ziye said with a smile.

Then after seeing the middle-aged emotion, he said: "Come, learn my movements, and slowly lift your right hand forward!" ”

Fang Ziye didn't pay much attention to it at the moment.

This is because level 3 manual reduction is a completely different understanding and concept from level 4 manual reduction.

There were quite a few patients outside, and there were still queues.

Saving time is a necessary behavior, although after adding a manual reduction to level 4, the time saved may only be one patient's time, so what if two are saved?

If you save a little time, you earn a little.

Fang Ziye seems to have entered the role at this moment-

Because this simple anterior dislocation reduction of the shoulder joint is too simple.

Shoulder dislocation is an extremely common joint dislocation in clinical practice!

Anterior shoulder dislocation is the most common among shoulder dislocations!

Fang Ziye, who has a level 4 proficiency level manual reduction technique, has at least four or five ways to deal with it, and he is as light as a weight.

In addition, Fang Ziye has a level 4 reading technique, and there is basically no loophole in the diagnosis, if there is, then Fang Ziye has also done his best to the limit.

Level 4 X-ray reading and level 4 manual reduction are preparations under their greatest strength-

Although there may be a waste of knowledge, Fang Ziye still doesn't dare to forget the oath he once made, he may have limited ability, but within the scope of his ability, do his best!

Naturally, the level 4 manual reduction technique greatly benefited Fang Ziye -

Clinically, the most commonly used and common technique for shoulder dislocation reduction and written in textbooks is the pedal hand pull method.

The scientific name is Hippocratic reduction method, but it is often called pedal-hand pull method in clinical practice.

This surgical reduction method involves alternating internal and external rotation of the humeral head while holding the foot against the affected axillary and giving longitudinal traction to the patient.

This technique is very classic and very simple, and its reduction success rate is okay, but there is a relatively high brachial plexus traction injury, and it is quite laborious, so it is not commonly used.

Other reduction methods that are quite labor-saving and simple to apply in clinical practice have long existed, namely external rotation reduction. This is the choice of the way of treatment.

The second type of promotion is the choice of timing.

In general, after a patient has a joint dislocation, there will be a subconscious protection and vigilance. It is equivalent to the sympathetic nervous system tense, so the muscles contract unconsciously.

Normally, if you want to do reduction, you need to use the strength of the surgeon to antagonize the contractility of this part of the sympathetic nervous excitation.

But there is an exception, and that is the unexpected.

It doesn't take much force to do it before the patient realizes that you're going to do it for him.

Effortless, and fast.

Moreover, such treatment behavior cannot be explained to the patient.

Explain to Xue Tao and others slowly, it will delay time even more, and it is better to reset it regularly.

In the case of conventional reduction, it is necessary to resist the patient's stressful muscle contraction due to pain and the patient's vigilant muscle protective contraction, and it is necessary to rely on large force or brute force traction with the addition of anesthesia or muscle relaxants, and then reduce.

According to clinical studies, it can be found that the protective contractility produced by the patient's voluntary vigilance is greater than the contractile force caused by the stress caused by pain.

Therefore, it is the best time to choose to reduce the patient inadvertently and completely unsuspectingly.

And just now, the patient happened to be talking to Xue Tao, and Fang Ziye also showed him the place to go in a 'fake look', making the patient think that he really wanted to change places.

It is completely possible to achieve the effect of surprise.

It's a sense of grasping and heat for a disease.

Of course, only Fang Ziye knows these things, the patients don't know, and Xue Tao and others still don't know.

The patient also looked at Fang Ziye with resentment, and then glanced at Xue Tao, who looked older.

What the hell do you care?

Otherwise, I'll complain to you later.

Xue Tao also looked at Fang Ziye suspiciously, and didn't quite understand Fang Ziye's behavior.

Because he always felt that Fang Ziye's recklessness just now was slightly inconsistent with his temperament and his style of acting, but he didn't know what the specific reason was.

Fang Ziye still didn't explain to Xue Tao, but continued: "Uncle, say something." If the pain is worse, then I should admit your mistakes, and if it is really the same as what I said, then you can wear a forearm sling, and you can go home and rest first. ”

"There are still patients coming in the back, right?"

"If you don't speak, I don't know if it's good or bad." Fang Ziye explained very calmly.

The middle-aged man frowned suddenly.

If you feel it carefully, if the pain at the time of dislocation before may have been the size of an egg, the pain just now suddenly turned into a basketball, and now it is only the size of a grain of rice.

Fang Ziye was right!

Fang Ziye can lie to himself, and even his wife can lie to himself. But I don't lie to myself about my feelings.

So the patient began to move his left hand suspiciously!

Lift slowly.

Hey, it's okay.

Outreach, too, ok.

Lifted, lifted.

Suddenly, the patient's eyes lit up, and he looked at Xue Tao and Fang Ziye, and his tone immediately became much better: "Director Xue, doctor, what am I?" Am I? ”

"Okay?"

He saw with his own eyes how much time it took for the first few patients to enter the operating room and leave.

When he came in this time, he and Fang Ziye have been looking at each other for a long time now, and it has only been two or three minutes, which also includes Fang Ziye's physical examination and reading time.

But for the others, it's basically about ten minutes.

When Fang Ziye heard this, he replied: "You had a joint dislocation before, and the main symptoms of joint dislocation are pain and limited mobility. ”

"Now you can see that the activity has been restored, and if you have felt a great relief from the pain yourself, then the dislocation of the joint has been reduced. Later, you can take a realigned X-ray and get the results. ”

"The reason why I took advantage of your unpreparedness just now is to lighten your defense, reduce the force of vigilant muscle contractions, just like ......"

Fang Ziye began to explain in detail this time, he wanted to completely inform the patient and Xue Tao of his treatment process and treatment ideas.

The first is to involve the patients themselves in the whole diagnosis and treatment process, so that they can understand, which is called accurate size and heat.

Otherwise, if the doctor has a precise grasp of the disease unilaterally, but the patient himself does not understand it, it means that the communication process is not done well.

The second is, vaguely inform Xue Tao that I actually have a bit of effort in manual reduction, if you want, you can let me solve the patients outside more quickly, so that the knowledge I consumed can return some blood.

Of course, it doesn't matter if you don't believe it.

I will not ask for it.

Talk less, do more, commit less, ask less.

On the first day of coming, it was impossible for Fang Ziye to take the initiative to ask for too many opportunities, which seemed too stupid, but he could properly show his ability and let Xue Tao choose by himself.

Xue Tao listened to Fang Ziye's words, first stunned, and then stunned a little stupid.

Fang Ziye: This is for himself.

It's just a dislocation of TM's technique, which is so mysterious, is it true or false? Why does it sound a little unreliable?

"Zhang Jinchuan, you take the patient out to prescribe a postoperative follow-up order, and then put on a forearm sling. Dr. Fang and I will deal with the patients in the back again. Xue Tao hesitated for a moment before saying.

He had all kinds of doubts in his heart, and it was not an opportunity to ask.

Solving the problem of pain in front of the patient is the first task, and everything else, at this time, has to be in the back row.

Questioning or asking in person, that is only played in TV dramas.

When the patient heard this, he hurriedly thanked Fang Ziye, and looked at Fang Ziye's gaze changed slightly.

"Next." Immediately afterwards, Xue Tao took the initiative to call the next patient in.

However, such a routine is easy to use for the first time, and it is naturally impossible to use it repeatedly.

Moreover, this patient also seemed to have heard the previous reset call, so he had been looking at Fang Ziye very vigilantly.

(End of chapter)