The trauma center has a total of five senior titles, and three chief physicians have senior titles, namely Zhang Mingcan, director of the ward, Wu Guonan, director of the group, and Hong Du, the old director.

Then the title of deputy chief physician of Deputy Gao is Xue Tao of Wu Guonan Group and Huang Kai, Deputy Chief Physician of Hongdu Group.

Zhang Mingcan's director group, he did not bring himself a deputy senior title, but only brought a few more junior doctors.

Xue Tao immediately realized the ambiguity in the wording and explained: "It's not the kind you understand, it's just a digestive disease caused by the imbalance of water and electrolytes." ”

Fang Ziye's eyes blinked when he heard this, and he said in his heart What is the essential difference between this, it's just that he didn't hang up, right?

But Fang Ziye didn't complain, and still followed Xue Tao into the deputy high office.

Sure enough, without Huang Kai's joining, there was no one here, after Xue Tao came in, he asked Fang Ziye to directly close the door, and then said: "Ziye, there are a total of three computers here, and before Li Yuanhong was promoted to the deputy high school, there would always be an empty one, all of which were connected to the intranet." ”

"If you can't find a computer over there in the future, come over directly, which is also what Director Zhang meant."

"In the deputy high office, except for me and Huang Kai, the general director will not come in casually." Xue Tao seemed to be setting rules for Fang Ziye, but he broke the rules.

Being able to grab a computer with someone else in the ward is naturally an extremely friendly thing, but with such an exception, Fang Ziye is still thinking about whether he can make an exception for a long time.

It's not Qinggao, but to think about whether it will become a Mu Xiu Yulin in the eyes of a lower-level doctor, and pull hatred.

However, after thinking about it for a few seconds, Fang Ziye still thanked: "Thank you, Brother Tao." Thank you, Director Zhang, too. ”

What are you thinking about now, there are seven or eight beds for the patients in charge of the ward, and the medical records and doctor's orders for these beds have to be busy by themselves.

Fang Ziye had not made preparations in advance, so the current doctor's orders could not be pondered slowly by consulting the literature, so he temporarily prescribed the regular doctor's orders given by Wu Guonan and Xue Tao during their ward rounds.

Most of them are trifecta.

Swelling, analgesic, anticoagulation. It is a preoperative medication.

Fang Ziye carefully corresponded while checking the amount, frequency and usage of the medicine ordered by the doctor.

Then asked: "Brother Tao, which direction is our Director Wu generally good at?" I think there are quite a lot of sub-diseases in our department. ”

Although the sign posted by En'an Central Hospital is a trauma medical center, in fact, the diseases inside are very messy, and there seems to be diagnosis and treatment for trauma, hand surgery, joints, sports medicine and minimally invasive spine.

If you want to find the key point, you naturally need to ask yourself what the director of the group is good at.

Xue Tao said: "Director Wu Guonan used to be a subspecialty in hand surgery, so the main direction he is doing in the ward is trauma and hand, in fact, you can also understand it as treating fractures and tendon sutures. ”

"Director Hong Du's words, in the past, spine surgeons took the route of trauma surgery plus sports medicine and minimally invasive spine, while Director Zhang Mingcan mainly did trauma and joints."

"The sub-diseases in our department are definitely not as detailed as those of Zhongnan Hospital, just doing a direction, and we can't get enough to eat." Xue Tao joked.

In fact, it is not that the platform of Enshi Central Hospital is not good, but that the trauma surgery of Enshi People's Hospital and Minmin University Hospital was very good, so that most of the development direction of the central hospital in the past few years has been in the direction of joints and spine.

At present, the level is the top, about 50% of the joint and spine surgery surgeries are in the central hospital of En, and the other two hospitals are only 50% equally divided.

As for the subspecialty of trauma surgery, the other two hospitals account for 70% of the patient volume, and the central hospital is now filling this shortcoming.

Xue Tao then smiled bitterly and said, "Of course, Dr. Fang is here at the right time, there are currently a lot of trauma patients in our department, and they are also very specialized. It's going to take care of it for a long time. ”

Fang Ziye nodded.

He also said: "Brother Tao, in our group, how many surgeries can we usually eat a day?" ”

"Three or four is the limit. Not as fast as Zhongnan Hospital. Xue Tao replied.

Fang Ziye's heart tightened when he heard this-

It's no wonder that there are now more than 30 patients in the group who have not undergone surgery, and they can't eat four units a day, and they can't eat it for a week.

This is not counting the routine trauma patients on weekdays, the current situation of the three groups is similar, if you don't want to deal with it, you may not be able to see other diseases within half a month, and the patients and their families will definitely be very irritable.

If you can't wait for surgery for so long, can you not worry?

"Actually, it's not less." Fang Ziye replied and smiled at the same time.

In Zhongnan Hospital, the maximum number of operating tables that a group can eat is only three or four per day, but the difficulty of the surgical diseases in En'an Central Hospital cannot be compared with Zhongnan Hospital.

Compared with the quantity, Zhongnan Hospital may not have so many central hospitals.

It's just that the difficulty is higher.

If it is really just a fracture, whether it is a simple fracture or a complex fracture, Professor Deng Yong's group will not do ten or eight units a day.

After all, whether it is Deng Yong, Xie Jinyuan or Yuan Weihong, they can open the stage at will, and even if it is a simple fracture patient, it is no problem for Qin Geluo to take someone to open a separate one.

If you divide it like this, you can eat more than a dozen units all day long.

It's just that for the prefecture-level city hospitals, there is no such strong resource allocation, even if Wu Guonan wants to share, there are not so many people.

In the group, the current sub-industry is counted, that is, there are five people, and it is the ultimate to divide into two.

"Hurt, do it slowly."

"Ziye, you haven't managed so many beds, have you?" Xue Tao stood up suddenly, and then hurriedly walked towards Fang Ziye.

He forgot one thing, that is, he forgot to take Fang Ziye step by step to prescribe medical orders and how to establish medical records.

This is En's Central Hospital, and the medical record system and doctor's order system are not consistent with Zhongnan Hospital.

The case and doctor's order system of Zhongnan Hospital are in the same system, and the system of En'an Central Hospital, I don't know who collected the money, and TM is so difficult to use that it is so difficult to use, but until now there has been no intention of updating and replacing the system.

However, seeing that Fang Ziye was already proficient in operating the medical order system and medical record system, Xue Tao didn't have much to do, but he was secretly shocked that Fang Ziye's learning ability was really fast.

Oh no, the attitude of learning is also very fast, because Fang Ziye doesn't know when, he has already recorded all the accounts and passwords of the medical record system and the doctor's order system in his notebook, and also recorded some key points.

"Dr. Fang, it's not that I deliberately blame you, with your learning attitude, pigs can go up the tree." After reading it, Xue Tao praised it without hesitation.

"Brother Tao, then can I reply, how is the stationery?" Fang Ziye doesn't have any genius baggage.

Regardless of whether he is a genius or not, whether his memory is good or not, Fang Ziye likes to record it in a notebook and check it carefully one by one, and when he reads literature, he prefers to print it out and read the paper version.

Although this will cost more, it will look more feeling, and Fang Ziye likes to take notes in books, densely, it is necessary or not, Fang Ziye maintains this habit.

"J8 calves." Xue Tao patted Fang Ziye gently.

"By the way, Ziye, after you finish issuing the doctor's order later, you will first establish a template for fracture manual reduction and plaster external fixation in the conversation signature system for all patients."

"Director Wu is not very interested in the types of trauma surgery, and he said in the morning that he was going to find Dr. Huang and come over to help the patients in the department do manual reduction of fractures."

"Those who can be directly reset and discharged from the hospital can be directly handled." Xue Tao touched his nose as he spoke.

looked at Fang Ziye's notebook, and then looked at himself on an A4 paper that looked like a dick, a little ashamed.

Fang Ziye's notebook, it is estimated that the patient can still find his previous medical order records for a month after being discharged from the hospital, but he may not dare to confirm whether he has any notes tomorrow to know which medical orders were issued today.

Fang Ziye happened to finish prescribing the second patient's medical order at this time, and after checking it, he clicked submit.

He turned his head and asked, "Brother Tao, what kind of immortal is this Dr. Huang that Director Wu went to find?" Some fractures that should not be reduced by manual reduction can still be disposed of by manual reduction? ”

Both manual reduction and surgical reduction have their own indications, and the indications of the two are actually complementary to each other in certain cases.

Whether a patient's fracture type can be solved by manual reduction is a problem at both the cognitive and operational levels, but in Fang Ziye's memory, it seems that no suitable patient can be found that can be dealt with by manual reduction and plaster external fixation.

How it is assessed, which is related to the principles of treatment of fractures.

There are three principles in the treatment of fractures – reduction, fixation, and rehabilitation.

Rehabilitation is much the same, everyone is different, and the most important point is reduction and fixation.

The form of reduction can be roughly divided into manual reduction and surgical reduction, the indications of the two are different, generally speaking, patients with contraindications to manual reduction must use surgical reduction.

For some patients with special contraindications to surgical reduction, manual reduction is preferred.

It sounds like a paradox, but in fact, patients with general contraindications to manual reduction are unable to achieve the fixation effect by plaster external fixation after manual reduction, so they must be fixed with the help of surgical reduction and internal fixation with steel plate screws or intramedullary needles.

Patients with contraindications to surgery are some patients who cannot tolerate the impact of surgical treatment, and the risk of surgery is extremely high.

That's basically lying in bed. In such a case, manual reduction and external fixation of plaster cast belong to palliative treatment, try your best to treat, restore and see fate, anyway, you can't operate, and you can't get off the stage after surgery.

When Xue Tao heard this, he raised his thick eyebrows and laughed, as if he had finally poked the pleasure of Fang Ziye's knowledge blind spot-

"Ziye, you don't know this, do you?"

"Then don't believe it, this Doctor Huang is the deputy chief physician with a very good personal relationship with Director Wu, originally from traditional Chinese medicine, and now he is in the trauma surgery department of the Minmin University Hospital, and is the deputy director of the trauma surgery."

Xue Tao said this, and bowed his hand slightly: "Director Huang studied under our best Chinese medicine master in Enshi, Dr. Chen, although Dr. Chen is no longer in Enshi, but Director Huang has learned the essence of Dr. Chen's bruises. ”

"In the treatment of fractures, within the scope of our modern medical cognition, if manual reduction is not possible, he can really solve it by manual reduction, and achieve functional or even anatomical reduction, and after reduction, with plaster external fixation, the effect of fixation can be achieved."

Two unfamiliar names were remembered by Fang Ziye.

Director Huang, Dr. Chen, Traditional Chinese Medicine.

Is this the big cow that his master confessed before going to the countryside? He can't even mess with the bull.

"Ao Ao Ao ......" Fang Ziye nodded a little admiringly.

He didn't understand Chinese medicine, and he didn't study it systematically, but he also respected it.

Without him, Fang Ziye's own grandfather was robbed of his life by an old Chinese medicine doctor in Enshi, and one of his uncles was also well treated and treated by Chinese medicine.

Traditional Chinese medicine is true, but good Chinese medicine is hard to find. The more traditional Chinese medicine practitioners on the market are all people who sell dog skin plasters that only make you skin infected, and these patients, Fang Ziye has seen them when he is in Zhongnan Hospital, and their skin is so festering that Fang Ziye feels pitiful......

Xue Tao returned to the computer, and then continued: "Director Wu and Director Huang have a good personal relationship, I heard that back then, they were good friends, but they took different routes, and now they naturally have no personal friendship." ”

"The reason why the trauma surgery department of the Minmin University Hospital has been able to flourish in recent years is due to Director Huang, but because there is no special scientific research output, the chief physician who has been promoted to Zhenggao is missing."

"Of course, Director Huang is also relatively young, and his title can't be promoted so quickly."

"When I first came to work, I didn't believe it, and I said, can you influence the indications for surgery and manual reduction determined by so many experts and professors?"

"But later I learned that the upper limit of manual reduction in modern medicine fixes the relative limitations of surgical indications and manual indications."

"I remember that during the annual meeting of that year, a professor mentioned this and he said that the contraindications and indications for manual reduction are related to the individual. You won't, then even a type A fracture is a contraindication to manual reduction and an indication for surgical reduction. ”

"But if you can, then a B2.3 fracture, or even a C-fracture, can be resolved by manual reduction."

"However, the reason why manual reduction is more difficult to promote seems to be that it is difficult to correspond to the diagnosis method of traditional Chinese medicine and the X-ray of modern medicine, and some people have done experiments, the same type of fracture, the same doctor to deal with it, the results are very different, it is very strange."

"A small manual reset, but it restricts both Chinese medicine and modern medicine, which is also quite funny."

Fang Ziye listened quietly, pondered carefully, and felt that what Xue Tao said made sense.

But after thinking about it more carefully, I felt that the professor's statement conveyed by Xue Tao was a bit unreasonable!

If the indications for surgery and manual reduction cannot be uniformly reflected in the guidelines, then the trauma surgeons in modern medicine can only go home and farm.

There's no way, the first is difficult to learn, the second is that I learned surgery, which can be treated by surgery, and your guide says manual reduction, but I can't, so I can only push it out, otherwise the ability is not good.

Isn't that?

If the technology is not accessible to everyone, then it is not broad-spectrum.

Why there are guidelines, the first is the guidance of experts and medical workers on the understanding and treatment of diseases, and the second is the blueprint for the relative assessment of a doctor's dispute over whether there is medical fault.

It is generally accepted that you can't go wrong by following the guide.

Personal ability is personal ability, but how do you ensure that everyone's personal ability is so strong?

The revision of the guidelines is related to the national medical average, not the local level, if the guidelines are formulated according to the average level of Huaguo Union Medical College Hospital and West China Hospital.

The people in the country's rural health centers, including all county hospitals, have been emptied, and it is a mistake to do so, which is certainly not in line with the truth.

"That's a little bit looking forward to Director Huang coming over to teach earlier." Fang Ziye said.

To be able to increase your knowledge is to accumulate the world.

The world is big and full of all kinds of impossibilities that outsiders don't understand.

It's like, a doctor like Fang Ziye can't even give injections, do you dare to think about ordinary people? But Fang Ziye really can't, he has never injected a patient.

Puncture and local anaesthesia do not count.

Then the two of them didn't talk anymore, everyone's task was very heavy, even if Fang Ziye shared part of the task, there were still seven or eight beds of admission medical records that needed to be written.

There are also various necessary procedures and signatures, such as the signature form of admission interview and the notice of self-payment of the trauma patient.

Why trauma patients have to pay for themselves, this is a medical insurance regulation, not a doctor's regulation, and Fang Ziye can't explain it in particular depth, just inform patients and their families, if you need to know more about it, please go to the medical insurance window below.

At about 12 o'clock in the afternoon, Fang Ziye finally finished writing the major medical records and hospitalization records of the eight patients, and had not yet started to talk and sign.

But the meal had already arrived, so Xue Tao said, "Ziye, the doctor's order is over, right?" ”

"You can not worry about the medical records first, eat first, Director Wu called a box lunch to the director's office."

"And Director Wu and Director Huang are already eating." Xue Tao stood up and touched his stomach.

"Director Wu took Director Huang to eat a boxed lunch together?" When Fang Ziye stood up, he was slightly stunned.

To be honest, this is not the way to treat the director of the outer courtyard, Fang Ziye has never learned such hospitality from any teacher.

Whether it is a teacher from a higher-level hospital who comes from afar, a brother from a level-level hospital, or a brother from a lower-level hospital, they all treat each other well.

"Brother Tie, what's it to eat a boxed lunch, I also saw them using peanuts and rice to make a few dollars of wine in the department." Xue Tao said with some envy.

"Down-to-earth, true brother."

Fang Ziye could imagine that strange scene, two middle-aged people with senior titles, in their forties, hiding in the department, using ordinary peanuts and drinking a few yuan of wine.

This is no longer wine, but a human touch.

(End of chapter)