After the shift is the ward round, the rhythm and process of the ward round are not much different.

Fang Ziye is both a doctor and a hospitalist, and he was arrested by Professor Deng Yong for the first time.

"Xiao Fang, can you tell me about the current research progress and dilemma of damage treatment?" Deng Yong instructed Gu Yi and Yan Zhiming to spread out a little to make room for Fang Ziye.

The bed where the ward rounds are made is the ankle joint damage patient that Professor Deng Yong, Professor Qi and Professor Duan Hong cooperated with before.

At present, the treatment effect of this patient is not optimistic.

It can only be barely said that the blood circulation of the lower limbs has been temporarily restored, so there is a certain possibility of healing.

Fang Ziye tightened his eyes, and after thinking calmly for more than ten seconds, he said, "Master, there are three most difficult points in the treatment of damage injuries. In fact, it can be summed up in two points. ”

"One is that it is difficult to debride; All tissues should be excised, as understood by debridement, and amputation is the safest treatment option. There is a paradox in the degree of damage between limb salvage and dismemberment. ”

"Second, it is difficult to rebuild blood vessels. The damage is not simply the damage of muscle, fat, skin and other tissues, but the destruction and collapse of all tissues in the whole layer. ”

"Without blood vessels, people have no food and no water for their lives."

"The third is that postoperative infection is susceptible, such as this patient, the existence of this infection is actually because of the combination of the above two factors."

"In principle, if the debridement treatment should be retained for limb salvage, the chance of infection will increase, and local necrosis of the soft tissue will also occur, and the necrotic site will be infected by bacterial colonization."

"In addition, after intravenous injection of antibiotics in the body, the concentration of antibiotics in the blood of the whole body is sufficient, but due to poor blood vascularity, the drugs are not delivered, and the preventive and therapeutic effects cannot be achieved......"

"How to make further breakthroughs in these aspects is the direction that needs to be considered to get rid of the current predicament...... However, there is very little research progress at present..."Fang Ziye mainly focuses on analyzing the current predicament.

As for the research progress, there is almost no progress at present, which has led to a very, very low limb salvage rate of disfigured injuries, and there are no systematic case studies reported at present.

It's not that no one has explored and studied this issue, but the results of research and discussion are really too ugly to be published.

Everyone knows that the amputation rate is close to 100%, and it is a bit shameful to spend energy writing articles to prove that the amputation rate is close to 100%.

"Yes, I heard it, this patient and his family."

"Before the operation, we discussed this issue with you in detail, and you also turned over several hospitals before finally transferring to me."

"However, don't look at the scope of your disease, but the difficulty of dealing with it is much greater than theirs."

"Even if I found two other professors from Tongji and Union Hospital as helpers, the current curative effect is still progressing slowly, and infections still occur, which can no longer be prevented by manpower."

"If there is a problem, we will deal with it slowly, and you must not ......be anxious," Professor Deng Yong patiently explained to the patients and their families.

In fact, patients and their families have a lot to say at the moment, but Professor Deng Yong grabbed their throats just right.

It is also a fact that he was referred many times, and it is also a fact that he still asked for limb salvage after several rounds of conversations when he was treated to Zhongnan Hospital, and it is also a fact that Deng Yong invited Professor Duan from Tongji Hospital and Professor Qi Qiaowen from Union Hospital to perform surgery together.

But it's not something that can be prevented by human beings, and they don't know if it's true.

The patient whispered, "After all the surgery, how can the infection occur?" None of the others were infected. ”

It is also true that the incidence of infection in the ward is not high, so he is depressed.

After you are infected, it is equivalent to your own leg, which may be hovering on the edge of not being able to be saved......

"You're talking nonsense, infection after surgery is one of the very common complications, not in our department, our ward, our hospital, this situation has appeared."

"It's a phenomenon that can occur anywhere in the world, in any surgical ward, and has happened to all of them."

"What's more, your situation is even more special, the damage is damaged, and the principle is to amputate it." After Deng Yong explained this.

"This patient asked for a consultation from the pharmacy department, and the wound is currently exuding, and the exudate is sent to a bacterial culture and drug sensitivity, insisting on changing dressings every day, and continuing to combine empirical intravenous antibiotics with topical antibiotics." ”

"If the infection does not improve after a period of observation, then debridement may be required, and if the infection is still uncontrollable after debridement, then the leg can no longer be saved."

Deng Yong's words were very decisive and ruthless.

As soon as they heard Deng Yong say this, the patients and their families immediately panicked.

"Professor Deng, do you have to think of more ways for us......" The eyes of the two of them were flustered.

"Isn't that figuring it out?" Deng Yong smiled casually and left with the large army.

Fang Ziye and the others secretly kept this scene in their hearts behind them. Communication with patients, blindly forbearance and regression, in fact, has little effect and effect, and occasionally a tough attitude will be more convenient for medical communication.

……

The situation of the other patients in the hospital is close to stable, although there are occasional infections, but the infection of these patients is not as bad as the consequences of the infection of this damaged patient.

"Yuan Weihong, Qin Geluo, Fang Ziye, let's go to the office with me. Let's take a closer look at the diagnosis and treatment plan for patients after the injury. Deng Yong touched the mole on his right chin as he walked.

Obviously, although Professor Deng Yong was in the ward, he said that amputation was a big deal.

However, as the first clinical patient to undergo disfigurement limb salvage in Zhongnan Hospital, no matter how much he tried to do it, he could not easily go to the terminal stage of the clinical topic (amputation)!

Fang Ziye was stunned for a moment, and then nodded immediately.

As a resident and doctoral student, I finally got into the intelligent center of this hospital.

Now I am a person from this hospital, and I am a person from this group in the department, and when I encounter an incurable disease, I can finally make up a number.

In the past, this kind of small meeting was held privately by Deng Yong with Xie Jinyuan, Qin Geluo, Li Nuo, Yuan Weihong and others, and it was impossible to bring students like Fang Ziye with them.

To be invited in is to cross a threshold.

Fang Ziye was suddenly named, and Dr. Luo Tingzhu and others also caused sudden discomfort.

Even if Luo Tingzhu is Fang Ziye's girlfriend, he was quite unaccustomed to hearing that Fang Ziye was taken away from the doctor's pile by Professor Deng Yong alone when he encountered an incurable disease.

Wang Yuanqi and others are even more difficult to get used to.

When Luo Tingzhu first arrived for the doctorate, the relationship with Fang Ziye was not bad, but when Fang Ziye entered the doctor's admission, everyone had no sense of participation, and then half a year would pass.

Fang Ziye's graduation has not yet had time to participate, and in the preparation in their hearts, Fang Ziye is still a junior and disciple, but he didn't expect that in the blink of an eye, he would become a 'mutant superior'!

Professor Deng Yong left after speaking, without considering the feelings of the students.

If it is just because he can't bear it and has to find more balance for them, then Deng Yong is more suitable to be the director of the empathy department rather than the administrative director of trauma surgery.

"Then you go get busy first, Shu Lang, Jiehan, you two remember to bring the intern students better, and you can give two more opportunities to change dressings." Fang Ziye explained so casually, then turned around and followed behind Qin Geluo's ass.

Behind Fang Ziye, a group of people's minds became different again.

……

Fang Ziye was in the office, and he was not forced to express any emotion, or to show his might, he just made up a number.

Of course, soon, Fang Ziye was released because his total hospitalization consultation phone rang.

The reason why Fang Ziye was called over by Deng Yong is because Fang Ziye's current identity should appear in the case discussion meeting, not because Fang Ziye is indispensable, and his personal ability is the highest peak in the group.

After leaving the director's office, Fang Ziye answered the phone: "Hey, hey, okay!" ~ Come in a moment, thank you brother. ”

Fang Ziye knew that this was a person from the emergency surgery clinic who had intercepted a few simple fracture patients for himself.

Manual reduction of fracture patients can gain a lot of knowledge.

In line with the principle that no matter how small a mosquito is, it is also meat, Fang Ziye can not let it go, if he really doesn't have time on the operating table, Fang Ziye will send a good message to these brothers on duty in advance.

Let them send the patient to another small hospital for surgery.

Of course, Fang Ziye also planned to think about it later, whether there was anyone in the department who was suitable to learn manual reduction, and learn his previous relationship with the general hospitalization of "Jin Hongzhou", Fang Ziye stuffed similar patients into the department.

There are other juniors and disciples who can reset the operation, check the reset indications by themselves, and if they can also obtain knowledge points, then it is a new way to learn points.

Now, because Senior Brother Wu Xuanqi has left Enshi and is not close to Chen Lao Traditional Chinese Medicine, the 'topic' of the new classification of fractures and the new use of fracture manual reduction before Fang Ziye is not so widely applicable in clinical practice.

There are not many knowledge points that can be purely gained every day.

After returning to China, Luo Tingzhu did not go to the laboratory every day, and the previous large research group has now dispersed, and Fang Ziye has no additional knowledge points to observe the experimental results.

As a result, the current sources of knowledge are very limited.

Every bit of knowledge is worth cherishing.

Fang Ziye then walked in the direction of the emergency department.

Lan Tianluo happened to go out of the office at this time, and after seeing Fang Ziye coming out of the director's office, he happened to greet him: "Senior brother, it's just right, I'm going to discuss something with you!" ~”

"...... in the Lab"

As soon as Lan Tianluo spoke, Fang Ziye interrupted: "I'm going to the emergency department to deal with a fracture manual reduction now, do you have time to run together?" ”

"If it's inconvenient, then let's come back and talk about it carefully?"

"Urgent consultation? Then senior brother, you go first, what I want to say is not in a particularly hurry. "Lan Tianluo understands that Fang Ziye's current identity needs to focus on emergency consultation, and he is no longer the student who was before, as long as he does a good job of managing the bed and doing experiments, he can get away with it.

"Not enough, still not enough. It's far from enough......" On the way to the emergency department, Fang Ziye muttered like this.

[Current knowledge point balance: 6904.3 points.] 】

Looking at the list of skills again, it seems to be luxurious, and the level of some skills is not low, but in the overall field of trauma surgery, due to the short contact time, many surgeries have not had time to activate.

Of course, Professor Deng Yong and his master Yuan Weihong have said that each stage should do what should be done at each stage.

In the total stage of hospitalization, the time is not fixed, and the state is not fixed, so it is not good to teach and operate on the opportunity to feed.

Before the general stage of hospitalization, in fact, the general physician of our hospital will train for a period of time under the professor group before serving as the general inpatient officer.

But Fang Ziye's ability is strong enough, so he skipped this stage.

In order to save Fang Ziye's early time, Professor Deng Yong also gave full play to the words "time squeezing".

The purpose of this is to let Fang Ziye enter the queuing stage of intermediate titles as soon as possible, and then promote to deputy high and positive high as soon as possible.

The teacher has arrangements and plans, and what Fang Ziye needs to do well is the reserve of his own ability, as well as the preparation of a beautiful resume.

The planning of promotion does not mean that you have a beautiful resume, the former needs the latter, but the former does not necessarily mean that there must be the latter.

The person on duty has changed from Brother Chen of the Chen family during the day yesterday to Brother Fang Songlin at night, and today is naturally Brother Hui of the Department of Neurosurgery on duty.

"Brother Hui, thank you for reminding me, the patient is over there in the operation room, right?" After Fang Ziye arrived, he vaguely greeted and thanked him very politely.

It is a favor for Li Hui and others to help retain patients, and it is their duty not to help.

That is to say, a few people are quite kind, otherwise if they are afraid of trouble and are unwilling to accept favors, they are more willing to deal with the treatment of patients in a one-size-fits-all manner after knowing that Fang Ziye can send patients away or not.

Instead of being like now, it takes time to calm the patient's emotions, and at the same time, it is necessary to notify Fang Ziye, the general hospitalist.

"Xiao Fang, this patient is a bit difficult, you should pay a little attention, if he has a tougher attitude?"

"Don't do it." Li Hui is of medium stature, about 1.8 meters tall, with slightly fair skin and vigorous hair, and the hair on his hands and forearms is prominent.

"Okay, hard work Brother Hui."

"Wait a while, Brother Hui will take the takeaway." Fang Ziye responded and walked out.

"Ziye, are you luring us to make mistakes, is bribing coffee a violation?" The person named Brother Hui, in the office, shouted this very funny, laughed a little obscenely, and he was not really scared at first glance.

Fang Ziye didn't reply for the time being, but walked to the operation room to see the patient first.

Not all patients are wonderful, but not all patients' family members are not, it can only be said that there is a chance to encounter, and such a probability will become 100% after accumulation.

However, Fang Ziye thought like this, what kind of family member is this, will it be more difficult?

It turned out that there was still an old acquaintance in this consultation room.

Big bald head, big face, short neck.

There is only one person dressed like this in Fang Ziye's memory: "Director Zhang? What's wrong with you? ”

(End of chapter)