Two Hundred and Ninety-Nine Third Types

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In the first twenty-four hours, Zhang Fan also fought directly in order to be able to shake mountains and shake tigers. Sometimes, in terms of surgical techniques, there is really no way to compare, especially conventional surgery, you say you are doing well, and I say I am doing well. Difficult surgeries, after all, are still in the minority, and they are not encountered every day. Therefore, Zhang Fan's 24-hour continuous operation is also a way to show his cards, telling everyone directly and rudely: I'm coming!

Doctors can be regarded as literati. In departments or hospitals, there are very few bayonet-like tit-for-tat, unless it is an emergency, such as changing the dean or director. Under normal circumstances, the means of competition are relatively mild. But Zhang Fan couldn't wait, he didn't want to waste time on this kind of thing, so he directly announced in a rude way: I'm coming!

Of the seven operations, Zhang Fan performed seven operations in a row, and the anesthesiologist, surgical nurse, and itinerant nurse changed three times. The assistants were Wang Yanan and Xue Fei. By the end of the last operation, Xue Fei was so tired that he lay on the floor of the operating room and couldn't get up!

"Doctor Zhang, you are exhausted too, lie down for a while! Seven surgeries are really amazing!" the older nurse in the operating room said to Zhang Fan. Zhang Fan was waiting for this sentence. Both Wang Yanan and Xue Fei fell to the ground like dead pigs after the operation, and they were unwilling to open their mouths, let alone other things.

"It's okay, what's the matter here, I haven't had surgery for a long time, and I haven't had a good time yet!" Zhang Fan said cheerfully, and then helped the nurses pack their things. Isn't Zhang Fan tired? Damn, it's definitely tiring, and he's just pretending to be aggressive this time!

"Hey! Doctor Zhang, you don't dare to move anymore, we will clean up by ourselves." Another nurse hurriedly took the things from Zhang Fan's hand.

"I'm really not tired." Zhang Fan said with a smile.

"If you're not tired, take a rest, drink some water, go to the bathroom or something!"

Zhang Fan really wants to say one more thing, there is no one who can fight, but no one is flattering him. The nurse finished packing and left, Xue Fei and Wang Yanan had already fallen asleep!

Although Zhang Fan felt that the pretentious effect was not very good, the next day, the surgical system already knew it, especially the three orthopedic doctors, "Do you know, Zhang Fan performed seven consecutive operations yesterday, and the last operation was completed?" From now on, just say directly, if there are any more, then the activity will start!"

"real or fake?"

"Have you heard?"

"what?"

"Ms. Zhang is going to dominate the operating room!"

"How can I do it? Hey! You say this thing, not to mention the high technology, the physical strength is as good as a big animal. Let others live!" This is a chat between two orthopedic doctors.

In the morning, have a morning meeting. Zhang Fan and his team take over shifts, and in the department, whoever is on duty usually takes over. Zhang Fan started his shift: 43 original patients, 11 discharged, 12 new recruits, and 10 surgeries yesterday. Among them~~~~, these new patient numbers and surgical patient numbers and discharge patient numbers are all to be accounted for, what surgery was performed, what is the situation of the surgery, what is the situation at night, and what is the situation in the morning.

At night, whether the patient has pain or fever, how to deal with the pain and fever, what medicine is used, whether he bleeds, whether the gauze has been infiltrated, all these must be explained, because these are the daily work of doctors. Most people think that doctors may be performing operations all year round, doing operations every day, and not doing other things.

In fact, except for some senior surgeons, ordinary surgeons perform operations during working hours, observe patient numbers and write medical records during off-duty hours. Busy, for example, this medical record has a time requirement, and now it is all electronic medical records, a new patient number, within how many hours must complete the major medical records, beyond this time, well, I can’t write, just can’t type directly Open this big medical record, and then wait to be criticized and fined. The leader doesn't care how many surgeries you performed yesterday.

Zhang Fan explained the situation of the patients one by one, and the orthopedic doctor opened his mouth in surprise. Others only performed three operations, and Zhang Fan performed all the remaining operations. A voice sounded in the hearts of the doctors in the department at the same time: Is this still a human being!

Normally, in such a situation, the doctor would divert the patient and let the doctors in other groups do it, but Zhang Fan and his group just finished the operation without saying a word. Can you not be shocked!

After Zhang Fan finished his shift, Lao Gao said: "In the future, when there are many surgical patients, call people who can call people, don't be exhausted."

"Good Director!"

After yesterday's patient handover was clear, the discussion on tomorrow's operation followed. In general, especially for non-emergency operations, there must be a large discussion in the department before the operation. What kind of operation method and what kind of fixation equipment will be used must be pre-planned.

"Tomorrow, a patient with 16 beds in our group will be admitted due to oblique femoral fracture. After completing the relevant examinations, he plans to undergo internal fixation of femoral fracture tomorrow with a plate. Choose a titanium alloy locking plate~~" Zhou Chengfu, a patient in his group. It's time to bring it up and start a discussion.

Zhang Fan frowned when he heard this, what should I say. Especially this kind of femur fracture surgery, the medical field is particularly controversial, there are two schools. They are divided into two factions because of the characteristics of bones. Because there are two sets of bone nourishment and blood supply, one is the tiny capillaries crawling on the surface of the periosteal bone, and the other is the blood supply inside the bone marrow.

Surgery is to cure diseases and save lives, but because it is an open treatment method, there must be damage. Doctors are constantly improving the operation method in order to reduce the damage. For example, for this femur fracture, there are two conventional methods and two internal fixation methods.

One is a steel plate, which fixes the broken ends of the fracture. The advantage is that it is simple and direct. The disadvantages are also obvious, a large amount of periosteum is damaged, and the fixed form is a bit too strong. Bones are not wood, and the firmer the fixation, the better. In fact, how can a fracture heal quickly? To heal well, it means that the broken end of the fracture can have a slight degree of mobility under the fixed and solid precursor, not less than two millimeters. Activity. Sounds paradoxical, but that's the biological nature of bone healing.

Another fixation method is intramedullary fixation. Make an opening from the proximal femur, drive the intramedullary needle into the femoral cavity, pass through the broken end, and then fix it at the distal end. The advantage is that the axis is fixed, which not only hardly damages the periosteum, but also conforms to the biological characteristics of bone growth. The disadvantage is also obvious, it will damage the blood supply system in the medullary cavity.

Zhang Fan is not an admirer of any kind of operation, he prefers to choose the most suitable operation method based on the situation and the patient's condition.

After Zhou Chengfu introduced his condition and operation plan, he looked at Lao Gao. In the department, the doctor in charge first makes a plan on how to perform surgery on a patient and what method to use, while the director decides whether to perform surgery, when to do it, and who will do it.

Lao Gao, looking at the x-ray on the film viewer, said to everyone: "Discuss and discuss. Everyone express their own ideas." Hospitals, especially the surgical department, usually everyone talked and laughed, and worked together during the operation We work together to resist diseases and pains, but when discussing before the operation, we often get blushing and thick necks. Especially when this kind of academic has not been finalized, and there are still many such unconfirmed times.

"Let me talk about it. I think intramedullary fixation is better for this operation. The first patient is a woman in her 60s. The plate fixation damages the periosteum too severely. It is difficult for the patient to recover in the later stage. If the plate is removed later, it will be a second time." Injury." A vice-senior from another group spoke. At this time, the resident doctors in Zhou Chengfu's group were recording that this discussion was to be recorded, and everyone's speech would be reflected in the medical record.

"Yes, it will cause periosteum damage, but the secondary damage is not necessarily the case. This patient is over 60 years old, and the current titanium alloy steel plate is already antibacterial. At such an age, there is no need to take the steel plate again, and the second intramedullary fixation Is there no damage? The patient is quite old, and the blood supply of the bone is mainly from the bone marrow, so plate internal fixation definitely has advantages over intramedullary fixation."

The doctors began to express their opinions one by one according to their grades. Not all surgeries will have this kind of discussion, but once they encounter such an academically inconclusive surgery, the debate will be very intense. This is an academic debate, a debate on interests, and a debate on the right to speak.

When it was the turn of the attending doctor and the resident to speak, they immediately stood in line. Doctors at the sub-senior or high-level level had already made their advantages and disadvantages very clear. There was no need for the resident doctor to talk nonsense, just stand in line! At this moment, once the director is unable to suppress and technically cannot suppress and crush, the department will become a battlefield over time without cohesion.

Five groups, two groups supported plate internal fixation, and two groups supported intramedullary fixation. In the end, Zhang Fan and his newly formed team members were left to express their opinions.

"Xue Fei." Lao Gao called his name.

"I think it's all appropriate!~" This thing is heartless, but the words are really impeccable. Yes, both are suitable. And there is no evidence-based medicine to prove which is better!

"Zhang Fan." After Lao Gao gave Xue Fei a hard look, he continued to roll the roll.

Everyone looked at Zhang Fan unanimously. The old doctor who had seen Zhang Fan's previous achievements also wanted to hear Zhang Fan's opinion. He knew that he would not be able to escape this shackle, but he still looked over. Young doctors, especially the newcomer Xu Xian, also want to see Zhang Fan's vision. He thinks that intramedullary fixation is definitely an advantage, and it depends on whether Zhang Fan has this vision.

"I don't think the two surgical methods are suitable!" Zhang Fan really couldn't stop talking.

"What? I want to fix it outside. Isn't this a joke!" Zhou Chengfu and his team's vice-senior became impatient when they heard it. External fixation is also a way of fixation. To put it simply, it's like putting it on the outside of a building when building a building. Fractures can also be fixed in the same way as steel frames. The advantages are obvious and the damage is small, but the disadvantages are also obvious. The applicability is too narrow, and it is easy to be infected, and the post-care is too troublesome.

This femur fracture is not suitable for external fixation, and this fracture is even more unsuitable for external fixation. Therefore, the impatient deputy high-level officer directly interrupted Zhang Fan's speech. Although it was a bit impolite, his mood was understandable.

Zhang Fan didn't care about it, but smiled and said, "Director Chen, do you think external fixation can be used for this operation?" If you can persuade others, you have to come up with real things. Since you can interrupt me, I will ask you, so that when you discuss in the future, you should think about it when you talk, and then interrupt after you have thought about it. I!

"Eh! No." Dr. Chen lost his momentum immediately. When Zhang Fan asked back, Dr. Chen broke out in a cold sweat. Zhang Fan didn't say it was external fixation. "Hi! Gross." Old Chen scolded himself in his heart!

"Continue! Let's talk about surgery." Lao Gao interrupted Zhang Fan's questioning. Lao Gao's face was colorless, he was neither happy nor sad, and embraced with both hands. He also wanted to hear Zhang Fan's thoughts. In this operation, Lao Gao actually prefers intramedullary fixation.

At this time, Zhang Fan got up and gently swung the hem of the white coat with his hand, just like an ancient master shaking the hem of the coat before going on stage, a burst of momentum came out. "Crack!~" Zhang Fan opened the folding plastic ruler that is usually used to measure bones, held it in his hand, and walked to the film viewing light.

"Everyone, please look! The broken end of the fracture is interrupted in the femur, and it is an oblique fracture and an unstable fracture. But the displacement of the port plane is not very severe, and it is a non-open fracture, combined with the age of the patient, so my The opinion is intramedullary fixation."

As soon as Zhang Fan finished speaking, he heard a disdainful "tch" from many doctors below, Lao Gao also frowned, but after a little thought, his face became expressionless again. Xu Xian was also slightly disappointed when he heard that, Zhang Fan had enough momentum, but his words were lacking. "That's it!" He thought secretly in his heart.

Everyone overlooked the fact that the two surgical methods mentioned by Zhang Fan were not suitable. Lao Gao understood, but the operation was too difficult.

"Closed intramedullary fixation!"

"Closed intramedullary fixation?" There are many words, but the difficulty has increased by an order of magnitude! Someone couldn't help but ask out a voice. This involuntary question is only produced by a doctor at the first level of the sub-senior level. Doctors below the sub-senior level still can't understand the difficulty of this operation. Several vice-high officers looked at each other, their faces were not shocked but puzzled. However, some attending doctors and a group of resident doctors who are not well-studied are full of confusion. Yes, it is confusion. What is closed intramedullary fixation? For example, Xue Fei is like this!

Closed intramedullary fixation is actually simple, that is, direct fixation without incision of the skin and soft tissue, without exposing the broken end of the fracture. The operation method is only used for fairly stable fractures. Even for stable fractures, ordinary hospitals and doctors will not choose it.

Yes, this operation method is the least damage to the patient, but it is too dangerous for the doctor, because it is blind typing, and the possibility of accidents and deviations is too high. This kind of fracture error is only two centimeters or even millimeters. of. Once the fixation is not good, or the broken end of the fracture is displaced to form an angle after fixation, which then leads to deformity of fracture healing, this becomes a medical malpractice. Once a medical malpractice occurs, no one cares whether you are considering the patient. Therefore, this kind of surgery, not to mention in grass-roots hospitals, even in large hospitals, doctors who are not director-level, generally will never do it lightly.

"This is an oblique unstable fracture, not a stable fracture, my little brother! Can you guarantee that the broken end reaches the physiological and anatomical position?" Another deputy director said to Zhang Fan with regret or helplessness. This is the helplessness of doctors. If the technology is not enough, they will never dare to try, and dare not take a step forward.

"I can!" Zhang Fan stood in front of the lantern viewing machine, holding a ruler, and said with a straight face.

"Eh! He can." The doctor who was the first-level deputy senior, who was about to speak, stopped talking. Because Zhang Fan's record is terrible! They doubt and don't doubt, it's very tangled!

The voice of the original private discussion is gone, quiet! As if Jingjiehu appeared, everyone lost eye contact and looked at the director quietly, but the director looked at Zhang Fan.

Finally, Lao Gao said: "Have you ever done it?" This is a primary hospital, no matter how skilled you are in surgery, when encountering a special operation, the first thing to ask is whether you have done it before and do you have any experience! Large hospitals still have the conditions and various guarantees for you to innovate, while the primary hospital is safety. What is a grassroots hospital? Except for the top 30 hospitals in Huaguo, they are all grassroots hospitals!

The difference between these grassroots hospitals is the advanced level of equipment, the level of education of doctors, and the speed of learning new treatment methods from higher-level hospitals. Engage in scientific research! What are floating clouds, that is, swirling around the edges and corners of the disease.

Want to take a risk and innovate? Leaving aside the patient's family members, the hospital can break your leg! There are good and bad things about this matter, and there is no way to discuss it, but one thing is very clear. Although the technological development progress is very slow, and all the research tasks have been handed over to the higher-level hospitals, medical accidents have indeed decreased significantly, saying that they are responsible for patients. It seems irresponsible, anyway, it's awkward.

"I've done it!" Zhang Fan's face didn't turn red. Although he hadn't done it in reality, Zhang Fan didn't have a white liver in the system. It's hard to say about the surgeries in other departments, but for orthopedic surgery, Zhang Fan has already done this kind of surgery. Know how many times. This is his guarantee, this is his confidence!

"Sure?"

"Sure!"

Lao Gao pondered and hesitated! It seems that centuries have passed, but in fact it is only a dozen seconds. Then he turned his head, "Director Chen, what do you think?" Lao Gao asked, in fact, this is to give Lao Chen face, Lao Gao has already leaned towards Zhang Fan, now it is to give Lao Chen a step up!

They are all smart people, if Lao Chen stretched his neck and disagreed, it was useless, Lao Gao directly gave Zhang Fan the sick number, if Zhang Fan's operation was successful, it would be difficult for Lao Chen in the future! This is the authority of the director, the authority that most doctors yearn for.

"It's too difficult! I'm not sure at all, Director!" Lao Chen could be harsh or teasing to Zhang Fan, but he was very low-key to Lao Gao.

"How about I take Dr. Zhang to do this operation?" Lao Gao asked again. This means that each other has put up the steps. Lao Gao asked for the surgery alive, risk? The risk is not small, if Zhang Fan can't do it, or if there is a medical accident, it will be Lao Gao's turn to do it, and the director will not be able to do it.

But Lao Gao was willing to trust Zhang Fan and was willing to support Zhang Fan. This is a technical dog engaged in technology, not a politician. In the technology industry, once you can show your excellence, someone will definitely support you, that is, the strength of support is different.

And Lao Gao really supported Zhang Fan wholeheartedly. What is a great doctor? This is what Lao Gao is! There are too many such doctors in this place of life and death who take the risk by themselves and let the younger generation go forward! They are the cornerstone of Huaguo's medical industry!

"Okay, I'll help too!" Old Chen didn't add insult to injury or be a bystander. Academics can be debated, once confirmed, the rest is to work together, this is an excellent department!

"Okay! Tomorrow is not an emergency operation, all of them are stopped, let's observe this operation!" Lao Gao finally smiled, with a smile on his face, since this is the case, he might as well just raise the table a little higher, maybe it will allow Zhang Fan to take off earlier!

At this time, the doctors turned their heads to look at Zhang Fan. Zhang Fan was smiling like Lao Gao, and slowly closed the ruler in his hand, "Crack!"