"Director Tang, let's start the basic operations next?"

Director Huang asked cautiously.

Tanglou nodded calmly: "Okay."

Director Huang looked at the question bank of basic operations, thought for a while, and asked in advance: "Director Tang, look at the abdominal puncture, bone marrow puncture, skin disinfection of the surgical area with iodophor, spread of surgical drapes, and surgical drapes, we

Which one to choose?”

Tanglou chose one at random: "Then bone marrow aspiration."

"Okay, as expected of Director Tang, the first move is very difficult, so let's move to the operation area."

Of course, the skill assessment cannot be conducted with real people, but is conducted directly on medical simulators.

The invigilator read the question: "Please ask the candidates to perform bone marrow aspiration on the following patient: The patient is a 34-year-old female. Routine blood tests found that red blood cells, white blood cells, and platelets were all significantly lower than normal values. She is suspected of suffering from aplastic anemia and needs surgery now."

Bone marrow aspiration (operated on a medical simulator) (20 points)”

After listening to the question, Tanglou looked at the medical simulator and directly redeemed and upgraded the comprehensive puncture technique (three stars, 9) in the system.

Then the operation begins. The first step is to adjust the patient's position to facilitate the selection of the puncture point.

Seeing Tang Lou's clear steps, Director Huang and others nodded. It seemed that Director Tang was very proficient in the surgical process.

The invigilator recorded Tang Lou's operation on the side: "The candidate chooses the posterior superior iliac spine puncture point: the mannequin is prone position, both sides of the sacral vertebrae, and the protruding part above the buttocks. The operation is accurate and the steps are correct, +2 points."

The second step is to start aseptic operation, disinfection, draping, and local anesthesia.

The first step directly to Tanglou is to perform routine skin disinfection, with the diameter controlled to 15cm, followed by wearing a hat, mask, and surgical gown.

The invigilator watched the operation of Tanglou carefully. This kind of practical skills examination is very strict and cumbersome, and it is much more standardized than the preparation before ordinary surgery.

This feeling must be deeply impressed by children who have taken the driver's license test subject three. Even if you are an experienced driver who has been driving for more than ten years, asking him to take the road test may not guarantee that he will pass.

Ordinary driving is completely different from subject three.

At this moment, after putting on the hat, Tanglou lifts up the two ends of the collar with both hands behind the mask, shakes the whole clothes, puts both arms into the sleeves, lifts the belt, crosses the hands on the opposite side, and signals the other invigilator to come over and tie the knot.

However, Director Huang, with his quick eyesight and quick hands, rushed ahead of the invigilator and tied up the Tanglou.

Another invigilator recorded on the side: "The routine disinfection steps are performed correctly, +2 points, and the hat, mask, and surgical gown are worn correctly, +3 points..."

After completion, Tanglou began to put on sterile gloves, opened the surgical bag, took out the gloves, and pinched the fold of the gloves with his left hand.

Insert the 5th finger of the glove with your right hand and put it on.

The invigilator looked at it carefully and quickly wrote in the record book: "+2 points."

Tanglou continued the operation that he had done countless times. With his gloved right hand, he inserted four fingers except the thumb into the fold of the other glove. He put on the glove with his left hand and turned the fold to the cuff of the surgical gown with both hands.

After completing this step, the puncture officially begins.

Tanglou first laid a drape on the medical simulator, and then used 2% lidocaine to locally anesthetize the bone marrow. Since he had developed a strong aura through long-term surgery, he directly issued the order: "2% lidocaine...

"

In this regard, Director Huang naturally cooperated very obediently, causing the idle invigilator to have a look of resentment on his face, which was dispensable and had no experience as an invigilator.

Then the puncture begins. Since it is a medical mannequin, candidates are required to speak orally.

Tanglou explained the entire operation process very calmly:

"Fix the bone marrow puncture needle holder to an appropriate length (ilium puncture is about 1.5cm), fix the puncture site with the thumb and index finger of your left hand, hold the needle with your right hand and insert it vertically into the bone surface. When the needle tip touches the bone,

then will

The puncture needle rotates left and right around the long axis of the needle body and slowly drills into the bone. When the resistance disappears and the puncture needle is fixed in the bone, it means that it has entered the medullary cavity. If the puncture needle is not fixed, drill a little more to reach the point.

Until it can be fixed."

After listening to Tanglou's argument, the invigilator didn't know why, but he felt as if he was listening to a senior doctor's lecture in the operating room. He wrote down with one hand: "The answer is detailed and the content is completely correct. +2 points."

Director Huang also nodded, agreeing very much with Tanglou's discussion. This kind of answer is definitely not something that an ordinary young doctor can answer by rote memorization.

Tanglou continued his dictation of the operation: "Pull out the needle core and place it in a sterile tray; connect it to a dry 10ml or 20ml syringe and aspirate with appropriate force (if the needle is indeed in the bone marrow cavity, the patient will feel a slight sensation during aspiration).

(slight soreness), and then a small amount of red bone marrow fluid enters the syringe. The appropriate amount of bone marrow to be absorbed is 0.1~0.2ml."

After hearing Tanglou's analysis, Director Huang understood that only those who have experienced surgery can notice how important the control of suction force is.

Instead, like some young doctors, they just memorize the answer and don't pay attention to the suction strength at all.

Just like those who have just made a girlfriend and been married for several years, the jerky single rhythm is naturally not as good as the fast and slow, and the straight and straight is not as graceful as the conflict between left and right. Only an experienced person can understand the taste!

"It's very detailed, amazing."

Director Huang sighed in praise, Director Tang's basic skills were indeed solid.

The invigilator on the side also silently wrote: "The answer is completely correct. +1 point."

"Then the extracted bone marrow fluid is dropped on a glass slide, and several smears are quickly prepared for morphological and cytochemical staining examination."

After hearing this detailed step in the Tang House, Director Huang secretly gave a thumbs up. Many candidates would miss this step.

However, Tang Lou's answer was not over yet, and he continued: "If the bone marrow fluid cannot be extracted, it may be that the needle cavity or subcutaneous tissue block is blocked or the needle is dry. At this time, the needle core should be re-inserted, rotated slightly or re-drained.

Drill in a little or withdraw a little, pull out the needle core, and if you see blood stains on the needle core, start suctioning again."

When he heard this, the proctor on the side was also a little surprised. Of course, what Tang Lou said was correct, and his analysis was very comprehensive. However, these analyzes were beyond the scope of the standard answers.

"As expected of Director Tang, others got 90 points because they could only get 90 points, but Director Tang got 100 points because the test paper only got 100 points."

After completing this operation, Tanglou began to finish: "After the suction is completed, reinsert the needle core; perform local disinfection, take sterile gauze with the left hand and place it at the needle hole, and pull out the puncture needle together with the needle core with the right hand, and then

Cover the skin pinhole with gauze and press it for 1 to 2 minutes, then use tape to press and secure the gauze."

The invigilator was numb to Tanglou's comprehensiveness and rigor, and recorded again: "The answer is completely correct, +2 points."

Tanglou completed the basic operations in the skills test superbly.

Naturally, Tanglou passed the next electrocardiogram and imaging tests with full marks.

Under the respectful greetings of the three examiners, Tanglou walked out of the examination room.

The theoretical test on the second day was even simpler, and the tenement building was completed quickly.

A few days later, before Tang Lou entered the office, he saw Director Qian Gang coming out: "Director Tang, congratulations on passing the examination for your medical practitioner certificate!"

"Congratulations, congratulations, Director Tang."

The other doctors also congratulated him, and at the same time, another colleague put the name of the tenement building on the wall.

"Director Tang, from now on you can truly be on your own!"
Chapter completed!