Chapter 43 Want to Incarnate as a Divine Beast! PS:
Chapter 43 I want to transform into a mythical beast! (PS: Please collect, recommend and read!)
Zhou Cheng currently has three perfect-level skills, and his fracture reduction technique is a redefined level.
Therefore, he increasingly felt that it was extremely necessary to clearly distinguish levels in the clinical process.
Define first, diagnose later.
After diagnosis, classification is required.
Only by strictly classifying dislocation and other diseases can we better understand how to treat them.
Be adaptable.
If you don’t even understand the clinical definitions and classifications and just format and apply them, you will definitely not be able to do clinical work well.
Clinical medicine is an evidence-based medicine and an empirical medicine.
Evidence-based, as the name suggests, lies in finding accurate evidence, grasping the current scale of the disease, and then finding the right point of treatment according to the type of disease. Only then can it be called perfect.
This is especially true in surgery.
If a surgeon cannot clearly grasp the indications and contraindications for surgery, and cannot grasp the size well.
There are definitely two situations.
1. Excessive medical treatment is like performing surgery directly after seeing a fracture. It is simple and mindless, but it is actually a waste of medical resources and increases the financial burden on patients.
2. Reckless treatment. If patients who should not undergo manual reduction undergo manual reduction, or patients who should have internal fixation with plates and screws, use Kirschner wires or intramedullary nail internal fixation, the result will be natural.
It will be unexpected.
As a clinician, you have to believe in all kinds of accidents that exist in clinical practice.
How did the unexpected situation happen?
It is unexpected, but if we can better grasp the situation during the diagnosis and treatment process, we can minimize the occurrence of such accidents.
Just like a foot fracture, on a simple X-ray, there will be overlap of bone imaging, hiding the otherwise obvious fracture line.
If occult fractures are not discovered in time, they will cause sequelae that cannot be ignored.
However, if fractures can be completely ruled out on X-rays or through comprehensive means such as physical examination, then there is no need to do CT!
"It's been taken, and the films are here." Du Yanjun quickly took out the patient's examination bag and sorted the CT films from different planes one by one to Zhou Cheng.
Then he handed it over and said, "There is no fracture on the CT report."
"Let me take a look and then talk. A professional orthopedic surgeon cannot completely trust the CT report." Zhou Cheng had already entered the role at this moment, completely unaware that what he was saying to Du Yanjun now should actually be said by the superior doctor.
"Let's look at the coronal plane. This is the talus, this is the calcaneus, and this is the tou bone level."
"From these bone planes, we can see that the continuity of the bone is intact, the integrity has not been damaged, and no fracture line is visible, so we can basically rule out a fracture."
"And, Yan Jun, you see, from this sagittal plane we can also see that the cuboid joint surface is offset by about 2cm."
"There is a ruler here. 2cm is equivalent to a real 0.4cm. The direction of dislocation is upward from the cuboid bone."
"Then in such a situation, according to the treatment principles of calcaneal joint dislocation, manual reduction can be performed, and it is within the indications for manual reduction, right?"
Du Yanjun blinked his eyes, his whole body was numb.
How the hell am I supposed to know?
What are the indications for manual reduction of calcaneocuboid joint dislocation? Is there such a thing?
Zhou Cheng didn't remember until he saw Du Yanjun's expression!
All right.
This is Du Yanjun, not the students he taught in the simulation copy. Forget it, don't make things difficult...
The patient next to him listened to Zhou Cheng's calm and calm teaching style and hurriedly asked with a smile: "Dr. Zhou? Is my condition serious?"
"As for your situation, as I just said, there is dislocation, not fracture!"
"It can be restored manually."
"However, manual reduction also has its inherent risks. If you are unwilling to accept such risks, you can alternatively choose safer surgical treatment."
"This?" The patient became embarrassed at that time.
Why do we still need surgery?
"Yan Jun, I'm going to get an informed consent form for surgery, and I'll talk to the patient. Can you help me write medical instructions for the patient? Then get one."
Zhou Cheng looked at the patient's body shape again and said: "Bring me a 12.5cm*75cm plaster and three rolls of gauze."
There are two types of plaster width: 10cm and 12.5cm. This patient is quite strong, so he had to choose a wider model.
"Oh, okay!" Du Yanjun was stunned and left.
Only when he went out, Du Yanjun's forehead lines wrinkled slightly because he just had an illusion.
That is, when Teacher Luo Yun usually diagnoses and treats joint dislocations for patients, he does not seem to be as relaxed as Zhou Cheng is now.
And the explanation was very detailed, but I just didn't catch it.
A somewhat weird idea popped up in my mind.
Could it be?
Is Zhou Cheng higher than Luo Yun?
But Du Yanjun immediately shook his head!
He said firmly: Impossible, this is absolutely impossible, how could such a thing happen?
How could I have such thoughts?
…
After Du Yanjun finished prescribing the medical order, printed the QR code, and asked the patient to scan the QR code to pay, he took the gypsum polymer material from the material room and prepared to go to the operating room.
Luo Yun wandered back to the department at some point. When he saw Du Yanjun holding a plaster, he knew there was a patient in the operating room.
He shouted softly: "Yan Jun, come here."
Du Yanjun looked in the operating room, where Zhou Cheng was talking to the patient, and then he gestured to Luo Yun with the plaster in his hand.
"Come here first." Luo Yun continued to wave.
Du Yanjun went to see Luo Yun first. Since Zhou Cheng was just talking to Zhou Cheng, the operation would definitely have to wait for a while.
When he came to Luo Yun, Du Yanjun was very polite: "Teacher Luo, Brother Zhou Cheng asked me to give him a plaster."
"What kind of patient is inside?" Luo Yun asked Du Yanjun.
He was afraid that Zhou Cheng would use manual repositioning to remove the fractured patient again.
Du Yanjun didn't think much and replied directly: "Oh, he is a patient with dislocation of the cuboidal joint."
There is a little question mark on Luo Yun's head.
???
Calcaneocuboid joint dislocation?
Is there really such a patient here?
I was just talking this morning!
"By the way, Teacher Luo. Do you want to take a look?" When Du Yanjun said this, he turned to make way for Luo Yun.
At this moment when I turned my head, I missed a very exciting scene on Luo Yun's face.
I nia!
Don't go, don't go.
Get away quickly.
"I'm not going, I still have something to do." Luo Yun replied decisively.
TM is really afraid of what will happen, the cuboid joint, or this kind of small joint dislocation that is not a large joint!
It’s really not that our joint surgery majors are incompetent!
In fact, most of the patients in this field are foot and ankle surgery and hand surgery patients, and we don’t have that many opportunities to contact them.
I'll go see it, I'll go see some mahua.
How embarrassing would it be if Zhou Cheng asked me to reset my teaching methods?
At this moment, Zhou Cheng also finished the conversation. Perhaps he didn't wait for Du Yanjun, so he walked out of the operating room and immediately headed towards the nurse station. As he walked, he turned around to inspect Du Yanjun and discovered that
Du Yanjun was talking to Luo Yun.
Zhou Cheng sighed inwardly, and decided to tell Luo Yun. He turned around and walked towards the two of them, explaining at the same time: "Teacher Luo, here happens to be a patient with cuboid joint dislocation that you mentioned in the morning. You
Let’s take a look together.”
Luo Yun's limb muscles trembled involuntarily.
Damn it.
I suddenly wanted to transform into a mythical beast——