Chapter 56 Dead End! (PS: Please collect, recommend and read!)
Yan Haihan did not force himself to make anything special for Yang Yifeng. He simply said: "Since everyone is almost here, Chaoshuo, you can start reporting the cases."
Originally, the case report of Yan Haihan's team was supposed to be reported by deputy director Dong Qiansheng, but now Dong Qiansheng was on the operating table, Yan Haihan asked his students to take on this role, and by the way, he would increase his impression points in the department.
Min Chaoshuo quickly opened the title page of the ppt, and then said openly: "Dear teachers, good afternoon, classmates, our group has prepared 15 beds of difficult cases today."
"This patient's basic condition is as follows."
"Patient, Liu, male, 71 years old..."
During the case reporting process, whether it is communication within the department or external communication, only general information is generally given, and any information related to the patient's private information must be hidden.
For example, your name, ID number and mobile phone number can be replaced by someone.
This information will not affect your reading of the disease itself at all.
"A week ago, he accidentally fell and caused pain, swelling and mobility impairment in his left femur. He was immediately sent to the emergency department of our hospital. An X-ray was performed and he was diagnosed with a femoral fracture. He was admitted to our department."
"Afterwards, the relevant examinations were improved and the diagnosis was clear. It was diagnosed as femoral fracture AO C3.1 type."
"However, after completing relevant examinations, the patient's current condition is that he has a history of coronary atherosclerotic heart disease and his current cardiac function is NYHA class III."
"In addition, there are type II diabetes, which currently has good blood sugar control, and grade II hypertension, which is a very high-risk group."
"We have invited relevant departments of cardiology, anesthesiology, and respiratory medicine for consultation. Currently, they consider that the risks associated with the patient's surgery are extremely high, and surgical treatment is not recommended."
"The ongoing treatment is plaster external fixation."
As a graduate student specializing in orthopedics, Min Chaoshuo obviously put a lot of effort into this case.
The description process is all in professional terms.
After listening to Min Chaoshuo's report, almost everyone present frowned.
Clinically, C-type fractures are not uncommon.
I have a history of coronary heart disease and my heart function is nyha III, which is a bit harsh.
Belongs to a category in which physical activity is significantly limited.
Coupled with diabetes and high blood pressure, it is very likely that the patient will not be able to get off the operating table.
When Yan Haihan heard this, he interrupted Min Chaoshuo and said: "This patient still has some conditions like this. His family members and patients have higher functional requirements in the later period."
"But the family members do not agree to the operation, but the patient himself has a relatively strong desire for surgery."
"This is very difficult for us."
The patient and family members have different opinions, which makes the doctor not even know how to proceed, let alone who to listen to.
Originally, in principle, the patient's first wish should prevail, but in China, especially the opinions of the elderly, family members and children, must also be respected.
After hearing what Yan Haihan said, Hu Ming said:
"Since the patient and his family members have different opinions, then conservative treatment with bone traction is better. Anyway, if the surgery is to be performed, it is up to the patient himself to convince the patient's family members."
Hu Ming felt that Yan Haihan's presentation of this case was completely unnecessary.
Whether or not surgery is necessary, apart from whether it is possible, also depends on the wishes of the patient and family members. Is there anything to discuss about this?
Bone traction or skin traction + conservative treatment is enough.
Bone traction and skin traction can not only avoid fracture shortening and displacement, but also separate the fracture ends and reduce pain.
Of course, what Hu Ming meant was to ask Yan Haihan why you didn't give the patient traction treatment.
Yan Haihan did not reply, but Min Chaoshuo continued: "Mr. Hu, here are the patient's films and the results of the three-dimensional CT reconstruction."
Immediately afterwards, Min Chaoshuo released the patient's plain X-ray and CT results.
Everyone in the shift room immediately took a breath of cold air!
It can be seen from both CT and X-ray levels that the broken end of the fracture is quite sharp!
The angle of lateral displacement is extremely large.
It seems that the sharp end of the fracture happened to be inserted directly into the muscle or other soft tissue.
Many people looked in the direction of Hu Ming, as if asking, would you go for bone traction for such a patient?
The muscles on Hu Ming's face twitched and he cursed Yan Haihan secretly!
Scheming villain!
Min Chaoshuo then added: "Although the patient's current fracture classification is type C3.1, it is classified based on the fracture line and fracture part."
"But the patient's current situation is very special. We can see from the CT scan that the acute angles of the proximal and distal ends of the fracture have been completely deformed under the pull of the muscles."
"So our team considered that the patient's fracture end might have punctured the soft tissue and caused compression."
"Therefore, even if bone traction is performed, the chance of traction reduction is very small. And during the traction process, if the traction force cannot completely return the broken end of the fracture."
"Incomplete traction will cause the sharp edge of the fracture to cause severe cuts to the soft tissue, and even the possibility of severing the femoral artery is not ruled out."
"Moreover, if this patient does not receive surgical treatment and chooses conservative treatment, it is absolutely impossible to recover from the fracture."
"Now, please give me more guidance, teachers." Min Chaoshuo was very calm throughout the whole process.
Hu Ming was looking at his eyes, his nose, his nose, his mouth, his mouth and his heart, and had no time to talk.
This is definitely a trap that Yan Haihan instructed Min Chaoshuo to leave for everyone, and it was only left for himself and Cai Dongfan.
Cai Dongfan is more shrewd and has been keeping quiet.
Otherwise, according to the normal case discussion process, the X-ray results should be placed on the first ppt.
Hu Ming heard some things about this patient!
Someone in the family works in the health system, and his position is not low. He was originally an acquaintance of Cai Dongfan, but Yan Haihan took him into his group.
Hu Ming didn't bother to pay more attention to this nonsense...
The situation now is quite complicated. The side has been displaced by at least five or six centimeters, and the broken end of the fracture has penetrated into the muscle.
Even with conservative treatment until death, it is impossible for the fractures on both sides to heal, and there will be no way for bone cells to crawl.
No need for bone traction.
The force of bone traction is limited, and the intensity of traction cannot be controlled properly.
It is really possible for the sharp edge of the fracture to turn into a knife, swing it through the body, and cut off muscles or nerve blood vessels.
I can't do surgery again.
This situation has been discussed long ago.
Yan Haihan then calmly looked at everyone and said very sincerely: "Everyone has seen this patient's situation. It is quite special. No matter who has any opinions, they can speak freely."
"I'm here to ask for advice from you today."
However, naturally no one responded to Yan Haihan's words.
"Director Cai?" Yan Haihan pointed out Cai Dongfan's name specifically.
Cai Dongfan laughed and said, "Director Yan, it's better for you to take control of this patient's situation yourself. I can't control it."
Hu Ming's warning was right next to him, so of course Cai Dongfan didn't say anything! He was afraid of falling into another pit left by Yan Haihan or detouring himself into a dead end.
I am not Hu Ming, I have to prove that I am strong.
The gain outweighs the loss!
This is a dead end, surgery cannot be done, and there is no recovery without surgery.
Lying down all the time is almost synonymous with blood clots and cardiopulmonary failure, and you can only wait for death.
And didn’t you insist on bringing this patient into your own group before? When I told you that he was an acquaintance of mine, you still relied on the principles of treating patients in the department.
Seeing that no one was speaking, even Hu Ming and Cai Dongfan, who were qualified to talk to Yan Haihan on an equal footing, were twiddling their fingers.
Yan Haihan could only take the initiative to ask: "Xiao Yang, if your teacher encounters such a case, how will he deal with it?"
Following these words, everyone turned to look at Yang Yifeng.
His eyes lit up.
Yes, a top student from the Shonan University Affiliated Hospital happened to be in the department today, so it was a good time to ask him if he had ever seen such a "weird" case and how to deal with it.
Yang Yifeng took a small step forward and said: "Director Yan, this patient has a disease between relative contraindications and absolute contraindications for surgery. If the heart function cannot be improved, surgery can be performed anywhere in the short term.
It’s unrealistic.”
"And the characteristics of this patient's case require additional intervention."
“If the conservative treatment of traction + plaster external fixation is no longer an option, then the only option left is manual reduction + plaster external fixation.”
"But my teacher has never encountered such a special patient before, so this is just my personal opinion."
Yang Yifeng generously and calmly admitted that his knowledge was limited. He had never heard of such a weird patient.
But these words made many people turn their heads to look at Yan Haihan...