Chapter 306

In the first 24 hours, Zhang Fan directly spelled it in order to knock on the mountain and shake the tiger. Sometimes, at the level of surgical technology, there is really no way to make comparison, especially routine surgery. You say you do well, and I also say I do well. Difficult surgery, after all, is still a minority, not every day. Therefore, Zhang Fan's 24-hour continuous operation is also a way to show his cards. He directly and rudely told everyone: I'm coming!

Doctors are also literati. There are few tit for tat bayonets in departments or hospitals, unless it is a critical moment, such as changing the dean and director. Generally, the means of competition are relatively mild. But Zhang Fan couldn't wait. He didn't want to spend his time on such things, so he directly announced in a rough way: I'm coming!

Seven operations, Zhang Fan performed seven operations in a row, and anesthesiologists, surgical nurses and itinerant nurses changed three times. The assistants are Wang Yanan and Xue Fei. By the end of the last operation, Xue Fei was tired and could not get up directly on the ground in the operating room!

"Doctor Zhang, you're tired too. Lie down for a while! Seven operations, really great! " The older nurse in the operating room said to Zhang Fan. Zhang Fan is waiting for this sentence. Both Wang Yanan and Xue Fei are put on the ground after surgery. Like a dead pig, they don't want to open their mouths, needless to say anything else.

"It's all right. Where is this? I haven't had an operation for a long time. I haven't enjoyed it yet!" Zhang fanle said happily, and then helped the nurses pack up their things. Isn't Zhang Fan tired. Pull, absolutely tired, he will be forced to dress!

"Oh! Dr. Zhang, you don't dare move any more. Let's clean up by ourselves. " Another nurse hurriedly picked up the things in Zhang Fan's hand.

"I'm 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 that there is no one who can play, but no one supports it. The nurse packed up and left. Xue Fei and Wang Yanan had fallen asleep!

Although Zhang Fan felt that the forced effect was not very good, the next day, the surgical system already knew, especially the three orthopedic doctors, "you know, Zhang Fan had seven operations in a row yesterday. After the last operation came down, he directly said, is there any more? This is the activity!"

"True or false?"

"Have you heard?"

"What?"

"Zhang is going to dominate the operating room!"

"What can I do? Hi! You say this thing is highly skilled. It's as strong as a big livestock. Let others live! " This is a chat between two orthopedic doctors.

Morning, morning meeting. Zhang Fan and his team hand over the shift. In the Department, who is on duty usually hand over the shift. Zhang Fan began to hand over his shift: there were 43 original patients, 11 discharged, 12 newly admitted, and 10 operations yesterday. Among them ~ ~ ~ ~, these newly admitted patients and surgical patients are to be explained, including what surgery they have done, what is the next operation, what is the situation at night and what is the situation in the morning.

In the evening, whether the patient has pain or fever, how to deal with the pain or fever, what medicine to use, whether the bleeding has occurred, and whether the gauze has penetrated, all these should be explained, because these are the daily work of doctors. Most people think that doctors may be doing hand surgery all the year round, just doing surgery every day and doing nothing else.

In fact, except for some senior surgeons and ordinary surgeons, they do surgery at work, observe patient numbers and write medical records at work. These things take no less time than the operation time, so doctors are busy and have to be busy. For example, this medical record has time requirements, and now it is an electronic medical record, a new patient, You have to complete the major medical record within many hours. After this time, you can't write it. You can't open the major medical record directly. Then you wait to be criticized and fined. The leaders don't care how many operations you had yesterday.

Zhang Fan explained the patient's situation one by one. The doctor of orthopedics opened his mouth in surprise. The others did three, and the rest of the surgery was done by Zhang Fan. The doctor in the Department heard a voice: is this still a person!

In general, doctors will divert patients out and give them to doctors in other groups, but Zhang Fan's 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, those who can call people call people. Don't be tired."

"Good director!"

After yesterday's patient handover is clear, the discussion of tomorrow's operation will follow. In general, especially for non emergency surgery, it is necessary to discuss in the Department before operation. What kind of operation method and what kind of fixed instruments are used, and the scheme should be predetermined.

"Tomorrow, 16 patients in our group will be admitted due to femoral oblique fracture. After improving relevant examinations, we plan to perform femoral fracture plate internal fixation tomorrow. Choose titanium alloy locking steel plate ~ ~ "Zhou Chengfu is a patient in their group. At this time, take it out and start the discussion.

Zhang Fan frowns a little when he listens. How can he say that. In particular, there are many debates in the medical field about the operation of femoral fracture. There are two schools. They are divided into two groups 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 periosteum and bone, and the other is the blood supply inside bone marrow.

Surgery is to treat patients and save people, but because it is an open treatment, there will be damage. Doctors continue to improve the operation method in order to reduce the damage. For example, for this femoral fracture, there are two conventional methods, two internal fixation methods.

One is the steel plate, which fixes the broken end of the fracture. The advantage is simple and direct. The disadvantages are also obvious. It damages a lot of periosteum, and the form of fixation is too firm. Bones are not wood. The firmer they are fixed, the better. In fact, how can fractures heal quickly and well? That is, under the firm fixed precursor, the broken end of the fracture can have a slight degree of activity, not less than 2mm. It sounds very contradictory, but this is the biological characteristic of bone healing.

Another fixation method is intramedullary fixation. Make an opening from the proximal femur, drive the intramedullary needle from the femoral cavity, pass through the broken end, and then fix it at the distal end. The advantage is axial fixation, which not only hardly damages the periosteum, but also conforms to the biological characteristics of bone growth. The disadvantages are also obvious. It is necessary to 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 appropriate operation method in combination with the situation and patient conditions.

After Zhou Chengfu introduced his condition and operation plan, he looked at Lao Gao. In the Department, the doctor in charge should make a plan on how and how to operate a patient, and the director should decide whether to do the operation, when to do it and who to do it. He can be regarded as the last examination and approval gatekeeper before the operation.

Lao Gao, looking at the X-ray on the film viewer, said to everyone, "discuss. Everyone says what they think. " Hospitals, especially surgical departments, usually talk and laugh. They work together to resist disease and pain during surgery, but they often blush and have a thick neck during preoperative discussion. Especially when there is no final academic conclusion, and there are still many times when there is no final conclusion.

"Let me talk about it. I think intramedullary fixation is better for this operation. The first patient is a woman in her 60s. The periosteum is too seriously damaged by plate fixation. It is difficult for the patient to recover in the later stage. If the plate is taken in the later stage, it is a secondary injury." A Deputy High Commissioner from other groups made a speech. At this time, the resident doctors of Zhou Chengfu's group are recording. This discussion should be put on record. Everyone's speech will be reflected in the medical record.

"Yes, it will cause periosteal injury, but the secondary injury is not necessarily. The patient is over 60 years old. Now the titanium alloy steel plate is antibacterial. There is no need to take the steel plate at such an old age. Is there no damage to the second intramedullary fixation? The patient is not young, and the blood supply of bone marrow is mainly bone marrow, Therefore, plate internal fixation is absolutely superior to intramedullary fixation. "

Doctors begin to express their opinions one by one according to the level. Not all surgeries will have this kind of discussion, but once they encounter this kind of surgery with no final academic conclusion, the debate will be very fierce. This is not only an academic debate, but also an interest debate and a discourse right debate.

When it's the turn for the attending doctor and resident doctor to speak, they will directly become standing in line. Doctors at the deputy high or positive high level have shown their advantages and disadvantages very clearly. They can stand in line without any more nonsense from the resident doctor! At this moment, once the director can't suppress and roll technically, the Department will become a battlefield without cohesion over time.

Five groups, two groups supported plate fixation and two groups supported intramedullary fixation. Finally, Zhang Fan, a newly established member of the group, was left to express his views.

"Xue Fei." Lao Gao called the roll.

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

"Zhang Fan." Lao Gao held Xue Fei's eye and continued to roll call.

Everyone looked at Zhang Fan. The old doctor who had seen Zhang Fan's achievements wanted to listen to Zhang Fan's opinions. He knew that he could not jump out of this shackle, but he still looked over. Young doctors, especially the new Xu Xian, also want to see Zhang Fan's vision. He believes that intramedullary fixation has an absolute advantage. It depends on whether Zhang Fan has this vision.

"I don't think either operation is appropriate!" Zhang Fan is really silent and endlessly dead.

"What? I want to fix it externally. Isn't this nonsense! " The vice High School of Zhou Chengfu's group is very anxious. External fixation is also a kind of fixation method. In short, just like the steel frame erected outside the building when building, the fracture can also be fixed. The advantages are obvious, the damage is small, but the disadvantages are also obvious. The applicability is too narrow, and it is easy to be infected. The later care is too troublesome.

This femoral fracture is not suitable for external fixation, and this fracture cannot be fixed externally. Therefore, this acute sub vice high school directly interrupted Zhang Fan's speech. Although it was a little impolite, his mood was understandable.

Zhang Fan didn't care, but smiled and said, "director Chen, do you think external fixation can be used for this operation?" Now Zhang Fan is going to set up a flag, especially this kind of academic discussion. He can't convince others with humility. He should take things out realistically. Since you can interrupt me, I'll ask you, so that you can think about it when you talk in the future and interrupt me when you think about it!

"Well! No. " Dr. Chen's momentum immediately disappeared. Zhang Fanyi asked back and directly asked Dr. Chen out of a cold sweat. Zhang Fan didn't say it was external fixation“ Hi! Rough. " Lao Chen scolded himself in his heart!

"Go on! Say surgery. " Lao Gao interrupted Zhang Fan's cross examination. Lao Gao's face is colorless, neither happy nor sad, surrounded by his hands. He also wants to hear what Zhang Fan thinks. In this operation, Lao Gao also prefers intramedullary fixation.

At this time, Zhang Fan got up and gently waved the hem of his white coat with his hand, just as an ancient master shook the hem of his coat before going on stage“ Click! ~ " Zhang Fan opened the folding plastic ruler usually used to measure bones, took it in his hand and walked to the film viewing lamp.

"Look, everyone! The broken end of the fracture is interrupted in the femur, and it is an oblique fracture and an unstable fracture. But the port plane displacement is not very severe, and it is still a non open fracture. Combined with the patient's age, my opinion is intramedullary fixation. "

As soon as Zhang Fan finished speaking, he heard a "bang" disdained by many doctors below. Lao Gao also frowned, but after a little thought, his face became expressionless. Xu Xian was also slightly disappointed. Zhang Fan had enough momentum, but his words were worthless“ That's it! " He thought to himself.

Everyone ignores that the two surgical methods mentioned by Zhang fan are inappropriate. Lao Gao understands, but the operation is too difficult.

"Closed intramedullary fixation!"

"Closed intramedullary fixation?" More than two words, but the difficulty is the increase of magnitude! Someone couldn't help asking. This can't help but be generated by doctors at the vice high level. Doctors below the vice high level still don't realize the difficulty of this operation. Several vice high school students looked at each other. Their faces were not shocked but confused. Some attending doctors and a group of residents who are not solid in learning are full of confusion. Yes, it is confusion. What is closed intramedullary fixation? Like Xue Fei!

In fact, closed intramedullary fixation is simple, that is, it does not cut the skin and soft tissue, and it is fixed directly without exposing the broken end of the fracture. In short, it is blind beating, which has too high technical requirements. Moreover, this surgical method is generally the surgical method only for fairly stable fractures. Even for stable fractures, ordinary hospitals and doctors will not choose.

Yes, this operation method has the least damage to the patient, but it is too dangerous for the doctor, because it is a blind blow. There is too much possibility of accident and deviation. The fracture error is two centimeters or even millimeters. Once the fixation is not good, or the fracture end is displaced to form an angle after fixation, which leads to fracture healing deformity, this will become a medical accident. Once a medical accident occurs, no one will care whether you are considering for the patient. Therefore, this kind of surgery, let alone in grass-roots hospitals, even in large hospitals, doctors who are not director level, generally will not do it easily.

"This is an oblique unstable fracture, not a stable fracture, my little brother! Can you ensure that the broken end reaches the physiological anatomical position? " Another vice high school said to Zhang Fan with regret or helplessness. This is the doctor's helplessness. If the technology is not enough, he will never dare to try and take a step forward.

"I can!" Zhang Fan stood in front of the lamp watching machine, holding a ruler and said with a positive face.

"Well! He can. " The doctor of the first rank of deputy high level stopped talking. Because Zhang Fan's record is terrible! They doubt and do not doubt, very tangled!

The original voice of private discussion is gone, quiet! Like the appearance of the clean street tiger, we didn't even have eye contact. We quietly looked at the director, but the director looked at Zhang Fan.

Finally, Lao Gao said, "have you done it?" This is the grass-roots hospital. No matter how high your surgical technology is, in case of special surgery, the first thing to ask is whether you have done it or have experience! Large hospitals also have conditions and various guarantees for you to innovate, and the primary thing of grass-roots hospitals is safety. What are grass-roots hospitals? Apart from the top 30 hospitals in China, they are all grass-roots hospitals!

The difference between these grass-roots hospitals is the advanced level of equipment, the level of doctor's education, and the speed of learning new treatment methods from higher-level hospitals. Engage in scientific research! Which is a floating cloud, that is, it revolves around the corners of the disease.

Want to take risks to innovate? Not to mention the patient's family, the hospital can break your leg! There are good and bad things about this matter. There is no way to discuss it, but one thing is very clear. Although the technological development and progress is very slow and all the important research tasks are handed over to the superior hospital, the medical accidents are indeed significantly reduced. It seems that it is not responsible to be responsible for the patients. Anyway, it is very awkward.

"Yes!" Zhang Fan's face is not red. Although he hasn't done it in reality, Zhang Fan doesn't have white liver in the system. It's hard to say about the operations in other departments, but Zhang Fan has done orthopedic surgery for a long time. I don't know how many times. This is his guarantee, this is his confidence!

"OK?"

"OK!"

Lao Gao ponders and hesitates! It seems that several centuries have passed. In fact, it is more than ten 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 tended to Zhang Fan. Now it's to give Lao Chen steps!

They are all smart people. It's no use if Lao Chen stretches his neck and disagrees. Lao Gao directly gives the patient to Zhang Fan. If Zhang Fan's operation is successful, Lao Chen will be difficult to do in the future! This is the authority of the director, which most doctors yearn for.

"Too difficult! I'm not sure at all, director! " Lao Chen can still speak harshly or ridicule to Shang Zhang Fan, but he is very low-key to Lao Gao.

"Why don't I take Doctor Zhang for this operation?" Lao Gao asked again. This is why we have set up the steps. Lao Gao wants the operation alive. What's the risk? The risk is not small. Once Zhang fan can't do it or has a medical accident, it's his turn to do it. If he can't do it well, his director can't do it.

But Lao Gao is willing to believe Zhang Fan and take Zhang Fan with him. This is a technology dog, 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 wholeheartedly supported Zhang Fan. What is a big doctor? This is Lao Gao! There are too many such doctors in this land of life and death! They are the cornerstone of China's medical industry!

"OK, I'll give you a hand!" Lao Chen didn't fall into a well or be a bystander. Academics can argue. Once determined, the rest is to work together. This is an excellent department!

"Good! All non emergency operations will be stopped tomorrow. Watch this operation! " Lao Gao finally smiled with a smile. Since it's all like this, simply raise the platform a little higher. Maybe Zhang fan can take off early!

At this time, the doctors turned and looked at Zhang Fan. Zhang Fan, like Lao Gao, smiled and slowly closed the ruler in his hand, "Ka!"