Gou in the operating room to add some upgrades

Chapter 193: The Thinking of the Rich (please subscribe)

Fang Xian avoided his mother's urging for a blind date, so he went for a walk downstairs in the community.

While walking, Fang Xian once again thought about the current classification of medical skills and classification of diseases.

Certifications from medical associations are divided into physician level certification and skill certification.

There are 1-6 levels of doctors, and the classification of diseases is also divided into 1-6 types of diseases according to different mortality and disability rates. Whether it is closely related to the 6 levels of doctors cannot yet be accurately determined.

Fang Xian looked through the screenshots of some information he had found previously and saved them.

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"A first-level specialist certified by the Medical Association is a resident doctor. After statistical and comprehensive analysis of the top resident doctors in the country, the assessment standards for a first-level doctor are set."

"Trauma Surgery Level 1 Physician Certification Examination Requirements: Level 3 Medical Conventional Theory, Level 3 Orthopedic Conventional Theory, Level 3 Trauma Surgery Medical Conventional Theory... (Non-skill assessment requirements)"

"Basic skills assessment requirements: incision, suture, hemostasis, puncture, specialist film reading, and specialist anatomy must reach level 3."

"Basic skill requirements for specialists: debridement, vascular exploration, and nerve exploration must reach level 3."

"Level 3 operating skill requirements for trauma surgery: vasotomy, vascular suturing, nerve suturing, manual closed reduction of fractures, manual reduction of joint dislocations, arthrotomy, open reduction of open fractures, external fixation with external fixation braces …(Any [-] reaching Level [-] can pass the certification)”

"Age Restriction: None."

The doctor level is the doctor level, and the skill level is the proficiency level of the skill.In fact, there are still some gaps and differences between different skills.

For example, basic medical skills or basic medical operations are classified as level one in the medical association when classifying the difficulty of operations. Like some simple basic specialist skills, they are content that all residents can operate. .

The basic skills of specialists, such as the basic skills of trauma surgery, vascular incision, vascular suturing, etc., are divided into level two according to their difficulty.This second-level skill may be closely related to the second-category diseases.

Further up, for example, trauma surgery's fracture open reduction, plate and screw internal fixation, intramedullary nail internal fixation, arthroscopic anterior cruciate ligament reconstruction, etc., are the specialized skills of trauma surgery in the orthopedics department.

Such skills are classified as level three in terms of operational difficulty.

It has broken away from the category of basic professional skills and has developed in the direction of real sub-specialty.At present, the Medical Association’s ability requirements for level 2 physicians, that is, formal attending physicians, are to achieve a certain number of specialized skills, and the proficiency of professional skills can reach level 3 (specialty level)

On this basis, that is, based on mature specialist skills, there are also specialist highly difficult surgeries and specialist complex surgeries, which are defined as level four operations in terms of difficulty of operation and execution, which are extraordinary for each subspecialty. Diseases that doctors can come into contact with.

There are also some operational skills, such as new subspecialty treatment procedures, or innovative new procedures, as well as subspecialty treatment surgeries or operations for diseases with extremely high mortality and disability rates, or the coordination of plans, It is called a level five operation in terms of difficulty.

There are differences in operation difficulty and operation proficiency.

The first-level difficult surgical procedures in gastrointestinal surgery include:

Hemorrhoid clipping, hemorrhoid ligation, ultrasound-guided hemorrhoid ligation, other resections of perianal tissue, perianal abscess resection, anal papillary resection, anal cerclage, anal fistula closure, umbilical incision and drainage …

There are more than 60 basic skills in general surgery at the first level of operational difficulty.

Operations with level II difficulty include: gastrolithotomy, pyloromyotomy, pyloroplasty, repair of gastric anastomosis, gastric rupture repair, open small intestinal biopsy, transfusion loop Ostomy…

This is even more outrageous, close to two hundred types...

"Alas!~" After reading these lists, Fang Xian couldn't help but feel that his previous thoughts were still too naive.I think that I have some basic skills, and through evolution and evolution, I will be able to handle the medical field with ease.

There is an illusion that I am very awesome now.

In fact, when it was really applied to the professional field, Fang Xian found that he was still a frog in the well.

But this is a process that every doctor has to grow up.The better you master basic skills, the stronger your plasticity will be, and the more diseases you can deal with.

But in fact, the effects of diseases treated with basic skills are not the best. Specialist treatment can increase the upper limit of treatment.

However, when corresponding treatment plans, drugs, and procedures have not yet been developed for some diseases, such as natural enemies, other means are needed for substitute treatment.

The therapeutic effect of targeted specialized skills is greater than that of basic skills, and the effect of basic skills will be greater than that of misappropriated substitute treatment——

After Fang Xian thought carefully for a long time, he found that he had walked around the perimeter of the community several times.

His father had come back and called him, and then Fang Xian walked towards home.

When I got home, my father took me to the vegetable market. Uncle Fang Yun and Fang Qi'an would come over for dinner in the evening and planned to buy some side dishes...

In the afternoon, before dinner, Fang Xian's family was making preparations in the kitchen to welcome Uncle Fang Yun.

It's early autumn, just after the National Day, and the weather is neither cold nor hot. If the weather is not too hot, some of the main dishes left at noon can still be served, but my mother still plans to cook the side dishes and soup.

Fang Xian and Fang Qian were washing vegetables.

Fang Xian asked: "Dad, does our family always like to have names with single characters? Look at Uncle Fang Yun, I, and you, dad, are all named with single characters."

"Originally, small coins are also called square coins. Is there anything special about this?"

Fang Gan turned around and said, "Why, do you think the name your dad gave you is too old-fashioned?"

"I'm not like your Uncle Yun, who has met a colleague with the same name, right?"

Fang Qian gossiped first.

Fang Xian shook his head: "People with the same name have heard it, but my colleagues have not."

"Half a year ago, just before the Chinese New Year, a patient named Fang Xian came to our department. He was also a boy. To make it funny, my classmate recorded the pre- and post-operative surgeries, especially the time of insertion and removal of the urinary catheter. In the morning handover class, explain everything clearly."

Fang Xian didn't mention Li Qiu's name, but replaced it with his classmate.

"Actually, it doesn't matter. I just pick it up casually." Fang Qian said after washing the coriander roots one by one, rubbing them in his palms.

"In our Fang family, there are very few educated people in the previous generations, including ours."

"The reason why you are named Xian is because your aunt hopes that when you grow up, you can be more leisurely, not so busy, not so 'volume'. In fact, speaking of it, your aunt is still somewhat concerned about your Uncle Yun's career. opinion.”

"Although I can understand your Uncle Yun. In the face of a great crisis, you are capable and do your best. But from your aunt's perspective, the scene that time was indeed too dangerous. Even looking back now, it is still very dangerous."

"Also, I heard that your Uncle Yun's surgical skills are very good. If he were next to your aunt, even if your aunt had amniotic fluid embolism at the time, there would be no sequelae..."

When Fang Xian heard this, he drained the red amaranth from the vegetable basket, his hands seemed to be stained with blood: "Is it because of this that Auntie doesn't want to go back to Changshi?"

This is a doubt in Fang Xian's heart.

Logically speaking, it would be better for Uncle Yun to either work in Shashi, or it would be better for his aunt Wang Huan to work with Uncle Yun in Changshi.

It is much better for the couple to pray for each other if they work in the same place.

"That's not true. Actually, your uncle Yun came back to Changshi to do some research. It seems he also wanted to try to see if he could heal your aunt's hand."

"Hua la la la la..." Fang Qian turned on the faucet again, picked up the coriander root and put it down again.

"The doctor's hands may be different from those of ordinary people. If I feel inflexible, I will move things with my fingers together, but doctors are definitely different."

"I heard someone say that your aunt was also very powerful in the past. She was so young at that time. She was an associate professor when she just gave birth to her child. She was only 28 or nine years old. Isn't an associate professor at this age powerful?" Fang Qian I don't know much about the medical industry.

But I also work in a pharmaceutical company, so I know something about it.

"It's awesome. It was awesome even in the past. If it's now, it would be even more awesome." Fang Xian nodded.

Nowadays, it is more difficult to evaluate associate professors than before. In the past, only scientific research results were needed, but now what is needed is the number of students who have been taught. Moreover, teaching is very difficult, and it is necessary to train students to graduate from master's degree.

Such a professor is so valuable that you must think carefully about the teaching methods. If you are unlucky and have a few magical students, who are like your own 'teachers', you may really be pissed to death.

Professor is a teaching title, and you can be a chief physician, but in a teaching hospital, if you are not a professor, you will be laughed at. …

At around five o'clock in the afternoon, Fang Yun also came to the house, and he also brought something.It's a bottle of Wuliangye, but judging from the outer packaging, it should be of high value.

"Xiaoyun, why did you bring wine when you came here? Are my family members so polite?" Fang Qian was already pouring wine on the dining table.

"Second brother, since you said we are family members, you don't have to be polite. Xiao Xiaoqian and I just put two pairs of bowls and chopsticks here, right?"

"Isn't it normal to come back with some shopping?"

"Second brother has an objection, so I put on my shoes and go again?" Fang Yun said jokingly, having already changed into slippers.

"No, Uncle Yun." Fang Xian quickly stepped forward and squeezed the wine into his hand.

Fang Yun didn't have any files, and only had a key chain, which he conveniently placed on the entrance door.

After Fang Yun entered the door, he shouted: "Sister-in-law, I want to wash my hands first. I won't go into the kitchen to help today."

"No need to help, you can eat now." Chen Hui replied.

Fang Yun then explained to Fang Xian: "When I first came back, the emergency department received a patient with arterial bleeding in his lower limbs. I covered it and washed my hands again. There will definitely be bones to chew on later."

After speaking, Fang Yun sniffed, and he was relatively casual, and the professor's airs could not be seen.

"Uncle Yun, do you want a drink? I bought coffee, Oriental Leaves and soda."

"Then get a bottle of Oriental leaves, any flavor is fine." Fang Yun said as he turned on the faucet at the sink and said:

"Second brother, please stop pouring me wine. There is another operation tonight, and I probably have to go on stage. This patient who just came in this afternoon will probably be difficult for them to deal with..."

Fang Qian poured the wine, raised his head and asked, "Then you don't want to do the surgery now?"

"We can wait until you get off stage before eating."

Fang Xian helped go to the kitchen to serve food.

"Eat when you need to, and the people in the department must also grow. If they don't let them experience a few patients that they can't handle, they won't be able to grow."

"Second brother, I'll drink with you tomorrow." Fang Yun forced a smile.

Fang Qi'an didn't come back for dinner in the afternoon. He probably couldn't ask for leave. Maybe the afternoon was too short and there wasn't enough time to go back and forth.

"Uncle Yun, why don't I go with you for the surgery later?" Fang Xian suggested after placing all the food on the table.

After all, if you can go on stage, you can gain more skill points and consolidate your skills even more.

Now that he has decided to go to urology and gastrointestinal surgery first, Fang Xian also needs to plan carefully how to add more to achieve a better state of reconstructing urinary and bowel function.

The more skill points you have, the faster you will progress.

"Your aunt said you worked harder than me, but I didn't believe it at first."

"You just came back. Why did you get into the operating room?"

"Aren't you afraid that my brother and sister-in-law will have objections to me?" Fang Yun asked back.

Fang Qian and Chen Hui quickly shook their heads: "That won't happen, that won't happen for sure. Fang Xian still has to learn more from Xiaoyun. He is very junior now."

Fang Yun pursed his lips and said, "Uncle Yun, I'm really looking forward to watching a great professor like you perform surgery. I really want to learn."

Fang Xian's current vision and knowledge are not short-sighted, but there are also some shortcomings, that is, he has never seen a top professor like Fang Yun perform surgery.

Uncle Fang Yun's strength must be at a higher level than Professor Xu, Professor Zhu Daotao and others.

Moreover, Fang Xian also felt that if Fang Yun was doing research related to the functional reconstruction of his aunt's hand at the No. 1 People's Hospital in Chang City, he must be doing research on nerve transfer, functional reconstruction, etc., and he could not say that he was doing something wrong. Rebuilding bladder and bowel function is more helpful.

Having an existing path and a certain foundation will save a lot of time compared to slowly starting from scratch on your own.

Fang Yun didn't play any scheming or modesty with Fang Xian, and nodded: "Okay, if you are willing to go, then you can go with it, but the surgery I am going to do today is probably not what you want to see. Those ones."

While talking, Fang Qian was serving Fang Yun some food, two cured pig's trotters, the meatiest ones, alternate with fat.

"Oh oh oh, that's enough, that's enough. Stop pinching me. Brother, I'm not a child anymore. You gave me so much."

"Come on, Xiao Fang, give it to you, I'm already fat..."

After eating, Fang Yun and Fang Xian hurried towards the department without even having time to eat or even put away the dishes.

Fang Yun's prediction was correct, and there were no accidents during the operation, but it was something that others couldn't handle...

The incomplete rupture of the abdominal aorta resulted in 'arterial dissection' and 'pseudoaneurysm', which halted the entire operation.

If such an operation were performed by Professor Zhu Guangyu of the Vascular Surgery Department, then the operation must have been completed. However, Professor Zhu Guangyu is a professor of vascular surgery who is infinitely close to a fifth-level doctor. How can he be the directors of the No. 5 Civil Hospital in Chang City? Comparable?

The two hurriedly entered the operating room. Fang Yun walked quickly towards the operating room and said: "Pseudoaneurysm refers to the artery wall being torn or punctured, and the blood flows out from the breach and is absorbed by the adjacent aorta. Hematoma is formed by tissue wrapping, mostly due to trauma.”

"Do you know the principles of treating pseudoaneurysm? Just think about how to deal with this from a simple mechanical point of view."

Fang Xian heard this and replied: "Accurate diagnosis, stop bleeding, fill the blood vessel gap, and debridement."

A pseudoaneurysm is a rupture of a blood vessel caused by trauma, forming a hematoma with surrounding tissue.

Then it is necessary to make an accurate diagnosis and find out the location, size, number of the aneurysm, the parent artery and whether there is mural thrombus in the aneurysm.

If it is angiography, it is often characteristic that the image of the tumor cavity displayed by angiography is smaller than the actual size of the tumor, but it can provide a basis for diagnosis and differential diagnosis, and provide a reference for selecting treatment methods.

In addition, CT and MRI examinations also have great reference value for diagnosis. In particular, MRI can determine whether there is mural thrombus in the aneurysm when examining giant aneurysms.

Giant aneurysms often show mixed signals of various components. This patient has a fatal pseudoaneurysm of the abdominal aorta. For example, blood flow and vortex show no signal due to the flow void effect, calcification shows no signal, and thrombus shows high signal. Hemosiderin has low signal, and the aneurysm has concentric layered mixed signals. Thrombi are all on the inner surface of the aneurysm wall, which can be concentric. The aneurysm cavity is therefore reduced, occupying only a part of the tumor body...

Fang Xian was now full of theories, and he immediately conducted a thorough and detailed analysis of possible diagnoses.

Fang Yun stepped upstairs and continued to ask: "How to stop the bleeding and how to fill the gap?"

This is a further step to ask Fang Xian’s corresponding theory.

Fang Xian must have been able to think of ways to stop bleeding subconsciously.

Hemostasis is a basic medical operation: "Extravascular clamping and balloon intervention to stop bleeding. Then, an interventional puncture is performed to inject a coagulant around the hemangioma wall and outside the true artery to seal the breach, and the balloon can be used to block it in advance. The breach prevents coagulants from entering the blood vessels and reshapes the blood vessel shape in advance.”

For pseudoaneurysms, the treatment must not only stop the bleeding, but also clean up the blood packets that burst out of the blood vessels.

If it is a liquid hematoma, it is difficult to perform direct debridement. However, if a blood clot is formed after treatment with a coagulant in advance, there will be no blood explosion even if the hematoma is incised.

But this requires the use of very precise puncture, a basic medical skill.

For a pseudoaneurysm of the abdominal aorta, it is estimated that a grade 4 or lower puncture operation is not even possible, and a grade 4 puncture procedure can only be performed with reluctance...

"As expected of Dr. Ruyi, who has many level 5 skills. This therapeutic thinking is like a rich man throwing money..." Fang Yun turned his head and looked at Fang Xian.

Then he asked: "What if there is no suitable balloon and no suitable coagulant?"

"This is not the trauma center operating room of Shonan University Hospital!"

(End of this chapter)