The genius doctor starts from the game

Chapter 147 Consultation with Ten Thousand Phases!

In medical institutions, the first-diagnosis responsibility system and the consultation system are both core systems.

Among them, the responsibility of the first diagnosis is to avoid shuffling the patient and running here and there.

The essence of the consultation system is actually to cooperate in the diagnosis and treatment of diseases, and to hand over specialized problems to specialized doctors.
It is absolutely true that this patient needs emergency surgery, but if Lu Cheng and the thoracic surgeon did not write consultation records, once there are no consultation records and opinions except for any problems related to the department
No matter how perfect you are on the operating table, no matter how hard and tiring you are, if you make a mistake in the first step, it is all fake and you are fully responsible!
It is not counted according to the consultation.

Basically, people who go to consultations all the time will not make mistakes, but it is not ruled out that when they meet some newcomers and leaders, or people who are not familiar with the core system, they are often taken over in this way.

A fine can range from a fine to a conversation, and a license can be revoked if it is serious.

This is the biggest difference between being a doctor and being a student.

Practicing alone and being responsible alone, you need to take full responsibility for what you do, unlike when you are an attendant physician or a bed physician, the superior physician is usually responsible.

These are all growths on the road of being a doctor.

Naturally, this kind of question will not trap Lu Cheng, who has already printed the [-] core systems.

Moreover, for the follow-up processing and conversation, Lu Cheng only needs to be responsible for the conversations related to the orthopedics department, and does not have to take care of other departments at all, and can't take care of them.

Like in TV dramas or novels, a doctor can perform operations here and there,

Unless it is a small county hospital in a third-tier city, the entire major surgery is a department, which has this ability, otherwise, at least within the scope of practice in Huaguo, it can only be said.

Moreover, for diseases all over the body, unless it is simple debridement and suturing, emergency department doctors are qualified to handle it.
As long as it involves invasive procedures such as debridement and exploration, unless there is an emergency center or someone from a specialist department comes to sit for a consultation, the corresponding specialized surgery can be performed.

otherwise.

No matter how good your skills are and how high your professional title is, you must never touch diseases outside the scope of your department's practice.

Nothing happened, of course, once something happened,
No matter who the reason is, no matter whether you have handled the error or not,
That is full responsibility, and no one dares to do so unless the head is iron.

The truth of medical development is to specialize in specialties, divide them carefully, and study them together.

Lu Cheng quickly finished writing the consultation record, and then handed it over to the attending doctor in charge of the bed, saying: "You can prepare to contact the operating room for emergency surgery, and when the family members come, call him directly at the door of the operating room. I'll talk to him then."

"Thanks for your hard work."

After Lu Cheng said this, he was about to go to the operating room to prepare for emergency surgery.

But at this moment, another voice about him came from the outpatient clinic outside the emergency care unit.

"Another patient with a car accident trauma appears to have a dislocated hip."

"Call an orthopedic emergency consultation." This seems to be what the surgical emergency department said to the nurse in charge, because he still needs to perform other operations, so the emergency consultation call can only be handed over to other people.

But the nurse in charge said, "Doctor Liu, it seems that the general inpatient of the orthopedics department sees patients in the intensive care unit of our emergency department."

"It's the patient with multiple injuries on the third bed."

"Seriously. This?"

Doctor Liu said: "Then you go and get the film and ask him to take a look. This patient has no skin trauma for the time being. I will explain to him first, and then I will listen to what treatment needs to be done. I will look at his chest and abdomen and Is there any damage to the head?"

There are two overriding principles of the emergency department.

Save your life first.

The bottom line is to save your life!

"Okay!" The nurse hurried in.

The chief resident of the thoracic surgery department smiled and said, "Your orthopedics department is quite popular, here comes another one."

"I'll leave first and wait for you in the operating room ahead of time. By the way, my name is Han Xiaolu. I was just admitted to the hospital last year. What do you call my brother?" Han Xiaolu saw that although Lu Cheng was young, he was also a very calm person, and he was also the president. It's hard to be hospitalized, haha, I just want to get to know each other.

The general resident is a worker, the lowest level, who is in charge of everything about the patients. If you know more of the general resident, it will be easier to ask for consultations in the future.

Lu Chengcheng said: "I'm Lu Cheng, and now I'm the head attendant. Brother Zheng Liu is undergoing emergency surgery and can't come down."

"Brother Lu, take care of me in the future."

Lu Cheng was also very polite and took off his mask.

Seeing that Lu Cheng was so young, Han Xiaolu was also shocked for a while, but he came over immediately. In today's surgical system, and even the entire system, Lu Cheng's name is quite resounding.

In more than half a year, I have accomplished a feat that is difficult for others to accomplish in ten years, which is indeed quite amazing.

Moreover, the Department of Orthopedics in the second year of Hunan University is not a place to deliberately exaggerate people. If you don't have that ability, although no one will step on you, there will definitely be no one to praise and flatter you.

The point is that he also heard that Lu Cheng worked very hard.

Therefore, Han Xiaolu was not surprised that Lu Cheng was able to be the head of the class and was authorized by the director of the department to go to the consultation, so he said: "So you are the rumored new master. It's a surprise! I've heard about it for a long time, but I haven't seen it, wait You can chat next time."

"I'm from the Northeast, so I speak more straightforwardly." Han Xiaolu patted himself 1.8 meters tall, with strong muscles, and said straightforwardly.

But his stature is actually a little shorter than Lu Cheng: "It's best to be a man of temperament. If you have something to talk about. Friendship is still friendship. Brother Lu will take more care of him in the future."

Reasonable politeness is to win favors, and excessive politeness is to make up for one's own lack of ability.

Face is mutual, and the foundation is actually the ability to be recognized by each other, so Lu Cheng is not particularly polite, but rather well-behaved.

Han Xiaolu watched the nurse reviewing the film come over, and said goodbye: "I recognize you, brother, you have something to do, if you have something to say, wait for the operation later."

After finishing speaking, he left. He is also the general hospitalization, and emergency consultation must be given priority, but in fact, there are still operations in this group, the medical records of the department must be reviewed, and the patients in this ward must be taken care of.

Not much time.

"Are you the general inpatient of the orthopedics department? Doctor Liu at the outpatient clinic called you to take a look at this film. It just came out. The patient's feet are swollen and he can't move." The nurse in green walked up to Lu Cheng, finished speaking quickly, and said He pointed at the computer at the nurse's station.

There is a certain time limit for the printing of plain film, CT, MRI and other examinations, so each hospital will have an independent film reading system, as long as the examination is completed, the film can be read by computer.

However, this kind of film reading is mostly used for emergency patients, just to allow doctors to understand the condition in the first place.

If it is an outpatient clinic or in a less urgent situation, the average doctor does not have the time to read the film. After all, it is necessary to find the most suitable level to find out the problem from many levels of music. A day's outpatient service and ward There are dozens of patients here.

Tired to death.

The nurse just called Mr. Lu Cheng to be hospitalized, firstly because he was not very familiar with the orthopedic doctor system, and secondly to avoid politeness.

She has to manage at least a dozen emergency patients a day, and each patient even comes to three or four consulting doctors. If every doctor is polite, she will die of exhaustion.Over time, they are replaced by the general hospital, teachers and doctors.

It's not disrespect to Lu Cheng.

"Okay, let me take a look first." Lu Cheng immediately followed.

When I came to the computer and looked at it, a plain film was read out.

Posterior dislocation of the hip joint, and then look at the age, 54 years old, male.

This is a patient who is very suitable for emergency manual reduction, but Lu Cheng will not make empirical and operational mistakes.

One of the charms of orthopedics is manual reset. There are many patients who are in great pain after entering the hospital. It may be possible to relieve the pain of the patient immediately through manipulation. Some patients even enter the hospital lying down and walk out after ten minutes.

However, empirical mistakes must never be made.

For example, this patient has a very classic textbook-like posterior dislocation of the hip on the plain film.

If the manipulative reduction is simply performed, if there is a fracture of the ischium or fracture of the iliac bone that cannot be seen on plain radiographs, it may delay the best time for diagnosis and treatment of the patient.

The CT results must be retrieved again!
Orthopedic imaging studies fall into three categories:

Plain film to see the general fracture, CT to see the details of the fracture, and MRI to see the soft tissue and ligaments.Each perform their own duties and cannot be replaced!

Irreplaceable!

These four words have many old-timers who have taught the lessons of blood and tears for future generations.

Fortunately, Lu Cheng looked through all the aspects of the CT and found no signs of fracture. After reading it, he asked: "How is the patient's consciousness now?"

"Have you had any headaches, chest pains, or abdominal pains?"

"If not, I will directly print a template for manual reduction surgery for hip dislocation and send it to the operating room."

Manipulative reduction is also one of the operations. It is a potentially invasive operation. It is definitely not as simple as a doctor’s pinch, so the patient’s informed consent must be obtained.

The nurse shook her head and said, "Headache, chest pain, nothing, but Dr. Liu is still watching related films. I think you can prepare a consent form for the conversation first. If there is no problem with Dr. Liu, I will send it to the emergency operating room first. .”

"Then I'll call you after the anesthesia is finished. Just send this patient to the emergency operating room, right?"

"Hmm! I also have an incision and exploration to stop the bleeding. It may take a while, and it needs to be sent to the operating room for general anesthesia," Lu confessed.

The emergency operating room is not like a real operating room. The anesthesiologists inside may be the companions or postgraduates of the round department, who perform simple spinal anesthesia to practice their hands. Patients with general anesthesia must be sent to the operating room, led by a superior doctor. Anesthesia personally.

After the posterior dislocation of the hip, because the pain will cause muscle tension in the rear of the buttocks, muscle relaxants must be added.

Only with the cooperation of experienced anesthesiologists can it be reset in the fastest and easiest way, which Lu Cheng has personally experienced.

In foreign countries, the atmosphere of clinical controlled trials is particularly strong. Some orthopedic surgeons have done experiments. Patients with posterior dislocation of the hip joints underwent manual reduction under spinal anesthesia and general anesthesia, and the reduction time and success rate were recorded.

As a result, the general anesthesia basically exploded the spinal anesthesia in all directions.

The collection of these data took the professor ten years.

After ten years of sharpening a sword, this is the respect and importance the other party has for academics.

"Okay!" The nurse in charge didn't ask specifically,
She is in the emergency department. If she had to ask every doctor's order, many patients might die.

Unless she can spot a particularly egregious error.

Of course the chances of this are very small.

After this, Lu Chengcheng was really busy. He quickly found a computer and printed out two consent forms for surgery.

The operation consent form only wrote the name of the operation, complications and risks, and the basic information of the patient had to be filled in by hand.Because the patient is not hospitalized, it cannot be pulled into the medical record system.

One is for debridement and exploration, and the other is for manipulative reset.

I thought that I could go to the operating room after talking to the family members of the hip joint reduction manipulator first, but what I didn't expect was that when Lu Cheng had just finished talking and was about to enter the operating room, another middle-aged couple ran in outside, hugging each other. With a crying child.

The child is three or four years old at most, with one hand drooping, and his father holding his hand, his face is disfigured from crying, his eyes are red and red, and he feels wronged while crying.

The guide nurse immediately called the man to register first, and called his wife to take the child to the outpatient clinic first.

The woman shouted while running: "Doctor, doctor, show my baby!"

"He couldn't lift his hand all of a sudden, what's going on?" It could be seen that she was very anxious and eager to ask for help.

There are a total of three doctors in the outpatient clinic, and it was still the doctor Liu who received him.

When he saw someone coming, he gave Lu Cheng a helpless look, and said, "You need a photo first! How did you get hurt?"

"I took my baby to go shopping, I pulled him, and suddenly burst into tears."

"You don't listen to how you hug or how to coax, just say that your right hand hurts. Is this serious?" She immediately replied.

Very unprofessional reply, but it is indeed embarrassing for the patient's family to tell the story in professional terms.

Dr. Liu had almost made a decision in his heart, but when Lu Chengcheng was here, he had no choice but to say to Lu Cheng: "The orthopedic general hospital, you should come and see if you need photos and treatment?"

"I write medical records!"

It's not that he's being lazy or shirking responsibility, but since Lu Chengcheng is here, naturally he has to ask Lu Cheng for his opinion.

After listening to the medical history, Lu Cheng basically had his own diagnosis in mind.

Radial dislocation, photos may not be helpful, diagnosis is by history and physical examination.

Lu Chengcheng immediately put the list of conversations on the table, and then went up to touch the children's elbows.

The child hid while crying, and while retracting his right hand, his fingers still wanted to grab Lu Cheng, crying, "I don't want it, I don't want it. It hurts, don't."

In fact, Lu Cheng's hand has already touched his elbow, and his eyes have confirmed through his finger movements that there is no nerve damage for the time being, and his hand can still retract, which proves that the possibility of fracture is unlikely.

Just re-identify tenderness at the radius.

And at the same time, as long as you hold the wrist with one hand and the elbow with the other hand, press the radial head with your thumb, and rotate the forearm from extension to flexion of the elbow joint, the dislocated radial head can be reset.

He said in his mouth: "Little friend, let me check again, just check, okay?"

The child looked at Lu Cheng without a white coat, as if he had found someone of his kind, and nodded crying, "I'm afraid of pain."

But just when he finished speaking, Lu Cheng heard a slight click.

Then Lu Cheng bent the child's elbow to the position where the elbow was very close to the upper arm, and said, "It's done, you go and pay the fee first."

"A radial head dislocation reduction operation, another X-ray film, forearm sling suspension for a week will be fine."

As soon as Lu Cheng finished speaking, the woman said, "You're all right? Don't you fool me? Baby, are you still in pain?"

"Do it manually?"

The child nodded: "It still hurts, but it's not as painful as it started."

He moved his hands while speaking.

It doesn't seem to hurt at all.

Then the woman said: "I thought something was wrong. My baby is fine. Baby, let's go!"

(End of this chapter)