My medical skills are a billion points

When he was first admitted to the hospital, the internal jugular catheter was used, and now it is almost time to change the position.

Xiao Chu first said to the patient: "Now the time is up for the infusion tube on your neck. It's time to pull it out. We will replace it for you. You cooperate and it will be ready soon."

The patient nodded in understanding.

Before operating, Xiao Chu emphasized a problem to everyone.

"The subclavian vein puncture is the most commonly used puncture site. First of all, we need to position the patient. Whether the position is correct or not is related to the success rate of puncture. You must remember this well, and it is also a key point to pay attention to. .”

Xiao Chu said, picked up a pillow, supported the patient's shoulder, and put the pillow under his shoulder.

The patient's chest was pushed up and his head drooped.

"When padding your shoulders, you must pad them well, lay the pillow flat over your shoulders, and check whether the human body is on the same horizontal line.

If the patient's body is crooked, it may sometimes affect the success rate of puncture. "

"Put the body in place, and the next step is to choose the puncture site. Who knows where the puncture point is?"

The previous male doctor, who was a trainee, immediately stood up and said: "The puncture point for subclavian vein puncture is usually 1-2 cm below the clavicle at the inner third of the clavicle. Or 1-2 cm below the corner of the clavicle. The centimeter is the puncture point."

Xiao Chu nodded.

"Well, the puncture point you mentioned is good."

"Before disinfecting the puncture, we should do the preparatory work well. If a worker wants to do a good job, he must first sharpen his weapon, right!"

Xiao Chu said, put on the sterile gloves and opened the central vein puncture kit.

He explained the equipment and functions inside one by one.

When everything was ready, Xiao Chu began to disinfect the patient's right collarbone, and spread the drape after the disinfection was completed.

Then at the puncture point, local infiltration anesthesia was performed, and after the anesthesia took effect, Xiao Chu picked up the puncture needle with his right hand and began to puncture the puncture point.

While piercing, Xiao Chu explained the steps in detail.

"The shape of the subclavian vein is under the clavicle. After we select the puncture point, the needle tail should be inserted at an angle of 30 to 45 degrees.

First of all, we should first touch the clavicle, and then the puncture needle is drawn back around the clavicle, and punctures below the clavicle.

The puncture direction can point to the patient's Adam's apple or the suprasternal fossa.

When piercing, be sure to withdraw slowly.When a large amount of dark red blood enters the syringe, it means that the puncture has been successful. "

While Xiao Chu was explaining, his right hand didn't stop at all.

The puncture needle was slowly advanced, and in an instant, a large amount of dark red blood entered the syringe.

Xiao Chu fixed the needle tube with his left hand, picked up the guide wire with his right hand, and inserted the guide wire from the end of the needle.

"Did you notice when the puncture was done just now? The slope of the puncture needle must face the bottom of the body. This is good for the guide wire and can smoothly enter the superior vena cava. Do you understand?"

Everyone nodded.

"understood."

After the guide wire was implanted, Xiao Chu slowly withdrew the syringe, then picked up the skin expander to expand the skin.

"When expanding the skin, you must pay attention to it. You only need to expand to the dermis. Don't expand too deep to avoid massive bleeding."

Withdrawing from the skin expander, Xiao Chu picked up the venous catheter and slowly put it in along the guide wire.

When the catheter entered 15 centimeters, it stopped.

"The distance the catheter is put in, no more than 15 centimeters, and then the guidewire can be withdrawn.

Seal the tube with heparin water, fix the venous catheter, and the whole puncture is completed. "

The time Xiao Chu spoke, the whole piercing process was over.

His detailed explanation did not affect the speed in his hands at all.

Everyone nodded in admiration again.

Seeing that Xiao Chu completed the puncture of the subclavian vein quickly and steadily.

Several trainee doctors were very envious.

They have also come to study for several months, and have not done a subclavian vein puncture in person.

After all, most of these trainee doctors come from the county-level hospitals below.

For doctors in county-level hospitals, very few people can perform subclavian vein puncture.

So these trainee doctors, when they saw Xiao Chu's superb operation skills, nothing but envy or admiration.

A trainee doctor stood up, hesitated for a moment, and said, "Mr. Xiao, can we learn more from you in the future?"

Chapter 228 Fracture does not necessarily require surgery

These trainee doctors have already arranged for teachers to lead them.

Now they want to learn from Xiao Chu, which is definitely against the rules.

If all the trainee doctors followed Xiao Chu's words, then even if their substitute doctors didn't say anything, they would definitely be dissatisfied in their hearts.

Not to mention the emergency department, even in the entire Provincial People's Hospital, the number of doctors is seriously insufficient.

After all, the requirements for academic qualifications here are relatively high. If you want to enter the clinic, you must at least have a doctorate.

And it also requires those who graduated from 985 and 211 with a doctorate degree.

This has resulted in a shortage of clinicians.

However, the provincial doctor's reputation was too great, and a large number of county-level doctors from below were recruited to study.

Therefore, in the current situation of provincial hospitals, the main force in clinical practice, and trainee doctors also account for a part.

If all the trainee doctors in the emergency department follow Xiao Chu, then the work of the entire emergency department will definitely be greatly reduced.

Other doctors are sure to complain.

Looking at the earnest eyes of several trainee doctors, Xiao Chu couldn't speak so harshly.

"It's not impossible for you to study with me. However, you must obtain the consent of your instructor.

And you must finish all the work in your group before you can come here. "

Seeing that Xiao Chu agreed, several trainee doctors expressed their opinion immediately.

"Mr. Xiao, don't worry, we must finish all the work in the group before we come to study with you."

When these people were discussing how to learn from Xiao Chu in the future, Zhao Fangshu came over.

"Xiao Chu, I just received a patient with a broken bone. It may need surgery, come and take a look."

Zhao Fangshu's main research direction is thoracic surgery. As for orthopedics, she is not very proficient.

Xiao Chu is now an all-around talent in the emergency department. Of course, he has to take a look at this fractured patient who needs surgery.

When the two came to a hospital bed, Zhao Fangshu pointed to a 10-year-old boy and said:

"Xiao Chu, this child accidentally broke his arm, resulting in a fractured left humerus, and the dislocation is serious, it seems that surgery is needed, can our department perform this child's surgery?"

"Have you ever filmed it?"

Xiao Chu checked the little boy and asked.

"The film has already been taken. Here is his X-ray film."

In fact, Xiao Chu already knew about the fracture of the child.

The location of the fracture, the dislocation is more serious.

According to the normal process, open reduction and internal fixation is definitely needed.

If no surgery is performed, the little boy's arms will definitely grow into deformities.

Xiao Chu took the X-ray film, looked at it and said, "Actually, this child's fracture doesn't need to be operated on!"

"No need for surgery?"

Zhao Fangshu was very surprised.

From her cognitive point of view, such a fracture has already formed an angle, how can it be possible without surgery?

"Look at the two ends of this child's fracture. An angle has been formed. How can it be reset without surgery? Are you going to do it manually?"

Xiao Chu smiled slightly.

"Yeah, I'm going to reset the technique!"

Zhao Fangshu looked at Xiao Chu in disbelief.

"This child's fractured ends on both sides are so far displaced that manual reset is almost impossible. Are you sure you can do it?"

"I should be fine, the child is still so young, if he is given internal fixation, it will easily affect the growth of the child's bones.

If the manipulation is reset and fixed, the healing will be faster, and it will not have any major impact on the child. "

The mother of the child on the side also hurriedly said: "Doctor, can it really be reset by hand?"

As the child's mother, of course she doesn't want to have a knife and put a steel plate.

If it can be reset manually, that would be the best.

It's just that when she saw that the two doctors had different opinions, she felt a little upset again.

Looking at the expectant eyes of the child's mother, Xiao Chu smiled and said: "Don't worry, I will try my best to alleviate the child's pain. It is best not to have surgery, and after the manipulation is reset, the healing will be very fast."

Xiao Chu's sincere eyes, as well as her strong confidence and warm words made the child's mother feel a lot more at ease.

"Then the doctor will ask you to perform manual reset on my son. Thank you so much."

The child's mother is grateful.

Xiao Chu didn't send the child to the operating room either, so he decided to reset him by the bedside.

It's just a reset of the technique, and it doesn't take much battle.

Having prepared the instruments, Xiao Chu asked the child to completely expose the left arm, and began to give local anesthesia to the fractured part.

For Xiao Chu, this kind of operation without technical content is just a local numbness.

"Little friend, uncle will give you an anesthetic, and it won't hurt when you reset in a while!"

"Well, thank you uncle!"

Enduring the pain, the child nodded sensibly.

But in Zhao Fangshu's eyes, it was different.

"Xiao Chu, can you just give this child local anesthesia? Don't you need brachial plexus anesthesia?"

According to common sense, this child also needs to undergo incision and internal fixation surgery.

But Xiao Chu didn't need it.

And even if manual reduction is required, conventionally, brachial plexus anesthesia is required for reduction.

Because if the manipulation is reset, the pain of the child will be very severe.

Anesthesia with the brachial plexus would ease his pain.

But Xiao Chu only applied local anesthesia on the fractured end, in this case, the effect of anesthesia would be greatly reduced.

That's why Zhao Fangshu had this question.

"If the child's manipulation is reset, local anesthesia is enough, and brachial plexus anesthesia is not necessary."

As long as local anesthesia is fully in place, the effect is not worse than brachial plexus anesthesia.

It's just that if other doctors come to give local anesthesia, he can't completely deliver the anesthetic to both ends of the fracture like Xiao Chu.

So if someone else comes to do manual reduction, brachial plexus anesthesia must be given.

Although it was local anesthesia for the fracture, Xiao Chu also anesthetized it beautifully, and completely anesthetized the fracture.

The child felt no pain at all.

Seeing that Xiao Chu was about to reset the child's technique, Zhao Fangshu asked, "Xiao Chu, do you need my help?"

Usually, if you plan to do manual reduction of the fracture,

Generally, two doctors pull the two ends of the fracture and perform manual reduction.