"It is most convenient when more than two people are needed to operate. One person can fix the patient's fracture site and keep it stable, and then put on the splint. If the patient is younger or the cooperation is not high, then this method cannot be used and a hole must be drilled. Directly perform invasive external fixation.”
Dr. Xu's words scared the patient as well as a kindergarten baby.
After all, no one wants to have a doctor drill holes in their legs.
After handling the patient, carefully lift the patient directly to the flat bed.
Just transfer to the inpatient ward for care.
"Remember, patients with severe fractures like this must find ways to prevent sterile inflammation even if they are successfully reduced by manipulation. In severe cases, it can directly lead to bone necrosis and joint degeneration."
"OK!"
Li Jingsheng and Dr. Chen nodded to express their understanding.
Aseptic inflammation often occurs in bones and joints and is extremely harmful.
"The strong young man outside should be able to receive local anesthesia. Lao Yu, since you are here, give him a brachial plexus anesthesia before leaving! His muscles are stronger than a gorilla, and the dosage and injection depth are probably only yours. Only such an experienced anesthesiologist can be precise."
Doctor Xu looked at Lao Yu who had packed his treasure box and was about to leave.
"You are the only one who has many things to do! Well, why do we have any friendship at all?"
Lao Yu happily agreed.
"Also, I am an anesthesiologist, not an anesthesiologist, not an anesthesiologist!"
This statement made several people laugh.
Anesthesiologists hate being called anesthesiologists because it makes them sound like technicians.
In fact, they are serious doctors, and they are well versed in emergency medicine, critical care medicine, and anesthesiology, and they also have a certain knowledge of general medicine.
Being the master of surgery to treat diseases and giving anesthesia to save lives is not something you get in vain.
In the early days of critical care medicine departments, many of them were critical care medical teams formed by excellent anesthesiologists and excellent medical nurses drawn from various departments.
In particular, the medical care in the two departments of respiratory medicine and cardiothoracic medicine has made a huge contribution.
So far, the critical care medicine department still focuses on the two major signs of respiration and heartbeat when rescuing patients.
The establishment of the two major circulatory systems is basically based on these two physical signs.
Lao Yu carried the box and went out.
"Xiao Li, let him operate it while I guide you."
Dr. Xu really 'takes care' of his apprentice.
Just after I handed over a difficult case to my apprentice, another more challenging one came.
"Teacher, you saw that man's fist. It's bigger than a bowl. I'm afraid if I don't catch him properly, his fist will hit my face."
Li Jingsheng said with a grimace.
The patient just now was of high quality and good temper. Li Jingsheng treated him for a long time, and he didn't say a single bad word.
But the strong man outside had a temper that was not easy to offend at first glance.
The risk of getting beaten increases exponentially.
"As long as you follow my instructions, you'll be fine. You first need to remember the technique of the fold-top maneuver!"
Li Jingsheng has already been taught the operating techniques and skills of the folding top slalom.
It’s just that practice and theory are completely different things.
Li Jingsheng tried hard to remember the key points of the fold-top maneuver.
"During the operation, the thumbs of both hands are pressed against one end of the protruding fracture, and the other four fingers are overlapped and wrapped around the other end of the sunken fracture. Under traction, the thumbs of both hands are pressed downwards on the protruding fracture end to increase the angular deformity of the fracture, relying on the thumbs The feeling, predicting that the distal and proximal bone cortices of the fracture have reached each other, suddenly reflected..."
The following key steps involve the skill of bone-touching at a junior level, which is not very difficult.
At least he was completely confident in detecting changes in the patient's bone position.
The rotation technique is similar to the rotation technique in rotation, flexion and extension, but the specific operations are different.
When they came outside, Dr. Xu was already chatting with the patient.
"Young man, your muscles are very developed, and it takes a lot of strength to perform manual reduction on you. This can only be done by our young doctors. The young doctors are less experienced, so please be more careful when doing it. In case the manual reduction fails, Then there is no other way, you can only consider surgical reduction."
After hearing this, the strong man didn't even think about it, and readily agreed, "No problem, just give me the treatment. If it doesn't work well, I won't blame you, don't worry!"
Since the patients have agreed, there is nothing more to say.
Lao Yu personally gave the patient local anesthesia, and then Li Jingsheng reset him.
This man's arms are too thick.
Fortunately, the local anesthetic has a good muscle relaxation effect and provides the necessary foundation for manual reduction.
Just now Lao Yu was preparing a local anesthetic, but Li Jingsheng didn't see it.
It feels like there is definitely more than just lidocaine.
He remembered all the injection points for brachial plexus anesthesia on the patient.
"Xiao Li, please check the patient again."
Dr. Xu asked Li Jingsheng to touch the patient's bones again.
"There appears to be soft tissue embedded in the fracture site."
After the muscles were effectively relaxed, Li Jingsheng felt the bones more smoothly this time.
Not only can the bone image and bone position be clearly felt, but the surrounding soft tissue can also be felt more clearly.
"First use a roundabout maneuver to completely free the embedded soft tissue. You first determine the path of dorsal displacement of the fractured end."
After Li Jingsheng nodded to confirm that it was OK, Dr. Xu continued, "When turning, perform the operation in the opposite direction of the fracture displacement. During traction, you can boldly increase the force."
Li Jingsheng did as he was told.
"Yes, that's it. Turn it in the opposite direction according to the original displacement of the fracture so that the broken ends face each other. You can carefully listen to the bone fricative sound at the broken end until you are sure that the soft tissue is completely freed."
The teacher taught him step by step, and Li Jingsheng had a good foundation.
The operation process went smoothly.
"Both hands must hold the two fracture ends so that the broken bone cortices are close to each other to avoid increasing soft tissue damage..."
"Yes, yes, very well done!"
Dr. Xu can judge the progress of the reduction just by listening to the bone fricative sounds.
After Li Jingsheng finished, he touched it and said, "Just perform the top-folding method to reset it. You already know the other techniques, so I don't need to teach you anything."
The patient turned his head the whole time, not knowing whether he didn't dare to look or didn't want to look.
Releasing the embedded soft tissue is only the first step.
He began to use the folding technique to reset the patient's position.
After two consecutive operations, the reset was not successful, but his seventh advanced bone-setting technique reached the entry level.
This is simply giving a pillow when you feel sleepy.
Li Jingsheng secretly upgraded his newly mastered top-folding maneuver to a proficient level before the patient became angry.
This time my confidence increased.
Try again.
Still failed.
The patient's muscles are too developed, which makes the reduction exponentially more difficult.
"Damn it, I can't even reset the Master level. It seems I can only upgrade to the Xiao Cheng level."
It only takes 100 health points to upgrade to the proficiency level, and 500 to the minor level.
Fortunately, he has accumulated a lot of health points now.
It took another 400 health points to upgrade the top-folding maneuver to the minor level.
If it doesn't work this time, there's nothing we can do.
Try again.
Once it was done, the whole process went smoothly beyond imagination.
Small-level bone-setting techniques can help him more fully feel the resistance from muscles and soft tissues. When resetting, it is even possible to act with some resistance.
"alright!"
Just when the patient was feeling uneasy, the two words spoken by Li Jingsheng were like the sound of nature.
"Hey, don't move, don't move! It's not fixed yet!"
Li Jingsheng noticed that the patient wanted to stand up and quickly comforted him.
The advanced bone-setting techniques at the Xiaocheng level are really amazing. In the future, even if you encounter dorsally displaced oblique fractures, spiral fractures, severe soft tissue embedding, etc., he can treat them.
So far, he has only learned the last advanced bone-setting technique.
Massage is a type that is easy to learn but difficult to master.
It involves the mastery of comprehensive knowledge of muscles, bones, soft tissues, joint structures, blood vessels, etc., as well as the practical effects of massage.
For Li Jingsheng, what he likes the most is medical skills that are easy to learn but difficult to master.
As long as he enters the door, he can cheat all the way.
He only needs 500 health points to achieve the knowledge and experience that others can gain after ten years of practice.
"Old Xu, no wonder you made an exception, this kid's talent is so amazing!"
Lao Yu watched Li Jingsheng setting the patient's bones throughout the process.
Even if he is just a layman, he can clearly feel the terrifying speed of Li Jingsheng's progress.
When I first started using it, my technique was still very unfamiliar.
But after only three or four attempts, the level suddenly rose to a higher level.
That's not all. After another failure, we rose to a higher level again.
Lao Yu has been working as an anesthesiologist for so many years, but he has never seen any surgeon's skills improve so quickly.
A surgeon who has made great progress in one and a half years can already be called an excellent surgeon.
"This kid doesn't need to be praised. If you praise him, he will fly away." Dr. Xu said this, with a mix of satisfaction and pride on his face. Even a fool can see that he is particularly satisfied with this apprentice.
"Let's talk serious. My kid is going to graduate with a master's degree today, and he's also majoring in surgery. How about you make another exception and take that kid in?"
Lao Yu asked seriously with a slightly shy face.
It is undeniable that if you learn Dr. Xu’s skills, you will have nothing to worry about for the rest of your life.
And it can avoid the fierce competition in major surgery.
"Can't take it."
Dr. Xu refused directly.
Li Jingsheng stood beside Dr. Chen and silently applied the splint to the patient.
Hearing that Dr. Xu refused to accept Lao Yu's son as his apprentice, he couldn't help but secretly rejoice. He was so lucky to have been able to get a ticket and learn bone setting from Dr. Xu.
"Can't we make an exception because we are so familiar with each other?"
"It can't be broken!" Dr. Xu refused ruthlessly again.
"Okay, okay! I didn't say that! Let's go back!"
Lao Yu waved his hand depressedly and left with the treasure box.
Looking at the unwilling look in his eyes, he definitely won't give up.
"Is it done? Hurry up, there are many patients waiting outside!"
Doctor Xu urged Li Jingsheng.
"It'll be ready soon!"
Li Jingsheng has now learned seven advanced bone-setting techniques, and the weakest ones have been upgraded to the proficient level. Basically, more than 90% of fractures and joint dislocations can be treated.
Sometimes, people still have to push.
The potential is truly endless.
He also didn't expect that on his first day of work at the Second Hospital, he would directly learn two advanced bone-setting techniques.
And they are the two most difficult doors.
Now he has truly gained the ability to conduct medical consultations.
The next thing to do is to work hard to earn health points, and strive to upgrade all bone-setting techniques to above Xiaocheng.
…
I was busy until 12 noon.
Li Jingsheng didn't count how many patients he had treated in total.
There should be thirty.
"Let them come back after one o'clock in the afternoon!"
Dr. Xu has no idea of working overtime.
Directly ask the nurse to tell the patient to come back in the afternoon.
"From twelve to one o'clock is the time for eating and resting. At one o'clock in the afternoon, you should go to the clinic on time to work."
Dr. Xu left immediately after speaking.
Li Jingsheng felt a little unbearable when he saw that there were many patients queuing up outside.
But he also understands that doctors are humans, not machines.
Only by eating well, drinking enough, and being energetic can we treat more patients.
"Doctor, doctor, please treat my son! We came here at around nine in the morning and have been queuing all morning. My son's problem is very small, it's just a dislocated elbow joint."
A young mother walked into the clinic with a three- or four-year-old boy in her arms and begged Li Jingsheng to work overtime.
Li Jingsheng took the X-ray film taken by the patient and looked at it.
The problem isn't big, it's just radial head subluxation.
The radial head of children is not fully developed, and the annular ligament of the elbow is loose. Sometimes a fall or excessive pulling force by parents may lead to dislocation of the radial head of the elbow joint.
After dislocation, the child will cry because of the pain. The injured forearm cannot be supinated, the elbow joint cannot flex on its own, and the injured arm cannot be raised.
For a bone-setting master like Li Jingsheng, this is indeed just a small problem.
For children and parents, it is a huge deal.
Seeing their children crying in pain and with their arms in a semi-disabled state, parents will feel very frightened and worried.
"Okay, I'll work overtime to help treat the child. You pay the fee with your mobile phone."
Li Jingsheng issued a bill of charge items to the patient.
The child's mother was extremely grateful and quickly paid the fee directly using the hospital APP bound to her mobile phone.
I saw Li Jingsheng first feeling the child's bones to understand the bone position and soft tissue damage around the joints. Immediately afterwards, he pressed the thumb of his right hand on the child's radial head, held the child's wrist with his left hand, and then supinated the child's forearm.
Next, press the radial head firmly with your thumb.
"Click!"
A slight bone rumble sounded.
This is the bone ringing sound of successful joint reduction.
"alright!"
Li Jingsheng said to the child's mother with a smile.
"Thank you, thank you so much!"
The mother of the child thanked her profusely.
"His injury is not serious and does not need to be bandaged and fixed, but it needs to be carefully maintained for about two weeks. Children recover quickly and there should be no problems after two weeks."
Li Jingsheng successfully received a good review and cured another patient. He was also very happy.
Got 11 health points.
I learned how to easily reset the patient's prolapsed joints after osteopathic surgery, which gave me a sense of accomplishment.
When the patients outside, as well as nurse Li Li, Dr. Chen and others looked at him, the admiring looks they cast on him also made Li Jingsheng very happy.
In terms of growth rate, it is faster in large hospitals.
Spending three days a week in a large hospital and four days a week in a small clinic is quite good.
When he slowly earns enough health points and improves other medical skills to a higher level one by one, his status in the Second Hospital will not only be higher. It will even gradually gain a place in the domestic medical community.
The most comfortable state in life is this state where hard work is visible.
"Doctor, I broke my foot while riding a scooter, and it hurts a lot now. Your medical skills are so great, can you please work overtime and help me treat it too?"
Another patient walked in with a cane.
Completely uninvited.
Aged about forty years old.
The person following next to him should be his wife.
"We've already got off work, come back in the afternoon!"
Li Jingsheng found that not only did the patient ask the doctor to work overtime, but the patients and their families waiting outside were also staring closely at him.
At this time, as long as he agrees to work overtime, he will not want to eat lunch today.
There will be a steady stream of patients coming later.
It was his first time to officially work in a clinic.
Unlike the inpatient department, as long as the patient is processed at the right time and handed over to the doctor on duty, he can leave.
There is no handover system in the outpatient clinic.
When the time comes, you will get off work immediately, and it is impossible for the hospital to arrange additional doctors on duty.
Unless it's the emergency department.
"Didn't you work overtime just now to help treat this child? We have been waiting longer than this child. And my injury is more serious. You can do it. Can't you work overtime to help my husband treat it?"
The man's wife pointed to the child and the child's mother who left happily.
"I'm sorry, I'm off work now. I've been working all morning, and I need to eat and take a rest first, and then come back to work in the afternoon. Otherwise, I won't have the physical strength to cope with the afternoon's work tasks. Please understand."
Li Jingsheng firmly refused.
I can never agree to it again this time.
People are selfish. What patients and their families consider is to relieve their pain as soon as possible. What doctors consider is to eat, take a rest, refresh their spirits, and regain their physical strength so that they can be better qualified for the afternoon work.
"You can help them treat it, but you don't want to help us treat it. Isn't it just because the mother of that child is beautiful?"
The female family members are really sharp-tongued.
"In the eyes of our doctors, there are only patients and nothing else. Come back in the afternoon!"
Li Jingsheng's tone was much colder this time.
Meeting such unreasonable family members can really make doctors angry to death.
He will not be angry with his family members like Director Yang of the People's Hospital.
Li Jingsheng ignored the patient and the female family member and left directly.
I had just finished my meal in the cafeteria and was about to start eating when Dr. Xu called.
"Xiao Li, what happened? More than a dozen family members and patients called the medical department to complain about our outpatient department, saying that we treated them differently. Now the medical department asked us to go over and explain."
Doctor Xu probably didn't expect his apprentice to be so capable of troubleshooting.
He had only been gone for less than twenty minutes when Li Jingsheng stabbed such a big basket.
"Why do so many family members and patients complain about me? I just worked overtime to treat a child, and then a patient with a broken leg also asked me to work overtime, but I didn't agree. The female family member scolded me. I just I only talked back to this patient’s family and didn’t have any conflicts with other patients!”
Li Jingsheng is also one of the top two.
When this happened, he was simply more unjust than Dou E.
I worked overtime temporarily out of kindness, but I didn't expect that so many people would complain.
It's so chilling.
"I'm almost done eating, so I'll go over and ask in a moment. You hurry up and go to the cafeteria to eat. You may go to the medical department to explain it later. You also know that the medical department is specifically trying to deal with me."
When Dr. Xu mentioned the medical department, he felt somewhat resentful.
(End of chapter)
