MTL - Doctor’s Life Simulator-Chapter 3 Textbook-level ward rounds

While walking, Qian Liang taught the two of them a lesson:

"The ward round record is a core part of a complete case, and it is a record that the competent physician must complete within 48 hours of the patient's admission."

"The resident physicians in our hospital are checked once a day in the morning and in the afternoon. Patients who are critically ill or whose condition is not stable after surgery should be observed at any time, processed and recorded."

"As for the ward rounds of the director of the department, it is once a week. The director of the department and the head nurse of the ward participate in it. They mainly learn about the diagnosis and treatment of critically ill and complex hospitals, and problems in the management of the ward, and help them solve them."

After Qian Liang finished speaking, he stopped and looked at the two of them: "So when the director of the department will round the room in a week, I hope you will be prepared, not to mention you, even I may be asked by the director. Don't talk."

After the tense atmosphere was created, Qian Liang changed his words:

"Of course, this is also an opportunity for elite physicians to emerge!"

Cheng Yunfeng, who was on the side, obviously lit up and was eager to try. After all, as a scholar, he has a strong competitive spirit.

Qian Liang was naturally very satisfied with Cheng Yunfeng's fighting spirit, and continued to add:

"As for the hospital leaders' ward rounds, they are conducted once a month, and 2-3 wards are randomly checked each time, led by the dean or vice dean, and attended by the heads of functional departments, department directors, and head nurses in the ward to learn about ward management and The patient's diagnosis and treatment..."

Soon, following Qian Liang's words, the three of them came to bed number 18, a patient with diabetic foot.

In addition to conventional thermal injury, chemical burn, and electrical burn, the Orthopedic Burn Department of Hecheng No. 1 Hospital also treats various chronic wounds such as bedsores and ulcers.

Diabetic foot patients are naturally an important part of it.

Walking to the hospital bed, Qian Liang looked at the two of them: "Who will come first?"

Cheng Yunfeng looked at the patient on the hospital bed. The exposed sick foot, with full-thickness skin damage and an abscess visible to the naked eye, was panicked.

The burn knowledge I had prepared for several days was useless.

Qin Lang, who was on the side, walked out with a calm expression.

"Doctor Qian, I'll come."

Qian Liang was slightly surprised, but he didn't stop it.

After Qin Lang finished speaking, he stepped forward, his face was kind, and his tone was soft:

"Uncle, how are you feeling today?"

"Anything uncomfortable?"

...

Soon, Qin Lang was skilled in asking the patient's medical history and what tests he had done.

After the question, he completed the physical examination very smoothly and checked the results of various auxiliary examinations.

The whole process is very simple and efficient, even Qian Liang on the side is a little pleasing to the eye.

"Amazing, is this really a community doctor who came to study?"

Of course, the process can be trained in advance, but the diagnosis of patients requires targeted analysis.

Under the blessing of so many years of clinical experience, Qin Lang's whole personality changed, as if a higher-level doctor was explaining it to a lower-level doctor.

"The patient's diseased foot has full-thickness skin lesions, accompanied by abscesses, and myofascial space infection. According to the diabetic foot classification, it is Wagner grade 3. Early and effective dilatation is required."

Seeing Qin Lang's analysis, Qian Liang was slightly taken aback:

"Is this a direct statement of treatment and a new demand for care?"

"A little level."

Qian Liang is really interested now, as for Cheng Yunfeng, who had placed his expectations before, he has long forgotten about it.

"Qin Lang, tell me, what treatments can be used for Wagner grade 3 diabetic foot?"

Regarding the question raised by Qian Liang, Cheng Yunfeng, who was on the side, suddenly found that he could not understand a little, and he kept recalling in his mind, what is Wagner 3 diabetic foot, and how is it distinguished.

Qin Lang smiled softly and replied skillfully: "The treatment of diabetic foot mainly includes systemic anti-infective treatment, topical use of fungicides and surgical drainage. Of course, for this patient, the most basic and most critical is Debridement and drainage."

Qian Liang agreed with Qin Lang's answer, nodded, and continued to ask:

"Then which debridement method do you think patients should use?"

For Qin Lang, who has reached the intermediate level of debridement, this is naturally a matter of course, and he analyzes it in an orderly manner:

"Currently commonly used are open debridement techniques, closed negative pressure drainage techniques, and small incision counterpart drainage techniques..."

When the unfamiliar and familiar terms popped out of Qin Lang's mouth, Cheng Yunfeng frowned for a while, puzzled for a while, and then became confused again.

"He's amazing!"

Compared to Cheng Yunfeng's Ru Tingtianshu, Qian Liang kept nodding his head. Qin Lang was fine, so he continued to ask, "Let's talk about it."

Qin Lang nodded: "Under normal circumstances, the patient's condition, due to the slow healing of the wound and the difficulty of treatment, should choose the closed negative pressure drainage technology. First, it can create a closed state and isolate the wound from the air. , to avoid cross-infection, and secondly, it can also significantly reduce the number of dressing changes on the wound surface and reduce the pain of patients."

Hearing Qin Lang's analysis, Qian Liang agreed and said, "Yes, this is also the treatment we took for patients after the last round of wards."

However, to Qian Liang's surprise, the ward round, which was already coming to an end, suddenly changed.

Qin Lang looked at Qian Liang calmly: "Doctor Qian, under normal circumstances, continuing the closed negative pressure drainage technique is indeed the best treatment method for patients, but now I think the treatment plan should be adjusted."

"Is he questioning Dr. Qian's treatment plan?"

Cheng Yunfeng sucked in a breath of cold air, and looked at Qin Lang in surprise.

Qian Liang was also a little puzzled.

Qin Lang gave Qian Liang the latest examination results, especially the ankle-brachial index.

"This is?"

While Qian Liang was still reacting, Qin Lang pointed his gesture at the patient's sick foot:

"Due to the use of this technology alone and the inaccurate timing of application, the patient's diseased foot has complications, and the last wound drainage has not been effectively controlled, and the anaerobic environment in a closed state is more likely to cause anaerobic bacteria to multiply. , instead exacerbated the infection. Moreover, the necrotic tissue sloughed off, further causing blockage of the drainage tube..."

Under Qin Lang's calm and confident words, Qian Liang and Cheng Yunfeng instinctively followed his fingertips and looked over.

"Look, the granulation tissue here is pale and inactivated, obviously tissue necrosis..."

"Because of the continuous bleeding here, there is less new growth of granulation tissue, which cannot wrap muscles, tendons, and periosteum to expose them, which is prone to necrosis..."

"The most important thing is that the patient's ankle-brachial index is lower than 0.3, and the blood supply to the lower extremities is obviously poor. Therefore, I think the treatment method needs to be adjusted as soon as possible, and the patient needs to be treated with open debridement as soon as possible, thorough debridement and adequate drainage!"

Under Qin Lang's well-founded analysis, Qian Liang also suddenly realized: "Qin Lang, you are right. Very correct!"

If it wasn't for Qin Lang's meticulous observation, he might have neglected it. If the timing of treatment was delayed, it would likely lead to aggravation of the patient's infection, spread to the surrounding area, and even cause systemic infection and poisoning.

Thinking of this, Qian Liang also broke out in a cold sweat.

"When did the advanced doctor become so powerful?"

And this was just Qin Lang, who he didn't pay attention to. Qian Liang looked at the eight-year doctoral student next to him. Could it be that he was really old.

"Cheng Yunfeng, do you have anything to add?"

Cheng Yunfeng couldn't say anything other than calling Qin Lang Liu Liu Liu. After holding back his rough face for a long time, he finally shook his head.

Seeing Cheng Yunfeng's state, Qian Liang breathed a sigh of relief. Look, this is what a newcomer should look like.

Some of the moments in Qin Lang's discussion were given to Qian Liang, only a superior doctor with decades of clinical experience can have the certainty and old-fashioned eyes.

After thinking for a while, Qian Liang instructed: "Cheng Yunfeng, just follow the contents of Qin Lang's ward rounds, write down the case, and adjust the doctor's order! The format and content are just as accurate as Qin Lang's process just now!"

Hearing Qian Liang's order, Cheng Yunfeng could only nod his head.

Co-authored, he is going to saddle Qin Lang before and after, and write the medical records bitterly.

Why is it completely different from what I thought before I came?

Cheng Yunfeng glanced at Qin Lang's face, so handsome and eloquent, all of a sudden he became more and more aggrieved.

Thinking again, what Qin Lang said just now, UU reading www. uukanshu.com recalled:

Uncle, how are you feeling today? This and [email protected]#￥%%…&...

Cheng Yunfeng's whole face is twisted together, (⊙_⊙)?

[Congratulations to the host for completing the ward round task and rewarding 2 life simulation points. 】

Next, Qian Liang took the two to continue the ward round.

After completing the task and getting the simulation point, Qin Lang naturally began to calm down and gave the opportunity to Cheng Yunfeng.

The next case is a routine burn case. I have to say that Cheng Yunfeng is still a bit skilled in becoming an eight-year doctoral student.

In particular, I have secretly done my homework before. I have mastered the method of estimating the burn wound area, and I can describe and record the burn wound at different stages in a standard way.

Of course, it is still at the entry-level level, and Qin Lang's independent analysis, or even the amazingness of the improved treatment plan, is still incomparable.

Soon, the three of them completed today's ward rounds.

Overall, Qian Liang was very satisfied, especially Qin Lang's performance.

"Today you have done very well. Starting tomorrow, I will teach you the use of common dressings, and master the basic treatment skills of burn wounds at different stages, and strive to master the correct methods for different parts, depths, and types of burn wounds as soon as possible. deal with."

"Okay, Doctor Qian."

For being crushed by Qin Lang today, Cheng Yunfeng plans to regain his face in the next training.

In school, he practiced debridement, dressing and dressing.

Soon, the first day of training was completed.

After Qin Lang returned to the dormitory specially arranged by the First Hospital of the City, he started another simulation.