morning.
Director Huo Congjun came to the emergency department, brewed a cup of strong tea, poured out the first brew, sat down again, and drank the second tea in a leisurely manner.
Afterwards, he walked out of the director's office with his hands behind his back, and started his inspection from the observation room.
Behind Huo Congjun, there were three deputy chief physicians and six attending physicians.
Everyone, forming a sharp arrow, like a lion on the grassland, leading the lionesses to hunt.
The residents on duty waited quietly in front of the beds they managed, like jackals on the prairie, waiting for the crumbs left between the teeth of the lions.
The interns are vultures who seem to be free. They have no fixed position and are not valued by patients. They can only wait quietly to clean up the remnants left by lions and jackals.
The territory of a department is not large, like the observation room of the emergency department, there are usually only a few dozen beds, but order is still what the lions and jackals have to maintain.
In addition to Huo Congjun, there are two other chief physicians in the emergency department of Yunhua Hospital, and they don't have to follow him in rounds.
Although they are both named directors, Huo Congjun, the director of the department, is the owner of the territory because of his administrative powers. The other two chief physicians have only obtained senior titles, like stray male lions, and need to pay more efforts to maintain one's freedom.
Every morning at 7 o'clock is the time for the hospital to show order.
Ling Ran put on his white coat, put the 30-yuan Hetian Jade Buddha statue in his bag, and went to the emergency room, silently observing everything around him.
He already possessed some hunting skills and was able to kill specific diseases, but in the territory, that was not enough.
"Xiao Ling..." Huo Congjun suddenly called out, beckoning Ling Ran to come over.
"This is your patient, let me introduce you." Huo Congjun stood in front of the 12-bed patient, glanced at the medical record, and handed it to Ling Ran who came quickly.
According to the bed duty system, the patient should actually belong to the attending doctor Zhou. Even if everyone present knew that Ling Ran performed more than 50 sutures in a row the day before yesterday, they should first ask the attending doctor.
However, the director of the department is the king in the territory. He can do whatever he wants. Even if the director wants to remove the kidney of a seemingly healthy patient, the other doctors can only verbally object and cannot obstruct it.
Of course, patients and their families can refuse surgery, but in the hospital environment, the authority of the department director is still very high.
While recalling the patient's condition, Ling Ran opened the medical records and said, "The patient is a 19-year-old woman who was previously in good health. This time, her elbow was torn due to a fall from the stairs, and she underwent debridement and sutures..."
He half-thought half-spoken and completed his first bed check.
Before Yang Rui could catch his breath, Huo Congjun suddenly asked, "Why did you choose Line 0?"
Size 0 sutures are much finer than the 4-gauge thread commonly used in emergency room sutures. The No. 4 wire is 2-0 according to the standard of the United States Pharmacopoeia, and its diameter is 0.3 mm.
If the diameter of the two wires is twice the difference, the cross-sectional area will be four times different, similar to the difference between the little finger and the thumb.
Correspondingly, the tensile strength, that is, the strength to resist stretching, is much weaker.
In other words, wounds sutured with 0-gauge thread are more prone to rupture than larger 2-, 4-, or even 7-gauge threads.
Ling Ran was taken aback by the question, and the girl on the hospital bed and her family also looked at the young doctor in confusion.
"I think thread 0 can meet the needs of suturing." Ling Ran quickly answered, but the answer was somewhat irrelevant and too concise.
Small doctors such as interns, regular trainees, and residents are questioned and made things difficult during ward rounds. It is a daily routine in the hospital, but generally speaking, everyone will at least say a few more words.
Even if it is made things difficult, it is very rare.
Huo Congjun shook his head, and continued to ask: "Why don't you choose the regular thread? Use No. 0 thread, what should I do if the wound bursts?"
"If it breaks...re-sew it up again?" Ling Ran privately felt that this question was rather stupid, but he was not unreasonable. It was something that made the superior doctor unable to step down on the spot... Although he had done it before, he didn't have to do it every time .
Ling Ran gave a kind and caring smile, very sunny and handsome.
Huo Congjun didn't keep up with Ling Ran's train of thought. He had checked the ward every day for decades. He had never seen such a clever little doctor.
The Chief Physician, Deputy Chief Physician, Attending Physician and Resident Doctor who accompanied the ward round also fell into a long silence.
The good old Doctor Zhou sighed secretly, coughed, and said, "I didn't think the wound was very serious at the time. I guess the 0-line can guarantee the effect, so I allowed Ling Ran to use it."
"Don't defend him, you are at fault." Huo Congjun said in front of the patient's family: "Ling Ran chose line 0 without consideration, so you must point it out."
The family members of the patient who didn't understand at first suddenly became anxious, and the mother standing beside the bed hurriedly asked, "Doctor, is there something wrong with my daughter's arm?"
"There is no problem now, but we need more careful care and avoid movement. We mainly consider the tensile strength of the suture, because we are afraid that it will not be strong, and it will not heal well if it breaks." Huo Congjun was kind to the patient, and said It was not as serious as it was during the meeting, nor did it change because of the mild symptoms of the patient.
The patient's family members looked at each other, all looking anxious.
It was only at this time that Ling Ran understood the point of Huo Congjun's question, and immediately said: "The tension of the 0 line is sufficient. It is necessary to avoid activities and take care of it carefully, but I don't think you need to worry too much."
Huo Congjun said in the tone of educating junior doctors: "Don't you need to worry less if you use Line 4?"
"The patient is only 19 years old. The area of the wound tear is relatively large, but not deep. If thick thread is used, the scar left will be too large, which will affect his future life."
They just said on line 0 and line 4 that the patients didn't understand very well, but when Ling Ran talked about the details, a few people understood it in an instant.
The chubby girl on the hospital bed looked at Ling Ran no longer with suspicion, but with gratitude.
Huo Congjun, who was born as a military doctor, was unmoved and said, "It's okay to consider scars, but you have to understand that there are many reasons for scars, which are related to the patient's constitution and the condition of the wound. From this point of view, choose 0 number line, not advisable."
The girl on the hospital bed really became nervous at this moment, and hurriedly looked at Ling Ran.
"Besides the sutures, the tissues on both sides of the wound must be closely aligned and the skin smooth." Ling Ran raised his eyelids and said, "This can be achieved."
After a pause of two seconds, Ling Ran said again: "The distribution of suture tension should be concentrated in the subcutaneous tissue and deep dermis, with no tension in the superficial dermis and epidermis... This has also been achieved. I don't think there will be too much scar tissue hyperplasia, It is necessary to consider the thickness of the suture."
When Ling Ran first spoke, Huo Congjun and the doctors behind him were a little contemptuous.
From their point of view, Ling Ran obviously thought about a small problem and forgot the bigger problem. This kind of little doctor who can't figure out the priorities has seen many in their careers. .
However, the two questions that Yang Rui asked later really shocked everyone.
It's not that the problem is complicated, but that he can take care of it, which is really surprising.
"Is it time to change the dressing? Now." Huo Congjun found an excuse and asked the nurse to remove the gauze from the patient's arm.
All the doctors present bent down to observe the wound on the girl's arm.
Huo Congjun looked at it more seriously.
After a long time, Huo Congjun raised his head, but he called other residents and interns over, and said, "Ling Ran, tell me about your thoughts on suturing."
Ling Ran has never been stage frightened. He has mastered the master-level interrupted suture technique, and said more easily: "Generally, debridement sutures are interrupted sutures, and this time is no exception. During suturing, the main thing to pay attention to is the angle and depth of the needle insertion. It is in a raised state after suturing, which can act as a cushion before the scar forms."
Nearly 10 residents and more than a dozen interns surrounded a hospital bed, and there was simply not enough space, so some people simply stood on the chairs to see the patients inside.
The patient's family now understands that the doctor's operation is excellent, so they all happily gave up their place.
Ling Ran's voice was not loud, but he said clearly: "The basic principle is to insert the needle shallowly at the site with a thick margin, and to insert the needle deeply at the site with a thin wound margin. In addition, because the patient has skin defects, the injection The knot should not be too tight as this will cause poor blood circulation around the wound and delay healing... Afterwards, take care to remove the stitches, which should minimize the appearance of scar tissue...
"Very well said." Huo Congjun led the applause.
Staying in the room, there was a round of applause.
"Everyone has learned it." Huo Congjun looked at the young doctor.
"learned."
"learned."
"Understood."
The residents and interns nodded quickly.
"Just learn it." Huo Congjun nodded slowly, and then his voice became severe: "But no one is allowed to learn!"
Everyone was stunned.
Huo Congjun said: "There are many ways to cover up scars. For example, you can wear long-sleeved clothes afterwards, or use tattoos to cover up. As a doctor, the first thing you need to consider is treatment."
"I don't want to wear long sleeves, and I don't want tattoos." The girl shook her head quickly.
Huo Congjun ignored him, and said to himself: "Ling Ran's thinking is reasonable, but only those with high skills can be bold, and those who are not good enough, don't think about it so much. First, let me sew up the wound. do you understand?"
"Understood." This time, the morale of the young doctors was not so high.
No one wants to admit that they are weaker than others, let alone weaker than the little intern.
Huo Congjun, on the other hand, had the temper of the army, and raised his voice: "I didn't hear clearly, didn't you eat?"
"Understood." The little doctors raised their voices and answered unevenly.
After all, the hospital is not an army, so Huo Congjun didn't force it. He turned to Ling Ran and said, "This time, you pass the test. Let's change the medicine for the patient."
"Yes." Ling Ran quickly replied after being slapped by Doctor Zhou.
"Then will I have a scar?" The girl asked quickly, seeing that the inspection team was about to leave.
"The scars will be shallower, and it's impossible to leave no scars at all." Huo Congjun walked several meters away, and turned around to answer.
The girl gave a sensible "Oh", and then smiled sweetly at Ling Ran: "Thank you, Dr. Ling."
"You're welcome." Ling Ran nodded slightly, and was about to change his medicine, when a white treasure chest flashed in front of him.
New Achievement: Heartfelt Appreciation from Patients
Achievement description: The heartfelt gratitude of the patient is the greatest compliment to the doctor
Reward: Junior Chest