I can see the status bar

Chapter 1126 System Differences
The current situation is best described as chaos.Among the nine doctors, Sun Li'en is the only one who can still carry out consultation activities.If it weren't for the fact that there were still eight patients waiting in line, Sun Li'en would have gone crazy.

Ding Huiguo was left in the observation room at the side, and Sun Lien decided to let him wait in the observation room for now.At least wait until the results of the pathology department come out before freeing up to look at his problem.And the other patients who came to the consulting room... most of them were traumatized.Fractures and dislocations were basically split in half, and there was also a patient with eye trauma - Sun Lien's team did not have ophthalmologists, so he had to call Director Wu again urgently for support.

Patients with fractures and dislocations need to be evaluated by a specialized orthopedic surgeon, and then based on the results of the evaluation and imaging examinations, it is decided whether to perform manual reduction and fixation, or to perform reduction after surgery.

Because one of the patients who came to see a doctor had a fracture of the tibia and fibula.Therefore, in addition to telling the patient not to move around, so as not to cause severe pain after stimulating the periosteum, Sun Lien also carefully checked the dorsalis pedis artery pulse of the patient while observing the status bar.Fractures of the tibia and fibula, plantar injuries, fractures of the radius and ulna, and injuries to the palms can all cause compartment syndrome, and fractures in these areas must be handled with care.

After confirming that the patient's foot arterial pulse was normal, Sun Lien went out to push a wheelchair for the patient with a fractured tibia and fibula.But there is no way, now there are no nurses, nurses, or even interns and regular trainees who can be called to help.With apologies, he could only ask the patient to rock the wheelchair and go to the imaging department for X-ray and CT examinations.

As for the two dislocated patients... Sun Lien sighed, there is no full-time orthopedic surgeon in the team, and for this kind of repositioning, a film must be taken to check the damage first.So there was another toss - when they all went to finish filming, the orthopedic surgeon who was driven out from the red zone to do the reset also rushed to the scene.

The reduction of shoulder dislocation is a little "simple", which is mainly a laborious task.After the orthopedic surgeon reviewed the radiographs, he first examined the patient for axillary nerve injury.After the deltoid muscle reflex was positive and the sensation on the outer side of the patient's upper arm was confirmed to be normal, he said with a sigh of relief, "There is no problem with the nerve, it's just a simple anterior dislocation of the shoulder joint."

Later, the orthopedic doctor asked Sun Lien to find "the most powerful doctor here", and then confidently directed the patient to lie flat on the examination bed, while he took a "sheet" to replace the examination bed of non-woven fabrics.After rolling the non-woven fabric into a coarse cloth rope, the orthopedic doctor passed the cloth rope through the patient's armpit, stood on the patient's head, and then handed the rope to Dr. Brun who had just been called by Sun Lien. Then he directed Sun Li'en to hold down the patient.

"His dislocation is more... troublesome." The orthopedic surgeon said after indicating that Sun Li'en firmly grasped the patient's legs, "Generally speaking, we can do the reset by one person with the help of tools, but he can't do it—he... This..." The orthopedic doctor looked at the patient on the bed and sighed, "He is too strong."

The patient with a dislocated shoulder joint was roughly the same height as Brunn, but his muscles were much stronger than Brunn's.According to the patient's self-report, before the injury, he was playing sandbags in his room for daily exercise, but his mother suddenly pushed the door open.He subconsciously turned around and turned back, but inadvertently, the sandbag reverberated and knocked him down to the ground. During the fall, he subconsciously stretched out his right arm to try to grab something, but it happened to be a piece of wood beside him. on the chair.Then, the unlucky guy fell directly to the ground, and at the same time pulled his right arm and dislocated it.

Such a dislocation cannot be handled in a community hospital without X-ray and CT equipment.After all, they do not have these devices, nor do they have senior orthopedic surgeons, nor do they have the equipment to guarantee general anesthesia reduction after manual reduction fails.

Yes, the remedial measure after manual reset fails is general anesthesia reset.Manual reduction is possible to fail.This is more common in patients with well-developed musculature, or patients whose muscles are too tense due to tension-their muscles are so tense that doctors cannot reset them with simple manipulation.In such cases, general anesthesia and muscle relaxants are used to relax the patient's muscles.After the muscle tension is eliminated, manual reset is performed.

Of course, general anesthesia reset also has the possibility of failure.When the reduction fails again, the doctor will start to consider open reduction.

Let's hope the poor burly dude doesn't have to cut and reset.

When the shoulder joint is freshly dislocated, if there is humeral neck and humeral shaft fracture, or glenoid fracture embedded in the joint, or the long head of biceps brachii is embedded in the joint, or combined with blood vessel and nerve injury, it is necessary to directly perform open reduction .

The current overall condition of Zhuang Shuo is good, at least no nerve damage has been found, and no combined fractures have occurred.Therefore, incision is naturally not the first solution.

"Okay, grab it." The orthopedic doctor's tone sounded a little...excited.It seems that it is also because I have not been engaged in the treatment content of this profession for a long time, so I am a little excited to get started.He first twisted his arms a few times in the air, as if he was waking up the memory sleeping in his muscles and joints.He then grabbed the patient's right arm with both hands and yelled at the still dazed Brunn, "Pull!"

Bruen exhausted all his breastfeeding strength and began to pull up the "cloth rope" in his hand. Sun Lien was almost staggered and fell to the ground.Fortunately, he quickly adjusted his posture, and then firmly grabbed the patient's feet.

Being strangled by a bear-like figure like Brunn with a cloth rope, the pain is certain.What's more terrible is that the orthopedic doctor also began to pull down the patient's right arm with all his strength-in order to ensure that he would not let go of his hand and cause more serious trauma when exerting force, the orthopedic doctor even placed a pad under the patient's armpit where the clothes were removed. A piece of gauze, and then directly stepped on it with his left foot.

Pulling with a cloth rope and pedaling, this kind of action that seems to have nothing to do with "medical treatment" is actually the key to ensuring the reset of the manipulation.The rope is used to stabilize the rotator cuff, and the pedals are also used to stabilize the shoulder joint.If the shoulder joint with anterior dislocation wants to be reset, the humeral head must first be dislodged downwards, and then it can return to its original position under the traction of ligaments and surrounding tissues.

The three big masters tried their best...the dislocated place was the one they were tossing about, and the pain is certain.Sun Lien had known for a long time that most muscular men couldn't bear the pain, but he really didn't expect this old man's voice... to be so good.

This "嗤" voice is really high-pitched...it's High C, right?

The old man howled out loudly, and as Brun and the orthopedic surgeon continued to exert force, the howling sound began to show obvious fluctuations.After howling for about seven or eight seconds, the orthopedic surgeon began to slowly rotate the arm in his hand outward.

Ok, the tone has reached HighD.

Continue to pull hard, and as the arm rotates to the outside, the howl of the old man becomes even worse.Sun Lien could hardly hold down his own legs—judging from the patient's muscular development, he might be able to push Sun Lien out with one leg.

Fortunately, my brother still has control over his body. His rationality tells him that the doctor is treating him.And pain requires patience.

With his unfixed left hand, the elder brother tried his best to twist the railing next to the bed, and his hand squeezed against the plastic railing, making a tooth-piercing "creaking" sound.And when his howling sound was about to reach the final limit that his lung capacity could support, Sun Li'en felt a sudden vibration in his hand.

This is obviously not a movement that humans can produce through subconscious and spontaneous control of muscles-from the feel, it seems more like something slipped into a pre-set... slot.

Almost at the same time as this action, the old man's howling suddenly stopped.Of course, it's not that he suddenly stopped speaking, but that the high pitch of HighD suddenly turned into the "afterglow" of the end of shouting.

The orthopedic doctor signaled Brun to stop the movement of the leb rope in his hand. He squeezed his brother's shoulder with his hands, and then nodded in satisfaction, "It should have been reset."

"Awesome." The muscular old man praised the orthopedic doctor in a hoarse voice. He felt his shoulder and said in shock, "I don't hurt anymore!"

"Don't move too quickly." The orthopedic doctor quickly stopped the old man's intention to move his right arm. He pushed the old man's right arm so that his arm rested on his chest and rested on his left shoulder. "Just hold it down and don't move."

The shoulder lap test is the quickest and most direct way to examine a patient for a shoulder dislocation.Once the patient has a shoulder dislocation, the shoulder test must be positive - unless it is forced, it is absolutely impossible to put the hand on the dislocated side on the other shoulder while keeping the elbow close to the chest wall.

The shoulder test was negative, which proved that the patient's shoulder dislocation had been implanted, and the biggest difficulty was over.

"The next thing you have to do is to keep your upper limbs fixed." The orthopedic doctor took out a roll of bandages from his side, first tied a simple triangular bandage on the muscular brother, and then said, "Just temporarily fix it like this, wait Yes, I'll put you back in a cast. Wait about two weeks before you can start moving again. But you have to keep in mind that you can only do light exercises to start moving again, and the lifting function can't start until four weeks later-now During the epidemic, the situation is quite special, and after two weeks, you can go directly to the community hospital to remove the plaster."

Sun Li'en glanced at his brother's status bar, then nodded secretly.The orthopedic surgeon deserves to be the most qualified professional. During the reduction process, no soft tissue damage was caused, and at the same time, the patient's shoulder dislocation problem was perfectly solved.

"Then do I still need to prescribe some medicine?" It is the common perception of most ordinary people that medicine must be prescribed when you go to the hospital for treatment.Although the process of joint reset was painful, it did solve my problem immediately.The muscular brother decided to be a kind person—doctors prescribe medicines to make money, and asking him to prescribe more should be regarded as thanks to others.

"No need to prescribe medicine." Unexpectedly, the orthopedic doctor shook his head directly, and he said with certainty, "This is the first time you have dislocated your dislocation. After repositioning, you only need to rest and immobilize, and you don't need oral medicine to assist you..." Speaking here , the orthopedic doctor smiled and asked, "You don't feel any pain or itching now, where do you need medicine?"

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After putting on the plaster and sending the muscular brother away, the orthopedic doctor turned to Sun Lien and introduced himself, "My surname is Jiang..."

"Your name shouldn't be 'Dao De'?" Sun Li'en asked with a smile.Due to the epidemic, doctors in protective suits cannot shake hands with each other.Therefore, the "special plan" is to greet each other with elbows.

After touching elbows with Sun Lien, Dr. Jiang from the Department of Orthopedics smiled and said, "My parents are pretty reliable, they didn't just give me a name - my name is Jiang Junyi."

Bruen suddenly intervened in the conversation between Sun Lien and Dr. Jiang, "Of course I know it's impolite to interrupt other people's polite conversation, but I really... have a question I want to ask." He asked Dr. Jiang Junyi , "This kind of reset without analgesia is... the norm in China?"

When Bruen usually worked in the emergency room of the fourth hospital, he was mainly in charge of the internal medicine department.In other words, most of the patients he deals with need to be intervened and rescued by medical means.As for trauma rescue, he really had no experience in the Fourth Hospital.

If it is in the United States, a certain degree of pain relief and anesthesia must be performed before treatment for dislocated patients.For ease of use, this anesthetic generally uses inhaled nitrous oxide.

As an inhalational anesthetic, nitrous oxide is safer than other anesthetics.But this is also limited to use under hospital supervision.As an anesthetic, nitrous oxide is also addictive.The long-term use of large amounts of nitrous oxide may cause extremely serious sequelae including paralysis.

"Why do you need analgesia?" Dr. Jiang Junyi didn't quite understand Bruen's question, "It hurts a bit, and it's not an unbearable pain. We don't analgesic when we treat wounds, some wounds heal It’s not good to have granulation, we will directly scrape it with a medicine spoon..."

When Sun Li'en heard the word "medicine spoon", he suddenly felt a phantom pain in his stomach - Bruen had done this to him after he was hit with a knife.

"Doesn't analgesia help muscles relax?" Bruen was still a little puzzled, "And you don't need to take an MRI to see the soft tissue damage before you reset?"

"The nerves are not damaged, the arteries are pulsating and the skin temperature is normal, so there is no need to go for an MRI." Dr. Jiang Junyi was taken aback for a moment before replying, "Just go for an MRI for this kind of dislocation, isn't that considered excessive medical treatment?"

Hearing this, Sun Lien probably understood what Brunn wanted to ask.He replied bluntly, "This is the difference in the starting point. The purpose of domestic medical treatment has always been to control medical expenses and the use of medical resources as much as possible under the premise of ensuring the treatment effect-good steel is used wisely. The United States Although some hospitals still need to guarantee the treatment effect, they will try their best to choose the most profitable treatment content for the hospital under the premise of ensuring the treatment effect. Besides, when using nitrous oxide, you have to monitor your vital signs, right? You have to find an anesthesiologist to perform anesthesia, right? MRI is the same."

"As for the items that can be done or not, American hospitals will be more inclined to do it-although the reasons stated are for the comfort of patients and more detailed examinations...but in fact, who knows?" Sun Lien shrugged his shoulders, Looking at Brunn, he said, "The medical system under capitalism is still very different from ours."

(End of this chapter)