Doctor's Life Simulator

Chapter 3 Textbook-Level Wards Rounds
While walking, Qian Liang taught the two of them:

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

"The resident physicians in our hospital check every morning and afternoon. Patients who are critically ill or whose condition has not stabilized after surgery must be observed at any time, dealt with and recorded."

"As for the department director's ward rounds once a week, the department director and the head nurse of the ward participate. They mainly understand the diagnosis and treatment situation of critically ill and complicated hospitals, and problems in ward management, 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 makes his ward rounds a week later, I hope you are ready, let alone you, even I may be answered by the director. No words."

After the tense atmosphere was created, Qian Liang changed the subject:
"Of course, this is also an opportunity for elite doctors to make their mark!"

Cheng Yunfeng's eyes lit up, and he was eager to try. After all, as a top student, 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 ward rounds of the hospital leaders, it is once a month, and 2-3 wards are randomly checked each time. The dean or deputy dean leads, the person in charge of the functional department, the director of the department, and the head nurse of the ward participate to understand the management and management of the ward. Patient Diagnosis and Treatment”

Soon, following Qian Liang's words, the three of them came to bed No. 18, which was a diabetic foot patient.

The plastic surgery and burn department of Hecheng No. [-] Hospital, in addition to conventional thermal injuries, chemical burns, and electrical burns, also treats various types of chronic wounds such as bedsores and ulcers.

Diabetic foot patients are also 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, full-thickness skin damage, and abscess visible to the naked eye, he was flustered for a while.

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

At the side, Qin Lang walked out with a calm expression.

"Doctor Qian, I'm coming."

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

After Qin Lang finished speaking, he stepped forward, with a kind face and a soft tone:

"Uncle, how are you feeling today?"

"Anything uncomfortable?"

Soon, Qin Lang proficiently asked the patient's medical history and what examinations he had done.

After the questioning, 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 who is watching it is a bit 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.

With the blessing of so many years of clinical experience, Qin Lang's entire temperament has changed, as if a superior doctor is explaining to a subordinate doctor.

"The patient's diseased foot has full-thickness skin damage, accompanied by abscess and myofascial space infection. According to the diabetic foot classification, it is Wagner grade 3. It is necessary to effectively reduce the tension as soon as possible."

Seeing Qin Lang's analysis, Qian Liang was slightly taken aback:
"Is this directly proposing a therapeutic point of view and a new requirement for care?"

"It's a little level."

Qian Liang was really interested now, as for Cheng Yunfeng, who had placed high hopes before, he had long forgotten about it.

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

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

Qin Lang smiled lightly and answered deftly: "The treatment of diabetic foot mainly includes systemic anti-infection treatment, local application of fungicides and surgical drainage. Of course, for this patient, the most basic and most critical is Debridement and drainage."

For Qin Lang's answer, Qian Liang agreed very much, 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 no-brainer, and he analyzed methodically:
"Currently, open debridement techniques, closed negative pressure drainage techniques, and small incision-to-mouth drainage techniques are commonly used."

When unfamiliar and familiar nouns popped out of Qin Lang's mouth, Cheng Yunfeng frowned for a while, was puzzled for a while, and was confused for a while.

"He is amazing!"

Compared to Cheng Yunfeng's as if listening to heavenly scriptures, Qian Liang kept nodding his head, Qin Lang is fine, and continued to ask: "Expand and talk about it."

Qin Lang nodded: "Under normal circumstances, due to the slow healing of the wound and the difficulty of treatment for this patient, the closed negative pressure drainage technique should be selected. 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 wound dressing changes and reduce the pain of patients."

Hearing Qin Lang's analysis, Qian Liang agreed and said, "That's right, this is also the treatment we did for the patient after the last ward round."

However, to Qian Liang's surprise, the ward round, which was already drawing to a close, suddenly changed.

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

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

Cheng Yunfeng gasped, 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 at the sick foot of the patient again:

"Due to the use of this technology alone, the timing of the application is inaccurate, and the patient's foot has complications, and the last wound drainage was not effectively controlled, and the anaerobic environment in a closed state is more likely to cause anaerobic bacteria to multiply. , but aggravated the infection. Moreover, the necrotic tissue fell off, which further led to the 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 newly grown granulation tissue, which cannot wrap the muscles, tendons, and periosteum, making them exposed and 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 limbs is obviously poor. Therefore, I think that the treatment method needs to be adjusted as soon as possible, and the patient needs to be treated with open debridement, thorough debridement and adequate drainage as soon as possible!"

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

If it weren't for Qin Lang's meticulous observation, he might have neglected it. If this delays the timing of treatment, it is very likely that the patient's infection will aggravate, spread to the surroundings, and even cause systemic infection and poisoning.

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

"When did the trainee doctor become so powerful?"

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

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

What else could Cheng Yunfeng say besides calling Qinlang 666, he held back his rough face for a long time, and finally shook his head.

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

Some moments of Qin Lang's discussion gave Qian Liang the certainty and sharp eyes that only senior doctors with decades of clinical experience have.

After thinking for a while, Qian Liang ordered: "Cheng Yunfeng, just follow Qin Lang's ward rounds, write down the medical records, and adjust the doctor's orders! The format and content should be exactly as Qin Lang did just now!"

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

Co-authoring, I am going to write the medical records bitterly for Qin Lang.

Why is it completely different from what I thought before I came here?
Cheng Yunfeng glanced at Qin Lang's face, he was so handsome and handsome, and he felt more and more wronged all of a sudden.

Thinking about what Qin Lang said just now, I recalled:
Uncle, how are you feeling today?This @#￥%%...&
Cheng Yunfeng's entire face was twisted together, (⊙_⊙)?
[Congratulations to the host for completing the ward round task, rewarding 2 life simulation points. 】

Next, Qian Liang took the two of them to continue rounds.

After completing the task and obtaining the simulation point, Qin Lang naturally began to hold back his edge and gave up the opportunity to Cheng Yunfeng.

The next case was a routine burn case. It has to be said that Cheng Yunfeng was quite capable of becoming an eight-year doctoral student.

In particular, I did my homework secretly before, and I have initially mastered the method of estimating the area of ​​burn wounds, and can make standardized descriptions and records of burn wounds at different stages.

Of course, it is still at the entry-level level, and there is no comparison with Qin Lang's independent analysis, and even the amazing improvement of the treatment plan.

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

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

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

"Okay, Doctor Qian."

Regarding being crushed by Qin Lang today, Cheng Yunfeng is going to save face in the next training.

In school, he had practiced debridement, changing dressings, and bandaging.

Soon, the first day of training was completed.

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

(End of this chapter)