Auto chess in the operating room

Chapter 380 I finally got the certificate, and I'm on my own!
"Director Tang, shall we start the basic operation next?"

Director Huang asked cautiously.

Tang Lou nodded calmly: "OK."

Director Huang looked at the question bank of basic operations, thought for a while, and asked in advance: "Director Tang, look at this paracentesis, bone marrow puncture, skin disinfection of the iodophor operation area, surgical drape, and surgical drapes. Which one to choose?"

Tang Lou chose one at random: "Then bone marrow aspiration."

"Okay, as expected of Director Tang, it's very difficult to make a move. Let's move to the operation area."

Of course, it is impossible to conduct skill assessments with real people, and they are all directly operated on medical simulators.

The invigilator read the title: "Candidates are asked to perform bone marrow aspiration on the following patient: the patient is female, 34 years old, the blood routine examination found that the red blood cells, white blood cells, and platelets were significantly lower than the normal value, suspected of aplastic anemia, and now needs to be tested Bone marrow aspiration (operated on a medical simulator) (20 points)”

After listening to the questions, Tang Lou looked at the medical simulator, and directly exchanged and upgraded the comprehensive puncture technique (three stars, 9) in the system.

Then start the operation. The first step is naturally to adjust the patient's position to facilitate the selection of the puncture point.

Seeing Tang Lou's clear steps, Director Huang and the others nodded. Director Tang was very proficient in the operation process.

The invigilator recorded Tang Lou's operation on the side: "The examinee chooses the puncture point of the posterior superior iliac spine: the simulated person is in prone position, on both sides of the sacrum, and the protruding part above the buttocks. The operation is accurate and the steps are correct, +2 points."

The second step is to start the aseptic operation, disinfection, draping, and local anesthesia.

The first step in Tanglou is to carry out routine skin disinfection, and the diameter is controlled at 15cm, followed by wearing a hat, mask, and surgical gown.

The invigilator stared carefully at Tang Lou's operation. This kind of practical skills test was very strict and cumbersome, and it was much more standardized than the usual pre-operation preparation.

This kind of feeling, children's shoes who have taken the driver's license test subject three must be deeply impressed. Even if it is an old driver who has been driving for more than ten years, asking him to take a road test may not guarantee that he will pass.

Ordinary driving is completely different from subject three.

At this moment, after putting on the hat, Tang Lou raised both ends of the collar behind the mask, shook off the whole clothes, stretched his arms into the sleeves, raised the belt, crossed his hands on the opposite side, and signaled another invigilator to come and tie the knot.

However, director Huang had sharp eyesight and quick hands, and rushed ahead of the invigilator to tie the knot for Tang Lou.

Another invigilator recorded on the side: "Routine disinfection steps are performed correctly, +2 points, hats, masks, and surgical gowns are worn correctly, +3 points."

After finishing, Tang Lou began to put on the sterile gloves, opened the surgical bag, took out the gloves, and pinched the folded part of the gloves with his left hand.Insert the 5 fingers of the right hand into the glove and put it on.

The invigilator looked at it seriously, and quickly wrote in the notebook: "+2 points."

Tanglou continued the operation he had done countless times. With his gloved right hand, he inserted four fingers except the thumb into the fold of the other glove. He put on the glove with his left hand and turned the fold to the cuff of the surgical gown with both hands.

After completing this step, the piercing will officially begin.

Tang Lou first laid a drapery on the medical simulator, and then used 2% lidocaine to anesthetize the bone marrow locally. Due to the long-term operation as the chief surgeon, he developed a strong aura, and directly issued an order: "2% lidocaine"

In this regard, Director Huang naturally cooperated very obediently, causing the idle invigilator to look resentful, dispensable, and had no experience of an invigilator.

After that, the puncture begins. Since it is a medical mannequin, candidates need to dictate.

Tang Lou explained the whole operation process very calmly:

"Fix the bone marrow puncture needle holder to an appropriate length (ilium puncture is about 1.5cm), fix the puncture site with the thumb and index finger of your left hand, hold the needle with your right hand and insert it vertically into the bone surface. When the needle tip touches the bone, Then rotate the puncture needle left and right around the long axis of the needle body, and slowly drill into the bone. When the resistance disappears and the puncture needle is fixed in the bone, it means that it has entered the medullary cavity. If the puncture needle is not fixed, drill in again. A little until it can be fixed."

After listening to Tang Lou's discussion, the invigilator didn't know why, but felt like he was listening to a superior doctor in the operating room, and recorded with one hand: "The answer is detailed and the content is completely correct, +2 points."

Director Huang also nodded aside, agreeing with Tang Lou's statement very much. This kind of answer is definitely not something that ordinary doctors can answer by rote memorization.

Tang Lou continued his operation dictation: "Pull out the needle core, put it in a sterile tray; connect it with a dry 10ml or 20ml syringe, and suck it with an appropriate force (if the needle is indeed in the bone marrow cavity, the patient will feel a little bit of pain when sucking). A slight soreness), and then a small amount of red bone marrow fluid entered the syringe. The amount of bone marrow aspiration should be 0.1~0.2ml."

After hearing Tanglou's analysis, Director Huang understood that only those who have experienced surgery can notice how important the control of suction power is.

Instead, like some young doctors, they just memorized an answer and didn't pay attention to the suction force at all.

It’s like someone who has just had a girlfriend and been married for several years. The jerky single rhythm is naturally not as fast as it is slow, and the straightness is not as good as the gracefulness of left and right.
"Very detailed, amazing."

Director Huang sighed in admiration, Director Tang's basic skills are really solid.

The invigilator on the side also silently wrote: "The answer is completely correct. +1 point"

"Afterwards, the extracted bone marrow fluid was dropped on a glass slide, and several quick smears were prepared for morphological and cytochemical staining examination."

Hearing the detailed steps of Tang Lou, Director Huang secretly gave a thumbs up. Many candidates would miss this step.

However, Tang Lou's answer was not over yet, he continued: "If the bone marrow fluid cannot be drawn out, it may be that the needle cavity or subcutaneous tissue block is blocked or the pumping is dry. At this time, the needle core should be reinserted, slightly rotated or re-inserted. Drill in a little or withdraw a little, pull out the needle core, if you see blood stains on the needle core, suck again."

Hearing this, the invigilator at the side was also a little surprised. What Tang Lou said was of course correct, and the analysis was very comprehensive. However, these analyzes have gone beyond the scope of standard answers.

"As expected of Director Tang, other people got 90 points because they can only get 90 points, but Director Tang got 100 points because the test paper only has 100 points."

After completing this operation, Tang Lou began to finish: "After the suction is completed, reinsert the needle core; local disinfection, take sterile gauze with the left hand and place it on the needle hole, pull out the puncture needle together with the needle core with the right hand, and immediately Cover the pinhole with gauze, press it for 1-2 minutes, and then fix the gauze with adhesive tape.”

The invigilator was numb to Tanglou's comprehensiveness and rigor, and recorded again: "The answer is completely correct, +2 points."

Tang Lou Chaogang completed the basic operations in the skill test.

Tang Lou also passed the next ECG and imaging studies with full marks.

Respectfully sent off by the three examiners, Tang Lou walked out of the examination room.

The theory test on the second day was easier, and Tang Lou finished it very quickly.

A few days later, before Tang Lou entered the office, he saw Director Qian Gang coming out: "Director Tang, congratulations on passing the examination for your medical practitioner certificate!"

"Congratulations, congratulations, Director Tang."

The rest of the doctors also congratulated, and at the same time, another colleague put a sign with Tang Lou's name on the wall.

"Director Tang, from now on you will be able to truly be on your own!"

Director Qian Gang looked at Tanglou with great satisfaction. Having a medical practitioner certificate meant that he could actually operate in his own name and even start flying knives.

(End of this chapter)