Those years when I hung up and upgraded in the hospital

Chapter 17: It’s hard to lead a top student (please read it)

Longxian Second People's Hospital does not have a shift room, only an office, so shift shifts and work are all gathered here.

Fang Yun had just finished his 24-hour shift and had been in the department. I got up around 07:30, brushed my teeth, washed my face, wiped my face with the dry towel I brought with me, and then put it in a plastic bag to be picked up after work.

But when Fang Yun walked from the lounge to the office, he found that Peng Qingsong's subordinates had not come. Instead, Dong Yunshan and Chen Shengwu, two "big brothers" who were more senior than him, were already sitting in the office, frowning, as if They don't look very happy.

When he saw Fang Yun, Chen Shengwu turned around and said, "Two new patients came to the department yesterday?"

Fang Yun nodded quickly: "Yes, Director Chen. One is the outpatient clinic you visited before, and the other is a patient with postoperative wound infection who was transferred back from Jishi People's Hospital."

"New patients are placed in bed 7, and infected patients are placed in bed 6 to avoid possible low-probability cross-infection." Fang Yun reported.

Chen Shengwu said: "There are not many patients in the department at present. The arrangement of hospital beds can be a little more casual. It is not impossible for one person to have one room."

"Have you checked the medical records of this patient with postoperative infection?" Chen Shengwu asked as he flipped the medical records up and down.

"After a brief look, I just gave my opinion. Youde made the changes himself. They have been learning." Fang Yun did not take any special credit, there was no need for it.

What he needs is more opportunities to operate, rather than excessive performance in front of Chen Shengwu. Fang Yun understands what is fundamental.

Although he is a superior, everyone comes from lower-level doctors.

"They are doing a good job. This 7-bed hospital is actually suffering from avascular necrosis of the femoral head. The patient is currently young. If the hip replacement is performed too early, he may have to undergo another revision or even multiple hip revision surgeries in his life."

"That's why I asked her to choose hip-preserving surgery. Do you know about the underlying diseases this patient has?" Chen Shengwu asked before starting the ward rounds.

Fang Yun nodded again. When the patient asked to be hospitalized yesterday, Fang Yun only read his outpatient medical record, but on the last page, it said hip osteoarthritis.

The diagnosis given by Fang Yun on her hospitalization certificate was also written based on this. At that time, there were still ward rounds, so he did not check her medical records in detail or conduct other inquiries.

However, after she was admitted to the hospital, when Fang Yun checked her past medical history and outpatient examination data again, she realized that the diagnosis of hip osteoarthritis was not accurate enough.

"The patient has a history of systemic lupus erythematosus and needs to continue taking oral hormone drugs to control the progression of lupus. It is avascular necrosis of the femoral head caused by hormone drugs." Fang Yun not only found the diagnosis, but also listed the causes.

It's just that when Fang Yun explained this, his tone was slightly hesitant.

"Yes, she is actually only in her 40s this year. Systemic lupus erythematosus is an autoimmune disease. If glucocorticoids are not treated, further progression of lupus will lead to damage to organ function and even life-threatening."

"Such a disease?"

"If you have something to say, just say it..." Chen Shengwu said when he saw that Fang Yun kept hesitating to speak while doing science popularization.

Fang Yun thought about it carefully and then said: "Director Chen, avascular necrosis of the femoral head is a secondary diagnosis and symptom. Its surgical factors mainly include pain, progressive osteonecrosis, severe damage to joint function and evaluation Comprehensive considerations include the area and degree of osteonecrosis.”

"The current clinical diagnosis and treatment indications for avascular necrosis of the femoral head mainly use the Arlet staging system. The patient currently belongs to stage II and only has mild joint pain and discomfort. X-ray shows mild necrosis of the femoral head."

"The patient's Harris hip score is currently acceptable."

"So actually, even for hip-preserving surgery, there are no corresponding indications yet." Fang Yun's expression flashed as he spoke——

To say these words is to take risks.Everyone knows what the current surgical situation is like.

Hip-preserving surgery is difficult, and there are few people in Long County who can perform it. That is to say, Chen Shengwu was able to bring such surgery to the Second People's Hospital of Long County, but now Fang Yun is holding the patient's lack of indication for surgery and wants to perform it. The operation was stopped.

This actually does not take the actual situation into consideration.

After all, this patient is young and will definitely continue to take oral glucocorticoids. Sooner or later, she will undergo one or even multiple surgeries. The earlier the surgical intervention, the longer the use time of her own joints will be.

Sure enough, when Fang Yun finished speaking, he saw that both Chen Shengwu and Dong Yunshan, who had always been frowning, looked at Fang Yun seriously and carefully.

Chen Shengwu's eyes were calm, but Dong Yunshan's eyes seemed to be filled with an intriguing flavor. He felt that Fang Yun was either careless or wanted to go against Chen Shengwu...

Now that Director Chen had just arrived, he finally brought an operation from the county hospital, but Fang Yun wanted to stop it.

However, in Chen Shengwu's field of vision, Fang Yun did not speak much, but his professional level was deep enough that he did not dare to deal with it carelessly to avoid being laughed at by his 'peers'.

Fang Yun's theory was better. After Chen Shengwu came to take office, he found that one of his colleagues in the department was missing, so he made inquiries.

Then he asked: "So now that this patient's symptoms are still there and getting worse, do we have to wait until her femoral head collapses and reaches the indication for surgery before undergoing surgery?"

Fang Yun was searching for his knowledge reserves and did not answer immediately.

Chen Shengwu straightened his raised legs and said, "You continue, don't be afraid. I don't like to talk in a single tone. I prefer an atmosphere of discussion. Even if you are wrong, you dare to question and communicate, which proves that you are thinking."

"It's better than people who have big brains and don't think about things." Chen Shengwu said this in a weird way.

Dong Yunshan next to him immediately lowered his head, his face slightly dark.

At this moment, Fang Yun finished organizing his speech and then said: "Director Chen, the main pathological principles of avascular necrosis of the femoral head caused by glucocorticoids are vasoconstriction and reduced blood supply caused by glucocorticoids——"

"The femoral head is a highly metabolically active tissue that requires adequate blood flow to supply oxygen and nutrients. When blood flow is reduced, the cells of the femoral head begin to be deprived of oxygen, which may lead to cell death and necrosis."

"Glucocorticoids can also cause inflammation and apoptosis - the infiltration and activation of non-infectious inflammatory cells. They cause damage to blood vessels and cells in the femoral head, and promote self-apoptosis, resulting in cell damage."

"Third point, glucocorticoids inhibit bone formation while promoting bone resorption, leading to osteoporosis. This will reduce the bone density of the femoral head and increase the risk of fracture and necrosis.

"The fourth point is that glucocorticoids can affect lipid metabolism, leading to fat deposition in bone tissue."

"So, whether it is before hip-preserving surgery or joint replacement reaches the surgical indications, conservative treatment can be carried out based on these four points to extend the patient's joint life before surgery."

"It is also possible that some patients do not need hip-preserving surgery before reaching the appropriate age for joint replacement..." Fang Yun said, putting down his hands and looking at Chen Shengwu calmly.

When Chen Shengwu heard this, he opened and closed his mouth twice, and his face turned a little dark.

It’s hard to lead a top student...

(End of this chapter)