top student at medical school

Chapter 295 Raw Can Be Cooked (Please Subscribe)
Today, Fang Ziye finally realized what Yuan Weihong had once told him—

Most hospitals take into full account the travel time from the operating room to the emergency room for emergency consultations when setting the location of the operating room.

Zhongnan Hospital is no exception.

Such an opportunity to confirm something was something Fang Ziye had only dared to dream about occasionally in his dreams, and he never dared to imagine it becoming a reality.

The current method of prophecy no longer needs to be proven to be true or false; it only needs to be verified that the master's boastful claims do have some merit.

Fang Ziye was no stranger to the emergency department.

During his professional master's studies, Fang Ziye also needed to be included in the orthopedic residency rotation program. One month of the 33-month orthopedic rotation program included a rotation in the emergency department.

At that time, although Fang Ziye was only assigned to the emergency surgery ward, it made him realize that the emergency department of Zhongnan Hospital was actually quite well-equipped.

In the emergency department, there are not only specialized emergency internal medicine and surgery departments, but also specialized emergency clinics such as emergency cardiothoracic surgery, emergency neurosurgery, emergency neurology, emergency cardiology, and emergency respiratory medicine!

In other words, if a multidisciplinary injury occurs in the emergency department, an urgent consultation needs to be requested from departments other than those mentioned above.

Many of the diseases treated in these departments are more likely to be fatal.

These emergency departments are all outpatient and emergency clinics, not inpatient facilities such as internal medicine and surgery wards, observation wards, emergency resuscitation rooms, and EICUs.

When Fang Ziye arrived at the emergency room, the emergency room doctors had already established an intravenous line for the patient and implemented various initial resuscitation measures.

Furthermore, even the patient's emergency room medical record had been "spoofed" countless times by others, becoming nothing more than scraps—

"Teacher, which patient here requests an urgent consultation?" There were only two patients in the emergency room, and one of them had a very obvious open injury to his lower limbs. However, Fang Ziye still asked one more question to make sure that he was not making a guess about the identity of the patient.

Asking a question won't kill you.

"Yes, it's the one on the left. His blood pressure is currently unstable, and his pulse is rapid and weak. We have already consulted with multiple specialists and conducted examinations."

"Finally, intracranial and thoracic/abdominal hemorrhage diagnoses have been ruled out! Look." The speaker was balding, slightly overweight, of medium height, and the remaining part of his 'beautiful hair' was matted, as if he hadn't been able to tidy it up in a long time.

"They've already consulted all these departments before asking us, the orthopedics specialist, for a consultation?"

"Have you ever done CTA?" Fang Ziye asked, his brow furrowing slightly.

As the fat man slowly approached, Fang Ziye could clearly smell a stench of sweat and grease on his body.

“We’ve already done it, but we couldn’t rule out damage to hollow organs beforehand.”

"Moreover, the patient's open injury had actually been temporarily treated before, so we did not call for an emergency orthopedic consultation at the very first moment."

"In addition, we were also on a rescue mission before." The fat man looked slovenly, but when he answered the questions, he was methodical and logical, leaving no loopholes for Fang Ziye to exploit.

They were even very cautious, as if afraid that every question Fang Ziye asked would be formulaic, behaving quite formally.

"But after ruling out injuries from other departments, there's still an active lower limb hematoma! Brother, you'd better get over there and start the show." The fat man patted Fang Ziye on the shoulder, appearing slightly closer to him.

Fang Ziye was a little afraid that the other person was a glass person who was difficult to understand, so he stepped back a little and carefully looked at the other person's name tag before saying, "Brother Zhi, do you need surgery? Let me see the opinions of other subspecialties first."

"If they have already processed the specialist consultation opinions, then I will immediately arrange for someone from the department to come over for a talk and to sign the consent form."

Are the patient's family members here?

Deng Zhi is the name of a Mediterranean fat man.

His name wasn't special, but Fang Ziye noticed that he had another identity: the chief resident of the emergency department, at least that's what his name tag indicated.

In this way, Fang Ziye understood the other party's gesture of goodwill.

The two major victims who made their joint exit were none other than the two heads of the trauma surgery and emergency departments, right?

"Just outside."

"Brother, are you very familiar with Professor Xie?" Deng Zhi glanced at the patient's current vital signs and saw that the fluctuations were not very large, so he started eating melon.

By this time, Fang Ziye had already reviewed the consultation opinions from other departments. At least in the medical record, the consultation opinions from other departments stated that there was no indication for emergency surgery, but there was an indication for elective surgery, and the patient could be observed and treated for the time being.

There's a saying that means Fang Ziye no longer needs to worry about these subspecialty matters.

Because even if the sky were to fall, the people who wrote these words, along with their superiors and professors, would be too tall to be hit by anything.

Specialized treatment.

Professor Xie is Xie Jinyuan.

Although Xie Jinyuan had temporarily left the trauma surgery department for the emergency department, Fang Ziye dared not pretend not to know him.

Associate Professor Xie Jinyuan was promoted to associate professor and came to the emergency department to prepare for promotion to full professor. Who knows when he will go back to fight for him?

It is precisely in these uncertain situations that we need to be even more careful.

"It's alright, Teacher Xie has put in a lot of effort to teach me before."

"Brother Zhi, please thank Professor Xie for his concern." Fang Ziye casually chuckled.

His relationship with Associate Professor Xie Jinyuan wasn't particularly harmonious; they were merely acquaintances and had some contact.

However, neither Xie Jinyuan nor Fang Ziye had any private interactions, not even sharing a meal together.

Even so, Fang Ziye still needs to at least maintain a respectable appearance.

"No wonder."

"I knew it!"

"Professor Xie has been advising me recently, saying that I shouldn't generalize and condemn the entire department. Young people in trauma surgery are still trustworthy..." Deng Zhi then patted his chest.

"Deng Zhi, the biggest traitor in the emergency department."

"Fang Ziye, the chief resident assistant in trauma surgery." Fang Ziye also introduced himself, though in a relatively conservative manner.

However, Deng Zhi seemed to know a lot about Fang Ziye: "I know you're low-key and haven't graduated yet. This means you've already beaten out the wife and taken her place."

"Wouldn't this be considered a mistress taking over the position before the husband?"

Fang Ziye turned his head sharply, surprised to find that Deng Zhi was quite humorous!
……

What happened next was not surprising.

Emergency exploratory surgery is required to check for active bleeding in the lower extremities!

If bleeding is found during the examination, it should be treated immediately. After treatment, the patient should be transferred to the observation ward of the emergency department for anti-inflammatory treatment.

However, if no active bleeding is detected in the lower extremities, then the patient will need to undergo a second comprehensive consultation in the operating room.

After the orthopedic surgery was completed and everyone was safely out of the picture, those who had previously assessed their department as not having any absolute indication for emergency surgery quickly came forward to take the blame and make amends!

……

When Fang Ziye called Jie Han this time, the other party did not hesitate at all: "Senior brother, all my assignments have been changed. I can come to the operating room or other places at any time."

Jie Han made a solemn vow.

After hanging up the phone, Jie Han opened his memo and made a heavy note on it: "Starting to work in clinical practice."

Vigorously develop clinical skills—Previously, when Jin Hongzhou was the chief resident, most of the emergency procedures were assigned to the doctoral and master's students in Jin Hongzhou's group for practice.

This is because their group has an inherent advantage in terms of total hospital stay.

Now that the situation has changed, Jiehan naturally needs to change his plans as well.

Originally, Jie Han thought he was quite talented.

It's true, Jiehan really thinks so.

There are several reasons.

First of all, Jie Han ranked first in both the written and oral exams for orthopedics. He must have read quite a few books, right?

Secondly, Jie Han himself published SCI papers during his undergraduate studies, and shortly after entering master's program, he defected with his papers.

Third, Jie Han felt that he was doing quite well in the group and that he had good relationships with people in all aspects.

Barring any unforeseen circumstances, Jie Han considers himself a successful graduate student.

But even with his achievements, starting point, talent, and learning speed, he was driven to question his existence in just a year and a half.

Even Jie Han often doubted whether he was a complete idiot, that he shouldn't have gone into scientific research, that he should have honestly accepted that he didn't have the talent for scientific research, and that doing clinical work was his ultimate way out.

Now, Jie Han has finally come to his senses and no longer doubts whether he is a fool. Instead, he believes that he has no talent for scientific research and only has the talent for producing low-quality articles.

Jie Han had no choice.

Master, please don't speak of it. Master is not bad to begin with.

My current focus is on clinical practice, where I'm doing quite well.

His focus is now on scientific research, and he has already been awarded the title of Excellent Young Scientist, which explains everything.

Then there's my senior, Fang Ziye, BMJ. What else is there to explain?
Now let's talk about my junior brother.

Jie Han didn't want to mention his junior brother at all. "It was my junior brother who made me question my existence!" he thought.
Fang Ziye had no idea that Jie Han planned to "change careers," transforming his dream of becoming a scientific research leader into a plan to become a clinical leader.

The patient's vital signs were already unstable, so there was no need for unnecessary words or procedures.

The patient's family members had no chance to make a decision.

Surgery is necessary; otherwise, he will die.

There is no third option.

Not many people went up on stage; only Fang Ziye and Jie Han did.

The surgery required is not actually complicated; it's just an open injury to the lower limb, not even an open fracture!
"Senior brother," Jie Han called out to Fang Ziye.

Fang Ziye did not agree, but continued to operate diligently.

What Fang Ziye and Jie Han were supposed to do was to investigate and clean up the wound.

Of course, before this, Fang Ziye had already used his Level 4 physical examination to roughly know that the patient's active bleeding was not in the lower limbs, but in other hidden places.

However, Fang Ziye had no way to explain it.

People from other specialized fields have already given their opinions; they have no problems with their specialized fields.

However, open injuries in orthopedics are visible to the naked eye, have evidence, and are consistent with the patient's hemorrhagic shock.

Therefore, under such circumstances, if Fang Ziye wanted to have other departments conduct another consultation, he would need to obtain a certificate proving that he was not infected.

To prove the innocence of my subspecialty, to verify from a more objective perspective, the exploration was completed, and the surgery reached the innermost layer!

Then, the case is handed over to the anesthesiologist, who will conduct an emergency consultation and call in other specialists.

Because Fang Ziye didn't know which specialty was causing the problem at the moment, he hadn't even reviewed the CT and MRI scans from other subspecialties!

He only looked at the orthopedics section; there was no fracture.

Then, it was gone.

This comes from a piece of advice he received from his mentor, Yuan Weihong.

No matter how capable you are, at Zhongnan Hospital or a place similar to Zhongnan Hospital, never overstep your professional boundaries or make decisions outside your specialty.

Be cautious when considering cross-sub-specialty programs.

The reason is that other specialized schools are not without staff, not completely wiped out, so it's not your turn to take on this responsibility!

"Senior brother." Jie Han saw that Fang Ziye hadn't taught him such a simple detection technique, so it must be because he hadn't been proactive enough.

"Shh!" Fang Ziye had no time to listen to Jie Han's opinion.

He quickly exposed the open wound to the bone end, finally ruling out the presence of a hematoma.

After further examining the blood vessels at least 5 centimeters above and below the open wound and finding no further bleeding, Fang Ziye finally breathed a sigh of relief.

Then tell the anesthesiologist: "Anesthesiologist, there is no hematoma or vascular damage in the open wounds in our department."

"The patient's bleeding is probably still in another location. Call the emergency department again, or go directly to the operating room for an emergency consultation!"

"What?" The anesthesiologist was in his forties and wearing a floral headscarf.

Ben was lying down, flipping through a comic book, showing off his absolute control and anesthesia skills. But Fang Ziye's words immediately made his scalp tingle, and he read the contents of the comic book aloud.

"The patient's hemorrhagic shock has nothing to do with our trauma surgery department."

"There's no hematoma in the pelvis, nor is it a retroperitoneal hematoma, so we might need to look for other issues." Fang Ziye knew this was a bit of a misunderstanding.

The patient's emergency room medical record is still lying in the even colder medical record folder in the operating room.

The medical record states that many subspecialties do not have absolute indications for emergency surgery.

These words were originally their department's protective charm, but now they have taken on a different meaning!
Hemorrhagic shock, cause to be determined, vascular injury of the limbs has been ruled out.

Hematomas caused by vascular damage in the limbs are the most easily visible to the naked eye, and since Fang Ziye had already conducted an exploratory examination, there really couldn't be any further problems.

"Holy crap!" The associate professor in the anesthesiology department could no longer remain calm.

The first person he called was the head of his own department, and at the same time he yelled at the operating room door, "Circulating nurse, find your head nurse!~~~"

This could potentially lead to a medical dispute.

He remained completely unfazed.

At this moment, he hoped that Fang Ziye was a complete novice, a complete beginner, and that something had gone wrong.

It shouldn't be a particularly skilled surgeon who can confirm everything with a single diagnosis, but rather one whose previous diagnosis was flawed, requiring extensive multidisciplinary joint exploration during the operation.

What on earth is causing this patient's shock?

(End of this chapter)