top student at medical school

Chapter 5: The Correct Way to Read (Please add to your favorites and read on!)

Fang Ziye was in charge of beds 7-9, while his junior colleague was in charge of beds 10-11.
Bed 11 was the last bed whose doctor's orders he revised.

After Qin Geluo finished giving his instructions, Fang Ziye immediately and skillfully wrote out the corresponding medical orders and created a consultation request form for the pharmacy department in the medical record system.

Quickly jot down notes in your notebook, writing out detailed medical records and marking them with stars.

Fang Ziye then said, "Brother Luo, I'll go see the patient first, and I'll send you photos of the wound on WeChat later."

"This patient in bed 11 had his dressing changed yesterday, and I haven't checked his wound this morning."

For elective surgical procedures, dressings are changed every 2-3 days, so there's no need to constantly check the wound.

Qin Geluo had complete confidence in Fang Ziye's ward management skills. He nodded and replied with a smile, "Hey, Brother Qing, this is Qin Geluo, from trauma surgery. I'll have to trouble you to come and take a look again."

"I have a post-operative patient here..."

There are three forms of consultation requests. Two of them are simple procedural forms, namely, urgent consultation or regular consultation, where you just need to send out the request form.

But there is a third form, which is telephone consultation, where you ask a doctor you know or have a good relationship with to come and take a look. It's not an emergency consultation, but it's better than an emergency consultation and can solve the problem the fastest. This is when you need to rely on your personal connections.

……

Five minutes later, Fang Ziye put on a disposable cap and mask, took two culture tubes, two examination gloves and a dressing kit in his pocket, and went to find Lan Tianluo.

Lan Tianluo had just finished changing the dressing and was planning to go back to return the dressing cart.

Turning back to see Fang Ziye leave, Lan Tianluo was taken aback: "Brother Ye, is there any more dressing to change?"

Fang Ziye, a professional master's student in his third year, is only in charge of three beds. It's impossible that there are other beds that need dressing changes that he doesn't know about.

"Bed 11, the patient under Jie Han's care, is not doing well. Let's go check on the wound; we suspect there's some seepage." Fang Ziye grabbed the dressing cart and turned around.

11. Bedside.

The patient and their family were very enthusiastic: "Dr. Fang, are you here to change my dressing today?"

Jie Han had previously explained to the patient and his family that Fang Ziye was his senior colleague and a veteran in the department, while he had only recently started clinical practice.

It's only August 10th, and Jie Han has only been in the department for a short time. Fang Ziye guided Jie Han through the consultation and physical examination for patient 11, so the patient and his family naturally had more trust in Fang Ziye.

"Dr. Jie has other things to do, I'm here to change your dressing." Fang Ziye handed his phone to Lan Tianluo to take a picture while using professional orthopedic bandage scissors to cut off the bandage on the patient's leg.

Sure enough, a pale yellow mixed with light red exudate was seen on the gauze under the sterile dry cotton pad.

Fang Ziye frowned instantly.

The patient was immediately alarmed after reading it: "Why is there still bleeding, Dr. Fang?"

"Have you been doing any strenuous activity in the last two days? Has your wound gotten wet?" Fang Ziye asked as he removed the gauze, while gesturing for Lan Tianluo to take photos from various angles.

When the gauze was lifted, it was indeed seen that the incision on the anteromedial side of the tibia was slightly necrotic!

The rotting wound, along with a thin layer of pus, clearly indicates that the infection came on very suddenly and severely!

Fang Ziye quickly and carefully wiped away the purulent coating with two cotton swabs, then placed them into two culture tubes and handed them to Lan Tianluo, who had just finished taking pictures, and tightened the caps.

"How could this be? I didn't do anything!"

"No, right?" The patient looked at her husband to gain Fang Ziye's trust. "No, it's okay. It's probably just a postoperative infection. Postoperative infections are common in surgery. Don't worry. We're already handling it." Fang Ziye reassured the patient and her family.

Only after the specimen was collected was the patient allowed to lift their feet off the bed so that the disinfection process could begin.

First, rinse with saline solution, then apply hydrogen peroxide, iodine chelate, and then rinse again with saline solution. Only then can you use clean cotton balls that are not contaminated with iodine chelate to wipe the surface of the wound.

As you can see, the cut edge is slightly swollen...

A small amount of pus was still seeping from the sutured opening.

Fang Ziye picked up the hemostat and carefully inserted it into the inner layer of the suture. Since the incision showed no signs of healing due to infection, inserting it at this moment would not break the local tissue or cause pain.

After extending inwards by about four millimeters, Fang Ziye reached the bottom, which should be a localized subcutaneous infection, and did not continue to penetrate further.

After cleaning away all the pus and white discharge, Fang Ziye began disinfection.

Infected wounds require retrograde disinfection, starting from the outside and working inwards. These procedures are handled exceptionally well by the professionals!

After applying gauze and sterile cotton pads, Fang Ziye asked again, "Your wound shows signs of infection. For now, we'll send it for a culture test and see if it can be controlled with medication. If not, we may need to perform debridement."

"How could someone get infected out of nowhere?"

"Bacteria and microorganisms are everywhere in the air. Our hospital's disinfection procedures are very standardized, and dressing changes are strictly carried out according to procedures. If there is still an infection, it may be due to other reasons, such as physical condition or other factors."

“But don’t worry, we will definitely solve the problem, and right now we need to solve the problem first, and then find the cause…” Fang Ziye explained.

Then, pushing the cart, they left...

Naturally, the pharmacy consultation arrived quickly, and a consultation form was written, recommending that the antibiotic level be upgraded from cefuroxime to piperacillin-sulbactam sodium. Fang Ziye followed the advice and modified the prescription, then sent a message to Jie Han, asking him to accompany his aunt to the outpatient appointment before returning...

Furthermore, Fang Ziye also mentioned this matter to his teacher, Yuan Weihong, so that Yuan Weihong would be aware of it. It wasn't a complaint; Yuan Weihong would eventually find out about the patient during rounds the next day.

Informing the teacher in advance will allow Yuan Weihong to properly inquire with Jie Han and find out the reason.

After all that was done, Fang Ziye was finally able to leave his work in the department and head to the training room.

"Knowledge Points +2!"

As Fang Ziye walked toward Lan Tianluo, he suddenly saw the panel flicker.

Fang Ziye was startled: "How can it be so tall??"

Fang Ziye carefully considered what he had done that morning, and it seemed there was nothing special. He had only suggested to his superior, Qin Geluo, that bed number 11 had an infection.

Does this mean that the knowledge gained from the diagnosis is greater than that gained from the treatment?

Or to put it more cautiously, is it that critical diagnosis is more important than non-critical treatment?

Is this the correct way to do it?

Giving away two knowledge points at once is simply too outrageous!
One hour of hands-on training yields 0.1 points; twenty hours of intensive training are needed to achieve 2 points.

Lan Tianluo was walking towards Fang Ziye, inviting him to go to the training room together.

Jin Hongzhou, the chief resident of Professor Dong's group, called out to Fang Ziye first: "Ziye, are you on the emergency shift today?"

(End of this chapter)