Chapter 10, Great Harvest

Fang Xian continued to push slowly

Looking at the simulated skin of this suturing operation device, the outermost layer has not been sutured, yet the surface of the skin is aligned neatly. As long as the apposed surfaces of the skin are secured without loosening, it will definitely meet the standards for healing

In terms of medication, anti-infection, protein powder supplementation, sugar water

However, this is not permitted in a teaching hospital like Xiangnan University Affiliated Hospital, and such a choice is also not favored

Fang Xian said good!

So—

Generally speaking, the knowledge system of a subspecialty, Level 1 signifies that you have an understanding of this knowledge, knowing many things that colleagues from other subspecialties are unaware of, which determines your profession. Therefore, it is called the foundational theory of the specialty, serving as the first line of defense of the professional barrier

High fever, headache, transient positive fecal occult blood test, is it due to stress-induced gastrointestinal ulcer? Or is it that there was already a gastrointestinal ulcer with no symptoms, which worsened under the stress of trauma

CRP (C-reactive protein), ESR (erythrocyte sedimentation rate), and other inflammatory markers such as interleukins are also elevated. Infection is certainly present, what is the current body temperature?

There are no useless skills or knowledge; it merely depends on how you apply that knowledge. This is a matter of application, which is not directly related to the original knowledge or theory

Positive occult blood? One plus sign, but it was not present upon re-examination before the surgery. There has been no further examination after the surgery

The foundational theoretical knowledge of your specialty represents the cake shape of the knowledge system you have achieved, determining the weight of your knowledge

After consulting, Fang Xian believes that the opinion from the gastroenterology department is likely to be a combination treatment of antibiotics and proton pump inhibitors (PPIs). If the patient is currently receiving intravenous medication, it is estimated that only one PPI treatment will be sufficient

Re-examine the inflammatory indicators, it is essential to achieve this and do it well.

Fear not, for it stems from knowledge, cognition, and the confidence of thought

Let's get some protein powder later, it should be cheaper in the hospital than in the pharmacies outside Five-pointed star mark

Fang Xian possesses self-awareness, understanding that he is capable at present, and he has a sense of control.

The details of the conversation regarding the signature indicate that the infection may be difficult to control, the hospitalization period is prolonged, and the fracture may still be difficult to heal after surgery. The corresponding treatment plan is explained to the patient in detail, primarily addressing when surgery would be appropriate. After these thoughts flashed through Fang Xian's mind, he began to work.

There is no need to rush

Such strength is the foundation of others' trust and recognition in you

There are 53 skill points remaining

At most, it is merely a matter of identifying the problem and referring it for consultation; this is a decision that a senior physician must make when time is limited and there are numerous patients.

Suturing technique level 3, equivalent to specialization level, specialization level suturing technique, with no specific time limit or requirements for suturing methods. The practitioner must carefully clarify the various layers of subcutaneous tissue and achieve a horizontal suturing level, with no need to suture the outer skin. ... The wound can heal by using a zipper-like skin closure, allowing for patient recovery ...

Fang Xian thought that if he could perform suturing better, perhaps the senior physician would give him more opportunities to suture

The three levels of the subspecialty knowledge system represent specialization

The Level 2 of the subspecialty knowledge system signifies that you have a sufficiently in-depth understanding of trauma surgery, enabling you to proficiently diagnose common diseases and be familiar with the diagnostic protocols. This goes beyond mere understanding; it reflects a skilled mastery of diagnostic techniques

Specialization is not a joke, nor is it merely flattery; it signifies that you have deeply understood the common diseases in orthopedic surgery through hetushu.com, gradually forming your own system. Your understanding of diseases begins to develop your own ideas, and you gradually start to establish your own diagnostic and treatment thinking

The incision I previously sutured, although standard and proper, merely clarified the layers, far inferior to what it is now

In the skills training room, there was only Fang Xian, so he was not afraid of others hearing him express his joy, as they had no idea what he was excited about.

No accompanying diseases such as hypertension or diabetes

According to incomplete statistics, currently in the surgical field, no more than sixty percent have truly elevated the foundational theories of subspecialties to level 3, with nearly half of the individuals only pursuing the level of skill operation while neglecting the theoretical foundation

You advocate for guiding the diagnosis of patients with gastrointestinal ulcers, establishing the diagnosis of gastrointestinal ulcers in relation to Helicobacter pylori infection, and have requested consultation support, leading to appropriate management of the patient. You have assessed the damage caused by gastrointestinal ulcers (Stage A1) to be a total of 51 points (damage accounting for 55%), earning 51 skill points

Then continued to delve into the skills training room

If one wants to reach level 4, it is uncertain how long one will have to wait, but this is also an alternative. One must take the initiative and cannot passively wait to be fed

However, achieving this well is not sufficient at level 3; it may require level 4 to be effective. Only then can one seize opportunities and gain favor over other master's degree peers with a doctor's degree.

Therefore, the level of proficiency in suturing among these professors, including Professor Lin and Associate Professor Song Yu, is estimated to be at a level 3 specialization, sufficient for practical use only

Fang Xian decided to first improve his suturing skills

The diagnosis needs to be more comprehensive and detailed, requiring the continuous extraction of certain detailed factors to be included within the scope of the diagnosis

Entry-level understanding leads to proficiency, which allows for flexible application. Familiarity with various techniques signifies that you can navigate with ease, develop your own interpretations, and establish your own thought processes and focal points

This is specialization

There is nothing else, just to review this case report

Then her blood test results were translated.

What on earth, why is this albumin so low? 32?

However, Fang Xian mentioned this detail to Dr. Xue Li, the attending physician who was on duty for the rounds on Sunday. Xue Li simply stated that they would wait for the consultation opinion. Fang Xian and the orthopedic department need to focus on whether there are any contraindications for surgery and the sensitivity of the infectious bacteria to antibiotics

After adding some points, when Fang Xian was once again practicing suturing in the skills training room, he finally understood why the senior physicians were willing to give more suturing opportunities to those with a doctor's degree or master's degree.

This is a question that requires consideration

32, has reached the indications for oral protein supplementation, but has not yet met the criteria for intravenous supplementation

The minimum requirements for the surgical authority of physicians and medical students at Shonan University Hospital are as follows: Trauma Surgery theoretical level 3, X-ray interpretation level 3, and for debridement, suturing, and incision procedures, all must reach level 3

Who says theory is useless? The foundational theory of trauma surgery, when it reaches level 3, becomes particularly useful

It was only under the stress of trauma that ulcerative bleeding occurred, with a positive result in a hidden blood test on one occasion

Review the other inspection materials again

Re-examine liver function tests

What surprised Fang Xian was that, just the next day, during his rounds on Sunday, he actually saw that the patient's HP test was positive, indicating that she had a Helicobacter pylori infection, which may have led to ulcer damage, but without any obvious symptoms.

Focus on the significant while disregarding the trivial

Suddenly, he flipped back to the previously overlooked examination data and ultimately discovered a point from the routine examination results at the beginning of his hospitalization at Huai City First Hospital, specifically from his first admission.

nice

Antimicrobial treatment must not be interrupted, and the four measurements of Tid must be adhered to! In cases where the patient is indifferent, the physician must be vigilant to the severe consequences that may arise if the infection subsequently affects the cranial or cardiac regions

If this is still of no use, then at least fifty percent of surgeons should quit their jobs

Pass

Having attained a specialization level in suturing is nearly equivalent to possessing the suturing skills of most surgeons. The majority of surgeons believe that achieving level 3 in this fundamental skill is sufficient, and there is no need to invest additional time in further mastery.

This is what theory brings to you

The admission medical orders should include inflammatory markers, liver and kidney function electrolytes, routine urinalysis and stool analysis, electrocardiogram, and chest X-ray. Additionally, a bacterial culture of the wound exudate and a routine microscopic examination should be sent. Let's also conduct an HP test, better safe than sorry

The medical community has long provided explanations; the level of medical foundational knowledge represents the breadth of your understanding of the overall medical field, while the theoretical foundation of surgery represents the depth of knowledge in the surgical domain

D dimer levels are high, and the color Doppler ultrasound indicates the formation of a thrombus. Anticoagulation must be implemented, and a follow-up deep vein color Doppler ultrasound is necessary. It is imperative to absolutely avoid the detachment of the thrombus, which could lead to unavoidable consequences. This is a fundamental requirement.

A routine stool examination is a necessary standard check upon admission; it is essential to follow up on the results. I will inquire about her dietary habits shortly

Trauma surgery falls under the category of surgery, and medication should be simplified, precise, appropriate in dosage, targeted, and attentive to numerous details. It can be succinctly summarized with the phrase 'to the point' which is the most exquisite expression

The white blood cell count has reached 20 +

Surgery emphasizes practicality and does not focus excessively on trivial details, as everyone is quite busy. If something is overlooked, so be it; more energy should be devoted to surgical procedures

That night, while Fang Xian was still practicing his suturing skills, a bright light suddenly flashed, jolting him to attention

Since they are all of the same level, then Professor Lin's suturing and that of his peers, or other doctoral degree senior colleagues, are not significantly different and are of little consequence

In terms of consultations, it is currently necessary to invite the vascular surgery and pharmacy departments for a consultation, and it is planned to invite the gastroenterology department for a consultation

Because increasing investment further is inefficient and does not possess a return on investment.

Of course, this is merely Fang Xian's own thoughts and has not been communicated externally

At the end of the day, Fang Xian's progress in suturing practice had not increased by even 1 point. Fang Xian estimated that it would take him three to four months to level up a skill, and that it required 25 skill points to reach level 2 for a skill, which means it would take three days to increase by 1 point.

Fang Xian recorded on one side, analyzing the case of a new patient, which was something he had not done as well or as skillfully before

OB + ''

This indicates that this is the pre-ulcer stage or the initial stage

When Fang Xian turned over.

And this is precisely what Fang Xian can seize

After finishing work, although there were no substantial gains, Fang Xian still felt a strong sense of accomplishment. After completing her admission-related examinations, Fang Xian immediately went to the skills training room to begin practicing suturing techniques

Fang Xian promptly requested a consultation with a gastroenterologist to see how the specialists would arrange and plan the case. On the consultation form, Fang Xian specifically emphasized the previous occurrence of a transient positive fecal occult blood test.