In the morning.
Department Director Huo Congjun came to the Emergency Department and made a cup of strong tea. He poured away the first cup, sat down, and slowly drank the second cup of tea.
After that, he walked out of the operating room with his hands behind his back and started to patrol the observation room.
Behind Huo Congjun were three associate chief physicians and six attending physicians.
All of them formed a sharp arrowhead, like a lion on the grassland leading the lionesses on a hunt.
The resident doctors on duty waited quietly in front of the beds they were in charge of, like jackals on the grassland waiting for the debris left behind by the lion's teeth.
The interns were vultures that seemed to be free. They did not have a fixed position, and they were not valued by the patients. They could only wait quietly to clean up the residue left by the lions and jackals.
The territory of a department was not big. For example, in the observation room of the Emergency Department, there were usually only a few dozen beds. However, order was still maintained by the lions and jackals.
Other than Huo Congjun, there were two other chief physicians in the Emergency Department of Yun Hua Hospital. They did not need to follow him for ward rounds.
Although they were all chief physicians, Huo Congjun, as the department director, had administrative power and was the owner of the territory. The other two chief physicians only had senior titles. They were like wandering lions, and they needed to put in more effort to maintain their freedom.
Every day at seven o 'clock in the morning was the time for the hospital to show its order.
Ling Ran put on his white coat, put the 30 RMB Nephrite Buddha statue into his bag, and went to the resuscitation room to observe everything around him quietly.
He already had some hunting skills that could kill specific diseases, but in the territory, it was far from enough.
"Young Ling …" Huo Congjun suddenly called out and waved for Ling Ran to come over.
"This is your patient, right? Introduce him to me." Huo Congjun stood in front of the patient in Bed 12, glanced at the medical record, and handed it to Ling Ran, who walked over quickly.
According to the duty system, the patient should actually belong to the attending physician, Doctor Zhou. Even if everyone present knew about Ling Ran's "magnificent feat" of suturing more than fifty cases in a row the day before yesterday, they should first ask the attending physician.
However, the department director was the king of the territory. He could do whatever he wanted. Even if the department director wanted to remove the kidney of a seemingly healthy patient, the other doctors could only object verbally and could not stop him.
Of course, the patient and the patient's family could refuse the surgery, but in the hospital environment, the authority of the department director was still very high.
While Ling Ran recalled the patient's condition, he flipped open the medical record and said, "The patient is a female, nineteen years old, and has always been healthy. This time, she suffered a laceration in her elbow due to a fall from the stairs, and she underwent debridement and suturing …"
He spoke half-heartedly and completed his first inspection of the bed.
Before Yang Rui could catch his breath, Huo Congjun suddenly asked, "Why did you choose Line 0?"
The # 0 suture was much thinner than the # 4 suture that was commonly used in the emergency room. According to the United States Pharmacopoeia's standard, the fourth line was 2-0 with a diameter of 0.3 mm. According to the USP standard, the fourth line was 4-0 with a diameter of 0.15 mm, which was exactly half of the fourth line.
The diameter of the two lines was different by one time, and the cross-sectional area was four times different, similar to the difference between a pinky and a thumb.
Correspondingly, the tensile strength, which was the ability to resist stretching, was much weaker.
In other words, compared to the larger thread 2, 4, or even 7, the wound sutured with thread 0 was more likely to split open.
Ling Ran was stunned for a moment by the question. The girl on the hospital bed and her family members also looked at the young doctor in confusion.
"I think the # 0 suture can meet the needs of the suture." Ling Ran quickly gave an answer, but it was somewhat irrelevant. It was too simple.
It was the hospital's daily routine for interns, housemen, resident doctors, and other junior doctors to be asked questions during ward rounds and given a hard time, but usually, everyone would at least say a few more words.
Even if they were given a hard time, it was still very rare.
Huo Congjun shook his head and continued to ask, "Why didn't you choose the regular thread? What if the wound ruptures if you use the # 0 suture? "
"If it ruptures … should I suture it again?" Ling Ran secretly felt that this question was rather stupid, but he was not an unreasonable person. Even though he had done it before, he did not have to do it every single time.
Ling Ran gave a kind and caring smile, and he looked very handsome.
Huo Congjun could not keep up with Ling Ran's train of thought. He had been doing ward rounds every day for decades, and he had never seen such a clever young doctor.
The chief physicians, associate chief physicians, attending physicians, and resident doctors who accompanied Ling Ran for ward rounds also fell into a long silence.
The good Doctor Zhou secretly sighed, cleared his throat, and said, "At that time, I didn't think the wound was very serious. I reckoned that the # 0 suture would be effective, so I allowed Ling Ran to use it."
"Don't defend him, you are also at fault." Huo Congjun said in front of the patient's family, "Ling Ran's choice of the # 0 suture was thoughtless. You must point it out."
The patient's family members, who did not understand at first, suddenly became anxious. The mother, who stood by the bed, quickly asked, "Doctor, is there a problem with my daughter's arm?"
"There's no problem now, but she needs more careful care and avoid activities. We mainly consider the tensile strength of the suture. We are afraid that it is not strong enough, and if it ruptures, it will not heal easily. " Huo Congjun was amiable to the patient. He was not as serious as he was during meetings, and he did not change his attitude because of the patient's mild symptoms.
The patient's family members looked at each other, and they were obviously a little anxious.
Ling Ran then understood the main point of Huo Congjun's question, and immediately said, "The tensile strength of the # 0 suture is enough. Avoiding activities and careful care should be done, but I don't think we need to worry too much. "
Huo Congjun used the tone of educating a junior doctor and said, "You don't have to worry even more if you use the # 4 suture, right?"
"The patient is only nineteen years old. The area of the wound tear is relatively large, but it is not deep. If we use a thick suture, the scar will be too big, and it will affect the patient's life in the future."
The patient did not really understand what they said about the # 0 suture and the # 4 suture, but when Ling Ran mentioned the thickness of the suture, the few of them instantly understood.
The slightly plump girl on the hospital bed looked at Ling Ran. Her gaze was no longer one of doubt, but one of gratitude.
Huo Congjun, who was a military doctor, was not moved. He said, "You can consider the scar, but you have to understand that there are many reasons for scarring. It is related to the patient's physique and the condition of the wound. Choosing the # 0 suture from this point of view is not advisable."
The girl on the hospital bed became really nervous at this moment, and she quickly looked at Ling Ran.
"Aside from the suture, the tissues on both sides of the wound must be tightly aligned, and the skin must be flat." Ling Ran raised his eyelids and said, "This can be achieved."
Ling Ran paused for two seconds and said, "The distribution of the suture tension should be concentrated in the subcutaneous tissue and the deep layer of the dermis. There is no tension in the superficial layer of the dermis and the epidermis … This can also be achieved. I don't think the proliferation of scar tissue will be too much, and it is necessary to consider the thickness of the suture. "
When Ling Ran first spoke, Huo Congjun and the doctors behind him were a little contemptuous.
From their perspective, Ling Ran was obviously thinking about a small problem and forgot about the bigger problem. They had seen many young doctors who did not know what was important and what was not important in their career.
However, the two problems that Yang Rui mentioned later really shocked everyone.
It was not that the problem was complicated, but that he could take it into consideration, and it was really surprising.
"Is it time to change the dressing? Let's do it now. "Huo Congjun found an excuse and asked the nurse to remove the gauze on the patient's arm.
The group of doctors in the room bent down to observe the wound on the girl's arm.
Huo Congjun looked at it even more seriously.
After a long time, Huo Congjun raised his head and called the other resident doctors and medical interns over. He said, "Ling Ran, tell us about your thoughts when you suture."
Ling Ran never had stage fright. He had mastered the Master Level Simple Interrupted Suture Technique, and he said with even more ease, "Most debridement sutures are simple interrupted sutures, and this time is no exception. During the suture, the main thing is to pay attention to the angle and depth of the needle. You must make the knot bulge after the suture, so that it can act as a buffer before the scar forms."
Nearly ten resident doctors and more than ten medical interns surrounded a hospital bed. There was not enough space, so some people even stood on the chairs to see the patient inside.
The patient's family now understood that the doctor's operation was excellent, so they happily gave up the space.
Ling Ran's voice was not loud, but he said clearly, "The basic principle is to insert the needle lightly at the thick edge of the wound, and insert the needle deeply at the thin edge of the wound. Also, because the patient has skin defects, the knot can't be too tight, lest the blood circulation around the wound deteriorates, and the healing is delayed … After that, pay attention to removing the sutures, and it should minimize the appearance of scar tissue … "
"Well said." Huo Congjun took the lead in applauding.
There was a round of applause in the observation room.
"Everyone learned it, right?" Huo Congjun looked at the young doctor.
"I learned it."
"I learned it."
"Understood."
The resident doctors and medical interns quickly nodded.
"It's good that you learned it." Huo Congjun nodded slowly, and his voice became stern. "But no one is allowed to learn it!"
Everyone was stunned.
Huo Congjun said, "There are many ways to cover up scars. For example, you can wear long-sleeved clothes after the surgery, or you can use tattoos to cover up the scars. As a doctor, the first thing you need to consider is treatment."
"I don't want to wear long-sleeved clothes, and I don't want tattoos." The girl quickly shook her head.
Huo Congjun ignored her and said, "Ling Ran's considerations make sense, but only when you are skilled can you be bold. If your other skills are not up to par, don't think so much. Let's suture the wound first, understand?"
"Understood." This time, the morale of the young doctors was not as high.
No one wanted to admit that they were weaker than others, let alone weaker than a medical intern.
Huo Congjun's temper from the army flared up, and he raised his voice. "I didn't hear you clearly. Didn't you eat?"
"Understood." The young doctors raised their voices, and their answers were uneven.
After all, the hospital was not the army, so Huo Congjun did not force them. He turned and said to Ling Ran, "You pass this time. Change the patient's dressing. "
"Yes," Ling Ran quickly answered after Doctor Zhou gave him a nudge.
"Will I have a scar?" The girl saw that the patrol team was about to leave, and she quickly asked.
"The scar will be lighter. It's impossible to leave no scar at all." Huo Congjun walked a few meters away, and he deliberately turned around to answer.
"Oh," the girl said sensibly. She then smiled sweetly at Ling Ran. "Thank you, Doctor Ling."
"You're welcome." Ling Ran nodded slightly. He was about to change the dressing when a white treasure chest flashed in front of him.
[New Achievement: Patient's Sincere Gratitude]
[Achievement Description: A patient's sincere gratitude is the greatest reward for a doctor.]
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