Chapter 145: What Kind of Doctor Is This? (Third Update, Asking for Subscriptions)

Outside the operating room, patients and family members continued to arrive one after another, and there were still low, muffled complaints.

It was the patients who had queued up later asking, "How come it's taking so long?"

"It's fine, this is treating an illness, not buying vegetables to weigh and measure; you didn't see that big brother earlier, he was in there for over half an hour before he came out." Someone replied rather enthusiastically.

"There are only this many doctors, and only this one operating room, we can only queue up slowly; just think that you haven't been injured, count it as having a little better luck than others." There were also those who took it in stride and persuaded...

There are many people, can't squeeze; originally everyone either has a fracture or a dislocation, if you squeeze and bump into someone, that's asking for trouble.

Who here isn't a patient, whose body doesn't hurt?

Zhang Jinchuan's broad shoulders, sturdy build, gave off a very strong Orthopedic Doctor pressure; standing at the doorway after opening the door, he naturally made the few patients closest to him unconsciously shrink back a step.

Zhang Jinchuan's physique was very sturdy; saying his arms were as thick as some girls' thighs was absolutely no joke, and he didn't look bloated at all; his voice at this moment was also raised several octaves: "Everyone, thanks for your hard work queuing up, we have to be responsible for every patient, everyone come one by one, absolutely don't squeeze and fall down."

Then the patient brought in by Zhang Jinchuan, about forty years old, his arm hanging limp and powerless, was also a local; at the doorway he spoke in a local accent: "Quick quick quick, hand the films to the doctor, I'll go right in."

He wore leather shoes, dressed in a suit, with a shirt underneath.

But right now, he had let his own wife cut off the sleeve of his shirt; half a suit, the sleeve hanging behind him, he walked inside like a kasaya.

"Director, should I lie down or sit?" He looked first at the older Xue Tao, and also glanced at Fang Ziye beside him.

After all, at this time Xue Tao was still chatting with Fang Ziye, and there was a hint of respect in his words.

A man in middle age, if he doesn't even understand this most basic ability to read people and situations, then he's useless. The more unfamiliar the field, the more you must know how to assess the person before acting.

So leaning by the bedside, he also observed Fang Ziye wearing a mask.

Not tall, estimated close to 1.8 meters, the whole person looked very spirited; although he didn't look as bulky as Zhang Jinchuan, his muscles were also firm...

While he was observing Fang Ziye, Fang Ziye walked over to him and said: "Uncle, what's the situation here, how did you get injured?"

Situation urgent, history taking and film reading conducted simultaneously, then physical examination.

Otherwise, the normal consultation procedure is history taking first, then physical exam, then film reading. But when necessary, time is the first resource...

The middle-aged man froze for a moment, but also took the initiative to answer—

"My situation is just that after the car swerved, this hand tightly gripped something; when it tilted over, I was still gripping it; the doctor down there said luckily I gripped tight enough, so it's only a dislocation, otherwise it would be a fracture." The middle-aged man still joked with some self-mockery.

History taking and film reading both matched the historical characteristics of anterior dislocation...

But Fang Ziye still did not dare to skip the physical examination step; the busier the time, the more precise diagnosis is the primary task to speed things up.

When Fang Ziye went to perform the physical examination on the patient, Xue Tao and Zhang Jinchuan on the side read the films while carefully confirming the diagnosis, to completely rule out occult fractures.

Confirming joint dislocation, history, physical examination, auxiliary examination, not a single item can be missing.

Moreover, besides confirming the diagnosis, differential diagnosis must also be done; if it's a dislocation accompanied by a fracture, then there is no need for closed reduction, just do skeletal traction and let the patient lie in bed.

A dislocation with a fracture, what wool yarn are you reducing.

Basically able to confirm diagnosis after.

Xue Tao then said to the patient: "Your situation is anterior shoulder dislocation. Requires closed reduction; sign here for convenience, then we can perform closed reduction on you, and apply a plaster cast, and then..."

Situation urgent, Xue Tao didn't have time to waste more words with him; the normal consultation process requires detailed discussion, but there are too many people, want to do it then do it, don't want to then leave.

The general matters are just that many, the risks are just these, no matter how much you talk, it's just wasting time.

When necessary, some links will be omitted.

"Okay, why don't you get my wife to sign? This is my writing hand, can't move." The patient pointed at his right arm; although he felt signing was quite troublesome, but now at least there was a professional doctor handling him, it was like meeting a savior.

This time, he really suffered; from the scene to the Emergency Department, he waited a long time; in the Emergency Department he waited a long time again; then at the doorway of the Orthopedic Trauma Center, he waited a long time again.

He wanted to cry but had no tears; after all, earlier a few anxious brothers who thought they had connections, after pulling strings the hospital still wouldn't let them jump the queue, they made a scene and were taken away directly by the police; the middle-aged man became obedient.

Pulling strings, that's a situation that occasionally happens in the hospital during normal times.

But under a major emergency situation, who dares make trouble, that's directly making Enzhou's leaders unable to keep their positions...

"Come with me this way, we are not conducting the reduction inside this operating room." Fang Ziye, seeing the patient's wife had already signed at the doorway, his examining hands changed to supporting the patient's affected limb, and used his mouth to gesture toward the doorway direction.

Fang Ziye's words were a bit caught off guard; the patient didn't think at all and just nodded: "Okay. Thanks! ~"

Naturally, hearing Fang Ziye's words, Xue Tao on the side also froze completely; where does this Fang Ziye want to take the patient?

Suddenly, as the patient's upper body just turned.

He suddenly felt a violent force transmitted from his right arm; this force made him instinctively panic and let out an "Awoo! ~" sound.

Immediately after, his center of gravity became slightly unstable, leaning back a little.

"Click!" A sound almost sequentially connected before and after the awoo sound.

Two sounds rang out simultaneously; everyone in the room was stunned!

The middle-aged uncle seemed to feel a burst of severe pain from his right shoulder again, immediately letting out a painful cry.

But the duration of this severe pain absolutely did not exceed two seconds.

A sudden sense of emptiness, as if for a short time, his hand had detached from his own flesh body.

In medical specialty examination, this is called the apprehension sign, accompanied by pain.

The sudden pain made him instinctively lean his right side down; the brief pain instantly covered his forehead in cold sweat! Veins bulged!

But in the very next moment, all pain completely eased; the rebound force of the upper arm muscles made his pain sensation instantly numb; he didn't even register the disappearance of the pain.

His left hand aggrievedly and resentfully clutched his right arm, angrily glaring at Fang Ziye standing on his right-hand side, as if angry emotions wanted to erupt.

Only, although Fang Ziye isn't tall, he counts as strong; one look and his strength isn't small; he currently only has one hand.

Can't win.

Can only scold: "You!"

Cursing in his heart: You motherfucker have no martial virtue, wasn't it agreed we'd walk this way...

At the same time, both Xue Tao and Liang Xueya were stunned.

Didn't figure out what situation this is.

The burly Zhang Jinchuan slowly stiffly turned his head toward the big-nosed, thick-browed Xue Tao, face full of question marks. But discovered Xue Tao's eyebrows at this moment contracted like knives, tightly furrowed.

Xue Tao then looked at Fang Ziye—

Fang Ziye immediately let go of his two hands and explained to the patient: "The reduction is done, try moving this hand?"

"It hurts!"

"Can't move it, can't move it. I can't move a damn thing." The middle-aged uncle's tone was not good.

In his heart he was cursing up a storm while pondering the matter of whistleblowing.

"If it weren't for this hand of mine being injured right now, you think I wouldn't argue with you? Where do you find a doctor like you? I'd have to hit you once."

"It's fine, Uncle, you move it. Before it was dislocated, now it's been reduced. Your pain intensification and persistence just now was a fear sign during the reduction process. This is an academic term; after existing briefly it will immediately disappear, and the original pain will also immediately ease."

"Am I right or not?"

"The reason I had you go elsewhere was to divert your attention and speed up the reduction. If I told you I was going to trick you into an unexpected reduction, you'd beat me up." Fang Ziye spoke while laughing.

Then, seeing the middle-aged man's expression was half-believing half-doubting, he said: "Come, learn my movement, slowly support your right hand and lift it forward!"

Fang Ziye at this moment completely ignored too much.

Because Level 3 Manual Reduction Technique and Level 4 Manual Reduction Technique are completely different understandings and concepts.

There were not few patients outside, still lining up in a queue.

Saving time is necessary behavior; although after adding points to Manual Reduction Technique to Level 4, the time saved might be just one patient's worth, what if it saved two?

Any bit of time saved is a bit earned.

Fang Ziye at this moment had already entered the role —

Because this kind of simple anterior shoulder dislocation reduction is simply too simple.

Shoulder joint dislocation is an extremely common joint dislocation in clinical practice!

Anterior shoulder dislocation is again the most common among shoulder joint dislocations!

Fang Ziye, possessing Level 4 Proficiency Manual Reduction Technique, has at least four or five methods to deal with it, handling heavy tasks as if light.

In addition, Fang Ziye possesses Level 4 X-ray Reading Technique; for diagnosis there are basically no loopholes. If there are, then Fang Ziye has also already exerted his utmost effort.

Level 4 X-ray Reading Technique and Level 4 Manual Reduction Technique are the preparation under his maximum capability —

Although there may be waste of Knowledge Points, Fang Ziye still dares not forget the oath he once swore. Capability may be limited, but within the scope of capability, do his utmost!

Naturally, Level 4 Manual Reduction Technique let Fang Ziye benefit greatly —

Clinically, the most commonly used, most widespread method for shoulder joint dislocation reduction written in textbooks is the Foot-bracing Hand-pulling Method.

The academic name is Hippocratic reduction method; clinically it's often called Foot-bracing Hand-pulling Method.

This surgical reduction method is: the operator braces their foot in the patient's affected axilla, while performing longitudinal traction on the patient, alternately internally and externally rotating the humeral head.

This technique is very classic and simple; its reduction success rate is okay, but there exists relatively high brachial plexus nerve traction damage, and it's quite laborious, so it's not commonly used anymore.

Clinically there have long existed other reduction methods that are quite labor-saving, simple, and applicable: the External Rotation Reduction Method. This is the choice of treatment method.

The second promotion is the choice of timing.

Generally, after a patient develops joint dislocation, there will exist subconscious protection and vigilance. Equivalent to the sympathetic nerves becoming tense, therefore muscles involuntarily contract.

Under routine circumstances, if you want to perform reduction, you need to use the operator's force to counteract this part of the sympathetic excitation contraction force.

But there are exceptions: that is the unexpected.

Performing reduction when the patient hasn't yet realized you will give them reduction doesn't require too much force.

Labor-saving, and fast.

And, this kind of treatment behavior cannot be explained to the patient.

Explaining slowly to Xue Tao and the others would waste even more time, not as good as routine reduction.

And if doing routine reduction, you must resist the patient's stress-induced muscle contraction from pain and the patient's vigilant protective muscle contraction, requiring reliance on brute force or under added anesthesia or muscle relaxants, brute force traction, then reduction.

Based on clinical research, it can be found that the patient's autonomous vigilance-produced protective contraction force is even greater than the stress-induced contraction force produced by pain.

Therefore, choosing to perform reduction when the patient is unaware and completely unprepared is the optimal timing.

And just now the patient happened to be speaking with Xue Tao, while Fang Ziye here was 'feigning' giving him guidance on where to go, making the patient think ah, really going to change places.

Completely able to achieve the unexpected effect.

This is the grasp and fire candidate of a disease.

Of course, only Fang Ziye knows these things; the patient doesn't know, Xue Tao and the others still don't know.

The patient still looked at Fang Ziye with resentment, then glanced toward Xue Tao who looked older.

"Are you going to manage this or not?"

"Otherwise later I'll file a complaint against you too."

Xue Tao also looked at Fang Ziye half-believing half-doubting, not quite understanding Fang Ziye's behavior.

Because he always felt Fang Ziye's recklessness just now was slightly inconsistent with his temperament, with his style of conduct, but the specific reason he didn't know.

Fang Ziye still didn't explain to Xue Tao, but continued: "Uncle, say something. If the pain is more severe, then I'll apologize to you. If it's really as I said, then you put on a forearm sling and can go home to rest first."

"There are still patients waiting for consultation behind, right?"

"You not speaking, I also don't know if it's good or bad." Fang Ziye explained very calmly.

The middle-aged man instantly frowned.

Carefully sensing, if the pain during dislocation before was maybe egg-sized, just now that pain suddenly became basketball-sized, now it's only rice grain-sized.

All were said correctly by Fang Ziye!

Fang Ziye can deceive himself, even his own wife can deceive himself. But his own feeling definitely won't deceive himself.

So the patient half-believing half-doubting began moving his left hand!

Slowly lifted.

Eh, not bad.

Abduction, also okay.

Elevation, also lifted up.

Instantly, the patient's eyes brightened, and he looked toward Xue Tao and Fang Ziye, his tone immediately improving: "Director Xue, Doctor, my... my... is it?"

"Better?"

He had personally seen the previous few patients, from entering the Operating Room to leaving, exactly how much time it took.

This time he came in, until now staring at Fang Ziye for a long while, it was only two or three minutes, and this still included Fang Ziye's Physical Examination and film reading time.

But the others were basically all around ten minutes or so.

Upon hearing this, Fang Ziye replied: "Before, you had a Joint Dislocation; the main Symptom of Joint Dislocation is pain and Limited Mobility."

"Now you can also see, mobility has already recovered; if you yourself already feel the pain has also greatly eased, then the Joint Dislocation has already been Reduced. In a bit, go take a post-Reduction X-ray follow-up, and you'll get the result."

"The reason I just now took advantage of your unpreparedness was to lessen your guard, reduce the force of defensive Muscle Contraction, just like..."

This time Fang Ziye began to explain in detail; he wanted to convey his entire treatment process and Treatment Approach completely to the patient and Xue Tao.

One, to let the patient also participate in the entire Diagnosis and Treatment process, let them be able to understand — only this counts as grasping the Dimension and Fire Candidate accurately.

Otherwise, if it's only the doctor unilaterally having precise Confidence/Assurance over the Disease, but the patient himself doesn't quite understand, that means the Communication process wasn't done well.

Second, to Subtly Inform Xue Tao that I actually have Some Kung Fu in Closed Reduction; if you're willing, you can let me subsequently solve the patients outside relatively quickly, letting the Knowledge Points I Consume recover a bit.

Of course, if you Don't Believe, it doesn't matter either.

Order Must Be Obeyed; I won't Actively Request.

Speak Less, Do More, Promise Less, Ask Less.

Just Arrived First Day, Fang Ziye can't Actively Request too many Opportunities; that would look too foolish, but he can appropriately display his own Capability, letting Xue Tao choose himself.

Xue Tao Listening to Fang Ziye's words, first froze, then freezing and freezing became a bit foolish.

Fang Ziye is speaking for me to hear, right.

Just a damn Closed Reduction, made so mysterious, is it true or False? How does it sound a bit Unreliable?

"Zhang Jinchuan, you Bring the patient out to open a Postoperative Follow-up Medical Order, then put on a Forearm Sling. Me and Doctor Fang will handle the next patients." Xue Tao Hesitated a moment, then said.

In his heart were ten thousand Doubts, but it wasn't the Opportunity to Ask.

Patient present, solving the patient's pain problem is the First Task; any other matter, at this time, must be pushed back.

Confronting and questioning or asking in person, that's something only acted out in Television dramas.

The patient hearing this, hurriedly thanked Fang Ziye, his Gaze toward Fang Ziye shifting slightly.

"Next." Immediately after, Xue Tao actively went to call the Next Patient in.

However, this kind of routine, works the first time; repeating it, naturally is Impossible.

Moreover, this patient seemed to have also heard the previous Reduction sound, so he kept looking toward Fang Ziye very guardedly.

(Chapter End)