Practicing Medical Skills in a Small Clinic

Chapter 309 - 170: Mastering Another Technique, But Good Deeds Can’t Be Done?

"When performing the procedure, it’s most convenient with more than two people. One person can stabilize the patient’s fracture site to keep it steady, then apply the splint. If the patient is quite young or not very cooperative, you can’t use this method, you have to drill directly for invasive external fixation."

Doctor Xu’s words scared the patient into being as obedient as a kindergarten child.

After all, no one wants the doctor to drill holes in their leg.

After finishing with this patient, carry the patient carefully to the flat bed.

Transfer to the inpatient ward for care.

"Remember this, for patients with severe fractures, even if the manual reduction is successful, you must find a way to prevent aseptic inflammation. If it gets serious, it could directly lead to bone necrosis and joint degeneration."

"Got it!"

Li Jingsheng and Dr. Chen nodded in understanding.

Aseptic inflammation often occurs in bones and joints and poses significant harm.

"The sturdy young man outside should be ready for local anesthesia. Old Yu, since you’re here, why not help give him a brachial plexus block before you go! His muscles are sturdier than a gorilla’s, and only an experienced anesthesiologist like you can accurately manage the dosage and injection depth."

Doctor Xu looked at Old Yu, who was packing up his toolbox ready to leave.

"You and your requests! Alright, who said we’re friends!"

Old Yu agreed cheerfully.

"Also, I’m an anesthesiologist, not an anesthetist, not an anesthetist!"

This remark made everyone laugh.

Anesthesiologists hate being called anesthetists because it makes them sound like technicians.

They’re actually bona fide doctors, well-versed in emergency and critical care medicine, anesthesia, and to a certain extent, multidisciplinary medical knowledge.

Saving lives with anesthesia is a well-earned reputation.

In the early days, many critical care units were formed by excellent anesthesiologists who led a team of outstanding medical staff from various departments.

Especially the contributions from the departments of pulmonary medicine and cardiothoracic medicine have been substantial.

To this day, critical care units still focus on respiration and heartbeat as the primary indicators for patient rescue.

The establishment of the two major circulatory systems is primarily based on these two indicators.

Old Yu left with his toolbox.

"Xiaoli, you perform the operation; I’ll guide you from the side."

Doctor Xu really was ’caring’ for his apprentice.

Having just handed over a high-difficulty case to his apprentice to solve, now comes a more challenging one.

"Teacher, you saw that person’s fist too, it’s bigger than a bowl. I’m afraid I won’t fix it well, and he’ll punch me in the face."

Li Jingsheng said with a bitter face.

The previous patient was very well-mannered and even-tempered. Li Jingsheng treated him for a long time, and he didn’t say a bad word.

But the big guy outside doesn’t seem like someone to mess with.

The risk of being beaten up increases exponentially.

"As long as you follow my instructions, you’ll be fine. First, recall the fold-top rotation method thoroughly!"

The fold-top rotation technique and skills had already been taught to Li Jingsheng.

But practice and theory are completely different things.

Li Jingsheng tried hard to recall the operating points of the fold-top rotation method.

"At the operation, place both thumbs against the protruding end of the fracture, overlap the other four fingers around the sunken end, and with traction, press down forcefully with the thumbs on the protrusion to increase the angular deformity of the fracture. Rely on the thumbs’ feel to predict when the bone cortices are aligned at the fracture ends, then suddenly reverse the fold..."

With Minor Achievement-level in Bone Touching Skill, the following key steps weren’t very difficult.

At least he’s fully confident in sensing changes in the patient’s bone position.

The rotation method has similarities with the rotational flexion and extension method, but the actual operation differs.

Outside, Doctor Xu was already chatting with the patient.

"Young man, your muscles are very well-developed. It takes significant strength to manually reset your fracture. This can only be handled by our young doctor. The young doctor might have less experience, so you’ll need to be more accommodating during the procedure. If manual reduction doesn’t work, you’ll have to consider surgical reduction."

The burly man replied without hesitation, "No problem, go ahead and treat me. If you can’t set it right, I won’t blame you, don’t worry!"

Since the patient agreed, there was nothing more to say.

Old Yu personally administered the local anesthetic block, and then Li Jingsheng performed the reduction.

This man’s arm was really thick.

Luckily, the local anesthetic provided a good muscle relaxation effect, which was necessary for manual reduction.

Earlier, Old Yu had prepared the local anesthetic mixture, and Li Jingsheng hadn’t seen it.

He felt it was definitely not just lidocaine.

He memorized all the injection points for the brachial plexus nerve block given to the patient.

"Xiaoli, recheck the patient."

Doctor Xu instructed Li Jingsheng to touch the patient’s bones again.

"It seems like soft tissue is caught in the fracture site."

With the muscles effectively relaxed, Li Jingsheng found bone-touching much smoother this time.

Not only could he clearly feel the bone structure and position, but he also had a better understanding of the surrounding soft tissue conditions.

"First, use the rotation method to completely free the soft tissue trapped inside. Judge the dislocation path of the fracture end first."

After Li Jingsheng nodded in confirmation, Doctor Xu continued, "During rotation, apply force in the opposite direction of the fracture dislocation, and you can boldly increase the traction force."

Li Jingsheng followed the instructions.

"Yes, just like that, rotate in the reverse direction of the original dislocation to align the fracture ends. Listen carefully for the sound of bone scraping at the ends until you’re sure the soft tissue has been completely freed."