medical simulator

Next time, we must find a very professional disease to have a look.

Zhou Chengzhun was about to step up, Zhang Zhengquan immediately said, "Brother Zhou Cheng, I'll call."

Zhang Zhengquan knew in his heart that the purpose of his coming here today was to earn a living. There were many patients in the outpatient clinic, so he definitely didn't have time to do teaching rounds. Zhou Cheng was willing to say that he could learn something now.

The time of the outpatient clinic is crowded and crowded, and it is not easy to waste a minute.

A second patient came in soon after.

She is an elderly woman with obvious deformity of her right lower limb. She is short, obese, with a very dark complexion and half-white hair that has not been taken care of.

She limped in and was supported by a woman in her 30s, who said, "Mom, walk slowly, and be careful not to trip over your legs."

After entering, Zhou Chengcheng quickly noticed that her right lower limb was obviously turned inward, and her lower limbs were obviously unbalanced.

The left leg is much longer than the right leg. When walking, after the left foot touches the ground, the right side of the body swings.

When her right leg touched the ground, she frowned and gritted her teeth, as if every step she took was in excruciating pain!

"Woman, you sit down first. How many years has your leg been hurting?" Zhang Zhengquan immediately asked the patient to sit down.

The middle-aged woman next to her replied: "My mother has been in pain for more than ten years. It hurts when it rains, and it hurts when I walk, and now it hurts when I sleep. I saw it in the county hospital and took medicine for a while. Now it hurts too much."

"Have you ever taken any pictures in the county hospital?" Zhang Zhengquan asked, looking at the plastic bag twisted in her hand, on which was clearly written C County People's Hospital.

"Yes, but it's been several months. Do you want to see it? Do you want to take a new one?" The woman said while taking a lot of films inside: "When I went to the county hospital before, the doctor It’s useless to say that the previous films are useless.”

"So I took photos every time I rechecked, and I kept a lot of them here."

"The ones from ten years ago to now are still there."

Luo Yun was shocked when he heard the words, and quickly said: "Useful, these films are the most useful!"

Just kidding, these X-rays simply objectively record the progress and history of the patient's condition, how could it be useless?

Neither the patients nor their families can tell the medical history in such a detailed and objective way. This whole set of X-rays can be said to truly record the development and evolution of a disease.

There are a lot of films, and they are arranged neatly. They are all arranged in chronological order. In addition to X-rays, there are also CT and MRI, but both CT and MRI are for the lumbar spine!

It can be seen that either this old woman is a fastidious person, or the middle-aged woman next to her, who is not sure if it is her daughter-in-law or daughter-in-law, is very considerate.

Because there are many films, Zhou Cheng and the others each have a film to watch!

I picked up the most recent film to watch first, and the plain film that was pushed forward a few months may be different from the current illness due to the time gap, but the content in the film is only slightly different.

Zhou Cheng is holding the one from a year ago, while Luo Yun is holding the most recent one.Zhang Zhengquan held the one from nine months ago.

When Zhou Cheng read the films, he found very obvious knee osteoarthritis!

Knee varus deformity.

After Luo Yun flipped through several films one by one, his heart was moved again!

Good guy, this movie is interesting again, so he looked at Zhang Zhengquan and asked, "Zhengquan, did you see something?"

Zhang Zhengquan's face froze immediately when he heard the words, his eyes continued to open a little bit, and after looking more seriously, he turned around and said, "This is knee arthritis!"

Luo Yun rolled his eyes when he heard this.

Ah tui!

What the hell?

Are you ashamed to say such an extremely unprofessional diagnosis of arthritis?

There are many divisions of arthritis, osteoarthritis, septic arthritis, tuberculous arthritis, gouty arthritis...

However, considering that Zhang Zhengquan is not a joint surgeon, Luo Yun will not complain about him.

Before Luo Yun turned his head to look at Zhou Cheng, Zhou Cheng asked the middle-aged woman, "Has your mother had a broken bone before?"

Hearing this, Zhang Zhengquan immediately turned his head to look at Zhou Cheng.

Have a broken bone?

How did you get it?

Brother Zhou Cheng, are you a doctor or a fortune teller?

This is not a good nonsense!

Luo Yun's expression flickered upon hearing this.

In addition to the types of inflammation that can be divided into arthritis, the etiology can also be divided.

This patient indeed had classic osteoarthritis.

The two classic manifestations of osteoarthritis are the narrowing of the joint space and the wear and tear of the articular cartilage. This is written in the definition, and it is also the content that can be read very clearly by reading the film.

but?

The diagnosis of traumatic arthritis is an etiological diagnosis. Generally, this diagnosis can be obtained by asking the medical history to complete the diagnosis.

Because you don’t even ask, how do you know if it’s a trauma?

Traumatic arthritis...

Of course, the traumatic experience of traumatic arthritis will be permanently written on the person's body, and it requires quite advanced film reading skills to be able to see that the patient has fractured or been injured before.

This is a very professional reading skill.

Originally, Luo Yun was going to leave this X-ray to Zhou Cheng and Zhang Zhengquan for a lesson, but he didn't expect that it was just the beginning, and Zhou Cheng would tell the truth again!

Zhang Zhengquan hurriedly asked the middle-aged woman: "Has she ever had a broken bone before?"

"No? My mother-in-law has never been hospitalized or injured?"

The middle-aged woman hesitated for a moment, but she was very sure.

Then he turned his head and asked in local dialect: "Mom, have you ever had a broken bone before? The doctor is asking you."

Then he said with some embarrassment: "Doctor, this is my mother-in-law. After I got married, she has been in good health, but her leg is not very good, and she has never had any surgery."

The patient understood what his wife said, raised his head and said, "The bone is broken?"

"Bones were broken. It was so young, teenagers. I was still a girl."

"At that time, I was working in my hometown, and I fell down. Later, the doctor in the village took care of my fracture."

"Doctor, how do you know that my bone is broken?"

"I personally almost forgot about it."

"You guys are amazing." Luo Yun and the others could understand most of what the patient said.

The patient immediately held Zhang Zhengquan's hand, pinching Zhang Zhengquan so excitedly that it hurt a little.

When Zhang Zhengquan heard it, I rely on (‵o′)!

It was really broken!

"It's seen on the film. I'm a woman." Zhang Zhengquan could only reply like this.

But when he went back to read the film seriously, he was a fool!

The film did not write the word traumatic arthritis!

Is it traumatic arthritis if the joint is deformed?

What's the matter?

Luo Yun said: "You are her daughter-in-law, right?"

"Yeah!" The middle-aged woman nodded.

"Her current situation is very serious. She can no longer walk. You just saw that every step she takes is a torment."

"To be honest, I admire her for being able to walk in such a situation now. Your mother-in-law can bear the pain very well." Luo Yun sighed.

The middle-aged woman nodded and said: "My mother-in-law is a person who can endure hardships. My husband and I wanted to take her for surgery ten years ago, but at that time my mother-in-law was reluctant to part with the money and thought she could barely leave, and the doctor at the time Said she was not old enough, said several years of surgery."

"But when I took my mother-in-law to see a doctor recently, my mother-in-law still refused to do it, so I can only bring her here." The middle-aged woman said helplessly.

Hearing this, Luo Yun nodded and said, "Well, I might have been younger before. If I had had surgery then, I would definitely have to have another surgery, so it can be delayed for a few years."

"I can still walk now, which proves that the muscles have not atrophied."

"However, surgery is necessary to recover." Luo Yun said directly.

This is an interesting case, the joint deformation is so severe, how to restore the line of force, how to make up for the shortened length of the affected limb, and straighten the re-deformed joint...

Still a little challenging.

Luo Yun was looking forward to it, his hands were almost sore, if such a complicated initial joint replacement could be his first joint replacement in the department.

It was really comfortable, and there was a feeling of reuniting with old friends...

"Are you going to have an operation?" The old woman stood up in fright, ignoring the pain in her leg.

But she immediately asked the key question: "So? How much would it cost?"

When the old woman asked, the middle-aged woman next to her said, "Mom, sit down first. This operation is not expensive. The doctor told me that it is not expensive."

Then he turned his head to look at Luo Yun, lowered his voice and said, "Doctor, don't tell my mother about the money."

"She is reluctant to part with money." The middle-aged woman said.

"At least [-] to [-] yuan must be prepared. She is going to have a joint replacement, and the joint prosthesis is at least [-] yuan. This will not be reimbursed." Luo Yun said blankly.

Who is not willing to part with money?

"doctor."

"Can our county hospital do this surgery? Should it be cheaper?" the middle-aged woman asked.

She remembered that when she was in the county hospital, the director also told her to do joint replacement, but she had to hire an expert. The money for the expert would not be reimbursed, and she had to pay for it herself. Otherwise, they would go to Shashi to see it by themselves , so as to avoid the cost of hiring an expert.

Luo Yun replied with some embarrassment: "I don't know. I haven't seen doctors in other hospitals, so I can't comment on it. They may or may not be able to do it, and I don't know the cost. gone."

"If it's on our side, it will cost at least 3 yuan to save a little."

"Zhou Cheng, write it down, it is recommended to perform joint replacement surgery. Otherwise, there will be risks of paralysis, muscle atrophy, etc."

After Luo Yun said this, he said again: "In her current situation, taking medicine will definitely not work, you see."

"On the plain film, her joints have completely collapsed, without any joint space, and the bones are grinding against the bones. No amount of painkillers can stop it. Taking painkillers can only make her stomach suffer more damage ...was a waste of money."

"Her current symptoms are that she can no longer walk. As I said just now, every step she takes is suffering for her."

The face of the middle-aged woman immediately changed, paralyzed?

Quickly asked again: "Then how long will my mother-in-law be paralyzed if she doesn't have an operation?"

"I can't judge this. If she doesn't move after she goes back, it may be the same as now, but if she doesn't move, then it's not much different from being paralyzed." Luo Yun can't guarantee, who can say about this matter Accurate?

"After the operation, will she be able to walk? Will she have to use a wheelchair or use crutches?" She then asked.

"Then if she still needs to use crutches or a wheelchair after the operation, I will definitely not do it for her." Luo Yun was very happy.

"People who are paralyzed can still move in electric wheelchairs. With the money for surgery, they can buy several wheelchairs."

"In her current situation, the prognosis of the operation may not be very good, but as long as she recovers well and exercises well after the operation, she will not be able to tell the difference in her walking posture from the old lady outside." Luo Yun replied confidently. road.

"It's definitely not a problem to take the grandson, cook, buy vegetables, wash clothes and other simple housework."

Luo Yun said pointedly.

The middle-aged woman's eyes lit up immediately after hearing this: "Thank you, doctor, I will think about it!"

After she finished speaking, she was about to open the phone's address book, as if she was going to make a call to ask someone.

But after hesitating for a while, he said directly: "Oh no, doctor, just give me a hospital certificate. I will take my mother-in-law to the hospital. I will perform the operation on her."

Luo Yun pouted his mouth towards Zhou Cheng, and Zhou Cheng hurried to write the hospital certificate, and gave Luo Yun a thumbs up in a bit dumbfounded.

Then Luo Yun said to the middle-aged woman: "You have to think carefully and discuss it with your family. Surgery for the elderly still has certain risks, and the cost is quite high."

"It's not as simple as going to the vegetable market to buy some vegetables." Although Luo Yun wanted to carry out the first joint replacement surgery in the department, he would not go for surgery just for the sake of surgery.

"Well, okay. Dr. Luo, I will discuss it with my family." The middle-aged woman said seriously.

Just now Luo Yun said a reason that she couldn't refuse.

My own mother-in-law, after the operation, was able to walk well, wash clothes, cook, and buy vegetables. For her, it was more than half of her liberation.I can also go to work well, and there are people to pick up and drop off the cubs.

Seriously.

"Then you can go to the second orthopedic ward to make an appointment later, and you should be able to be admitted to the hospital soon!" Luo Yun said, looking at the old woman and sighing.