"I tell you, Chen Cang speaks very well. I''ve heard others talk about thoracentesis before, but it''s too far from Chen Cang!"


    "The most important thing is to be handsome!"


    "Is it really that exaggerated?"


    "It''s more exaggerated than this. Yesterday, more than ten or twenty of us asked questions, but we didn''t ask others. We can do anything! I think Chen Cang is a must when talking about thoracentesis!"


    "I''m obedient. Chen Cang has no object yet!"


    "They are the establishment of the second Provincial Institute. Now they are sent out to study as graduate students. They are handsome, good units and good people. Come on!"


    ……


    Several girls from guipei had a good time talking. In fact, they didn''t come to the training today. They just came to continue listening. It''s the same as the class in college. Which teacher speaks well, looks handsome and sucks powder. There are too many people coming to the class!


    In fact, many of those who came to participate in the training were already graduate students, but they did not obtain the training certificate after graduation.


    Now when doctors, they are required to have a regulatory training certificate, which is as important as the qualification of medical practitioners. Without a regulatory training certificate, they can''t be promoted to an intermediate professional title.


    To put it bluntly, if you don''t have regulations and training certificates, you can''t be rated as the attending doctor.


    So many people come to the training.


    But at this time, we can see that the proportion of male and female medical students has come.


    There are seven girls and three boys in ten people.


    So in medical schools, boys are relatively easy to find.


    ……


    After they pushed the door into the chest room, they suddenly saw a man standing inside.


    This man... Oil head wants to cover up the reality of baldness, and the new white clothes want to stop the protruding belly. It looks very greasy


    Suddenly, the person who was preparing to sign in hesitated!


    This person should be... Not Chen Cang?


    "Is this Chen Cang? So... Abstract?"


    Even several people who came yesterday were silly: "no! I don''t know Chen Cang, my classmate. Where is Chen Cang?"


    Several people grinned and haw reluctantly signed, one by one looking at Shi Qi curiously.


    We''re all here. Can''t we go?


    Shi Qi looked at everyone coming, opened the PPT with a smile and smiled like Wu Yanzu: "well, welcome to the second provincial hospital. I''m Shi Qi. Today I''ll tell you about the operation and precautions of thoracic puncture."


    "Maybe you don''t know much about me, but you''ve been familiar with me for a long time. I used to be the director of thoracic surgery in our hospital. Later, I kept reforming. I went to breast surgery, so when it comes to the explanation of thoracic puncture, I think I should be the most appropriate in the second provincial hospital?"


    Speaking of this, Shi Qi smiled with humor.


    "Thoracic puncture is widely used in clinic. It is very important for medical workers. We are all future doctors, so it is really necessary to master such a skill."


    "I''m usually very busy, but after receiving the invitation from the planning and training center, I still think it''s more important, so I''m here. Now..."


    Shi Qi''s materials were left by Li Shijian at that time. At that time, Li Shijian outside his chest often trained with Chen Cang, so the materials were prepared.


    Shi Qi is now ready to be a director of the planning and training center. Because the old director of the breast department doesn''t retire, he can''t go at all, and... Clinically, he doesn''t want to do it now.


    Three years as director of thoracic surgery and three years as salted fish, where did you live such a hard life?


    It''s also comfortable to be a director of the planning and training center and manage hundreds of students.


    What Shi Qi said is... Regular, just like the scoring standard, very standard and official.


    You can hear it.


    However, those who heard Chen Cang''s explanation yesterday suddenly felt that they were not happy.


    There is no difference without comparison. Sometimes, the level of clinical doctors can be seen from explaining things. Some people are meaningful, while others are dry.


    However, considering that he was the original director outside the chest, everyone still felt that he should be very good. Maybe he was just not good at explaining.


    So he listened patiently. After talking, Shi Qi looked at everyone: "is there any problem?"


    At this time, a man asked: "Mr. Shi, the pleural disease guidelines of the British Thoracic Association in 2010 pointed out that for malignant pleural effusion, the extraction volume of therapeutic pleural puncture should depend on the patient''s symptoms at that time, and the single extraction volume should not exceed 1500ml. What you just said is not more than 700ml for the first time and not more than 1000ml in the future, while Concorde respiratory medicine believes that it should not exceed 600ml for the first time and not more than 1000ml in the future, which is the first in China It seems more conservative in terms of quantity. Why? "


    This problem is an exit!


    Most of the people present were blindfolded!


    This question is awesome!


    You are a master!


    Because in the 5678 version of internal medicine, it is not more than 700 for the first time and not more than 1000 in the future, but it seems that no one really asks why!


    Shi Qi was stunned. The question was good. He pointed to a girl in front and asked, "what do you think of this question?"


    The girl hesitated: "I use... The eighth edition of Internal Medicine..."


    As soon as he said this, everyone around him was dumbfounded and laughed.


    Shi Qi also smiled and said, "because too much and too fast fluid extraction will cause atelectasis, so we are relatively more conservative than foreign countries."


    The girl was stunned: "aren''t you afraid of 1500 for the first time abroad? Is the difference between our country and abroad because we are conservative?"


    Shi Qi was stunned: "each guide has a special understanding and a theory obtained through evidence-based medical research with a large number of case experience. I think we should respect the guide."


    At this time, a girl suddenly raised her hand and said, "Mr. Shi, in fact, this value has a source, and it is not a dead value."


    "Physiology tells us that the average total lung volume of adult men is 5000ML, including 3500ml vital capacity + 1500ml residual air volume. Based on this, we speculate that the volume of thoracic cavity should also be about 5000ML, so the volume of unilateral thoracic cavity is about 2500ml.


    For a patient with a large amount of pleural effusion, we draw 1000ml and 25 at one time on one side, which is quite a large amount. If 1500ml (one side) is drawn at one time, it will be 35 of the unilateral thoracic volume, which is basically an insurmountable gap. "


    "Evidence based medicine statistics show that it is an indisputable fact that European and American human bodies are tall. Correspondingly, their chest volume is also larger than ours, so it is understandable that their upper limit of single fluid extraction is larger than ours."


    "The real meaning of the guideline is not to emphasize this value, but this is only a critical value. In clinical practice, in fact, this" 700ml, 1000ml " It can''t be invariable, because each patient''s age, body shape and condition are different. We can''t use these two numbers. More importantly, we can observe the patient''s situation at any time. At the same time, it''s the same in foreign countries. The guide is a wide range. As every doctor, we should observe the patient and adjust the dosage at any time. "


    The girl''s voice was not loud, but it quieted the whole audience.


    With these words, the significance of the value of chest puncture and fluid extraction was suddenly said, which immediately made the whole audience understand and suddenly had a feeling of sudden enlightenment.


    i see!


    Even Shi Qi felt suddenly enlightened. It''s good to say. It turned out to be like this.


    Shi Qi couldn''t help asking, "this classmate said very well! He understood very well."


    In fact, the girl didn''t want to say anything, but one couldn''t help saying it. Naturally, she didn''t expect such a big response. Looking at the people around, she looked at her with a look of wow and blushed.


    "Actually... This is not what I said, this is what Mr. Chen said." the girl said with a embarrassed face, and then pointed to her classmates, "ask them, they know!"


    Several students nodded: "yes, Mr. Chen said."


    The people were dumbfounded!


    Who is a teacher Chen?


    Miss Chen?


    Even Shi Qi looks at a loss. Who is Mr. Chen? It sounds familiar.