Chapter 116 A big pit within a pit (second update, please subscribe)

Author: Jiangdi Youbai

Chapter 116 A big pit within a pit (second update, please subscribe)

"But the condition of his wound is still not very good. It is estimated that he may need another debridement to fix it." Guo Lixiang said while showing everyone the photos of his wound that he had taken before.

In the calf area, the surgical scar appeared red and swollen, and the swollen area was bright and bulging. The sutures were pulled into the skin by the swollen wound.

After reading this, Lu Junyin frowned and said, "Guo Lixiang, you will take out all the sutures of Uncle Zhou later, then open the superficial wound and drain out the pus inside."

If the incision is subcutaneously infected, the tighter it is, the more the infection will spread to the surrounding soft tissues under pressure, increasing the scope of infection. At this time, priority must be given to draining the subcutaneous abscess, and then debridement and suturing are performed as appropriate.

Wu Xie didn't speak, but just stared at the wound for a while, then frowned slightly.

Logically speaking, Uncle Zhou was transferred from the county hospital. Wu Xie had been there and knew most of the trauma surgeons at the People's Hospital. It's unlikely that these people didn't even know the most basic principles.

But they did not choose to remove the sutures to drain the blood. Wu Xie still couldn't figure out this doubt for the time being.

However, Lu Junyin's suggestion was in line with the principles, so before he found the specific reason, Wu Xie couldn't refute it, so he just wrote down the key points with a pen.

Guo Lixiang nodded and said yes. After taking notes, he asked: "Director Lu, how should I take the medicine now? Should I continue taking the medicine as before?"

"Do you have any drug sensitivity results?" Lu Junyin asked proactively.

Although the large influx of infected patients was due to Wu Xie's relationship, Lu Junyin still has a realization that even if the people at the People's Hospital will not poach Wu Xie, they probably will

He was taken away by Dr. Long Yuan who came to provide support at that time.

After Wu Xie left, the department still had to perform infectious surgery. Under this premise, he and He Ling had to take care of this disease, so they could not rely entirely on Wu Xie for everything.

Otherwise, once Wu Xie is taken away, there will definitely be problems in the department.

This was also the result of careful discussion between him and He Ling. He did not interfere in order to rob Wu Xie or pick peaches.

"No bacteria were cultured, but there was still exudate," Guo Lixiang replied.

Lu Junyin was a little confused at this, but he still said cautiously: "Then let this patient continue the discharge treatment plan of the county hospital for the time being. Remember to send a bacterial culture and drug sensitivity test of the exudate when changing the dressing tomorrow morning.

Test specimen.”

"Okay." Guo Lixiang still nodded.

Upon seeing this, Lu Junyin said: "Guo Lixiang, Zhong Yusheng, you two go first and then check on the patient, and try to ask more detailed questions about the medical history."

All the patients in beds 8-10 have been processed, and the remaining 11 and 12 beds are the patients in charge of Wu Xie.

Since these beds were given to Wu Xie to take charge, he felt that there was no need to interfere with Wu Xie's diagnosis and treatment. The reason why he wanted to gather 8-10 beds together and go through them was because he thought Wu Xie could help a little bit.

.

After all, both he and He Ling were dealing with infected patients transferred from other hospitals for the first time, and their relative experience and preparation were quite lacking.

Even He Ling was surprised by Lu Junyin's words, but he also understood that this was Lu Junyin's statement to Wu Xie, expressing his absolute trust in Wu Xie. Even if he asked Wu Xie how to deal with the 11th and 12th beds, he would only know

Ask in private.

The three complicated patients Qin Dahe, Jin Ping and Dong Lianghe were all handled well by Wu Xie. Even if Wu Xie was asked what he would do, it would be difficult to interrupt.

Then he smiled and said, "Director Lu, let me go see the patient too."

"It would be better for us to study the two beds in charge of Xiao Wu retrospectively later, so as not to disrupt Xiao Wu's diagnosis and treatment ideas."

This was a small flattery for He Ling.

What they are doing now is to proactively explore treatment options, which are unknown. They don't know how the disease will develop in the future, nor how to treat it, so they work together.

But everyone knows Wu Xie's ability. For the patients he manages, everyone only needs to retrospectively study the ideas after they get better. They don't need to push them any further.

Hearing what He Ling said, Zhong Yusheng and Guo Lixiang were filled with envy.

But I can only envy Wu Xie's achievements in making this move steadily and steadily. It is definitely not the favoritism of Lu Junyin and He Ling, but Wu Xie's true ability.

Lu Junyin gave them a lot of opportunities, but they didn't seize them, so naturally they couldn't get more opportunities.

Then He Ling took Guo Lixiang and Zhong Yusheng out of the office.

In the office, Wu Xie looked at Lu Junyin and felt a little shy and embarrassed: "Director Lu? Me?"

Lu Junyin pressed his back against the chair and turned his head left and right: "Okay, don't be so good as to get an advantage! After all, you really have a good way of treating infected patients."

"It's getting late now. After He Ling and the others check the patients, we still need to continue to discuss the medication plan for these three beds while waiting for midnight snacks..."

"Besides, these two beds are relatively simple. The 11th bed was infected by a patient who had undergone gallbladder stone surgery, and there was not much exudation from the wound. The 12th bed was infected by an Achilles tendon rupture, and the wound has basically healed now."

"And they are all transferred from the county. If the situation is really complicated, the People's Hospital and the Hospital of Traditional Chinese Medicine will not dare to transfer directly to us. After all, they must be responsible to a certain extent." Lu Junyin analyzed calmly.

With.

It seems that he has just arrived in the department, but in fact, he is very familiar with the few patients who have just been admitted to the department today.

Wu Xie's brows suddenly flashed. He knew that Lu Junyin would have such thoughts. After his eyelids twitched a few times, Wu Xie said: "Director Lu, that's not actually the case. This 11th bed looks like it's not just a simple postoperative wound infection."

So simple."

Just kidding, can an infected patient who can increase the gain of 3 knowledge points easily cause a wound infection?

Wu Xie's tone was solemn, and his expression gradually became serious.

Lu Junyin looked at Wu Xie's expression and his expression froze slightly: "What should I say?"

"To be precise, these 11 beds should be medical institutions or hospital-acquired abdominal infections! According to the Chinese abdominal infection guidelines, abdominal infections are divided into community-acquired abdominal infections and medical institution- or hospital-acquired abdominal infections!"

"This patient's APACHEⅡ score should be less than 10 points, which is mild to moderate abdominal discomfort, but according to the Mannheim peritonitis index score, her current score has reached 24. Once it increases to 26 points, she will be at risk of death in the hospital."

"Director Lu, the Mannheim peritonitis index is used to evaluate prognosis."

"So I suggest that she undergo CT and color ultrasound examinations immediately tonight!"

Wu Xie was afraid that Lu Junyin would look down on this seemingly simple case and think that her condition was not serious, so he made his words extra serious.

Because these things are not what he said, they are based on the score list recommended in the current diagnosis and treatment guidelines to evaluate the prognosis of patients with abdominal infection, and the results are obtained by making a score statistics.

Regardless of whether it is based on the Chinese abdominal infection guidelines or the American abdominal infection treatment guidelines, there is the following description: “It is recommended that patients with suspected abdominal infection undergo CT examination to confirm the diagnosis. It is recommended that patients with suspected abdominal infection undergo ultrasound examination.

To confirm the diagnosis. It is recommended that patients with suspected abdominal infection undergo laboratory tests to assist in diagnosis."

Laboratory tests were done before when I was hospitalized in the County People's Hospital, so!

CT and color ultrasound examinations must be done immediately, and antibiotics must be administered empirically within one hour after abdominal infection is suspected!

If CT shows abdominal abscess and effusion, puncture and drainage must be performed promptly!

Wu Xie believes that the current patient named Liu Chunhua can only be worthy of the three knowledge points she provided alone if he meets this situation.

Wu Xie's words shocked Lu Junyin severely. His expression turned blue and his face twitched: "This Liu Chunhua's condition is so serious, Lin Peiyuan will transfer her to our hospital? He is so

Isn’t it a scam?”

"Is he crazy?"

It is true that Xuan County Hospital of Integrated Traditional Chinese and Western Medicine and the County People's Hospital are counterpart hospitals in the referral relationship, but Xuan County Hospital of Integrated Traditional Chinese and Western Medicine is a lower-level hospital, a second-level medical institution, and the County People's Hospital is a third-level B hospital, a third-level hospital.

mechanism.

It is Lin Peiyuan's full responsibility to transfer such a malignant patient and eventually die!

Improper condition assessment!

Wu Xie said: "Director Lu, Director Lin probably did not mean this. After all, you have also seen that Liu Chunhua is not well except for the wound, but she has no other symptoms. There is no fever or peritonitis.

Symptoms such as generalized tenderness and rebound tenderness.”

"However, during a careful physical examination, some induration can still be palpated. It is suspected that it is localized peritonitis. It does not cause local or systemic symptoms, but once a localized intra-abdominal abscess breaks open."

"Then the consequences will be very serious. You can refer to the widespread diffuse peritonitis caused by the rupture of the abscess around the appendix."

"So, Director Lu, I suggest that this patient undergo CT and color ultrasound examination immediately, and then, depending on the situation, push him to the operating room for puncture and drainage!"

Wu Xie can't make a diagnosis now, but he can only gain 3 points of knowledge to make him suspicious.

Wu Xie, who specializes in surgical infectious diseases, can immediately find a breakthrough as long as there is a point of doubt. He did not expect that this panel could be of such use, but in the end he still had to rely on CT and color ultrasound to confirm the diagnosis!

Lu Junyin couldn't sit still at all: "Then do it quickly! I'll call the CT room and color Doppler ultrasound room. I'll do bedside color Doppler ultrasound. If there's any indication, I'll go directly to the CT room and operating room!"

I stood up and hurried out to make a phone call.

Lu Junyin had no doubts about Wu Xie's words and professionalism, and the reasons given by Wu Xie were also appropriate. It seemed simple to us. I guess Lin Peiyuan and the others just took Liu Chunhua as a simple patient without careful consideration.

Got referred.

Wu Xie was not idle either, although he was still recording some doubts about beds 12 and 10.

But there was no time to think about it in detail. For them, delaying medication for one night was definitely not a big problem, but for 11 beds, maybe one night, she would have to be transferred to the ICU in the county again!

This is simply a big pit within a pit!
Chapter completed!