I Spent Those Years In the Operating Room Fighting Monsters

Fang Nixin didn't worry about everything else.

Lu Cheng is only a student now. Although he has obtained a doctor’s qualification certificate and has first-level surgery authority, his ability has far exceeded his own junior professional title, so he can be strongly recommended by the provincial professional committee. Go to the medical department and ask for more advanced hand speed permission.

Fang Nixin had done this before, otherwise, she would not be able to perform arthroscopy, which is at least three types of surgery. The operation authority of arthroscopy is only open to senior attending physicians and above.

It's just that Fang Nixin was granted such surgical permission after she graduated. As for Lu Cheng, it is almost impossible for ordinary people to obtain such authorization when they graduate from graduate school. Such a speed is simply unimaginable.

Almost can chase the square mud Xin.

But Fang Nixin still thought to herself, what's so great, am I still younger than you?

Then the group started rounds, there were still not many patients, there were only four in total.

One is the patient with open upper arm trauma. After applying VAC, the current wound condition is very good. As long as there is no infection, he can be transferred to Professor Zhou Xuanqing's group in the first ward of orthopedics for skin flap transplantation.

The patient and family members were very happy, and enthusiastically invited Li Dongshan and others to eat fruit.

It is now in a ward round and of course was declined.

The general surgery patient has been discharged.

The remaining three patients are patients who need to undergo knee arthroscopy today (preparation of lateral meniscus suture of the right knee), and the other is a patient with a comminuted fracture of the tibial plateau.

The patient's preoperative examination has been completed and is currently waiting for the swelling to disappear. Patients have been given preventive anticoagulation.

The last one is the patient who was infected after the injury of the lower limbs, which everyone has a headache now.

When Li Dongshan was stationed in front of the patient and family members, the patient and family members looked at Li Dongshan blankly with light in their eyes. In their understanding, it seemed that after the patient came out of the operating room safe and sound, it was almost the same. back to normal.

As one of the top hospitals in Hunan Province, the Second Xiangya Hospital has no complications or anything.

And now it is possible to save limbs, and the family's money is enough, just waiting for Li Dongshan to announce that he can recover and be discharged at any time.

Li Dongshan said very calmly: "Jiang Congyue, and you, listen carefully. What I am going to talk about next is not to intimidate you."

"You have also seen what the patient's wound looked like before the injury. The bones were exposed, most of the muscles were crushed, and the meridians were embolized. The best way at the time was amputation, and the possibility of limb salvage was very small."

"Simply, he was lucky. We saved this leg initially. However, I told you about it before, and he just passed the first stage of the Long March."

"Furthermore, the most undesirable thing we want has happened at the moment, the wound is infected. And the infected bacteria are very scary, they are resistant to bacteria."

"What is multi-resistant bacteria..."

The patient is not a doctor, so Li Dongshan described the basic situation of the patient in detail in a popular and easy-to-understand way.

I understand, but the patient was anxious at the time: "Doctor, how did I get infected? How can I get infected? You are here at the Second Xiangya Hospital. Can't even an infection be prevented?"

This is very realistic and true.

But this is the fact.

Li Dongshan said: "I just talked about this. This is a special type of bacterial infection. There is a term for preventive infection in our surgery, but not all patients are 100% free from infection after preventive medication."

"Especially for patients with severe soft tissue damage like yours, the chance of infection is even greater."

"I don’t know if you have met with other doctors in private, or have learned about it on the Internet. Like your situation, I’ve talked about it before, even if you connect your bones, blood vessels, and tendons, you get an infection. The odds are still great."

"We also use medicine, but medicine is not omnipotent, and our doctor is not omnipotent. Bacteria, this thing, roams in the air, everywhere. Even though we have tried our best to give you the use of preventive Among the antibiotics, the best and the highest level still cannot prevent the current infection."

"This is like even if there are traffic lights on the road, there is still no guarantee that there will never be a car accident."

Although it is said that, the truth sounds to others, and it is easy to understand.

But what happened to the patient himself is very difficult for him to understand.

Jiang Congyue's wife immediately stood up and asked, "Professor Li, what do you mean is that my husband's trauma will cause infection 100%? No matter what medicine is used, it can't be cured?"

When she asked this, her son and daughter both took her hand. In fact, they all understood Li Dongshan's explanation, but she ignored or didn't want to bother.

No one is willing to accept the fact that the infection happened to them right away.

"It's not 100%, or very much. If the infection happens, it is 100%, and the chance of not happening is zero. It doesn't mean that if you happen, the next one will not happen. Or it is 95% chance, nine in front of me. None of the fifteen were infected, and the next five patients I will encounter will definitely be infected."

"This is a very complicated issue. Even in our current medical sciences, there is no complete theory to prove which patient will get the infection and which patient will not. It can only count how many people have the infection and how many people have not. "

"This is just a statistic, not a demonstrative number. It's like you plant a thousand seeds. You don't know which seed you plant will not germinate 100%, right?"

When Li Dongshan saw that Jiang Congyue and his wife were still talking, he stretched out his hand and interrupted: "I can understand your anxiety, but you should stop talking and listen to me first."

"Now that the incident has happened, it is no longer important to investigate and entangle the probability of this incident. Our main purpose now, the main difficulty is to control the infection while keeping the legs. ."

"This is a very difficult process, not only for you, but also for our doctor."

"It's not that there is no cure right now. Some cures are available, but the process will be very long and the recovery time will be long. This is already a fact, and it is also a fact that we expected before the limb salvage surgery."

"This is also the main reason why we suggested that you directly amputate your limbs."

"After we talked to you about the multiple difficulties encountered in limb salvage, you still insisted on choosing limb salvage surgery, and our doctors are also helpless. Your patients have the right to informed consent and the right to choose."

"If you have any doubts about our treatment process, all of our medical information is filed, and you can check our medication records at any time."

"No no, Professor Li, we must still believe you." After hearing this, Jiang Congyue and his wife could hardly accept it, but it seemed that they could only digest it like this. Li Dongshan has indeed talked about these situations, but they still have doubts in their hearts whether something wrong in Li Dongshan's treatment process caused the current infection.

But this cannot be said directly. What if Professor Li is offended?

So the two people are also particularly entangled.

Seeing that both Jiang Congyue stopped talking, Li Dongshan said: "Professor Yu, do you have any opinion on the treatment of this patient?"

Yu Youlin said in a deep voice: “Professor Li, the patient’s current situation is very complicated, and the patient is still infected with polytolerant bacteria. Debridement must be performed again or even multiple times to control the bacteria thoroughly before discussing follow-up issues. ."

"At present, the patient's blood vessel has been anastomosed, and infection has occurred again, and sepsis is prone to occur. Therefore, the intravenous antibiotics must be kept up and adjusted at any time. Otherwise, it will still be life-threatening."

Yu Youlin is a general surgeon, so it is not easy to say so much.

Then Li Dongshan called Zou Qian and Fang Nixin to express their opinions.

Zou Qian and Fang Nixin are obviously more professional, and they have put forward a lot of suggestions. For example, after this infection, sensitive antibiotics can be loaded with copper sulfate and slowly released locally to achieve the purpose of inhibiting bacterial reproduction.

For example, replace the flushing drainage, replace the VAC again after the renewed diligence, and continue the negative pressure suction, and so on.

Then Li Dongshan looked at Cao Xiaohe, who was trembling a little. Cao Xiaohe's eyes were directly on the ground. He obviously felt that the complexity of this patient far exceeded his knowledge reserves, and Fang Nixin and Zou Qian Finished talking about what should be said.

Li Dongshan looked at Cao Xiaohe's intimidation, and after cursing in his heart, he looked at Lu Cheng directly: "Xiao Lu, do you have any opinions?"

Li Dongshan still attaches great importance to Lu Cheng. Even if Lu Cheng said something wrong, he can correct Lu Cheng in time.

Lu Cheng thought for a while, and then said: "Master, just now Teacher Yu, Teacher Zou, and Senior Sister Fang have finished explaining the general principles of treatment, so I won't elaborate on them for the time being."

"But I think the patient has a more suspicious point now, and I don't know if it's right."

"The patient’s current bacterial culture results and drug susceptibility results were three days ago. At that time, the samples were taken out of the polytolerant infection. Then, when we adjust the medication now, should we consider whether it should be based on the original basis? More comprehensive."

"The antibacterial spectrum of amikacin is a variety of Gram-negative bacteria and a small number of Gram-positive bacteria, while the antibacterial spectrum of ciprofloxacin is also Gram-negative bacteria. In this way, if the patient’s infection is If there are gram-positive bacteria, the antibacterial effect may not be achieved."

"Moreover, if amikacin and ciprofloxacin can really play a role in killing the current pathogenic bacteria, the injured part of the patient is now an immune disorder, which is likely to allow other pathogens to settle and multiply. We must also be vigilant. Staphylococcus aureus wakes up again or settles here again through blood circulation."

"Therefore, I recommend adding an extra-broad-spectrum antibiotic, such as meropenem."

"Yesterday, I read some literature, and I also saw it above. During the treatment process, such polyresistance bacteria are prone to mutations or re-residential infections of other bacteria. It is more appropriate to choose at least two or even triple combinations. "

"Of course, for more specific medication plans, you can ask the pharmacy department for another consultation, or you can adjust the types of antibiotics after the drug sensitivity results come out."

"In some very rare cases, there have been reports of the use of quadruple antibiotics."

As soon as Lu Cheng said these words, Li Dongshan was a little stunned.

Is this still Lu Cheng?

Is this the same Lu Cheng who couldn't speak out during the rounds a few days ago? At that time, Lu Cheng was extremely high-handed and low-eyed.

Now, why is the theory so rich?

Even the antibacterial spectrum of this uncommon antibacterial drug has been memorized?

Fang Nixin raised her brows, thinking that Lu Cheng was too wrong. Could it be that he had read all the documents yesterday?

I haven't finished reading it myself.

He caused it all!

In fact, Li Dongshan doesn't read too much literature now, nor is it too detailed. Basically, he only looks at titles and abstracts. As for the more detailed content, he already has enough knowledge reserves, and feels that it is not important to not read it.

Lu Cheng's statement was reasonable and well-founded. After listening to this, Li Dongshan pondered for a while and said, "Then add a meropenem."

"Also, arrange tomorrow's surgery. This time, we still have to debride strictly and thoroughly."

"Okay." Zou Qian immediately remembered Li Dongshan's words.

Li Dongshan is a professor with a senior professional title. He has the authority to adjust the medications for diseases in the department. Even for antibiotics, only Li Dongshan's job number can be obtained.

Anyway, if Li Dongshan speaks, then he will be at the forefront of everything.

After checking the room, Li Dongshan and his party were on the way back. Li Dongshan praised: "Xiao Lu in our department has a very good talent~www.wuxiaspot.com~ and everyone has seen his growth rate."

"Xiao Cao, do you think you have more free time compared to Xiao Lu, which one?"

Cao Xiaohe lowered his head and secretly scolded Lu Cheng for being abnormal.

The person who scolds the best dish in this department has no human rights. Why don't you scold Fang Nixin, Teacher Li?

And Lu Cheng, is that the growth rate of a person? Pigs can't grow as fast as him.

"So, we have to work hard. Don't give yourself the guise of having no time and energy to read books~www.wuxiaspot.com~ will always be a shortcut to improve yourself, if everything is needed in clinical science, clinical practice How many cases do you have piled up before you can learn?"

"Only when everyone improves, our team will improve."

"Here, I commend Lu Cheng individually. I hope that everyone will learn from Lu Cheng and work hard to improve themselves, especially to address their weaknesses step by step, steadily and steadily."

"Okay, that's all for today's rounds. I'll go to the medical department with Xiao Lu first!"