Great doctor starts with adding points

"The condition of his wound is still not very good. It is estimated that debridement may be needed to fix it." Guo Lixiang said while showing the photos of his wound that he had taken earlier.

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

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

Subcutaneous infection of the incision, the tighter the infection, the more the infection will spread to the surrounding soft tissues under pressure, increasing the scope of the infection. At this time, the subcutaneous abscess must be drained first, and then debridement and suture are performed as appropriate.

Wu Xie didn't speak, but frowned slightly after staring at the wound for a while.

According to the theory, this Uncle Zhou was transferred from the county hospital. Wu Xie had stayed there and knew most of the trauma surgery doctors in the People's Hospital. These people don't even know such basic principles.

But they didn't choose to take apart the sutures for drainage. Wu Xie still can't figure out this doubtful point for the time being.

However, Lu Junyin's suggestion is in line with the principle, so before finding out the specific reason, Wu Xie couldn't open his mouth to refute, so he just wrote down the main point with a pen.

Guo Lixiang nodded and said yes, and after taking notes, he asked, "Director Lu, how should I take the medicine now? Should I continue the previous medicine?"

"Is there any drug sensitivity result?" Lu Junyin asked proactively.

Although the influx of infected patients is due to the introduction of Wu Xie, but so far, Lu Junyin still has a realization that even if the people in the People's Hospital will not poach Wu Xie away, they will probably He was taken away by Doctor Longyuan who came to support him at that time.

After Wu Xie left, infection surgery was still needed in the department. Under such a premise, he and He Ling had to take care of this disease, so they couldn't completely rely 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 discussions between him and He Ling, and it was not for the purpose of snatching Wu Xie or picking peaches, so he got involved.

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

Lu Junyin didn't quite understand this, but he still said cautiously: "Then this patient will continue with the discharge treatment plan of the county hospital for the time being. Remember to send a bacterial culture and drug sensitivity of exudate when changing the dressing tomorrow morning." test specimen."

"Okay." Guo Lixiang still nodded.

Seeing this, Lu Junyin said: "Guo Lixiang, Zhong Yusheng, you two go to check the patient first, and try to ask more detailed medical history."

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

Since these beds were handed over to Wu Xie to be in charge, he felt that there was no need to intervene in Wu Xie's diagnosis and treatment. The reason why he gathered everyone to go through the 8-10 beds was that Wu Xie could help a little. .

After all, it was the first time for him and He Ling to take over this kind of infected patients transferred from other hospitals, and their relative experience and preparation were quite insufficient.

Even He Ling was quite 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 Ask in private.

The three complicated patients Qin Dahe, Jinping, and Dong Lianghe were all handled well by Wu Xie. Even if Wu Xie was asked what he would do, it was not easy to intervene.

He smiled and said, "Director Lu, I'll go see the patient too."

"It's better for us to study retrospectively about the two beds that Xiao Wu manages later, so as not to disrupt Xiao Wu's thinking about diagnosis and treatment."

He Ling is a small flattery.

What they are doing now is just a forward-looking discussion of treatment options, which is unknown. They don't know how the follow-up will develop or how to treat them, so they work together.

But everyone knows what Wu Xie is capable of. For the patients he manages, everyone just needs to study the ideas retrospectively after they get better, and there is no need for them to force them.

Hearing what He Ling said, Zhong Yusheng and Guo Lixiang were so envious.

But I can only envy, Wu Xie's steady and steady performance of this move is definitely not the partiality of Lu Junyin and He Ling, but Wu Xie's real ability.

Lu Junyin also gave them a lot of opportunities, but they didn't grasp 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, but felt a little shy and embarrassed: "Director Lu? Me?"

Lu Junyin pressed his back against the chair at this moment, and turned his head left and right: "Okay, don't get cheap and act like a good boy! After all, you really have a way of treating infected patients."

"It's not too early now. After He Ling and the others have checked the patients, we will continue to discuss the medication plan for these three beds, and wait for supper..."

"Besides, these two beds are relatively simple. The 11th bed was infected after a gallbladder stone operation, and there was not much exudate from the wound. The 12th bed was infected after an Achilles tendon rupture. Now the wound has basically healed."

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

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

Wu Xie frowned, he knew that Lu Junyin would have such an idea, and after his eyelids twitched a few times, Wu Xie said, "Director Lu, that's actually not the case. This 11th bed, it seems, is not just a simple postoperative wound infection. So simple."

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

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

Lu Junyin looked at Wu Xie's expression, and his expression froze a little: "How to say?"

"These 11 beds should be accurately described as abdominal infections acquired by medical institutions or hospitals! Abdominal infections are divided into community-acquired abdominal infections and abdominal infections acquired by medical institutions or hospitals according to the guidelines for abdominal infections in Huaguo!"

"The APACHE II score of this patient should be less than 10, which belongs to mild to moderate abdominal sensation. However, according to the Mannheim peritonitis index score, her current score has reached 24. Once it rises to 26 points, she will be at risk of death in hospital."

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

"So I suggest to have a CT and color Doppler ultrasound examination on her immediately tonight!"

Wu Xie was afraid that Lu Junyin would take a look at this seemingly simple case and think that her condition was not serious, so she made it more serious.

Because these things are not what he said, they are based on the list of corresponding scores recommended in the current diagnosis and treatment guidelines for evaluating the prognosis of patients with abdominal infection, and roughly made a scoring statistics to get the results.

Regardless of whether it is based on the guidelines for the treatment of abdominal infections in China or the guidelines for the treatment of abdominal infections in the United States, there is the following description: "It is recommended that patients with suspected abdominal infection undergo CT examination to confirm the diagnosis. Ultrasound examination is recommended for patients with suspected abdominal infection To confirm the diagnosis. Laboratory tests are recommended for patients with suspected intra-abdominal infection to assist in the diagnosis.”

Laboratory tests were done before hospitalization in the County People's Hospital, so!

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

If CT shows abdominal abscess and effusion, puncture and drainage should be performed in time!

Wu Xie believes that the current patient named Liu Chunhua is only worthy of the 3 points of knowledge provided by her alone only if she meets this situation.

Wu Xie's words frightened Lu Junyin. While his expression turned blue, his face twitched: "This Liu Chunhua's condition is so serious, Lin Peiyuan will transfer her to our hospital? He Isn't it a scam?"

"Is he crazy?"

Xuan County Hospital of Integrated Traditional Chinese and Western Medicine and the County People’s Hospital are referral hospitals. That’s right, 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 hospital, which is a third-level hospital. mechanism.

It is Lin Peiyuan's full responsibility to transfer such a vicious patient to death in the end!

Improper assessment of the condition!

Wu Xie said: "Director Lu, Director Lin probably didn't do this on purpose. After all, you have seen that Liu Chunhua is currently not well except for the wound, but she has no other symptoms. I have not seen fever or peritonitis. Symptoms such as generalized tenderness and rebound tenderness."

"However, during a careful physical examination, some induration can still be felt. It is suspected that it is localized peritonitis, which has not caused local and systemic symptoms, but if the localized intra-abdominal abscess is ruptured."

"Then the consequences can be serious, and you can refer to the extensive diffuse peritonitis caused by the rupture of the abscess around the appendix."

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

Wu Xie can't make a diagnosis now, he just gained 3 points of knowledge points to make him suspicious.

And Wu Xie, who has a specialization level in surgical infection, can immediately find a breakthrough as long as there is a point of doubt. I didn't expect this panel to be so useful, but in the end it still depends on CT and color Doppler ultrasound to confirm the diagnosis!

Lu Junyin couldn't sit still at all: "Then do it quickly! I'll call the CT room and the color Doppler ultrasound room, and the color Doppler ultrasound will be the bedside color Doppler ultrasound. If there is direction, I will directly push the CT room and the operating room!"

Stand up and go out to make a phone call.

Lu Junyin didn't have any doubts about Wu Xie's words and his professionalism, and the reasons Wu Xie gave were reasonable. It seemed simple to us. I guess Lin Peiyuan and the others just happened to treat Liu Chunhua as a simple patient without careful consideration. Referral down.

On Wu Xie's side, she wasn't idle either, although there were still some doubts about beds 12 and 10.

But it's too late to think about it carefully. For them, it's definitely not a big problem to delay the medication for one night, but for the 11th bed, maybe one night, she will be transferred to the ICU in the county again!

This is simply a big hole in a pit!