Great doctor starts with adding points

After being complained by Lu Junyin for a while, Lin Peiyuan's originally good mood became gloomy at that moment, and his face turned slightly ugly.

He took another deep puff, then put out the cigarette butt in the ashtray, and after hanging up the phone, he decided to call Lao Zhang to ask what was going on.

Lao Zhang is the director of the general surgery department, and he has a good personal relationship with him.

When the phone was connected, Yu Sheng's voice came from inside: "Old Lin, it's because I didn't do a good job. I really didn't expect that this case, which seems to be a common incision infection in the abdomen, would have a localized abscess in the abdominal cavity. And the abscess is so big."

"To be honest, my back is getting cold right now!"

This tone was also blaming Lin Peiyuan.

Just kidding, it's okay for such a patient to be transferred to the state hospital. If there is a problem with the transfer to the town hospital, then Director Zhang, as the director of the general surgery department, will have to peel off his skin.

After all, the premise of the referral relationship between upper and lower hospitals is that you have to accurately characterize the patient's condition. If you transfer such a difficult patient to a lower level hospital, are you afraid that the patient will die slowly?

Lin Peiyuan is not pleasing to both ends. I thought it was a gift for Luo Wei to go to the town hospital to support his counterpart in surgery, but now, Lu Junyin is not pleasing to the side, and Lao Zhang, the general surgeon here, is not pleasing. I was blaming myself for yelling so much.

Lin Peiyuan asked: "Old Zhang, is Liu Chunhua's situation very complicated?"

"Before the abscess ruptures, it's a trivial matter, but if the abscess ruptures and becomes diffuse peritonitis if it is not discovered in time, then if the medical level is limited and emergency treatment is not available, the mortality rate is still quite high."

"Of course, I also have a certain responsibility. It's strange for you to say that this Liu Chunhua doesn't have a headache, but there is such a big abscess hidden in the abdominal cavity, and the physical examination can't find it out. She is still in a bad state. Good, you can eat and walk."

"I thought her condition was simple. I gave you a favor, brother. This is really messed up."

"If it wasn't for the person named Dr. Wu from Shazhen Hospital who was so sensitive enough to think of such a possibility, something serious might happen to this patient."

"But although this incident is quite strange, it also proves that what you said, Lao Lin, is correct. This Shazhen Hospital really has a way of treating infections."

"In such a rare situation, I can really suspect and diagnose it. The problem is that it can be dealt with. Where can you justify it?" Director Zhang said in the end, he was still amazed, but he didn't continue to blame Lin Peiyuan.

Because of this Liu Chunhua, if you don't refer her, there is a high probability that an abscess will burst in their department!

Once this is the case, the fun is not small.

"Well, Director Zhang, I don't need to deceive you about this. Dr. Wu has not been in our county for a long time. I still have a state hospital here. There are so few patients who can't be treated, and they are all settled by him."

"It's difficult for others, and the level is not bad. But the key is that he was originally a member of our department..." Lin Peiyuan complained to his good brother.

"Huh? This?"

"Dr. Wu used to be from your department? Isn't he a master's degree? Why did you let him go?"

"It's a long story, Lao Zhang, I'm causing you trouble..." Lin Peiyuan said so.

...

Xuan County Hospital of Integrated Traditional Chinese and Western Medicine, at the entrance of the operating room.

Wu Xie personally pushed Liu Chunhua out, persuading: "Auntie, cousin, the surface problem is basically solved now, and the follow-up is almost done with medicine, and this time we are in the operating room, we took the opportunity to debride and suture the wound again once."

"After going back, you still have to fast for a period of time, and you must not eat anything!"

Liu Chunhua heard the words and said: "Oh, this disease is really uncomfortable. I have been starving for half a month. You have to give your aunt more injections, Xiaoxie. This starvation is really uncomfortable."

"Good aunt, you can cultivate with peace of mind!"

Qin Chongyuan hurriedly took over Wu Xie's pushing bed, and said with lingering fear: "Doctor Wu, thank you very much."

Not to mention other things, just after Wu Xie's puncture and drainage, who would have prepared in advance that disgusting, foul-smelling pus?

With such a disgusting thing in his mother's stomach, something will happen sooner or later.

What's more, Qin Chongyuan himself called Director Zhang again, knowing the danger and the difficulty of meeting a good doctor like Wu Xie. At this moment, Qin Chongyuan really felt that Wu Xie's reputation was really not blown out. of.

There is no need for Director Zhang of the People's Hospital to tell lies, he is only afraid that he will scold him.

"It's okay. I'll arrange the needle immediately after I go back. Don't spoil your aunt to feed her. If it causes hiccups in the gastrointestinal tract, if it chokes the trachea, it will be troublesome, and I'm also afraid of intestinal obstruction. " Wu Xie confessed to Qin Chongyuan with a smile.

"No, Dr. Wu. Certainly not, I promise!" Qin Chongyuan then said to Liu Chunhua: "Mom, it's not that my son is cruel. This little crab has said so, you will have to suffer a little bit."

Then amidst laughter, the group sent Liu Chunhua back to the ward.

After Wu Xie settled Liu Chunhua, he found that Qin Chongyuan's cousin Qin Ling had also come to the department, presumably to see his aunt, and then thanked and praised Wu Xie.

Wu Xie exchanged pleasantries with them for a minute before walking back to the doctor's office.

Lu Junyin and He Ling also just changed into casual clothes and came up from downstairs, holding a big bag of barbecue at the same time, and said: "Everyone has worked hard today, and the barbecue is just here, let's eat together."

"Thank you, Director." Guo Lixiang and Zhong Yusheng hurriedly expressed their thanks, and then began to tidy up the desktop in the office.

Wu Xie said: "Director Lu, I want to issue a doctor's order. In Liu Chunhua's case, antibiotics must be used as soon as possible. In principle, antibiotic treatment should be given within one hour of suspicion."

"I have to use your work number, director, to issue a doctor's order. My work number can't prescribe meropenem."

Lu Junyin wanted to nod when he heard the words, but when he heard that Wu Xie was going to take meropenem, he was taken aback: "You want to take meropenem?"

According to the "Administrative Measures for the Clinical Application of Antibacterial Drugs", antibiotics are divided into non-restricted use grades, restricted use grades and special use grades.

Non-restricted use resident physicians and attending physicians can prescribe; restricted use requires associate director and above physicians to prescribe; for example, meropenem requires the consent of two chief physicians, the deputy chief physician of the ward and the chief physician of the pharmacy department. to go up.

In surgery, only Lu Junyin's job number is deputy senior.

And the price is relatively not cheap, it is more expensive than levofloxacin and others.

"Well, Director Lu, this Liu Chunhua's condition is a hospital-acquired abdominal infection. In the absence of a drug susceptibility test, meropenem should be used for empirical anti-infection treatment." Wu Xie nodded back, and then added.

"It is clearly written in the guidelines for the diagnosis and treatment of abdominal infection-when the initial empirical treatment is used.

"For patients with mild-to-moderate community-acquired intra-abdominal infection, it is recommended that moxifloxacin, cefoperazone-sulbactam, and ertapenem be used as single drugs for empiric anti-infection therapy, and cefazolin and cefuroxime be used as combined drugs. , ceftriaxone, cefotaxime, ciprofloxacin, levofloxacin combined with nitroimidazoles.

"For patients with hospital-acquired abdominal infection, it is recommended that carbapenems such as imipenem-cilastatin and meropenem should be used as single drugs for empiric anti-infection therapy, and third-generation drugs such as cefepime and ceftazidime should be selected as the combined drug regimen. Cephalosporins combined with nitroimidazoles."

Wu Xie's answer was an explanation of why Meropenem was used, but it also showed everyone his powerful knowledge reserve, like a walking guide library.

Lu Junyin went to lift off the thermal insulation foil of the barbecue, and solemnly said to the others: "In the future, everyone in our department must know the guidelines for the diagnosis and treatment of infectious surgery."

"Xiao Wu, post the corresponding guide in the group later, I will print it out and post a copy in the department."

A good memory is not as good as a bad pen. Even if you know everything well, occasionally the speed of recalling the memory is slow and inaccurate. Since the department is going to transform into infection surgery in the future, the corresponding guidelines must be clear, which is the most basic requirement.

"Okay, Director Lu." Wu Xie quickly issued some medical orders, but as soon as they were opened, Wu Xie laughed.

The conditions in the town hospital are still too poor. This patient needs to be given parenteral nutrition of amino acids, but this is not available in the hospital, so a gastric tube must be inserted as soon as possible and enteral nutrition can be given as soon as possible.

If it is in the county people's hospital, there is no such restriction.

Of course, nothing can be requested, so after writing the doctor's order, Wu Xie suggested when walking towards the spread barbecue pile: "Director Lu, our hospital should introduce some enteral and parenteral nutrition medicines."

"Because infected patients are all high-wasting diseases, we can use the Nutritional Risk Screening Scale or the Critically Ill Patients Nutritional Risk Scale to evaluate the nutritional status of all patients with abdominal infection when they are admitted to the department."

"Because patients with abdominal infection need to fast for a period of time."

"If there is a risk of malnutrition, early nutritional therapy with enteral or parenteral nutrition can improve its prognosis. For patients with abdominal infection who can receive gastrointestinal feeding, early (within 24-72 h) administration of enteral nutrition should be considered. Internal nutrition therapy: Parenteral nutrition therapy should be given as soon as possible to patients with abdominal infection who cannot receive gastrointestinal feeding or are intolerant to gastrointestinal feeding; if enteral nutrition alone cannot achieve the target energy supply, combined parenteral nutrition can be used for treatment. "

Lu Junyin listened and nodded seriously: "Okay, I will tell the purchasing office and the pharmacy that we must have these things."

"We also have to report the type and quantity of antibiotics in our hospital, and the hospital will complete the joint collection with the county health committee as soon as possible."

"Then bring over some of the collectively purchased medicines that have not been used up by other hospitals this year!"

Although Wu Xie's words sounded like pretentiousness, Lu Junyin felt very at ease when he heard it. Everything was well-founded, so he was not afraid of trouble, even if it was an unclear diagnosis and treatment process, and there was no way to reason if something happened.

The diagnosis and treatment process is clearly explained. Even if an uncontrollable accident occurs, the responsibility of the department is very small.