Great doctor starts with adding points

"Director Fu, I have no other choice, so I have no choice but to agree. I hope I didn't cause you any trouble, right?" Wu Xie felt that his professional ability still needs to be improved.

I went to a few consultations today, but was pushed by some directors of other surgeries to the point where Wu Xie was asked to perform a teaching operation on an infected patient.

Moreover, these directors are quite enthusiastic and prepared, and they have greeted the hospital's medical department in advance.

During Wu Xie's consultation, after analyzing the medication and so on, they realized that what they have to consider now is not how to prevent infection, but let Wu Xie teach them how to solve the problem of infection that has already occurred.

And ah, these people are very shameless, they have prepared a lot of things in advance, just waiting for Wu Xie to enter the pit.

Once Director Fu Jinjin of the Department of Orthopedics agrees, patients can come to the hospital at any time.

Well, it was an infected patient from a private hospital in the city, and the infected part was after orthopedic surgery.

Fu Jinjin also had nothing to say: "People are shameless, what else can we do?"

"Is your hand okay? If it's inconvenient, I'll ask Professor Zhou Xiaoning to come over and help."

A group of shameless old directors deliberately dug holes for Wu Xie, and the hospital also agreed to such a formulation in order to reduce the infection rate and cure rate in the hospital. What can Wu Xie do?

Wu Xie shook her head: "No need, Director Fu, my hands are almost ready."

"It shouldn't cause any trouble to the department. This is a patient transferred from another hospital."

"But the procedures are complete." Wu Xie explained.

Fu Jinjin nodded and said, "It's okay, I'll just go to them and collect tuition fees. I really didn't expect them to be so shameless——"

In the operating room, the patient has been anesthetized by the anesthesiologist on the operating table. Because the scope of the operation is relatively wide, general anesthesia is given.

However, when Wu Xie went to the operating table, he saw that the patient's right lower limb, from the thigh to the ankle above the calf, had surgical scars and incisions, like a graceful dragon swimming, and the water inlet and outlet pipes of the drainage tube were buried in the skin. .

This is a fresh surgical incision, and the old surgical scar, dark!

It's like a few huge centipedes clinging, it's a little shocking to see.

At this time, Huang Yaolong and Guan Yun and Cao Zhiyuan were preparing to pull out the drainage tube and complete the disinfection operation before debridement.

In addition to Huang Yaolong and Guan Yun Cao Zhiyuan, there was another person who was an orthopedic surgeon in a private hospital, and seemed to be the deputy chief physician.

Wu Xie and Fu Jinjin came to power at the same time.

"Director Quan, you said earlier, where are the patient's drainage tubes placed?" Wu Xie couldn't remember clearly, or maybe Quan Hongxing didn't describe clearly before.

"The side of the thigh and calf. The thigh is through the quadriceps gap, and the calf is through the tibia gap." Quan Hongxing replied professionally.

"Doctor Wu, is there a problem?"

Wu Xie shook his head: "I'll just ask casually."

In front of so many people, Wu Xie naturally wouldn't tell the truth in his heart. There is a problem, but there is no problem, it's just that their cognitive levels are different.

Wu Xie stood at the main operator's seat, and after each put on double-layer gloves, he said, "Teacher Tour, our hospital should have a large saline bag for sports medicine. This patient needs a lot of water for washing. Go get a few bags, so that you don't get your hands dirty when you open the normal saline solution for washing."

The small bottle of normal saline is only 500ml, and the large one is 3,000ml. It is very convenient to connect multiple bags at the same time.

In severe infection surgery, thorough debridement and thorough lacuna flushing are particularly important.

Fu Jinjin was afraid that Xun Xun would find Wu Xie unfamiliar, so he immediately repeated: "Xu Xun, go get the flushing gun and the flushing tube, I didn't think of it before."

Tour responded quickly.

At this time, a lot of people from the surgery department came to see it. It would be unacceptable not to give Wu Xie enough face, it would be embarrassing.

When preparing these things on tour, Wu Xie had already led people to start the exposure work, and the wound was a bit big. This can be said to be the biggest wound since Wu Xie underwent surgery.

From the proximal end of the femur to the distal end of the tibia, the surgical incision is as long as the entire lower limb. It is estimated that it will take two hours to suture...

There was a surgical incision before, so Wu Xie didn't make another incision, but went down along the original surgical approach.

There is nothing special about this process at all. The original incision is opened, that is, the sutures are cut, and the exposure process is quite satisfactory, and no tricks can be made.

This kind of operation made them feel that Wu Xie's level was like this?

This seems to be a bit sorry for his current reputation in the hospital?

Moreover, after the opening was exposed, Wu Xie still completed the debridement operation step by step. Debridement is nothing more than cutting the necrotic tissue and the rotten tissue on the surface of the infected muscle, scraping it off, and completely removing it. This is the most basic. In principle, there is nothing to see.

Coupled with the washing with a washing gun and the soaking of multiple dilutions of complex iodine, the re-exposed wound surface is not surprising. Wu Xie's operation is not fast. It took about an hour to complete the surface debridement , a normal surgical rhythm.

Seeing this, Quan Hongxing said: "Doctor Wu, can the incision be closed now? I think the parts that should be debridement have been cleaned up."

But Wu Xie shook his head: "Director Quan, don't rush to close it for the time being. This is just the most basic debridement, and there are still some latent cavities that we haven't opened. If they are left untreated, the patient's postoperative The chances of re-infection will still be higher."

"This operation has just begun." Wu Xie replied.

A case is the best teacher!

Wu Xie's current concept of surgical infectious disease is the medical school.

Quan Hongxing was a little embarrassed when he heard this, but still chose to respect Wu Xie's choice.

Just curious, what will Wu Xie do next.

However, immediately after, Quan Hongxing discovered that Wu Xie began to move the quadriceps muscles in strips from the proximal side of the thigh, carelessly pulled them apart, and, using blunt hemostatic forceps, continuously provoking something.

This is an operation on a single muscle. What is it for?

But soon, Wu Xie's manipulator gave Quan Hongxing an answer, and Wu Xie inadvertently exposed a milky white liquid the size of a grain of rice, which appeared to everyone. in front of the field of vision.

In the normal structure of the human body, there is no milky white color.

Muscle is red, even if it is rotten muscle, it is mostly dead milt, not milky white, fat is light yellow, and necrotic fat tissue is that kind of dry white.

Milky white is usually formed by emulsification after the infected tissue destroys the structure of normal tissue.

Can Wu Xie find this too?

"Doctor Wu, there are abscess cavities in this place, under normal circumstances, it is difficult to find it?" Quan Hongxing's expression became serious.

Although he is a physician in a private hospital, he has the title of deputy chief physician.

Don't underestimate the existence of this rice-grain-sized infection focus. With its existence, it will take another five days to refill all the infection focus that has been cleaned up before. This is not alarmist talk!

Behind Quan Hongxing, there was already a slight sweat oozing out!

If it wasn't for Wu Xie to discover such an infection focus, I am afraid that after the operation, the debridement effect this time?

"It's hard to find, but I have carefully read the patient's MRI before the operation, and I feel that there is almost an edema signal in this place." Wu Xie gave a reasonable explanation.

Yes, on NMR, there is a lot of information given out, so much that it is difficult for ordinary people to fully understand it.

However, this did not bother Wu Xie, who had expert MRI reading skills.

"Ah!~~~" Quan Hongxing felt a little embarrassed.

A group of people also moved towards the viewer curiously.

It was found on the NMR, why didn't I see it?

This was the first time that Quan Hongxing felt that Wu Xie could be so terrifying.

However, this was not over yet, and then, Wu Xie moved a little further down, and used the hemostat again to peel off the second milk, which was the size of a little fingernail.

Although it is milky white, it is like red, with white sticky substance hidden inside, and even scabs.

Wu Xie took it out and observed it in front of his eyes for a while: "This thing still has an envelope? Send a bacterial culture. I guess, this patient has multiple bacterial infections and has different bacterial sources."

At this moment, the scalps of Quan Hongxing and the others began to go numb.

Before that, they all felt that the operation of this operation should have been completely completed.

Wu Xie was also able to find the first infection focus, which may be due to luck and strength, but the existence of this infection focus sounded a wake-up call on their heads.

Perhaps, the reason why the infection will repeat is not an accidental event, but an inevitable event due to lack of strength!

However, how did Wu Xie discover such a hidden focus of infection?

Quan Hongxing's eyes intertwined with the other directors of the Minda Hospital standing outside the operating table, and they could see confusion and shock in their eyes. Quan Hongxing is the chief physician in charge of the patient. He doesn't have the time to question, but is afraid and reflective.

What I thought before was that I had done my best, but was it really my best?

So many infections, could it be because of my own ability?

However, how to find such a hidden focus of infection?

"Doctor Wu, is this also seen through MRI?" Ask if you don't understand, the big deal is to strip yourself more thoroughly and admit your shortcomings, which is not a shameful thing.

Because Quan Hongxing knows very well that if he is still ignorant in the field of orthopedic trauma surgery, then at least 90% of the doctors in the country are laymen.

It can only be that Wu Xie is too outrageous.

"Yes. There are actually a lot of information we can read on the MRI. If Director Quan is interested, we can discuss it next time, or after the operation is over, we can do a review of the scans." Wu Xie didn't reply proudly.

The first state of film reading is not to watch the film, but only to read the report, which is what most residents do.

The second state is to be able to see the problems of specialists. It belongs to the state that doctors in the imaging department cannot see it, but specialists can see it. It is separated from the report and only looks at plain films. This is the beginning of not being a film doctor.

The third state is to be able to see part of the anatomical structure, through the anatomical structure, to read the specialized diseases, abnormalities and abnormal places completely, and to speculate the diseases that should be based on the clinical. This is the strength that only many professors have.

If it goes further up, it will be a deeper level. Through the MRI, all the above contents can be read completely, which is equivalent to completely cutting the patient's lower limbs in front of the doctor, and constantly stripping and reorganizing them in the brain.

The size of the lesion, normal structure, and damage can all be read out completely.

This is not something that can be done by printed plain film. The microscopic level on the MRI can fully display the microvascular structure, but this is time-consuming and brain-intensive. Only the world's top-level film reading at this level Only experts in the imaging department and specialists can achieve it.

So, this can't be blamed on Quan Hongxing and others, the director of a prefecture-level city hospital. It's a bit embarrassing for them to need such profound strength.

People with such abilities will not only stay in prefecture-level city hospitals.

"Thank you, Dr. Wu!" Quan Hongxing replied without hesitation.

Of all the people in the operating room now, Quan Hongxing is the most stressed one. He is the director of the patient.

Originally, as the director of a private hospital, he had no status, but Quan Hongxing really wanted to prove that his profession was okay.

However, Wu Xie was defeated by Wu Xie again and again, and his Dao heart was a little loose.

Up to now, he had to be convinced, standing in front of Wu Xie like a child.

This is absolute strength, there is no skill at all, and Wu Xie is not trying to beat him, but just seeking truth from facts.

"Send this one for bacterial culture too," Wu Xie said.

The itinerant nurse also noticed something was wrong on the operating table, so she quickly called in another helper. She might not be able to handle this operation by herself.

I thought it was coming to an end.

However, Quan Hongxing and others still underestimated the degree of abnormality of Wu Xie, or underestimated the severity of this patient's infection.

The twelve hidden infection foci were searched out by Wu Xie from various places one by one. His actions were precise and not procrastinated, and the actions must be rewarding, with different sizes.

"Doctor Wu, is there any more?" Huang Yaolong, who was piously pulling the hook and constantly observing and studying, asked in a very respectful tone.

This is the first time Wu Xie has shown such oppressive force from a superior doctor in front of Huang Yaolong!

This operation is just debridement and suture.

Resident doctors can carry out, but their strengths are not the same.

However, Wu Xie gave him a painful blow in this most basic field!

It seems to be venting to him, the dominance from Wu Xie's era.

"No, the infection foci in this kind of cavity have almost been cleaned up. However, there should be some small infection foci in the periosteum of the joints and bone surfaces. This number is quite a lot. We have to find them carefully. Find it."

"Today I will probably stay in the operating room until very late at night." Wu Xie said helplessly.

"More? A lot?" Quan Hongxing despaired of her ignorance.

However, Wu Xie's words cannot be false. The re-discovery of so many infection lesions before is the best proof.

"It's not too much, it's just that it's very troublesome to clean up. After cleaning up all these things, it can be considered a complete debridement."

"After surgery, it is necessary to use antibiotics in combination, followed by continuous irrigation and drainage, so as to prevent the recurrence of infection to the greatest extent, but it cannot be absolutely avoided."

"It's too annoying to be infected with this thing."

"Drugs are very important, and debridement is also very important. It is even more important for drugs to reach the focus of infection." Wu Xie said.

This infection case is more interesting than anything Wu Xie encountered before.

Even Wu Xie didn't know how these directors of non-trauma surgery found this case.

And how did Quan Hongxing create such a special case.

But these are not important, since we met, and the hospital and Fu Jinjin both agree, Wu Xie will of course have to deal with it.

Otherwise, such a patient, if it wasn't for me, would probably go to the step of amputation very soon.

However, Wu Xie said cautiously: "Dear directors, I am not as professional as you in the theory of other surgical specialties, but I think the existence of infection, such a hidden abscess in the cavity, is a big influencing factor. "

"In fact, such abscesses can occasionally be found when changing the dressing, and it is also very important to injure them locally."

"This is a way of thinking about preventive anti-infection. Such a concept of preventive anti-infection is not only in the change of antibiotic types, but also in the operation."

"If you only rely on medication for preventive anti-infection, then this kind of thinking about infection prevention is relatively narrow. At least for orthopedic diseases, that's how I understand it."

"Intravenous medication, topical medication, and micro-movement debridement allow the drug to reach key parts and produce anti-infective effects. This is a concept that I prefer and respect at present."

"After these, when it comes to treatment, accurate diagnosis and identification of bacterial strains are more important factors."

"Before, when I was in Xuan County Hospital of Traditional Chinese and Western Medicine, I didn't..." Wu Xie stopped abruptly after saying this.

He felt that it was inappropriate for him to say that. He was still young, so it was not appropriate to pretend to be forced by the past.

Hearing Wu Xie's words ended in the middle, maybe a director of the general surgery department also understood what Wu Xie meant, and said, "Doctor Wu, it's okay for you to continue talking."

"We are actually very curious about how you carried out anti-infection treatment in the lower-level hospital before."

When the conditions are more primitive, Wu Xie can still cure many complicated infections, which is also a skill. And it's something everyone is curious about.

Only then did Wu Xie explain slowly: "Deliberate, ponder slowly, first find out the signs of infection, deduce whether it belongs to bacillus or coccus, and then after confirming the large area, use sensitive antibiotics empirically..."

"But in fact, this is not good, and it is not worth promoting. It is just an expedient measure. Our current unit is very good. The results of bacterial culture and drug susceptibility are returned in a timely manner. An ordinary microscopic examination can roughly determine the bacterial strain. Type of identity."

"I can always find antibiotics with corresponding effects and use them locally..." Wu Xie said slowly, dissolving the antibiotics in normal saline, and showing everyone how to use them locally...

It seems to be saying, I am invincible, so you can do whatever you want.