I Spent Those Years In the Operating Room Fighting Monsters

Lu Cheng glanced at Cao Xiaohe and said nothing.

Fang Nixin glared at him, Cao Xiaohe shrank his neck in fear, probably because he remembered the days when he was dominated by Fang Nixin, and he was a little scared, so he added: "I'm not looking at everyone's mood. That's right, just kidding everyone."

"Now the patients in our group are not easy to handle."

Lu Cheng nodded.

From the descriptions of the doctors in charge of the bed just now, Lu Cheng also has a general understanding of the current patients, but it is definitely not enough just to hear it.

After checking the conditions of all the patients, Lu Chengcai really understood how complicated all the patients are now.

Bed 1: Bacterial infection, non-union wound, bone defect, and deep vein thrombosis in both lower extremities after debridement of polyarticular tuberculosis.

2 beds: septic arthritis, multi-resistant infection, variable resistance to multiple antibiotics, hypertension, diabetes. Current blood sugar control is poor.

3 beds, after sinus surgery, the infection is still uncontrollable, and there is a lot of exudate from the wound every day.

Bed 4: Multiple closed fractures, intermittent AV block, all drunk.

5 beds and 6 beds are in good condition and ready to be discharged.

7 beds are ready to be transferred to the fourth department of orthopedics.

8 beds, fractured femoral neck, and sleep apnea syndrome. Blood oxygen levels are poorly controlled.

9 beds, infected after multiple amputations, and the current treatment status has not yet been determined.

10 beds, refractory postoperative infection.

11 postoperative patients, delirium.

The last patient is a 12-bed, 12-bed situation, which is a little more special.

Ugh!

After sorting out the basic situation of the patient in bed a little, Lu Cheng had the idea of ​​escaping deep in his heart. However, this kind of thinking is just a thought.

While Lu Cheng, Fang Nixin and others were struggling, Professor Qu Hongsheng came to the doctor's office and shouted, "Go, go to the ward round."

Qu Hongsheng gave an order and everyone stood up. Then he followed Qu Hongsheng to the patient in charge. Although Qu Hongsheng intends to be a hands-off shopkeeper, today is the first day. As a professor leading the group, he will definitely have to lead Lu Cheng in the department for at least one or two months before he can fully let Lu Cheng perform operations on all patients in the main department. Way.

It may not be enough for two months, but at least some routine and simple operations can be given to Lu Cheng to do.

Qu Hongsheng thought about it carefully, and decided to pick and choose the patients before pulling them into the department.

The group filed into the 1-3 bed wards.

Although today is the beginning of the month, it is not a Monday. Ji Pei and the doctor in charge of the bed have rotated the departments, but the interns have not rotated. So the scale is not very large.

It is already the beginning of November, and the annual postgraduate examination is in December. Basically, several affiliated hospitals of Xiangya Medical College give interns a holiday from November 1 until the postgraduate entrance examination is over.

The 1-bed patient was built by Xie Jian.

After entering the ward, Xie Jian said: "Mr. Qu, this patient is a multi-joint tuberculosis patient. The joints infected with tuberculosis include bilateral hip joints and right knee joints. At present, only the debridement of the left hip joint has been done. Today It was the fourteenth day after the first operation."

"On the sixth day after the first debridement, the wound oozes blood and exudate, and the exudate is light yellow purulent exudate. Escherichia coli was cultured in the pus."

"On the second day after the purulent exudate was found, a second debridement was performed, and continuous irrigation and drainage were performed after the operation. The most recent bacterial culture was three days ago, that is, on October 27. , the result of the culture is still Escherichia coli."

"However, the latest bacterial culture result, cefazolin, which was still sensitive before, has developed drug resistance. This is the bacterial culture result I printed out. Please take a look."

Xie Jian reported the patient's past medical history in great detail, and then glanced at the patient's wound at the same time. The irrigation and drainage tube running through the left joint up and down was smooth, and no liquid leaked from the skin at the entrance and exit.

Qu Hongsheng glanced at the checklist of bacterial culture drug susceptibility results, then glanced at Xie Jian, and asked, "Your name is Xie Jian? Is it a graduate student or a regular training?"

Today is the first day of admission, and it is Tuesday. According to reason, it should be the operation day of the Qu Hongsheng group. However, there are currently no new patients in the group, and the preoperative patients are not suitable for surgery for the time being. Therefore, Qu Hongsheng Want to come to a teaching ward round.

Take Lu Cheng et al. and the doctor in charge of each bed to sort out all the patients in the department. By the way, he can also grasp the situation of the patients in his group in more detail.

Before, he had an associate professor to help him, but now he is the superior of Iron Ding. He wants to scold people, but it is not so easy to scold.

Teaching ward rounds naturally has the appearance of teaching ward rounds. Qu Hongsheng has been away from the clinic for many years, but he has been teaching, so he still knows how to do teaching ward rounds.

Xie Jian was stunned for a moment, then his face darkened, and he quickly said, "Mr. Qu, I am a student of Mr. Chang Weilong Chang in the fourth ward of the Orthopedics Department."

Although Chang Weilong is the deputy senior of the fourth ward of the Orthopedics Department, outsiders can call Professor Chang, but Xie Jian still mentioned his full name, for fear that Qu Hongsheng might not know his teacher.

Qu Hongsheng really didn't think of it. When Qu Hongsheng was still in clinical practice, Chang Weilong estimated that he was just a graduate student. At that time, the graduate students didn't need to rotate every department like the current graduate students, so Qu Hongsheng really didn't listen. Too often Willon.

Even if they met sometimes, he didn't remember each other's name.

Xie Jian's heart was a little messy. Mom, he knew right away that I was a graduate student of orthopedics.

Isn't that a sure question?

"Orthopedics?" Qu Hongsheng was quite surprised, Oh Huo, the first person was from our orthopaedic department, so he could just use it for beating and beating.

Qu Hongsheng glanced at Lu Cheng and others, and found that Lu Cheng, Fang Nixin and others were expressionless.

Then he turned his eyes back to Xie Jian: "Then why do you think this patient has Escherichia coli? Why should the left hip be done first, instead of choosing the right hip or the right knee? What about the joints?"

Xie Jian's pupils narrowed slightly.

This question is a bit deep, Teacher Qu.

However, Xie Jian still closed the notebook in his hand, then blinked and said: "Patients infected with tuberculosis have lower resistance, so bacteria in other places, such as Escherichia coli normally existing in the intestines. The bacterial spores may penetrate the protective barrier of the colon's conjunctiva and enter the bloodstream."

"And then settle in places where the TB infection is less resistant."

Xie Jian made an answer based on his own understanding based on some basic knowledge reserves he reviewed during the postgraduate entrance examination.

Naturally, he was still looking at Qu Hongsheng's expression when he answered.

Qu Hongsheng nodded, indicating that Xie Jian's answer was not bad, and it seemed that he had read the book seriously.

As a graduate student at the Second Xiangya Hospital, Xie Jian must have defeated a bunch of opponents before entering the hospital.

Xie Jian looked at Qu Hongsheng and nodded, his heart eased a little, and then he said with a little confidence: "The reason why I chose the left hip joint is because the patient currently has three major joints with tuberculosis infection."

"And if one of the right hip or right knee joints is done, the other joint still has lesions, and the patient is still unable to stand. If the lesions on the right side are removed, if the patient recovers properly after surgery, he may be able to use crutches. With the help of , I walked down the ground."

Xie Jian considered that the possibility of this reason is the greatest. After all, the choice of surgical method should also be selected according to the actual situation of the patient.

Qu Hongsheng listened and nodded. Then continue to look at Xie Jian.

Xie Jian's pupils shrank again, and he thought to himself, I have finished speaking? Teacher Qu, according to the script, shouldn't you go to someone else?

"Mr. Qu, that's all I know." After Qu Hongsheng stared at Xie Jian for more than ten seconds, Xie Jian confessed and immediately lowered his head to admit his mistake.

Anyway, it is definitely not wrong to admit it at this time.

Qu Hongsheng didn't embarrass Xie Jian: "The rest of you, do you have anything to add?"

Because Qu Hongsheng was not very familiar with other people, he didn't want to be embarrassed one by one, so he simply asked the past.

Cao Xiaohe looked at Lu Cheng and Fang Nixin, while Fang Nixin and Lu Cheng looked at Cao Xiaohe.

Fang Nixin also touched Cao Xiaohe's elbow. The other two people who were not orthopaedic were shivering, their expressions fully expressed their attitude, we are just tool people, this is too difficult!

Too professional to cut?

Cao Xiaohe scolded Lu Cheng and Fang Nixin for looking down on others, who is the best? I won't say it first.

At this time, it is whoever is the one who expresses his opinion first, and it is the charge.

Qu Hongsheng then also looked at Cao Xiaohe: "Does Xiao Cao have something to say?"

Cao Xiaohe twitched the corners of his mouth a few times, then stood up and said, "Professor Qu, in addition to colonizing the joints through blood, Escherichia coli may also colonize locally through the outside world. Because the patient's three joints are currently affected by movement. There are bound to be inconveniences in unwinding.”

"Another reason is that after we applied antibiotics before and after surgery, the flora in the field was disturbed, which may make Escherichia coli become the dominant flora and multiply in large numbers, and the application of a large number of drugs will lead to intestinal mucosa. destruction."

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"Escherichia coli and its secretions may enter the blood circulation through the intestinal mucosa, and then settle locally in the wound."

"The fourth reason is that the tuberculosis bacteria infected in the joints before the operation may be transplanted into the intestines, causing intestinal tuberculosis, and then bringing Escherichia coli into the surgical wound."

"That's what I think about why there's an E. coli infection."

After Cao Xiaohe said this, not only Qu Hongsheng, but also Lu Cheng and Fang Nixin were taken aback.

Oh, this Cao Xiaohe has been in Kyoto for a few months, and he has improved so much. What has he experienced and learned in Kyoto?

Looking at it this way, Cao Xiaohe's current knowledge reserve is not low. He is not lying, he really learned a lot in Kyoto, but maybe a little less than what Lu Cheng and Fang Nixin learned.

However, learning this thing also needs to talk about the basics in the early stage. The foundations of Lu Cheng and Fang Nixin are better than Cao Xiaohe.

Cao Xiaohe glanced at a few people and continued: "The tuberculosis of the hip joint may spread to the knee joint through the muscle space and cause knee arthritis."

"The reason why the right knee joint is not done first is because the tuberculosis bacteria in the right knee joint and the right hip joint can also spread down through the original channel, resulting in a persistent source of infection. If the right knee joint is to be done first If so, I can only do the right hip first.”

"And the reason why I chose the left hip joint from the left and right hip joints, in addition to the reason Xiao Xie just mentioned, there are three reasons."

"First, to avoid TB in the left hip, it spreads down again through the hidden gap in the hip and knee joints, again causing arthritis in the left knee."

"Second, the muscle strength of the patient's left side is better. If the left lower limb is treated as soon as possible, it will be more conducive to the recovery of activities and the preservation of function."

"Third, there is no bone defect in the left hip joint for the time being, so it is more likely to preserve the function of the left side first. The operation is simple, and the effect and expectation of postoperative recovery are better."

After Cao Xiaohe finished speaking, he blinked a little and became much smarter, and replied, "Mr. Qu, that's all I can think of for the time being."

Xie Jian glanced at Cao Xiaohe and felt a little bitter in his heart.

Speaking of which, Xie Jian knew before that Cao Xiaohe was not actually a graduate student in orthopaedics before, but a graduate student in the emergency department, but he was transferred from the emergency department when he was going to study for Li Dongshan's graduate student by accident. orthopedics.

Belonging to the halfway home.

And Cao Xiaohe's contact with orthopedics only started this year. Although it is a little longer than his Xie Jian, the long time will not be much longer, and Cao Xiaohe is so powerful in such a short time. He found so many clues from places he didn't expect.

It really made Xie Jian feel unbelievable.

"Yes, the answer is very good. You explained it in such a detailed manner that even a little bit makes me feel very novel." Qu Hongsheng smiled and did not shy away from it.

In fact, what Cao Xiaohe said, Qu Hongsheng never thought about it before, just thought of other reasons.

However, Qu Hongsheng still looked at Fang Nixin and Lu Cheng, and asked, "Do you two bosses have anything to add?"

Now there is no attending doctor and no associate professor, so Lu Cheng and Fang Nixin can only be used as the attending doctor and vice-high professor.

Fang Nixin said: "Professor Qu, the treatment of joint tuberculosis began in the 1960s and 1970s. Generally speaking, when multiple joints of the same limb are infected with tuberculosis, the more upstream joint surgery is selected."

"If there is joint tuberculosis on both sides, choose the side with the least involved joint for surgery first."

"It's evidence-based medicine."

Fang Nixin's words directly summed up all the benefits.

The corners of Cao Xiaohe's mouth trembled.

I TM, said so much, is it actually nonsense?

"Yes. Not bad, Xiaofang Expo Group Literature." Qu Hongsheng nodded, indicating that he was satisfied with the answer.

No matter what Xie Jian or Cao Xiaohe said, they are all personal speculations based on existing knowledge, only their own speculations, without taking into account the evidence of evidence-based medicine.

Evidence-based medicine, but graded. Even the opinions of experts and the opinions in the guide book have only the third level of credibility. Compared with the support of a large amount of objective data, whoever thinks that it is actually useless.

Fang Nixin's face was expressionless. Fang Nixin had already read this classic document, and she was not proud of it.

Lu Cheng glanced at Fang Nixin, because Fang Nixin showed him this document, thinking that it was not for Cao Xiaohe, or it was for Cao Xiaohe, but Cao Xiaohe didn't read it.

Joint tuberculosis, this itself is a hard stubble, or multiple joint tuberculosis and infection, which is not easy to deal with...Click to download the APP of this site, massive novels, free to read!