Chapter 382 Can I really give it a try?!

"Well, it was in the afternoon when you were going to teach the graduate students and the resident trainees. We got together and had a casual chat. Mainly we talked about the issues that we can come into contact with." Dong Zhen said a little shyly

explain.

She may still feel that compared with geniuses like Zhou Linli and Peng Shanquan, there is still a gap between her and them, and she has not had time to adjust her mentality.

Lu Cheng smiled casually and picked up a large pile of medical records in his hand. Dong Zhen looked at them and helped Lu Cheng move a few stacks.

Lu Bencheng didn't plan to ask Dong Zhen for help. After all, these discharge medical records were really important. When Lin Hui was still there, he always heard Lin Hui say that life in the general hospital was not easy, but he could only truly understand it.

, I realized that all kinds of things in the general hospitalization are really too complicated, and I have to pay attention to everything.

It is not an easy task to say that these discharge medical records require final quality control. Medical record archiving is a summary of all the medical processes during a patient's hospitalization. It is not just for examination and explanation to the patient.

A good discharge medical record can also become a source of material and data for subsequent retrospective research.

Only studies and papers with basic data can withstand verification.

"Teacher Lu, it's okay. Let me help you a little. In fact, when I see you doing things, I can't bear to disturb you. But we all feel that it's a bit uncomfortable to bring the problem back." Dong Zhen followed Lu

After he grew up, he said it.

Lu Cheng nodded, and then took Dong Zhen into the demonstration classroom.

In the demonstration classroom, Lu Cheng saw six people. In addition to Xie Jian, Zhou Linli and other people whom Lu Cheng knew, there were also two unfamiliar faces, but judging from their badges, they seemed to be interns. They were probably interns.

People found by Zhou Linli and Peng Shanquan.

After Lu Cheng entered the door, Zhou Linli took the initiative to come up and help Lu Cheng put down the medical records, and then said: "Teacher Lu, I'm sorry, I must have disturbed your work, right?"

It can be seen with the eyes that the medical records in Lu Cheng's hands are very important, and quality control of medical records is something that the chief residents of each department have to do when they are interns in each department. Of course, some departments are more lazy.

The boss will hand over the quality control of medical records to professional doctoral students, because one of the graduation requirements for doctoral students is to serve as a general resident for eight months.

But the problem is that there are no doctoral students in the department where Li Dongshan is currently located.

Every year, the Second Xiangya Hospital has only a few places to train doctors, and there are actually not many doctors.

Lu Cheng casually put his hands on his hips and twisted a little and said: "It's okay, no need to be so polite. I'm curious. You guys asked Dong Zhen to call me over. What's the problem? Don't embarrass me.

Ah, to be honest, before I came to the Second Xiangya Hospital, I was just an undergraduate. Except for orthopedics, which I can give you more answers to, don’t embarrass me with questions from other departments.

"

Lu Cheng is telling the truth. If these interns mythologize him because of his reputation and think he is omnipotent, if they ask him questions other than internal medicine or orthopedics, just vascular surgery and neurosurgery.

Lu Cheng can deal with the problems, but Lu Cheng probably can't even touch the problems in the internal medicine department, as well as the problems outside the internal medicine and surgical departments.

There are specialties in medicine, but in terms of comprehensive knowledge and ability in all medical disciplines, Lu Cheng can't even match Fang Nixin's back.

So for people like Fang Nixin and Zhou Linli to be perverts, it wouldn't be shameful for Lu Cheng to beg for mercy.

"No, no, Teacher Lu."

"We just had a casual chat, and then we found out that there are more infection cases in trauma and general surgery than other patients. Then we briefly summarized the patients currently in the hospital, and we also

It was found that among these infection cases, there were also extremely many cases of recurrence and multiple infections while in the hospital."

"Then we discussed that all trauma patients were debrided when they were admitted to the hospital, and then after they became infected, they were still debrided. However, it may require multiple debridements before the final result can be achieved.

Treat the infection, why?"

"Teacher Lu, think about it, during the initial debridement, no matter how bad the patient's own wound is, there will be fewer bacteria than the infected patient's wound, right?"

"Then why can't the debridement be more thorough during the initial debridement?"

"During the initial debridement, where are the bacteria or foreign objects hiding? Is it all because the local resistance of the wound is weakened, and then bacteria from other places colonize the wound through blood circulation?"

"If this is the case? Then how should we define bacteremia?"

Lu Cheng frowned when he heard this series of questions.

As expected, the top students are really top students. They ask questions that cannot be found in textbooks and cannot be thought about in ordinary clinical practice.

To sum up, their problem is actually such a contradiction.

Why do infections occur after trauma?

Why do infected cases recover after debridement?

This question is no ordinary question!

Lu Cheng frowned slightly, and after thinking for a while, he said: "Not all trauma patients are infected, and patients who are infected after one or two debridements are not cured. There are many factors involved.

It’s over.”

"First of all, whether a person is infected or not has a great impact on whether the trauma they received is open, whether there is extensive soft tissue damage, and whether there is blood supply."

"We need to know first why preventive anti-infective treatment is needed."

Lu Cheng, who has top debridement skills, although he found the question difficult, he still gave his answer very calmly. Of course, the answer should not be answered randomly. Of course, he should start from the basics, and then slowly extend and

Distribute.

"The reason for preventive anti-infection is because of the risk of infection. The risk of infection mainly comes from two aspects. One is that open trauma may be infected by bacteria that may exist in the air and various places. In this aspect, we need to pass

Thorough debridement to solve and treat the disease and reduce the risk of infection is also the biggest reason why we need surgical intervention."

"The second aspect is that infection is caused by trauma that weakens local resistance, and then bacteria from other places migrate here to settle and multiply, leading to post-traumatic infection. Once this does not happen, we can prevent it

The sexual anti-infection effect is achieved because we preventively kill bacteria that may be latent in the blood or remain locally by injecting antibiotics.”

"However, antibiotics are not necessarily a panacea. According to our experience in treating infections, the main factors in surgical treatment of infections are as follows: First, thorough debridement. Second, strict aseptic principles during surgery

.Third, bacterial culture and use of sensitive antibiotics. Fourth: Adequate and appropriate course of antibiotic use.”

"Then, the factors that cause trauma infection may be that the type of antibiotics we use for prophylaxis is not the antibiotic that latent bacteria are sensitive to, or the amount of antibiotics used is not enough, which leads to infection. It may also be local blood circulation damage.

If it is too severe, our blood circulation cannot carry the antibiotics we use to the areas where bacteria lurk."

"The last point is the biggest enemy we encounter in surgical trauma. Once the injury is too severe, the body cannot heal itself, blood blockage, or embolism of small arteries and veins may prevent the drugs we use from reaching it.

The destination is equivalent to wasting it in vain."

"As for what you said, the reason why infected patients can be cured through debridement is that the first is thorough debridement, and the second is that long-term wound closure allows scar healing and small blood vessels and blood to be formed inside our bodies.

The reconstruction of the circulatory system and multiple adjustments of sensitive antibiotics brought the infection under control."

"What do you think?" Although Lu Cheng gave an answer, he did not say that this was definitely right.

When speaking and teaching with people who have sufficient knowledge reserves, even students, try to ensure the sustainability of the topic. If you talk too much all at once, the other party will not dare to express it even if they have ideas.

Moreover, there are actually not many geniuses in this world, and they are found in all aspects. Especially in today's developed society, it is an era where talents are emerging in large numbers!

Zhou Linli glanced at Dong Zhen and others, and then said: "Teacher Lu, I have carefully thought about your explanation just now, and I know that this is the best explanation that can be found so far. It's just, how many of us have

During the discussion just now, I had such an idea."

"Our body, especially in orthopedic trauma, has many muscles that run differently, and between each muscle, there is a muscle gap. Will this gap between muscles become the first or second time?

A hiding place for infectious bacteria?”

"Or, will it become a hiding place for wandering transplant bacteria?"

"Because wounds are random, bacteria are invisible and highly mobile. If we can perform very strict and standard debridement on every muscle gap after the trauma, or when debriding again,

If we pay attention to these muscle gaps, will it greatly reduce the chance of reinfection?"

"You see, the main course of small blood vessels is towards the muscles. The intermuscular space is the blind spot of the blood vessels. Our antibiotics can reach the furthest place inside the muscles through blood circulation."

"This is also our idea after considering that the number of infected patients after joint trauma is more than that of ordinary trauma patients, and it is more difficult to heal if the infection occurs. It is because there are almost no blood vessels running in the joints, our antibiotics

It is difficult to reach. So we speculated that the bacterial latent spots of patients with ordinary trauma are also in similar blind spots."

While Zhou Linli was talking, he was still drawing pictures in his notebook.

In fact, why do they need to draw pictures?

After listening to this, Lu Cheng felt that Zhou Linli and others were not simple. Such an analogy was well-founded and very novel. It was a very possible guess and conjecture.

However, after listening, Lu Cheng frowned slightly: "What you are thinking is not impossible. It's just that the movement of muscles is complicated. There are so many muscles in our bodies. If we are injured,

, if we just clean up all the surrounding muscle spaces, wouldn’t the workload be too much?”

"Moreover, will it cause more unnecessary damage? Will it also allow latent bacteria to go to more places and increase the infection area?"

This was something Lu Cheng considered, and it was also the drawback of the idea itself.

Bacteria are invisible, and no one knows where they will go. If you really follow what they said and turn out all the muscle spaces of trauma patients for debridement, the idea is good. But every few muscles constitute a different

Muscle spaces, their components, it is almost impossible to search for these muscle spaces one by one, or to reconstruct the possible spaces of these muscle spaces in the mind.

Moreover, if you clean the muscle space too much, you may expand the scope of infection even more if you are not careful. In this way, it is a thankless job.

After all, the clinical experience of Zhou Linli and others is still shallow, so after hearing what Lu Cheng said, they frowned deeply. Most of them discussed this idea, what are the advantages, and what are the analogies?

place, but I haven’t thought deeply about its disadvantages and practicality.

After speaking, Lu Cheng saw the expressions of Zhou Linli and others, and suddenly smiled and said: "But your idea is still very good, because although we cannot deeply examine every possible muscle gap, we can do trauma

The superficial debridement of the muscle space within the wound does not require deep peeling. In this way, our workload will be much less."

"Moreover, the operability is also very strong. But this requires more energy to perform micro-manipulation of the muscle space and strictly control the direction and angle of the scalpel. Such an operation is not simple to implement.
To be continued...