Chapter 423: Peeling off the cocoon!

Lu Cheng glanced at Cao Xiaohe and said nothing.

Fang Nixin glared at him, and Cao Xiaohe shrank his neck in fear. He was probably thinking of the days when he was dominated by Fang Nixin, and was still a little scared, so he said again: "I'm not looking at everyone's mood.

That’s right, I’m just kidding everyone.”

“It’s difficult to deal with the patients in our group now.”

Lu Cheng nodded.

Through the descriptions of several bedside doctors just now, Lu Cheng also had a general understanding of the current patients, but just hearing about them was definitely not enough.

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

Bed 1: Multiple joint tuberculosis debridement was complicated by bacterial infection, wound non-healing, bone defect, and deep vein thrombosis in both lower limbs.

Bed 2: Septic arthritis, multi-resistant bacterial infections, variable resistance to multiple antibiotics, hypertension, and diabetes. Current blood sugar control is poor.

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

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

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

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

Bed 8, fractured femoral neck, sleep apnea syndrome, poor blood oxygen level control.

9 beds, infection after multiple amputation, current treatment situation has not been determined.

10 beds, refractory postoperative infection.

11 postoperative patients became delirium.

The last patient was in 12 beds, and the 12-bed situation is even more special.

well!

After sorting out the basic situation of the patient in bed, Lu Cheng had the idea of ​​​​escape deep in his heart. However, this idea was just a thought.

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

Qu Hongsheng gave an order, and everyone stood up. Then he followed Qu Hongsheng to the patients in charge. Although Qu Hongsheng wanted to be the shopkeeper, today was the first day. As the leading professor, he must

It is still necessary to take Lu Cheng into the department for at least a month or two before he can fully allow Lu Cheng to perform surgeries on all patients in the main department.

It is possible that two months is not enough, but at least some routine and simple surgeries can be left to Lu Cheng.

Qu Hongsheng thought carefully and decided to pick out the patients before bringing them to the department.

The group of people filed into the ward with beds 1-3.

Although today is the beginning of the month, it is not Monday. The regular training and bedside doctors have rotated departments, but the interns have not rotated. So the scale is not very large.

It is already the beginning of November. The annual postgraduate examination is in December. Basically, several affiliated hospitals of Xiangya Medical College will give interns a holiday starting from November 1st until the end of the postgraduate examination.

The patient in bed 1 belongs to Xie Jian.

After entering the ward, Xie Jian said: "Teacher Qu, this patient has polyarticular tuberculosis. The joints infected with tuberculosis include bilateral hip joints and the right knee joint. Currently, only the left hip joint has been debrided. Today

It’s the fourteenth day after the first surgery.”

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

"The day after the purulent exudate was discovered, a second debridement was performed, and irrigation and drainage were continued after the operation. The latest bacterial culture was three days ago, that is, on October 27th.

, the culture result is still Escherichia coli.”

"However, the latest bacterial culture results show that cefazolin, which was sensitive before, has become resistant to the drug. This is the bacterial culture result I printed out. Please take a look at it."

Xie Jian reported the patient's past medical history in great detail, and then took a look at the patient's wound. The irrigation and drainage tubes running up and down the left joint were unobstructed, and no fluid leaked from the skin at the entrance and exit.

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

Today is the first day of admission, it is Tuesday. Logically speaking, it should be the surgery day for Qu Hongsheng’s group. However, there are currently no new patients in the group, and none of the pre-operative patients are temporarily suitable for surgery, so Qu Hongsheng

I want to come for a teaching round.

He took Lu Cheng and others and the doctors in charge of each bed to sort through all the patients in the department, so that he could have a more detailed understanding of the conditions of the patients in his own group.

He had an associate professor helping him before, but now he is the only one who is Tieding's superior. He wants to scold others, but it's not that easy to scold him.

Teaching rounds naturally looks like teaching rounds. Qu Hongsheng has been away from clinical practice for many years, but he has been teaching, so he still knows how to do teaching rounds.

Xie Jian was stunned for a moment, then his face darkened, and he quickly said: "Teacher Qu, I am a student of Teacher Chang Weilongchang from the Fourth Ward of Orthopedics."

Although Chang Weilong is the deputy chief of the Fourth Ward of Orthopedics, outsiders can call him Professor Chang, but Xie Jian still gave his full name, for fear that Qu Hongsheng would not recognize his teacher.

Qu Hongsheng really didn't remember that when Qu Hongsheng was still in clinical practice, Chang Weilong probably just went to graduate school. At that time, graduate students didn't have to rotate in each department like graduate students now, so Qu Hongsheng really didn't listen.

Very Weilong.

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

Xie Jian's heart was a little confused. Oh my god, now he knew that I was a graduate student in orthopedics.

Doesn’t this definitely lead to questions?

"He's from the orthopedics department?" Qu Hongsheng was quite surprised, oh, the first person is our orthopedics department, and he can be used for knocking.

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

Then he returned his eyes to Xie Jian: "Then why do you think this patient has Escherichia coli? Why do you want to do the left hip joint first, instead of choosing to do the right hip joint or the right knee?

Where are the joints?”

Xie Jian's pupils narrowed slightly.

This question is a bit deep, Teacher Qu.

However, Xie Jian still closed the cover of the notebook in his hand, then blinked and said: "Patients infected with tuberculosis have reduced resistance, so bacteria from other places, such as Escherichia coli that normally exist in the intestines,

The bacterial spores may penetrate the protective barrier of the large intestinal conjunctiva and enter the bloodstream."

"Then they arrive and settle in areas infected by tuberculosis bacteria with weak resistance."

Xie Jian relied on some basic knowledge he had reviewed during the postgraduate entrance examination and answered based on his own understanding.

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

Qu Hongsheng nodded, indicating that Xie Jian's answer was pretty good and he seemed to have read the book carefully.

As a graduate student at the Second Xiangya Hospital, Xie Jian must have defeated a lot of opponents before entering the hospital. He has no skills and has not read the books.

Xie Jian watched Qu Hongsheng nod, and felt a little relieved, and then said with some confidence: "The reason why I chose the left hip joint is because the patient currently has tuberculosis infection in three major joints."

"And if one of the right hip or right knee joints is repaired, there is still a lesion in the other joint, and the patient is still unable to stand. And if the lesions on the right side are cleared, the patient may be able to use crutches if he recovers properly after surgery.

With the help of others, I walked on the ground."

Xie Jian considered that this was the most likely reason. After all, the choice of surgical method should be based on the actual situation of the patient.

After hearing this, Qu Hongsheng nodded. Then he continued to look at Xie Jian.

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

"Teacher Qu, this is all I know." After Qu Hongsheng stared at Xie Jian for more than ten seconds, Xie Jian gave up and immediately lowered his head to admit his mistake.

Anyway, there is definitely nothing wrong with admitting your mistake at this time.

Qu Hongsheng did not embarrass Xie Jian: "The rest of you, do you have anything to add?"

Since Qu Hongsheng was not very familiar with the others, he didn't want to embarrass them one by one, so he simply asked them all.

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 orthopedics trembled. Their expressions fully expressed their attitude. We are just tool people. This is too difficult!

Too professional to kill?

Cao Xiaohe mentally cursed Lu Cheng and Fang Nixin for looking down on people. Who is the best? I won't say it first.

At this time, the person who favors the situation expresses his opinion first and is the one who leads the charge.

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

Cao Xiaohe twitched the corner of his mouth for a few times, then straightened up and said: "Professor Qu, in addition to settling in the joints through the blood, Escherichia coli may also settle locally through the outside world. Because the patient is currently affected by the movement of three joints.

There is a limit, there will definitely be inconvenience in relieving yourself."

"Another reason is that after we use antibiotics before and after surgery, the flora in the field is disordered, which may make Escherichia coli become the dominant flora and multiply in large numbers, and the application of a large number of drugs will cause intestinal mucosa

of destruction.”

"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 tuberculosis bacteria infected in the joints before surgery may first be transplanted into the intestines, causing intestinal tuberculosis, and then bring Escherichia coli into the surgical wound."

"That's why I think about having an Escherichia coli infection."

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

Oh, Cao Xiaohe has been in Kyoto for a few months, and he has made such a big improvement. What did he experience in Kyoto, and what did he learn?
To be continued...