Don’t comment on consultation opinions casually

When Qu Hongsheng praised Fang Nixin, the patient's family members came up and asked: "Professor Qu, how is my dad's condition now?"

"The wound is still bleeding pus now. I have been hospitalized for almost a month."

The person who spoke was the patient's son. He had a short head and slightly dark circles under his eyes. He looked a little sleepy, as if he hadn't slept well for a long time.

The patient himself was currently in a false sleep and did not speak. Only through the gap between his upper and lower eyelids could it be seen that he was not asleep.

This question was a bit difficult for Qu Hongsheng to answer, and he said: "Your father's current situation was told to you before the operation. It is very difficult. He is not young himself. He is sixty-eight this year."

"Furthermore, the long-term tuberculosis infection before hospitalization has resulted in being very thin now. Moreover, there is infection with Mycobacterium tuberculosis itself, coupled with malnutrition, the chances of tuberculosis recurrence and bacterial infection after surgery will increase. This is difficult to avoid.

matter."

"We considered that the risk was relatively high before, so we postponed the date of the surgery. I have told you this in detail."

Qu Hongsheng said this, and the middle-aged man nodded, but he kept scratching his hair and said, "I can understand what you said, Professor Qu. It's just that you also know my father's situation."

Speaking of this, the man spoke in a high-profile manner: "He has always been in good health before. I have an older brother and two younger sisters. The four of us are away from home all the time. Every time I call him and ask him if he is in good health, he always says yes."

"

"I also discovered that he was getting thinner year by year, but he wouldn't say where he was hurting. He just said that his body was good. Every year when he came back for the New Year, he would take painkillers. It wasn't until a few days ago that my mother suddenly gave him

We made a phone call and said my dad couldn’t move."

"You mean this?"

The man's eyes were slightly sparkling, "My father has really worked hard for us all his life, and when he is old, he is still reluctant to spend our money. It's just that no one has only one father. My father is not too old at all.

Of course you are not young anymore."

"We still hope that he can stand up on his own in the future without so much pain. Even if he can't walk, it will be fine if he can do it without pain. Based on this consideration, the four of us brothers have a strong desire for surgery."

"Well, I don't blame him or you. Even now that I see this situation, I suddenly feel that I can't accept it."

"Professor Qu, you are all great experts and great professors. You must think of more solutions. Even if you spend more money, it doesn't matter."

The middle-aged man put his hands together and kept asking Qu Hongsheng for help.

Lu Chengdu felt somewhat sympathetic to these words. He probably had the same mentality as his parents.

The tree wants to be still but the wind does not stop. Sometimes the elderly just want to avoid becoming a burden to their children. When they are about to die, they run away from home childishly, dragging the disease to disability, or even commit suicide.

.

Our parents are just a companion on a journey in our lives, but in their lives, since they have children, they are a lifelong companion...

Professor Qu Hongsheng may have more experience, so although he was moved, he still said calmly: "You may have misunderstood me. I am not thinking about money. I am thinking about the condition now. According to your

In my father’s case, he may need one or even two more debridement surgeries to control the infection.”

"In fact, joint tuberculosis can be treated with one-stage surgery. We have chosen a rather conservative approach to perform the surgery in two stages. We will soon provide a solution later. It's just quite troublesome, and I still have to take care of it.

Think it over carefully.”

Qu Hongsheng also had his own plans. If the patient's family had not had a strong desire for surgery and begged him before the operation to help his father stand up again, Qu Hongsheng would not have been willing to take on this trouble.

Being infected now is almost one of the worst outcomes. Qu Hongsheng himself has not yet made a final decision on how to solve this problem.

In fact, the simplest thing is to directly fuse the joints to completely solve the problem. However, after the joints are fused, they lose their own functions. He is destined to be paralyzed for the rest of his life. If he had no choice in the end, Qu Hongsheng would not choose this choice.

However, the treatment of tuberculous arthritis, especially multiple tuberculous arthritis, is a complex problem in itself. Coupled with malnutrition...

Qu Hongsheng then introduced: "This is Dr. Xie, who will be your father's bedside doctor from now on. If you have any questions, you can communicate with him at any time. If I have any ideas, I will do it as soon as possible."

This was discussed with you."

"If we don't get to the last step, let's not consider joint fusion, okay?"

"It's not that infection is an uncontrollable problem now. I just hope to find the best way to preserve the function, right?"

The patient is not very old. He is now sixty-eight years old, so he can still seek surgery to preserve his function. If he were eighty-six years old, and the lifeline itself was not very long, Qu Hongsheng might have just done joint fusion long ago.

.

"Hello, Doctor Xie." The middle-aged man shook hands with Xie Jian rather politely.

This made Xie Jianlue a little uncomfortable, but he could also see that, at least for now, this family member was still a very empathetic and filial person.

Qu Hongsheng then took off the patient's gauze and looked at the drainage tube. He found that the inlet and outlet of the drainage tube were slightly dissolved. This was caused by long-term pressure from the drainage tube, but the patient was malnourished, and the mouth of the drainage tube was removed.

secretions and bacterial infections.

"This patient, let's take some time today to discuss it in detail."

"Xiao Lu, what do you think about this?" Although Qu Hongsheng felt that Fang Nixin had reached the limit, he still wanted to see if Lu Cheng had any better opinions.

Lu Cheng frowned slightly and said: "Professor Qu, what new ideas are there to talk about? I think the most important step in tuberculosis and infection is thorough debridement. Especially the infected tissue in the joint cavity.

It must be cleaned up thoroughly.”

"As for other auxiliary treatment options, I still agree with the current medication. As for this debridement, I think we can try to find more sealed cavities."

"And this second debridement must be arranged as soon as possible."

If infection occurs after surgery, debridement must be performed as quickly as possible, and sensitive bacteria must be found as soon as possible. These are two particularly important points.

"Okay, then, let's arrange it until tomorrow. Tomorrow is Thursday, which happens to be the day of surgery for our team. We will try to completely eliminate the infection focus after tomorrow's debridement."

"Oh, by the way, Xie Jian, remember to check the patient's liver and kidney function at any time. The patient has been receiving anti-tuberculosis treatment. Pay attention to the results." Qu Hongsheng quickly ordered.

Qu Hongsheng is in charge of many troublesome patients, so he doesn't pay so much attention to the examination results of each bed every day. This must be reminded by the bed doctor at any time. The previous bed doctor has left, but the task still needs to be done.

Make a handover.

"Okay, Teacher Qu."

"Invite another person from the nutrition department to come for consultation and prepare a nutritious meal. For the oral protein powder, the family should go out and buy the domestically produced one. Our hospital prescribes imported ones, which may be a bit expensive."

"Others, especially the changes in the patient's body temperature and electrolytes, we must pay attention to. We must also remember to take samples for bacterial culture at least every two days, and do bacterial culture on the drainage tube mouth and drainage fluid."

"Thrombus should also be re-examined. After the re-examination, call the vascular surgery department for consultation at any time." Qu Hong arranged the event in detail.

For complex patients, the regulations in charge must be meticulous. Especially for patients with tuberculosis and infection, which is a wasting disease, nutrition and electrolytes must be kept up.

"Thank you, Professor Qu. My father has worked hard for you." The middle-aged man thanked Qu Hongsheng and others one by one, which made people feel quite sad.

…

Then the group came to the second bed.

Xie Jian once again reviewed the simple medical history of bed 2: "Bed 2, a patient with septic arthritis, had previously undergone a cannulated nail internal fixation operation for a femoral neck fracture in a prefecture-level city hospital, and an infection occurred after the operation."

"Before I was admitted to the hospital for debridement, I had multiple resistant bacterial infections, high blood pressure, and mild diabetes. My blood sugar level was well controlled before the surgery. On the second day after the surgery, my blood sugar level soared to 13.2mmol/L."

"Especially after dinner, the blood sugar level reached the highest level of 17.2mmol/L."

"Currently, there are no traces of pus from the wound, but the bacterial culture results of the recent drainage fluid are a bit confusing. It seems that the bacterial results obtained are different every time, and the sensitive antibiotics are also inconsistent."

"So the current antibacterial regimen has been changed from cefuroxime to piperacillin, and now polymyxin is used. However, the bacterial culture results taken two days ago showed that among the currently sensitive antibiotics, polymyxin

Sensitivity is average, but sensitive to vancomycin."

"Yesterday, I invited a consultation from the pharmacy department. The consultation opinion was to stop polymyxin, switch to vancomycin, add levofloxacin, and take oral rifampicin. The patient did not see tuberculosis bacteria. Yesterday's tube bed

The doctor hasn't prescribed it, so I don't know whether I should follow the consultation opinion for the time being." Xie Jian explained his views on the consultation opinion while introducing it.

However, just after Xie Jiancai finished speaking, Fang Nixin said: "In addition to being used for Mycobacterium tuberculosis, rifampicin is also commonly used as an antibacterial treatment for Staphylococcus aureus. Oral rifampicin is very effective in joint infections. It is not for

Anti-tuberculosis, it is a broad-spectrum antibiotic."

Fang Nixin also saw Xie Jian casually commenting on the consultation opinions of the associate professor of the Department of Pharmacy, so she warned him in advance not to think too much.

Xie Jianli immediately shut up obediently and wrote the corresponding medical instructions honestly.

"The current anti-infection plan should be modified according to the consultation opinions of the pharmacy department. For patients with septic arthritis, if the bacteria have developed multiple resistance, then the effect of vancomycin is relatively good."

"Since the current drainage tube is unobstructed, we will observe it for a few more days. If bacteria can still be cultured in the subsequent drainage tube, we may have to perform a debridement. However, the current bacterial species are variable and may not necessarily be a real infection.

Lesions.”

After hearing this, the patient's face lit up and he asked: "Professor Qu, is my infection cured? Is there no bacteria left?"

The patient heard something different. He was not very old. Moreover, his wife also looked at Qu Hongsheng expectantly, hoping that Qu Hongsheng could give a definite answer.

Qu Hongsheng quickly explained: "It's not good, it's just a temporary observation."

"If the culture continues and there are still bacteria, the situation will be quite complicated..."

"Ah? It's not healed yet." The patient immediately became disappointed.

It was a minor operation at the beginning, and the wound was only a few centimeters. I thought it would be cured soon, but who knew that it would turn out to be infectious arthritis. Now the femoral head has been taken out directly and bone cement has been made.

The neglect is still not healed.

This has been going on for several months. Not to mention missing work, the medical expenses are a lot, and there are still children at home who want to study. He has long been anxious and wants to go back to business as soon as possible.

"In your case, the unit where you had surgery before would not dare to accept you anymore. It will definitely be very troublesome."

"The previously infected bacteria are like wearing armor. We have to find the Achilles' heel so that we can really kill them, and then perform joint replacement on you so that you can get out of bed and walk again." Qu Hongsheng continued to explain.

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To be continued...