godfather of surgery

Even though antibiotics were used according to experience, Lu Jiangbei's high fever never went away, and her body temperature fluctuated. She relied entirely on antipyretics and physical cooling to suppress her body temperature. This showed that the lung infection was not under control at all, and empirical antibiotics were ineffective.

Three days later, the results of sputum bacterial culture came out. Yang Ping turned on the computer screen and called up the test results: MRSA, the abbreviation of several English letters is very eye-catching.

MRSA - methicillin-resistant Staphylococcus aureus, one of the superbugs.

The so-called superbugs are resistant to almost all antibiotics due to genetic mutations. They have become invulnerable and cannot be killed by antibiotics.

Because of their strong drug resistance, doctors have almost no weapons at their disposal against these bacteria, making them very difficult to treat.

To deal with MRSA, only vancomycin can be used.

The drug susceptibility test sheet also showed that, except for vancomycin, all other listed antibiotics were resistant.

What a careless guy, Yang Ping cursed in his heart!

The whole treatment process is extremely hard and full of twists and turns. If you make any mistake in one step, all your efforts will be wasted.

Director Pan didn't want to make this call, but there was no way. Facts were facts. They were really afraid of what would come. Almost all clinicians would be frightened when encountering superbugs.

"Professor Yang—"

"I have seen the inspection report and am coming over now. Let's meet and discuss it."

After a few words of communication, Yang Ping rushed to the trauma ICU again. Since it was not in the same building, it took some time to rush back and forth.

When Yang Ping arrived, temporary ICU workers August and Robert were already standing at the door to greet him.

After swiping the card to open the door, Yang Ping went straight to the doctor's office.

At this time, there were already people inside, including Director Pan, the doctor in charge, Dr. Zhou, the head nurse, and several colleagues from the Department of Respiratory Medicine, the Hospital's Infectious Diseases Department, the Laboratory Department, and the Blood Transfusion Department.

The emergence of super bacteria has put everyone at risk.

MRSA infection itself is not an infectious disease, but as long as there is infection with the pathogen, there is a possibility of cross-infection.

Once this super bacteria spreads due to cross-infection, the consequences will be very bad.

When Yang Ping came in, everyone stood up to show courtesy, and Director Pan personally welcomed Yang Ping to his seat.

"The patient has been moved to the isolation ward. The chest X-ray was reviewed and the infection area is expanding." Director Pan sat down and was the first to speak.

The director of respiratory medicine took a sip of water: "What should we do now?"

"What else can I do? Prescribe vancomycin! Xiao Zhou, use my work number to prescribe vancomycin. Use it now."

Director Pan was scolding his mother in his heart. Of course, he was not scolding others, but scolding this bacteria. He hadn't had such bad luck in a long time, and this time he was actually infected.

Vancomycin is a new type of antibiotic. It is known as the nuclear bomb among antibiotics. It will not be used unless it is a last resort. It is the last weapon of doctors to deal with infection.

The originator of antibiotics was penicillin, which at that time was called a "life-saving miracle drug".

Since the beginning of penicillin, mankind has entered the era of antibiotics. Many bacterial infections that were incurable in the pre-antibiotic era were easily cured by penicillin. Since then, many types of antibiotics have entered clinical medicine.

If bacteria are the shield, antibiotics are the spear.

There will naturally be a struggle between spears and shields. Bacteria are smart and will not sit still and wait for death. In order to survive, they will find ways to avoid the attack of antibiotics.

With the prolongation of the use of drugs, bacteria have accumulated rich experience in dealing with antibiotics. They pass these experiences down from generation to generation and optimize them continuously, making some antibiotics ineffective.

So-called drug-resistant bacteria arise, which are able to use methods to disable antibiotics and survive.

The principle of survival of the fittest is also applicable to the bacterial world. Drug-resistant bacteria survive and reproduce, while non-resistant bacteria die from the hunting of antibiotics and eventually become extinct.

Methicillin-resistant Staphylococcus aureus is the leader among these drug-resistant bacteria and has taken the crown of superbug.

Against this background, scientists had to invent new weapons to deal with drug-resistant bacteria, so vancomycin, the “King of Antibiotics”, was finally put into clinical use in 1972.

Vancomycin can be called a nuclear weapon among antibiotics. Since it was put into clinical use, it has been invincible and sterile. In the 16 years since its use, it has created an unbeatable record - not a single resistant strain has emerged.

It was not until 1988 that vancomycin's unbeatable golden status was broken. In 1988, the first vancomycin-resistant strain appeared. This type of bacteria was enterococci.

Since then, vancomycin has been somewhat powerless. In 2002, the first case of vancomycin-resistant Staphylococcus aureus (VRSA) appeared. Of course, this kind of bacteria is very rare at present, but once a VRSA infection is diagnosed, it is most likely to be disastrous.

Fortunately, Lu Jiangbei was infected with MRSA, not VRSA.

Even MRSA bacteria are enough to kill Lu Jiangbei, because he is not a patient with only lung infection, his whole body, including limbs and torso, is in a state of paralysis, and there are many fractures in the pelvis and the whole body. Anemia, the immune system of the whole person is in a state of near collapse.

If the lung infection cannot be controlled in time, once a certain critical point is exceeded, respiratory failure will occur from the sky. In the end, he will have to slowly die with the support of ECMO.

Dr. Zhou received Director Pan's oral medical orders, temporarily left the conference table, and went to the computer to write medical orders. Once the decision was made, he did not want to waste a single minute.

"That's the only way." The director of the Department of Respiratory Medicine nodded.

In the face of this superbug, vancomycin has become the only option. There is no controversy and no need for discussion. "Can your blood transfusion department be more relaxed and give more blood? If the hemoglobin cannot rise, the immune system will collapse sooner or later." Director Pan was straightforward and no nonsense. Now that Yang Ping is here, the blood transfusion department is afraid and will be more cooperative. Director Pan said in a tone of voice Also sharper.

Director Yuan of the Blood Transfusion Department was very embarrassed: "It's not that we don't give it, the blood station is very short of supply right now, and this patient has already reached over 70. It's a bit difficult to ask for a lot more blood, but we'll try our best."

Director Pan was very angry: "Don't always look at rules and regulations, but look at the specific situation."

"I can't help it. It's not just your department that wants blood. I can't count the departments of gastroenterology, general surgery, and obstetrics and gynecology. Which department doesn't rush us every day? The director of the general surgery department scolded me on the phone yesterday. It's useless to scold me. , I can’t bleed, if you can, you can draw my blood now.” Director Yuan stretched out his arm.

"Old Pan, please understand each other. Professor Yang is here today. I promise to give you priority in blood supply and try to meet your needs, but I really can't guarantee a sufficient amount. You have already requested more than 10 units of red blood cells. This time you are asking for 10 more units, what do you want me to do? Give them to 6 units first and then talk about it later."

"Six units?" Director Pan sneered, you are sending beggars away.

Indeed, Lu Jiangbei now desperately needs to continue blood transfusions. As his hemoglobin increases, his immunity will also increase. Moreover, if he undergoes surgery, a hemoglobin of more than 70 is not enough.

"8 units!" Director Pan argued.

Director Yuan didn't agree at all: "Impossible, a patient with a ruptured liver and spleen in the General Surgery Department yesterday was also waiting for my blood supply."

Director Yuan is also in a dilemma. Resources are limited and everyone is eagerly waiting for his blood. What to do, they can only strictly control it.

"Give me 10 units!" Yang Ping finally spoke.

Lu Jiangbei's current situation requires a blood transfusion, and several units of red blood cells are really not enough.

Director Yuan had just fought vigorously with Director Pan, but he was at a loss for words, and said slowly, "Okay, 10 units!"

The argument was over. The director of the infectious disease department of the hospital rubbed his brows and wanted to speak.

The Infectious Disease Department is a group of people who are hated by everyone in the hospital. Their job is to try to find loopholes in the hospital's Infectious Disease Department and make up for it in a timely manner. This kind of fault-finding work method is bound to be disliked by others.

"We should still investigate. We will investigate the cause of this infection. I hope it will not interfere with everyone's work. Please pay attention to washing your hands. We will focus on monitoring the trauma ICU these days." The director of the hospital's infectious disease department obviously lacked confidence and said very modestly. .

"Yeah!" Director Pan hummed in a low voice.
-
Because of the drastic changes in her condition, Lu Jiangbei's mother was once again pushed to the consultation room of the trauma ICU. In the past few days, Dr. Zhou of the ICU has talked to her several times.

She could have entrusted the family's diagnosis and treatment activities to relatives, such as her brother or sister, but she was uneasy and felt that she was competent, so she personally acted as a family member, and her brother and sister took turns to accompany and take care of her.

"When will the surgery be performed?" the middle-aged mother asked.

Yang Ping shook his head: "It can't be operated on yet, let Dr. Zhou explain it to you."

"Lu Jiangbei has been suffering from a high fever for the past few days. She has been diagnosed with a lung infection. The bacterial culture results have come out. It is methicillin-resistant Staphylococcus aureus, which is one of the super bacteria. We have now used the super antibiotic-Wangu However, there is no guarantee that the infection can be suppressed. His life will be in danger at any time and his breathing may stop at any time. You must be mentally prepared." Dr. Zhou, as the doctor in charge, led the conversation, with Yang Ping and Director Pan sitting next to him.

"Is this a condition notification? If respiratory failure occurs, do you need to use ECMO? The cost of ECMO is very high, and the out-of-pocket cost is very large." Dr. Zhou handed over several pages of the informed consent form.

Be mentally prepared!

When the middle-aged mother heard the last few words and read a few pages of the informed consent form, her head went blank and buzzed. In the previous conversations, every time the doctor talked about life-threatening dangers, she always dismissed it and always felt that this kind of thing Very far away from myself.

But this time was different. For some reason, she felt the pressure of death rushing towards her face, like a huge stone that made her unable to breathe, because she knew that not long ago, a patient with respiratory failure passed away here, and she saw her family members with her own eyes. Crying in the hallway.

"Originally he was not out of danger, but now a new danger has been added. Once the lung infection cannot be controlled, respiratory failure will occur, and then --- then it will lead to death." Dr. Zhou continued.

The mother's eyes were dull. At this time, the word "college entrance examination" was no longer in her mind. She had completely forgotten the existence of the college entrance examination, and her entire mind was occupied by the word "death".

"Doctor, help, save him-"

After a long time, my mother squeezed out these words in a pleading tone.

"We will try our best, but many things are beyond our control," Director Pan added.

The mother was very heartbroken, and nodded mechanically: "Can I go in and see the child?"

Director Pan took over: "He is now infected with super bacteria and is not suitable for visits. If you want to visit, you can visit him through the glass in the visiting corridor outside."

Sometimes it's really hard to tell. In this situation, respiratory failure and death may occur at any time. Director Pan is also a veteran of the battlefield and has seen many life-and-death farewells.

Under the arrangement of Director Pan, Lu Jiangbei's mother, sitting in a wheelchair, saw her son through the glass. He was lying on the hospital bed with various tubes connected to his body. Most of his upper body was covered by the brace. He could not see at all. Unclear face.

The mother couldn't help lowering her head, covering her eyes, and began to cry loudly.

Her mind was in a mess now, filled with regretful emotions. Those auxiliary machines and those channels made her truly realize that the child might leave her.

From childhood to adulthood, she has actually been complaining and scolding her child, comparing him with other children, never really considering his feelings, and always squeezing all his space with studying and college entrance exams. Every time the child's performance drops, it will After being insulted by her, every time her child's grades improved, she would always say lightly that he needed to continue working hard, and it was impossible to get 211 or 985 with such grades.

The more she thought about it, the more guilty Lu Jiangbei's mother felt. She felt that she had never really cared about her child.

If he can survive, no matter whether he can go to college or not, no matter what career he has, as long as he lives healthily, she will accept it. She will accept anything as long as he is good.

"Doctor, save him, save him no matter what." The mother repeated this sentence.

"We will try our best. We have already used vancomycin. We will wait a few days to see the situation. If vancomycin is not effective -" Director Pan stopped talking.