I run a clinic in the United States

Chapter 320 Little Master of Medication (please vote for me)

"One day is enough!" Chiba Nanako immediately stood up excitedly, walked out of the conference room quickly, and ran to the community hospital.

Elena followed out and shouted from behind: "I'll drive you!"

Although the community hospital is only a few hundred meters away, and people usually walk there unless it's urgent, but isn't it an emergency now? Therefore, stepping on the accelerator is definitely faster than walking.

"OK, thanks."

Although Nanako Chiba has obtained her driver's license, she has just arrived in the United States and has not yet bought a car.

Zhou Qiao advanced her one year's salary, two hundred thousand dollars, but since she was new here, she and her sister had to pay for various expenses, so she wanted to keep some money with her to feel safe.

Then, Elena drove her to the community hospital.

Hospitals in the United States are not like hospitals in China where parking is difficult. The parking lot of this community hospital is large enough and there are not that many cars. You can park wherever you like.

Nanako Chiba came to the patient's bedside and checked the patient's current condition, renal function, MIC and other related indicators. She also asked Park Soo-joo who was on duty here, and then she had an idea and adjusted the administration method of meropenem. .

Elena asked from the side: "Is this really okay?"

"It's okay, you'll know after you try it." Chiba Nanako was very confident.

Meropenem is actually a carbapenem antibacterial drug. It is suitable for infections in adults and children caused by single or multiple bacteria that are sensitive to meropenem: pneumonia (including nosocomial pneumonia), urinary tract infections, gynecological infections ( Such as endometritis and pelvic inflammatory disease), skin and soft tissue infections, meningitis, sepsis, etc.

Chiba Nanako carefully reviewed the test and based on the blood culture results, she believed that the previous medication selection was not wrong. Generally speaking, there is a risk that the test results will be wrong, but this probability is relatively small and we cannot question it casually. Assuming that the test results are accurate, are there any "flaws" in her drug administration method?

The drug instructions for meropenem have detailed usage instructions. For example, dissolve 0.5 to 1 g of the drug in more than 100 mL of liquid, and administer it by intravenous infusion over 15 to 30 minutes, with a dosing interval of 6 to 12 hours.

The advantage of this method is that it can reach the highest blood concentration in a short period of time. However, due to the short elimination half-life of meropenem, the blood concentration will soon be lower than the MIC of the pathogenic bacteria, and because meropenem is a time-dependent drug, This traditional infusion method is less effective.

Stupidly following the instructions for medication is the lowest level.

When using specific medications, appropriate adjustments need to be made for different patients and different conditions.

Naturally, Chiba Nanako could not use this "shallow" intermittent infusion method, nor did she use the ordinary 24-hour continuous infusion method. She used the intermittent delayed infusion method, which is a continuous infusion of 3 hours with a micropump. 3 to 4 times a day, this can ensure the safety and effectiveness of the drug to the greatest extent.

This is also a method currently used by many large hospitals, including the Affiliated Hospital of the University of Tokyo School of Medicine. Practice has proved that this method is quite effective.

If we want to use the version to explain, this is version 3.0 of the meropenem administration method.

I thought I could handle it, but I didn't know that the high fever kept coming back and forth and wouldn't go away.

During the meeting just now, Chiba Nanako's thoughts were racing, she reviewed it carefully in her mind, and finally discovered where the problem was.

That is, although version 3.0 can increase %fT > MIC, it will reduce the drug peak concentration (Cmax) and delay the peak time, thereby weakening the initial bactericidal ability.

Under tremendous pressure and desire to win, Chiba Nanako used her talent in pharmacokinetics to develop two solutions to this situation in a short period of time, which can be called versions 4.0 and 5.0.

4.0是别出心裁的两步输注法，前500mg用0.9%氯化钠注射液50ml溶解，微泵输注30min，后500mg用0.9%氯化钠注射液 50ml溶解，微泵输注4h。

However, she thought about it and found that it was still not perfect because the patient's condition was serious and required treatment time, requiring fever reduction and surgery as soon as possible.

So, she made slight modifications on this basis and derived version 5.0.

The first phase of version 5.0 is constant-rate drug administration, but the dosage of the drug is adjusted to quickly infuse part of the single dose (about 30/1) of the drug within 3 minutes, so that the blood drug concentration reaches the peak quickly and sterilization occurs as early as possible. In the second stage, the time is shortened, the intensity is increased, and the remaining drug (about 2.5/2) is slowly infused at a constant speed within 3 hours, so that the blood drug concentration can be maintained at the minimum inhibitory concentration of the pathogenic bacteria for as long as possible. , so as to maximize the efficacy of the medicine.

Elena and Park Soo-joo assisted Chiba Nanako in adjusting her medication while monitoring various data.

If the condition is urgent, they will not go back and stay by the patient's side.

The patient's family members are still very grateful, but they are also very scared.

Three medical staff suddenly came and worked around the patient, causing them to panic and think something was going to happen.

Seeing this, Elena went to comfort them: "I'm just adjusting the medication, hoping for better results."

Some medical staff from the community hospital passed by and learned about the situation, but they couldn't help but wonder in their hearts, is this really effective?

A miraculous scene occurred. The patient's high fever subsided quickly and did not relapse until the evening.

Seeing that the adjusted administration method was effective, Chiba Nanako couldn't help but breathed a sigh of relief.

If she can't handle this "trivial matter", how can she be qualified to say that she has expertise in medication in the future? Not to mention being looked down upon by Murphy and Stephanie, if Zhou Qiao feels that his level is not good enough, it will be a big loss!

Fortunately, it was eventually resolved. Chiba Nanako feels quite accomplished.

Murphy and Stephanie received the news, and after a little discussion, they decided to perform the surgery overnight!

Because time waits for no one. If the treatment continues, the patient's life may be in danger at any time.

And the time it took Chiba Nanako to get it done far exceeded their expectations!

The two of them gave Chiba Nanako a thumbs up at the same time.

Chiba Nanako smiled and said, "The rest is up to you."

In terms of surgery, she couldn't help much. She could only help formulate the medication plan after surgery.

Because the operation had to be performed overnight, Ariel and the black girl came to escort her in person.

Murphy and Stephanie put aside their usual petty thoughts and worked together. They are both young masters of surgery. Although the operation was difficult, it was successfully completed in the end.

Since the patient's persistent high fever was caused by infective endocarditis, he still had to be hospitalized after surgery and receive standardized anti-infective treatment.

Murphy and Stephanie completely ignored the subsequent medication. They now trust Chiba Nanako very much and admit that Chiba Nanako has expertise in this aspect.

Chiba Nanako won the title of "Little Medicinal Expert".

……

After Zhou Qiao came back from Boston, he heard about this and expressed his congratulations to Nanako Chiba for her successful integration into the team.

Chiba Nanako curled her lips and thought to herself, is she integrating into your harem? However, strangely enough, she didn't resist at all.

Chiba Nanako also thought about it privately, why is this?

After thinking about it, there is only one fact, that is, not only Zhou Jun is attractive, but also these beauties at Iris Clinic also have their own charms, which makes her unable to help but feel good about her and want to get close to them.

Not to mention the twins Elena and Ava, they have very thoughtful personalities, especially Elena, who is really popular. Although Murphy and Stephanie have their own characteristics, their superb surgical and academic standards put even Chiba Nanako to shame.

Although the two girls often secretly compete with each other, they are limited to medical skills and academics. They usually don't have any bad thoughts towards each other. When encountering critical illness, they can put aside their "prejudices" and work together in a tacit understanding. I have to say it’s very interesting.

Then, these four beauties, all with good looks and graceful figures, beheaded men and women... Thinking of this, Chiba Nanako couldn't help but tremble.

Because, to her horror, she discovered for the first time that she actually had a tendency to become a bender?

Curved? Oh my God!

But if you think about it carefully, that's not the case at all. Absolutely not.

Because Zhou Jun is more attractive to her!

As everyone knows, in the eyes of others, Chiba Nanako is also very attractive. She is beautiful, docile, and well-behaved. She has the unique gentleness of Japanese girls. It seems that no matter what she is asked to do, she will actively cooperate and tolerate anyone. I can't help but want to pinch it a few times.

Of course, the most important thing is that Chiba Nanako is not a flower vase, but a person with real abilities, who makes up for the "shortcomings" of Iris Clinic. With her, Irises Clinic has reached a higher level and become a truly top-notch medical clinic. Tiantuan.

Welcome team building is a tradition of Iris Clinic. Since he is busy with work recently, Zhou Qiao just led everyone to have a dinner together to welcome Chiba Nanako to join.

Zhou Qiao said that when he is free during Christmas or New Year, he will take everyone to visit distant attractions.

This time, they went to a restaurant in Half Moon Bay. The environment was very nice and they could watch the sunset over the Pacific Ocean while eating.

The Pacific Ocean is to the west of San Francisco, so they can't watch the sunrise over the sea, but the sunset over the sea is also uniquely beautiful.

At dusk, the setting sun seems to have sprinkled a layer of golden powder on the Pacific Ocean. The sky is gradually dyed with warm yellow and orange-red colors, complementing the sea water. From time to time, cargo ships or cruise ships pass slowly on the sea, creating golden ripples.

It has to be said that eating in a picture-scroll-like environment can increase people's appetite.

Chiba Nanako also brought her younger sister Chiba Ryukin, so Park Soo-joo naturally had to bring Yoona. Although Yoona and Chiba Ryukin were several years apart, they were almost the same height.

Yoona has light wavy curly hair, while Chiba Ryukin has twin tails. They have obvious Korean and Japanese styles in terms of temperament and dressing.

Maybe in the eyes of Rachel, Vivica and other Europeans and Americans, Japanese, Koreans and Chinese are all the same, but in Zhou Qiao's eyes, they are completely different.

Just like Chiba Ryunin can tell at a glance that Zhou Qiao is Chinese, Zhou Qiao's facial features, temperament, expression when speaking, and dressing style are also very different from Japanese and Koreans.

(End of this chapter)