Those years when I hung up and upgraded in the hospital

Chapter 16: Superfluous Superiors (please read more)
Before going to bed 6, Peng Qingsong and the others asked about the patient's basic information. The description of the medical history was basically consistent with what they had told Youde before, and there was no change.

Looking at the wound, the patient's wound showed local redness and swelling, and there were bruises in some places.The surgical incision showed light signs of drainage and decay.

"What do you think is the direct cause and trigger of his infection? Why did he become infected?" Fang Yun asked, standing beside the patient's bed.

Hearing this, the patient smiled and said, "Dr. Fang? If you know how, just say it directly. My infection is a headache."

Fang Yun replied: "Uncle, I'm not sure what's going on with your infection. We're trying to deduce the condition. If you can understand it at a glance, wouldn't it be possible for the experts in the state hospital to do it three times? Five divided by two is cured?"

"Why do you need to transfer to our town hospital to continue hospitalization?"

"Although you came here for an anti-inflammatory injection, the experts have not given any advice on such detailed issues as how to reduce inflammation and how to treat wounds."

"Here's just one sentence: I suggest you continue treatment and transfer to a local hospital for treatment."

The patient immediately stopped talking. His family members were not around, and his wife had gone back to make breakfast and had not yet come to the hospital.

Xiang Youde heard this and said tentatively: "The direct cause is bacterial infection? The trigger is surgery? Really? Brother Yun."

"This understanding is correct. The direct cause must be that bacteria invaded the local area and caused infection. The inducement is that the surgery caused the destruction of the local skin barrier."

"So in his case, during the postoperative management period, the doctors at the state hospital must have done a more formal job than us during the dressing change. The patient himself did not make any special scratching or other movements. How did his infection come from? "Fang Yun asked again.

Fortunately, these people had read some books and were able to listen to advice. Otherwise, Fang Yun wouldn't bother to talk so much.

Fang Yun said that the operating standards of the prefecture hospital were better, which directly suppressed Xiang Youde's reason that he might not have changed the dressing properly when he changed it.

Peng Qingsong said: "Bacteria are everywhere, and every patient has a chance of infection after surgery."

"In nature, there are more. What are the most common bacteria in surgical infections? What are the bacteria that infect him?" Fang Yun continued to ask.

"Escherichia coli." Xiang Youde added that he was a bedside doctor and knew more about the details.

Fang Yun no longer makes excuses: "Escherichia coli is a gram-negative bacterium. After infection, it generally does not cause the body temperature to rise too much. It mostly exists in the digestive system of the body."

"His infection is probably caused by a small amount of Escherichia coli entering the blood and migrating to the vicinity of the infected wound through blood circulation. The surgery was just performed in the anterior abdominal area, and the local immunity here is reduced."

"The clearance mechanism in the body is smaller than the reproduction of bacteria, which leads to local infection. Even when medication is used after surgery, the surgery will cause local microcirculation disorders and edema in the wound. When edema occurs, it will compress the circulation rate of micro blood vessels. "

"It makes it difficult for antibiotics to reach the wound. At this time, if a debridement surgery is to be performed, continuous antibiotic liquid flushing will also be performed."

"So, in the treatment of this patient, Xiang Youde, when changing the dressing, you can add a little gentamicin for topical application after disinfection with iodine complex and flushing with hydrogen peroxide."

"For intravenous medication, continue to use cefoperazone sodium and sulbactam according to the antibiotic the patient was sensitive to before discharge."

"The albumin in the patient's last blood test result was not low. It should be that the supplement was effective when he was at the Prefecture People's Hospital, so we don't need to continue using it."

"Uncle, you should eat more meat. You should continue to take injections." Fang Yun told the old man after he had reviewed the general diagnosis and treatment ideas. "Okay!" The uncle was very easy-going, because no matter who said what theory, he didn't understand it. Apart from trusting the doctor, he didn't even dare to question it.

"Add some medicine to protect the digestive system. I suspect that because the patient is an elderly man, the function of the digestive system has been reduced. It may be that after anesthesia and surgery, local gastrointestinal reactions or even ulcers occurred, allowing bacteria in the digestive tract to enter. Blood."

"Although these bacteria cannot cause normal tissue infection, secondary infection is still very likely at the wound site. If the source is not controlled, we are only treating the symptoms, and it may happen again in the future. Infect."

"The patient originally had no symptoms related to the gastrointestinal tract, so it was difficult for us to investigate the cause of the gastrointestinal tract."

"But one thing is that when the patient was in the state hospital, his albumin level dropped, which proves that his digestion or absorption function is not good after a period of time. We can make suspicions in this regard. If necessary, we can ask for internal medicine consultation and write a consultation Opinion……"

Problems with the digestive system are mostly related to internal medicine. The use of gastroprotective drugs, proton pump blockers, or gastrointestinal mucosal protective agents, etc. also requires consultation with a physician.

"Okay, Brother Yun!" Xiang Youde wrote down everything.

This is the end of the ward rounds.

"When you change the dressing, Youde, remember to bring a bottle of gentamicin. If you are interested, you can check the antibacterial spectrum of gentamicin and the antibacterial mechanism against different bacteria. This will be more helpful. You understand why it's gentamicin and not tetracycline or whatever."

"In addition, let me ask again, what is the inducement and direct cause of this patient's infection?" Fang Yun returned to this question again.

He said so much, if he didn't help a few young people sort it out, they might have their hair in the left ear and out in the right ear again.

"The trigger is the stress reaction of anesthesia and surgery, which leads to a decrease in local immunity, and a local stress ulcer in the digestive tract? The direct cause is that the bacteria in the digestive tract migrate to the local area with decreased immunity and multiply, causing Infection." Peng Qingsong's theory is better than the other two.

"Almost." Fang Yun nodded.

"So in terms of treatment of infection, in addition to blocking the source of infection and eliminating the direct cause, we also need to consider whether the inducement can be eliminated. Can this inducement be eliminated?"

All three shook their heads.

I have had surgery and anesthesia. How should I remove it?

"His triggers are transient, established triggers, not persistent triggers. So there is no need to deal with them, but if it is other aspects, such as scratching, allergies, or habitual smoking, etc., it is persistent. If there are inducements, then it is necessary to intervene through oral education to remove the inducements..."

"And if the antibiotics you take are not suitable for the symptoms, then the trigger is that the medicines are not suitable for the symptoms, and the treatment that needs to be dealt with is to find antibiotics that are sensitive to the disease. This is also a way to remove the triggers."

"When taking medication, treat the symptoms, find the cause and deal with it, and take corresponding measures according to the inducement. These are the more important medication ideas. These are all summarized by myself or heard from other teachers. You'd better do it. Knowing this whole idea…”

Time is like water.

Fang Yun continued to have leisure time while on duty.

However, when Director Chen Shengwu and Dr. Dong Yunshan returned to the ward the next day, they found that the two new patients in the department had been managed in an orderly manner. Their expressions also changed slightly, and they felt that they were redundant. The illusion...

(End of this chapter)