Doctor's Life Simulator

Chapter 8 Qin Lang's deduction is shocking
Peng Yun frowned, but did not stop Qin Lang.

Several little doctors looked expectantly at this handsome trainee doctor.

Qin Lang analyzed lightly: "I think that using conventional debridement to treat open fractures polluted by industrial wastewater will increase the infection rate of patients."

Qin Lang walked directly to Wang Qiang's hospital bed, took Peng Yun's place, and pointed at the patient's wound.

"According to the patient's self-report, after he was injured in the leg, the whole leg was soaked in industrial wastewater for more than 10 minutes before he was rescued by the workers. Therefore, the pollutants spread along the affected muscle compartment and tendon sheath to the entire muscle space. Therefore, it is difficult to completely clean up these pollutants during routine treatment, so I think extended debridement should be used!"

After Qin Lang finished speaking, both Qian Liang and Peng Yun were stunned. They had to say that Qin Lang's point of view was very possible.

However, Peng Yun's foundation is not generally solid, so he directly asked:

"Qin Lang, I agree with your point of view that there are merits. It is true that local debridement has its limitations for infection control, but have you ever thought about it? Extended debridement can effectively remove pollutants, but it also increases tissue damage. and increase the risk of infection."

"So I think, instead of performing extensive debridement at a huge risk, it is better to follow the routine partial debridement. Moreover, you have to be clear, the biggest problem we face is unknown pathogenic bacteria, and we can only wait for drugs to treat it." Allergy tests and bacterial culture can only be confirmed."

"However, it will take time. If the expanded debridement is carried out as you said, before the pathogenic bacteria are identified, the risk of aggravating the infection of the patient is too great."

Regarding Peng Yun's answer, if she hadn't gone through the experiment in the simulator world, maybe Qin Lang would have been convinced by her, but in the clinical experience in the simulated world, Wei Guoqiang, the director of the Department of Plastic Surgery and Burns of the No. Trial.

Evidenced by the treatment results of more than 400 cases, the use of extended debridement can effectively clear the infection, thereby reducing the infection rate. The infection rate is only 10.2%, while that of conventional debridement is 51.2%. The resulting infection is also much less severe than local debridement.

Of course, Qin Lang couldn't tell the result of this experiment, but he could try to convince Peng Yun and Qian Liang from another angle.

With the blessing of clinical experience in the simulator world, Qin Lang has the temperament of a senior resident doctor who has passed all the examination materials from Peng Yun.

Qian Liang and Peng Yun couldn't believe it, and said a word:

"In addition to local debridement, another reason is that the pathogenic bacteria were misjudged in the previous treatment plan and the wrong antibiotics were used. As long as we can use antibiotics correctly, the infection of patients can be greatly reduced. The rate is enough to support us to try to expand debridement."

After Qin Lang's voice fell to the ground, both Peng Yun and Qian Liang couldn't believe it:
"You said that we and the doctors in the lower-level hospitals all judged the wrong pathogenic bacteria and used the wrong medicine?"

Peng Yun is very familiar with antibiotics, so he said directly:
"The previous treatment plan was strictly in accordance with the "Guiding Principles for the Clinical Application of Antimicrobial Drugs in Huaguo" for the prophylactic use of antibiotics for open bone and joint trauma, and antibacterial drugs targeting Staphylococcus aureus were selected."

After all, he is a true scholar who graduated from Union Medical College Hospital. When discussing majors, Peng Yun always quotes widely and makes sharp arguments.

Qian Liang on the side also gave a wry smile. As expected of Peng Xueba, in the previous discussion about the illness, their group of residents had been crushed in various ways.

The eyes of Peng Yun's two little doctors were also full of admiration. They are indeed the most promising elite doctors of the young generation in the city's first hospital.

Peng Yun's aura is fully open: "And when I was in Union Medical College Hospital, I participated in a project of my tutor, counted 1337 cases of open fractures contaminated by toxic liquid, and carried out bacterial culture and analysis on more than 150 patients with deep infection. The drug susceptibility test found that it was Gram-positive bacteria, and 78% were sensitive to cephalosporins."

"So, based on the "Guiding Principles for the Clinical Application of Antimicrobial Drugs in Huaguo" and my personal practice, I think there is nothing wrong with the previous use of antibiotics."

Taking into account both theory and practical experience, it is true that Peng Yun's inference is impeccable.

Qian Liang on the side also nodded, which was also his judgment.

Regarding this, Qin Lang chuckled. If he had no clinical experience in the simulator, he would really have been defeated, but he knew that the real pathogenic bacteria was Escherichia coli!
A trace of calm flashed in Qin Lang's eyes:
"Dr. Peng is right. Generally speaking, there is no problem with the use of cephalosporins, but you have overlooked a crucial issue. Staphylococcus aureus is an aerobic bacterium, but the patient is in a chemical factory, and the injury is soaked The pool is for process requirements, and it is a strict anaerobic environment."

Qin Lang looked at the patient Wang Qiang. Although the latter was not clear about the deduction of this heroic little doctor, he could confirm one thing:

"This little doctor is right. The pool where the accident occurred in my work is an anaerobic environment built in strict accordance with the requirements."

Qin Lang followed Wang Qiang's words and looked aggressively at Peng Yun:
"So, the pathogenic bacteria infected by the patient are Gram-negative bacilli, so they are not sensitive to cephalosporins. Since it is a Gram-negative bacillus, combined with the environmental analysis of the patient's chemical plant, it is very likely that it is Escherichia coli bacterial infection."

"So, I suggest adjusting the antibiotics to quinolones, such as ciprofloxacin, moxifloxacin."

After listening to Qin Lang's well-founded analysis, Peng Yun, who is a top student, was in a daze for a while. Although she couldn't believe it, her reason told her that it was very possible!
As for Qian Liang, he had secretly given Qin Lang a thumbs up. Although he hadn't confirmed it yet, at least this was the first time he had seen Peng Yun so deflated.

But, it's not over yet.

In order to ensure the safety of subsequent treatment, Qin Lang continued to analyze:
"However, simply expanding the debridement does have some risks. Therefore, it is necessary to increase the auxiliary drainage technique."

For the first time, Peng Yun carefully sized up this young trainee doctor selected by the community hospital. In his tone, he asked for advice sincerely for the first time:
"Dr. Qin, conventional extended debridement assisted drainage techniques include simple negative pressure drainage, continuous flushing drainage and continuous sealing negative pressure drainage. Which one do you think should be used?"

Peng Yun obviously did not expect that this little doctor Qin thought so deeply and meticulously.

It is too sensitive and talented to deduce that the pathogenic bacteria are Gram-negative bacilli based on the factory environment where the patient is located.

This requires strong observation skills and solid basic skills.After listening to it, she suddenly realized.

Just when Qin Lang was about to continue discussing which drainage technique to use, there was a sound of footsteps outside the ward.

A little nurse ran over ahead of time:

"In view of the condition of the patient on the 13th ward, which cannot be cured for a long time, the chief director happened to be in the department today and asked if there was any special patient situation recently, so he planned to advance the director's ward rounds and discuss the patient's condition together. The rest of the residents And this batch of trainee doctors and Gui Peisheng also rushed over."

(End of this chapter)