Great doctor starts with adding points

"Bed 8, Mei Xiaoqing, female, 26 years old, was hospitalized in the State People's Hospital on October 11 due to cellulitis in the soft tissue of the left anterior femur. She underwent debridement and drainage, and the postoperative wound healed poorly. , and then performed debridement and suture again on October 19 and October 24, respectively, and the infection is still ongoing.”

After He Ling assigned beds 9 and 10 to Zhong Yusheng temporarily, he took the initiative to talk about the simple medical history of bed 8. In fact, he was just getting in touch with it, so he didn't know much about it.

Lu Junyin was also holding Mei Xiaoqing's medical history in his hand at the moment, and then he saw that the column of medical insurance was self-pay: "This patient is still at self-pay? Does the new rural medical system not have it?"

"Yes, Director Lu, Mei Xiaoqing used to have a unit, but then she resigned. It happened that the medical insurance payment stopped, and she didn't have time to apply for the flexible employment medical insurance. Now she is in a state of self-pay."

"She probably chose to come to us from the state hospital because of economic reasons. She is from Zhushan Town next door. She is currently unmarried." Guo Lixiang is the doctor on duty, so she asked more questions.

Moreover, he is currently not responsible for these five patients.

Lu Junyin frowned at this moment: "What's wrong with not having medical insurance? What kind of job did she have before? Did she resign naked?"

"I used to be a substitute teacher, and I was going to take the entrance examination. It seems that because of the tightening of policies, I don't allow substitute teachers. So now I still do substitute teachers, but I only have basic salary, and I don't have five social insurances and one housing fund."

"I didn't ask in depth about the specifics." Guo Lixiang's work was rather meticulous.

Without medical insurance, the patient pays all by himself, so there are many things to consider when dealing with it.

After reading the general medical history, Lu Junyin said with a sigh: "Speaking of which, the chance of postoperative infection is very small, but it is still a common case accumulated in the infection department of the State People's Hospital."

"The germs of wound infection are also quite changeable, from Staphylococcus aureus to Escherichia coli, and then to some strange diseases. Is this similar to Qin Dahe's situation before?" Lu Junyin said, watching To Wu Xie.

To be honest, although he is the director of the surgery department, there are not many surgeries in the department. Before that, a Jin Ping infection made him want to die. Although he read books and mended a few things later, Lu Junyin never thought about it before. I thought I would embark on the path of infectious surgery.

Hearing this, Wu Xie shook his head: "Director Lu, this should be very different from Jinping's situation. At least one point, Mei Xiaoqing currently has a whole body fever. Although it is a low-grade fever, we must be extra cautious about the state of bacteremia. .”

"Director Lu, our hospital still can't do bacterial culture right now?"

In a short period of time, the best solution Wu Xie could find was to do a bacterial culture and drug susceptibility test during the fever, otherwise, he would have to search a lot of information to find similar diseases.

"Yes, Dean Chen specially invited a technical instructor from the county hospital in advance, and he will arrive tomorrow or the day after tomorrow. The instruments and equipment of the laboratory have been shipped in a few days ago, and they are available at any time, only the professional staff is needed. .” Lu Junyin hurriedly told Wu Xie about this matter.

The reason why the laboratory department in the hospital has to carry out new projects is to cooperate with the clinical departments. The inspections that can be performed now do not need to be as complicated as before.

"Then check it again when you have a fever. For the current anti-infection treatment plan, I suggest you continue to follow Mei Xiaoqing's discharge doctor's order and the results of the last drug sensitivity test."

"However, Mei Xiaoqing is a self-paying patient, and it may be better to switch to some cheaper intravenous drugs as appropriate."

"Gentamicin is not suitable." Wu Xie reminded her.

The antibacterial spectrum of gentamicin is not suitable for Mei Xiaoqing's case. It is not a miracle drug and should not be used indiscriminately.

Hearing what Wu Xie said, Lu Junyin and others laughed.

He Ling said: "I'll add up later, check the Pharmacopoeia, and see what affordable alternative medicines our hospital currently has."

"It's just that in the case of suspected bacteremia, it is a high-consumption condition. I think Mei Xiaoqing's weight seems to have dropped quite seriously, and the nutrition seems to be unable to keep up."

"I'll talk to her companion later."

He Ling intends to pass over this case in this way. Mei Xiaoqing's infection is not particularly routine, but it is not particularly abnormal, so you only need to pay attention to some points.

However, He Ling made such an understatement, which made Wu Xie a little nervous, and then suggested: "Brother He Ling, we still need to pay attention to the rapid weight loss during the hospitalization period, and ask her if she has stomach and intestines. Tao's medical history is good."

These patients are not joking, at least the gain of 2 knowledge points made Wu Xie afraid to let He Ling go carelessly.

"Okay, I'll ask later." He Ling nodded upon hearing this.

"Let's continue talking about the ninth bed. This patient is relatively simple. She was transferred to our hospital from the infection department of the state hospital with Mei Xiaoqing. She is from our town and works in En City."

"He had no trauma, but an infection on the surface of the skin. After he was hospitalized, he didn't arrange surgery because of the cost. Then he listened to the advice of Dr. Qiu over there and said that he should be transferred to us."

"The opinion written in the discharge doctor's order is that anti-infection, symptomatic and supportive treatment is enough. The exudate from the skin surface was collected, and the sensitive bacteria showed were Staphylococcus aureus, and the sensitive antibiotic spectrum was penicillin and cephalosporin..." Zhong Yusheng gave a rough summary of the medical history. described it again.

It sounds like this case is the best to deal with. After all, it is Staphylococcus aureus infection, and it was transferred because of economic problems.

If it had been treated sooner, it would have been better.

Wu Xie's expression flickered upon hearing this.

In the case of Jinping, it is an extremely rare Rickettsia infection, which only gains 1 point of knowledge points. The current 9-bed has 2 points, so her condition will definitely not be milder than Dong Lianghe's condition, right? .

However, according to the current medical history data, the treatment plan can only be determined in advance.

Seeing Wu Xie's face changing, Lu Junyin asked, "Does Doctor Wu have anything to say to this patient?"

"Director Lu, I have taken a look at this patient's wound. I think that in this case, a triple combination of antibiotics is needed, and the level of intravenous medication should be raised a little bit."

"The second is to add topical antibiotics."

"Although the 9-bed lady did not undergo surgical treatment, she routinely received piperacillin sodium/tazobactam sodium in the state hospital. Piperacillin is a semi-synthetic penicillin antibiotic and tazobactam is a beta endocrine Amidase inhibitors. No obvious effect has been seen."

"If only cephalosporin antibiotics are used alone, I think the drug effect may not be strong enough to achieve the therapeutic effect."

"Because the drug of choice for S. aureus infection is semi-synthetic penicillin or cephalosporin."

"So I suggest using penicillin plus cefazolin sodium combined with intravenous anti-infection treatment, and then externally use streptomycin or left oxygen saline to clean the wound. Just keep the wound dry after cleaning." Wu Xie suggested this very cautiously.

At this moment, Wu Xie discovered that the experience in surgical treatment of infectious diseases at the specialized level is not enough, because it is necessary to extract the key points of diagnosis and treatment of infected patients in a very short period of time, which is a bit difficult, even It is strenuous.

Fortunately, his experience in using antibiotics has improved to a certain extent, so even if he didn't check the information carefully, he still knows the general antibacterial spectrum of some common drugs.

Wu Xie's opinion was well-founded, and Lu Junyin had no reason to object, so he looked at He Ling.

He Ling said: "Zhong Yusheng, write down Wu Xie's doctor's order, and then implement it according to this. If there are other auxiliary examination materials in the future, we will make changes."

"Then there are 10 beds. You can continue to report the medical records." He Ling chose to trust Wu Xie.

At least in this regard, Wu Xie now has more experience than he and Director Lu. In the past, when encountering infected patients in the department, they were discharged from the hospital if they could resist antibiotics, and they were transferred to another hospital if they could not. Son facing tough.

Guo Lixiang said: "Doctor He, Director Lu, I will take care of the 10 beds for Brother Yusheng temporarily, otherwise he can't take care of it alone."

"This 10-bed patient was transferred from the County People's Hospital. He is also from our town, and he is from the street. Because he is raising a child in the county, he was hospitalized nearby for treatment."

"This is a 60-year-old male patient. He had exudate and infection after taking a bath by himself after the operation. Currently, the wound surface is red, swollen and feverish. Bacterial culture was taken, and it was also aureus, but the results of the drug susceptibility test have not yet come out. .”

Lu Junyin opened his mouth slightly: "Why do you have to take a bath after the operation? What kind of person is this? Stubborn temper?"

"And take a bath by yourself!"

Our daily drinking water or even mineral water, as long as it is contaminated on the wound, regardless of whether the inside is clean or not, it will bring the bacteria on the outer surface of the dressing to the wound, which is also a good seed for infection.

"It's Uncle Zhou at the end of the street!" After Guo Lixiang said his nickname, he stopped talking.

Both Lu Junyin and He Ling rolled their eyes: "If it's him, he won't be able to do anything, the stubborn donkey is dead-headed. Has his son contacted him?"

"The only one who can control him is his son, his wife is useless."

Uncle Zhou is famous for his stubborn temper in the town. How stubborn is he? He goes to drink with his relatives, and leaves immediately after eating. , you eat and leave, don't look for a place to pay the bill, just need to be lively.

Walking alone, this is the only one in the whole town.

"I called and got scolded, and I'm in a good mood now, and I'm probably scared, and there's pain in the wound, and the wound shows signs of emulsification!" Guo Lixiang sniffed, speechless.

Uncle Zhou, if he believes that the bath water is clean, it is probably useless to the gods.

What can be done?