Great doctor starts with adding points

Postoperative peritoneal infection refers to bacterial infection that occurs after abdominal surgery, and its symptoms and signs include fever, abdominal pain, diarrhea, abdominal tenderness, and peritoneal irritation.

However, not all postoperative peritoneal infections are extensive and immediately cause the corresponding manifestations of peritonitis.

Therefore, caution should be exercised when assisting in the diagnosis.

When Lu Junyin was arranging the examination and talking with the family members, Wu Xie, just to be on the safe side, asked the patient about the clinical manifestations and physical examination again, and took the armpit temperature again.

The body temperature did not increase significantly, and the abdomen was still soft. Because the wound after cholecystectomy existed, the abdominal examination under the wound was not performed.

You can't press on the patient's wound.

However, from Liu Chunhua's mouth, Wu Xie still got the news that she hadn't defecated in the past two days. But this is also normal. After cholecystectomy, fast for at least two to three days, and the recovery diet is mainly liquid.

The food intake is reduced, and most of them are liquid diets, so it is normal to have unresolved stools, but this factor still has to take into account the presence of localized infection in the abdominal cavity, which then compresses the transverse colon, resulting in poor stool movement.

After the physical examination, Liu Chunhua's son walked in, and after entering the door, he jokingly said to Wu Xie: "Xiao Xie, if you have other considerations, you can arrange it directly. Or just tell me, you are still afraid of me Don't believe you?"

When Liu Chunhua heard this, her face immediately became serious: "That's absolutely fine, Xiao Xie, I was taking care of my children in the county town, so I thought about going to the county to see a doctor. It's close and convenient."

"Doctor Wu's level, can your aunt not believe it?"

Liu Chunhua is the wife of Qin Dahe's cousin. Wu Xie can call Qin Dahe uncle because of his aunt Wu Min, so it is only natural to call her aunt. They usually know each other, but they don't communicate much.

But Liu Chunhua and her son Qin Chongyuan were already close to Qin Dahe, so they were considered to be sent away to him before. Qin Ling prepared all the coffins at home, and invited people to come to the scene at any time so that they could go up the mountain for burial. Let it go.

Qin Chongyuan, who is a nephew, and Liu Chunhua, brother and daughter-in-law, have no reason not to believe in Wu Xie.

No, Wu Xie didn't tell them in person that they needed to be checked. Instead, he asked Lu Junyin to transfer the conversation, and made the two mothers and sons feel that Wu Xie was extraordinarily obnoxious, and his tone was slightly displeased.

Wu Xie said: "Auntie, uncle, I don't mean that. It's just that the situation is special and urgent. Director Lu and I will work separately to avoid delaying the illness."

"If it's an outsider, I'll tell you to go back to the county and tell me that our hospital can't handle it. Isn't this a matter of lip service?"

"My aunt's current condition seems to be relatively simple, but there is nothing wrong with being careful. It won't waste any money to do a checkup. I also hope that my aunt's condition will be better, so I made this suggestion."

"I just hope you can understand, cousin." Wu Xie's tone was also quite sincere.

"Yes, Director Lu said to arrange it right away. It's convenient for you to talk about this kind of thing in the future, you don't have to pay too much attention." Qin Chongyuan is also getting closer to Wu Xie.

Such a good doctor has a high level of medical skills. He is somewhat related. Everyone is old and young, born, old, sick, and dying. Maybe there will be a time when he asks for it. It is better to have a good relationship with Wu Xie than to please others. point.

After making such a decision, the doctor in the ultrasound department immediately brought up the color Doppler ultrasound, and did not dare to be careless, and directly performed a color doppler ultrasound near the incision beside the bed.

Because Wu Xie had doubts about the directionality in advance, so he just probed like this, and immediately saw the gas-filled abdominal cavity, and found the liquid echo.

Even a small amount of peritoneal effusion is usually not in the upper abdomen.

After that, the middle-aged doctor in the ultrasound department raised his head and said in a serious tone, "Tsk tsk, Dr. Wu, you are amazing. Ordinary people, even if they want to break their heads, they don't think that the incision will cause a localized intra-abdominal abscess. There is still a lot of liquid, which belongs to the state of being broken."

"If it breaks open, it will be really troublesome!"

"Go for CT and then think about the follow-up treatment. I just need to determine the personality here. CT can directly determine the size and position more accurately!"

Qin Chongyuan stood on tiptoe and asked, "Li Dajiao, is it really an abscess?"

"When we were discharged from the hospital, Director Zhang of the People's Hospital didn't say anything about it?" Although Qin Chongyuan was asking, his tone was weird and disdainful, as if to say that the level of the county hospital is too low.

And the reason why he is called Dr. Li Li Dajiao is because he really has big feet, he is 1.6 meters tall and wears shoes of size 46!

People on the street call it that, but they feel kind.

"It's because the chance of this kind of thing is so small, that's why I said Xiao Wushen." The person called Dr. Li put away the equipment while wiping the ultrasonic agent with paper, and then didn't change the dressing, just covered the previous dressing slightly for a moment.

"Qin Chongyuan, push your mother to the CT room below. This localized abdominal abscess is not a joke. After the location and size are determined, the operation should be performed, and the puncture and drainage should be performed. You should listen to Dr. Wu. arrange."

"I don't have to waste time with follow-up checks, and you won't be charged for this checkup."

"Hurry up." Li Dajiao put away the equipment and moved away.

One person was just suggesting that the two might have colluded, but all three said so, Qin Chongyuan didn't doubt anything, and just pushed the hospital bed and walked downstairs.

At any rate, the surgery department has an elevator that leads directly to the operating room, and there is a slope from the first floor to the first floor that pushes the bed directly. Otherwise, the bed can’t be pushed over, so you can only walk with your back...

About ten minutes later, when Wu Xie and Lu Junyin saw the CT of Liu Chunhua's abdomen and the localized peritoneal abscess, Lu Junyin called both Wu Xie and He Ling into the doctor's office.

"He Ling, although this patient has an intra-abdominal abscess, which belongs to the scope of general surgery, it is different from the traditional primary appendix abscess or pancreatitis. This is a postoperative limited intraperitoneal abscess."

"If it's primary, then just cut it directly."

"But it's not the original primary disease, so my treatment experience in this area is also limited, so let's add up the total. Listen to what Xiao Wu thinks."

Wu Xie said: "Director Lu, according to the clinical diagnosis and treatment guidelines for abdominal infection released by our country last year, the recommendations for source control of infection: (1) Patients with abdominal infection should be controlled early. Under the premise of infectious effusion, puncture and drainage should be performed early. (3) The timing of opening the abdominal cavity should be decided after comprehensive discussion by clinicians. Inability to close or massive active bleeding in the abdominal cavity can be used as reference indications."

"So, for this patient, puncture and drainage is currently the most appropriate suggestion, and open resection has not yet reached the corresponding indications. Of course, the conditions of our hospital are quite limited, and open surgical resection can also be done directly."

Possessing a specialized level of surgical infectious disease, Wu Xie is naturally quite proficient in the current national guidelines, otherwise it would not be a specialization.

It’s just that the guideline only stipulates the diagnosis and treatment recommendations of conventional hospitals, and it still needs to be treated differently according to the level of each hospital. If you want to use puncture and drainage in the township hospital, there is still a certain difficulty.

Lu Junyin and He Ling glanced at each other, and Lu Junyin made a decisive decision: "Can you do this kind of puncture and drainage under the guidance of the bedside color ultrasound? If you can do it, Xiao Wu will try it. If you can't do it, we will directly open the abdomen."

"The internal pressure of this local abscess should be in a state of rupture on the CT display, and a decision must be made as soon as possible."

"If there is ultrasound positioning, you can try it!" Wu Xie knew that it would be beneficial to keep the learning points for the time being, otherwise, in case he qualitatively added other skills to the points before, now he just I can stare.

"I'm sure." Wu Xie didn't finish his sentence.

"Go! Go to the operating room." After hearing this, Lu Junyin immediately stood up decisively.

Confess to He Ling: "Call Chen Chen in the operating room to prepare for surgery."

Chen Chen is the 'head nurse' in the operating room. Although there are only three nurses, there is still such a position.

"Okay!" He Ling immediately took out his mobile phone and made a call first.

When Wu Xie went downstairs, she was still expressionless, and searched carefully in her mind for the treatment principles of abdominal infection——

Control inflammation at the site of infection, drain fluid from the site of infection, correct fluid balance, maintain electrolyte balance, support nutrition, correct metabolic disturbances…

After all, this Liu Chunhua has gained 3 knowledge points, so don't be careless.

After the search, the first thing to do is to control the inflammation at the infected site, and puncture and drainage are the most suitable.

No longer doubting him, he went down to the operating room.

...

Half an hour later, at Lin Peiyuan's home in a community in Xuan County.

Lin Peiyuan is taking the time to avoid his wife on the window sill and order one. The weather in November is cool and the breeze is blowing on his face, which makes him feel good.

Then I found that the phone next to the ashtray on the table rang, and then I looked at the note——Shazhen Lu Junyin.

Lin Peiyuan was in a better mood. People who do good deeds do not expect rewards, but they also hope to be praised.

After confirming the referral relationship, two simple patients were sent to Shazhen to hone their treatment skills for the future development of the department. As the director of surgery, Lu Junyin should make a call.

After connecting it, I put it next to my ear, and laughed while talking: "Director Lu hasn't rested yet?"

But the voice on the phone was extremely stagnant, complaining endlessly: "Director Lin, even if you missed Xiao Wu by mistake, you don't have to hurt me like this."

"This Liu Chunhua patient had a localized abscess in the abdominal cavity after the operation, which was the size of a fist! If it broke, based on the distance between our hospital and your ICU, it is estimated that the patient would die that night."

Lin Peiyuan's face froze when he heard the words, and he searched around, but couldn't find out who Liu Chunhua was: "No, Director Lu, this Liu Chunhua is not a patient in our department, is it?"

"Yes, yes, is it a patient from the Department of Orthopedics? It's from the General Surgery Department, but Director Zhang of the General Surgery Department said that you called to ask him to transfer a patient to our hospital..." Lu Junyin's tone at this moment also became eccentric.

Although he didn't scold her, the tone was even worse than scolding her.

The anti-theft effect made the author a little dizzy and didn't want to talk. I thought it would be more than 400 for the real follow-up, but I didn't expect it.

Ask for some monthly tickets to support, fellow book lovers, almost all of them are booked to 600, you can add more.