Great doctor starts with adding points

"Didn't you eat? Auntie." Wu Xie asked after seeing He Ling and Qin Chongyuan finished chatting.

Liu Chunhua shook her head quickly, but after shaking her head, she licked her dry lips with her tongue: "I dare not eat or drink water, I just moistened my mouth with a cotton swab."

"Doctor Wu, how long will it take for me to eat?"

"Observe for another two to three days. If there is no problem at that time, you can eat a small amount. This process is difficult, but you have to hold back. After all, your previous situation was not very good."

"Pay attention to the feeling of the wound. If there is fever, bleeding, etc., tell our doctor immediately." Wu Xie instructed carefully.

Now the most critical period for Liu Chunhua is to raise her to prevent the abscess from recurring, and use antibiotics to limit or even kill the remaining germs.

Liu Chunhua sighed, feeling a little helpless.

It is uncomfortable to be hungry, and equally uncomfortable to be thirsty. Although there are intravenous injections of sugar and salt water, they can only guarantee that people will not die, without feeling full and thirsty, so Liu Chunhua's spirit is quite weak.

She thought she could endure it for a few more days, but now she really couldn't bear it.

But he didn't dare to speak.

Wu Xie saw that Liu Chunhua didn't want to talk anymore, so he wrote down another point in his notebook, and said, "I'll come over later to change my aunt's medicine and see the condition of the wound."

"It should be that after the simple debridement yesterday, the exudate will decrease today, and then if the antibiotics are used, after the drug sensitivity results come out, we can change it according to the situation."

Qin Chongyuan said: "Doctor Wu, why don't you give my mother some more water? She is so hungry and thirsty."

"Okay, I'll go back and add some sugar and salt water for intravenous medication, and get through these two days first, and then I can eat and drink later." Wu Xie also agreed.

The sugar and salt water he gave Liu Chunhua is actually not too little. The total amount of intake in a day is 2,400 milliliters, which is 400 more than that of ordinary patients on the day of fasting. But looking at Liu Chunhua's state now, it is still not enough .

This is related to the metabolic state of each person, but it can be a little more, as long as the daily urine output is recorded, the amount of water in and out is relatively balanced, and the swelling will not increase.

After Liu Chunhua passed away, there were 12 patients with Achilles tendon rupture.

He Ling was called down by Qin Chongyuan, and asked him some basic information, but He Ling couldn't push it away, so he could only explain slowly.

So Wu Xie and Lu Junyin went to bed 12.

The patient in bed 12 is a middle-aged male in his forties, not from the town, but from the next township, named Xu Hu.

There are towns and villages in Xuanxian County. The township where Xu Hu is located belongs to the jurisdiction of the next town, and his wife is accompanying him. After seeing Wu Xie and others enter the ward and start the rounds, they hastily put away the breakfast wreckage...

"Doctor Wu! Director Lu." Seeing Wu Xie approaching, Xu Hu smiled.

When Wu Xie approached, he saw that there was a faint green seepage on Xu Hu's gauze, and some of it had dried up into scabs.

Seeing this scene, Wu Xie immediately took out a pair of examination gloves from his pocket, put them on, and carefully removed the outer layer of gauze, and sure enough, he saw a light green pus moss on the surface of the surgical incision.

"Ouch!" Seeing the pus moss, Xu Hu and his wife were terrified, and looked at Wu Xie nervously.

"Director, it really is a typical local infection of Pseudomonas aeruginosa. This kind of green pus moss is relatively rare." After uncovering it, Wu Xie said to Lu Junyin.

Pseudomonas aeruginosa is Pseudomonas aeruginosa, just a different name.

The reason why Wu Xie suspected this thing before is because Pseudomonas aeruginosa has a very special characteristic, it is sensitive to some quinolones, such as ciprofloxacin and kolabitox, but not moxifloxacin.

Sensitive to some cephalosporins, such as ceftazidime, cefepime, and cefpirome, but not cefuroxime, ceftriaxone, and cefotaxime!

Sensitivity to some penicillins, but not the…

When the County Hospital of Traditional Chinese Medicine was treating this patient, it can be said that it was exhausted. It seemed that there were no sensitive antibiotics, and the antibacterial spectrum of commonly used antibiotics could not cover it.

The results of the bacterial culture and the drug susceptibility test have not yet come out, but the patient's condition is getting worse.

Lu Junyin nodded upon seeing this: "Then switch to piperacillin directly. After the results of the drug susceptibility test from the hospital of traditional Chinese medicine come out, adjust the medication."

He has seen the patina several times, so he knows the general treatment plan.

Wu Xie covered the gauze again: "Director Lu, I plan to give this patient a combination of piperacillin and Qingda."

After speaking, Wu Xie was afraid that Lu Junyin would misunderstand, so he quickly explained: "Because of Pseudomonas aeruginosa infection, the first choice is generally penicillin and aminoglycosamine antibiotics, and it is recommended to use them in combination, the effect will be better."

"When I was in the county hospital of traditional Chinese medicine, I also used the third-generation cephalosporin, so this time I chose to avoid this type of first-choice drug."

"After all, the best treatment for Pseudomonas aeruginosa infection is guided by drug susceptibility tests."

Lu Junyin smiled slightly when he heard the words: "Okay, you can figure it out, then let's deal with this patient in this way for the time being."

Seeing that Wu Xie had settled on a plan, Lu Junyin planned to evacuate.

Seeing this, Wu Xie quickly got up and whispered a few words next to Lu Junyin's ear, and then Lu Junyin turned his head back with a slightly embarrassed expression, and touched his throat.

Before the patient finished watching, he proposed to leave first, which seemed extremely amateurish.

Then Wu Xie turned around again, and while pulling the curtain, said: "Xu Hu, I still have to do a physical examination for you, please cooperate a little bit, there will be a little pain during this process, you have to be patient one time."

"By the way, have you brought the postoperative film taken at the hospital of traditional Chinese medicine? If so, just take it out and show it to Director Lu." Wu Xie took off his gloves and handed it to Guo Lixiang. , Said this to Xu Hu's wife again, and then rubbed the palms of his hands to warm them up.

"I've brought it, I'll give it to you." Xu Hu's wife hurriedly replied, and bent down to get the inspection bag from the bottom of the bedside table.

Xu Hu said: "Doctor Wu, start the examination, I am not afraid of pain."

Wu Xie suspects that Xu Hu has calcaneal compression disease, which mainly depends on imaging examination and Achilles tendon function examination!

The NMR hospital can’t do it, and it’s a bit wasteful to do CT again. There were plain X-ray films before, but it’s a bit sloppy to characterize it simply by plain X-ray films, so a specialist physical examination is necessary.

For example, plantarflexion test, forced plantarflexion test, etc., can evaluate the recovery of the patient's Achilles tendon function, and further determine whether the patient suffers from calcaneal compression disease...

After Xu Hu's wife took out the film, Lu Junyin pretended to take it, and then watched it up and down, but he would not see such an extremely rare complication such as calcaneal compression disease, just pretending to see if there were any fractures and special development of the Achilles tendon .

Then teach Guo Lixiang and Zhong Yusheng how to look at the Achilles tendon through plain film...

Wu Xie's inspection lasted for two minutes, but Xu Hu didn't say a word.

After putting Xu Hu's foot down, he said: "Okay, the inspection is over, the current integrity of the Achilles tendon is still good, which proves that the sutures are stable, I am afraid that after infection, the tendon will emulsify, and then sew The line causes the cut."

"During this period of time, don't get out of bed and walk. The plaster cast on the back extension has to last forever. Although it's a bit uncomfortable, there's nothing you can do about it."

"The current tendon is still in the recovery period, so you can't be reckless just for the sake of relaxation."

The Achilles tendon is located behind the heel. After the rupture, the suture must make the Achilles tendon in a relaxed position, that is, the plaster external fixation in the dorsal extension position, which is equivalent to standing on tiptoe.

This posture will be very painful if it continues, and the plaster will squeeze the dorsum of the foot and cause pain, but there is no way.

Once the Achilles tendon shrinks and the sutures are torn, the consequences are serious.

Xu Hu still nodded, and his mood was still cheerful: "Okay, Doctor Wu. A doctor told me about this before. There is nothing I can do about it. You always have to suffer when you are injured. No one will come to enjoy the blessing. "

Only then did Wu Xie walk over to solve Lu Junyin's problem, pointing to the distorted Achilles tendon and the position of the calcaneus on the plain film: "Director Lu, calcaneus compression refers to excessive friction on the contact surface between the Achilles tendon and the calcaneus. , causing inflammatory and painful lesions."

"Then you can see that there is still a certain double image between the Achilles tendon and the calcaneus, but the calcaneus has not caused any special changes, so it is still a mild type. We try to solve this problem through functional rehabilitation exercises. Lose."

"It can be properly tractioned, but this should be something after his Achilles tendon has healed, and it is still difficult to deal with it specially. Just be aware of this, otherwise, after he is discharged from the hospital, there will still be problems of wearing out the calcaneus or re-attaching the Achilles tendon." Possibility of breaking."

Lu Junyin nodded upon hearing the words: "Well, there is such a possibility."

Although he didn't understand what Wu Xie said, he just nodded at this moment anyway, which exceeded his knowledge threshold.

After this, Wu Xie and the others started to work on their respective positions.

Lu Junyin glanced at the busy people in the department with a flickering expression, thoughtfully.

During today's ward rounds, Wu Xie revealed a lot of things, even beyond his control as the director. This is a good thing for Wu Xie, and it is also a good thing for the department, but for the department In terms of development, it is not a particularly good thing.

Because Lu Junyin, as the director, knows that Wu Xie is the most comprehensive and comprehensive person now, but if he does not have the corresponding power, he will definitely have certain conflicts with himself in the future. How to coordinate and avoid such conflicts is up to him. Things the old man should think about.

Just as he was thinking this way, Lu Junyin found that his phone rang.

After picking it up, it was Lin Peiyuan calling. At that time, Lu Junyin slapped his head and ran out of the door. Luo Wei from the county hospital is coming to the town today. Although he drove here by himself, at least he had to ask in advance. Departure and arrival time, otherwise it seems not respectful enough.

This morning's ward round, I was so influenced by Wu Xie that I forgot all about it...