medical simulator

"However, I may be lucky. Today, there is Professor Zhuang Zhou from Xinjiang Medical University, who happened to be at the scene. Professor Zhuang Zhou is a master in joint infection. He is a big man. He might be able to make things difficult for us. I brought The case that came here happened to be related to joint infection."

"I hope Professor Zhuang can speak well after listening to it."

Then, Dong He opened the ppt.

Under the stage, Professor Zhuang Zhou sat with his hands behind his back and leaned back his stool, as if he was listening carefully and ready for battle at any time.

Dong He came here with a request. In such a venue, he retreated a hundred steps from the beginning, "humble" into the dust.

At this time, if there is a request that cannot be answered, it will be called not giving face, and naturally it will not work.And Zhuang Zhou is also curious, this Dong He is also interesting, bring the failed cases to the annual meeting?

What is he trying to do?

Medical history: middle-aged female, 58 years old, right knee joint pain for 10 years, aggravated for two years.

X-ray showed: stage 4 right knee osteoarthritis.

Dong Hedao: "Everyone has also seen the case information. It is actually not complicated. The patient was admitted to the hospital for the first time. We conducted a routine preoperative examination on him, and there was nothing special about it."

"So, we did a total knee resurfacing."

"On the third day after the operation, the patient's wound began to ooze clear fluid without bleeding."

"On the day we discovered the exudate, we immediately conducted a general microscope examination and bacterial culture on the exudate, and there were no pus cells and no bacterial growth."

"After the operation, the use of antibiotics was routinely extended to the fifth day after the operation. We took the fluid again for examination and re-examined the inflammatory indicators."

"The results showed that the inflammatory indicators were normal, and there was still no bacterial growth."

"However, at this time, the patient's exudate not only did not decrease, but increased."

Dong He posted a photo here, which recorded a large amount of seepage, and the gauze and cotton pads inside were dyed dark yellow.

"We consider that the patient's BMI = 27.5, which belongs to a slightly obese physique, and may be due to fat liquefaction."

"On the sixth day after the operation, the exudate had not stopped, so the first debridement and suture was performed."

Here, Professor Dong He released another photo with an explanation:

"We can see from the pictures that there is a large amount of clear, non-turbid, colorless liquid in the preoperative field."

"During the operation, we took the joint fluid and sent it for culture of bacteria, fungi and special bacteria. The results were all negative! After debridement, we performed continuous drainage."

"After debridement and suture this time, the patient's exudate disappeared. On the 15th day after debridement, the stitches were removed and he was discharged from the hospital."

"However, in the third month after the operation, the patient's knee joint swelled, and the skin temperature increased, and the floating patella test was positive. The joint fluid was taken and sent for bacterial culture, which showed that it was Staphylococcus aureus infection."

"We immediately performed joint cavity debridement and knee joint replacement gasket replacement. After the operation, a catheter was placed, and gentamicin solution was added to flush and drain the drainage until the bacterial culture was negative."

"Patient improved again and was discharged."

When Professor Dong He said this, he reluctantly opened the next picture: "Six months after the first operation, and three months later, the patient had the same symptoms of swelling and elevated skin temperature again. Into the hospital."

"But this time, when we took the joint fluid and sent it for culture, it showed Mycobacterium tuberculosis infection."

"Let's review the results of previous preoperative examinations and cultures. No tuberculosis bacillus growth was seen. Laboratory tests and a full set of tuberculosis tests were all negative."

"At this time, for the sake of insurance, we obtained the consent of the patient himself and performed joint fusion."

Speaking of this, Dong He walked away from the podium and said, "But just last week, the patient said that her skin temperature had risen in the joints of her affected limb."

"There may be suspicion of reinfection."

"So taking this opportunity today, I would like to ask Professor Zhuang Zhou, is there any inappropriateness in our handling of this case? I hope Professor Zhuang can enlighten me."

Dong He talked to such an extent. Although Professor Zhuang Zhou had shrunk his body when Dong He mentioned Mycobacterium tuberculosis, he was extremely unwilling to take this troublesome muddy water, but Dong He named it by name. up.

He also had to stand up and say:

"According to the patient's existing case data, during the first operation, there was exudate, but no bacterial growth. During the second operation, Staphylococcus aureus grew. In the third operation, Mycobacterium tuberculosis was directly cultured."

"It's clinically, fairly uncommon, and I haven't encountered it myself."

"However, there is one point. Ordinary infections will basically not change to special bacterial infections. Special bacterial infections generally persist."

"However, in the first two preoperative examinations of this patient, the culture of Mycobacterium tuberculosis was negative, which is somewhat difficult to explain. Now that the patient has undergone joint fusion, I think there is not much comparison on my side. Great suggestion!"

"I rarely meet patients with joint fusion nowadays."

Although Professor Zhuang Zhou is engaged in joint infection, it is just a simple joint infection. Where have you encountered this kind of Staphylococcus aureus for a while, and Mycobacterium tuberculosis for a while?

Can you be more professional about your infection?Can you be more dedicated and not change back and forth?

Joint fusion is actually the destination of patients with joint infection in the early years, but now it has been abandoned for a long time.But the case that Dong He encountered seemed to be inconsistent, and he didn't know how to deal with it.

You can do the renovation again, and the bacteria will gnaw again, which will hurt the patient's money.You have merged, the patient's joint mobility has disappeared, and the quality of life has been greatly reduced.

It's hard for Zhuang Zhou to say more, he is not a god.

He didn't get any useful answer, but Dong He still nodded gratefully: "Thank you Professor Zhuang for your clarification, perhaps, this patient had occult Mycobacterium tuberculosis infection from the very beginning, it's just something I couldn't understand. "

"Why can't this kind of Mycobacterium tuberculosis be cultured?"

After Dong He finished speaking, he was about to return to the middle of the podium.

Because when he replied to Professor Zhuang Zhou's words before, he walked out of the table of the podium in order to show respect.

But at this time, Professor Zhu from the Second Affiliated Hospital of Shonan University suddenly raised his hand!

He is the referee himself, so after raising his hand, he asked directly:

"Professor Dong, I have two questions, can I ask you for convenience?"

Professor Zhu is quite polite.

Dong He's expression remained unchanged, and he stretched out his hand: "Professor Dong, tell me."

"First, why didn't you choose joint revisions after you first found S. aureus?"

"The second question, after culturing Mycobacterium tuberculosis, why did you do joint fusion directly, instead of choosing to do the first-stage joint cleaning and the second-stage replacement?"

"Joint fusion is equivalent to allowing the patient to lose all mobility to control infection. Compared with the problems that this kind of surgery deals with, the impact on the patient's quality of life seems somewhat inequitable."

Ok.

The purpose of joint fusion is to control infection, but the cost is to lose all mobility, which is not worth the candle!

Zhou Cheng's expression darkened immediately. The question that Professor Zhu asked was indeed a bit sensitive.

Moreover, Zhou Chengcheng found that when these two questions were asked, the eyes of everyone at the scene immediately lit up.Including Luo Yun, who also saw a climax after watching a play, rubbed his hands together, and said to Zhou Cheng:

"here we go!"

This question is more vicious and direct than the questions asked to Zhuang Zhou, Chen Xueliang and others before, it is almost equivalent to going straight to the point.I almost slapped Dong He in the face for why did you do this.

But when you think about it, it makes sense.

In Hunan Province, medical resources and status are dominated by Shonan University, and other hospitals can't get ahead, so they will definitely join forces to break through the 'monopoly position'.

Hunan Provincial People's Hospital is the big brother of the affiliated hospital of Hunan University.If he doesn't take the lead in fighting, how will the others fight?

More than once on various occasions, began to spray.

Although I haven't sprayed it, I sprayed myself between the fourth and third positions!

Shonan University, with its three affiliated hospitals, should reasonably be ranked first, second, and third in Hunan Province, but there are private rumors that the Hunan Provincial People's Hospital is better than the third hospital.It's all about fighting!

You want to hit me, can I not fight back?

The professors of the Affiliated Hospital of Shonan University and the professors of the No. [-] Hospital will not fight each other at this time, and will be consistent with the outside world. After solving the external problems, they will fight over who is the big brother.

In this way, the current Professor Zhu can figure it out when he asks such a question.

……

The discussion below began to boil——

The case brought by Dong He is indeed full of doubts.

The content of the discussion was just as what Professor Zhu said.

Not when you should be doing a joint revision!

Joint fusions were done when they shouldn't be.

And brought it to such an occasion, isn't this asking for trouble?

All eyes were on Dong He.

Dong He didn't feel too uncomfortable, his face was just a little embarrassed for a while, and he straightened his collar.

Slowly said: "Thank you, Professor Zhu, for your question."

"As for these two issues, I will not explain them first."

"Please also wish the professor to continue listening."

"I'm not done yet."

As soon as Dong He said this, almost everyone in the audience could see Dong He's hidden embarrassment, some didn't quite understand?No, you should answer, what do you mean by continuing to talk?

What's the use of hiding these embarrassments?

Can you hide it?

You want to fight back, why do you continue to give lectures?

Also, how long is your stinky basket, haven't you finished talking yet?

I saw that Dong He just slowly opened the follow-up:

"After we cultured Staphylococcus aureus for the second time, we sent this case to Shanghai."

"And invited Academician Zeng for a consultation."

"At that time, the suggestion given by Academician Zeng was to replace the gasket directly. There is no need for joint revision."

"Furthermore, the patient was admitted to the hospital for the third time. After tuberculosis was detected, Academician Zeng considered that the patient may have multiple infections. Joint fusion is safer than joint revision. In terms of economic benefits, it is more beneficial to the patient."

"We communicated with the patient for a long time, and finally the patient decided to stay in our hospital for joint fusion."

As soon as these words came out, everyone's mouths opened slightly.

Then he directly shifted his gaze, which was originally focused on Dong He, to Professor Zhu Zhu Jinshan.

Now, is he a little embarrassed?

The two sharp questions that Zhu Jinshan asked at the right time directly hit Academician Zeng with one shot, and they hit the bull's-eye...

This Dong He, oh no, a person from Xiang Provincial People's Hospital!

It's like killing a wolf. I didn't explain the situation for so long before, and even asked Professor Zhuang Zhou if there was anything wrong with the handling. Isn't this just to draw Zhu Jinshan out on purpose.

Then?

Where is this asking for advice?This is a big fire pit specially set up, waiting for people to jump!

Perhaps, their original purpose was to wait here for the people affiliated with Shonan University.

Hunan Provincial People's Hospital is not an affiliated hospital of Hunan University, and it is not in the same system. It is a medical institution second only to the Hunan University system in Hunan Province.

It's normal for the two families to have friction with each other.

Even in the No. [-] Hospital of Hunan University and the No. [-] Hospital of Hunan University, it is rare to see people from the two of them sitting in the same venue at the same time and having friendly discussions on the same issue, let alone people outside the system.

Of course, this is internal, if it is external.

You say Hunan University sophomore, don't mention Hunan University, once it is mentioned, Hunan University First Attached will definitely help.

Similarly, outsiders, don't directly upgrade any hospital in Hunan Province to the provincial level.

Inside is contention, if you don't fight, you won't advance.

If you are fighting outside, then progress is slow, and that is regress.

If there is no competition, then it is impossible to outcompete others.

Although I know this, but at this time, digging a hole for the Second Hunan University Hospital is quite unkind, and this hole also involves an academician.

If it is an academician of our school, then it may be fine if you talk about it in private.

They are academicians from other schools. If this is not done well, it will affect the relationship between the two schools.

Academicians, even in the highest institutions of higher education in Huaguo——Huaqing University, Kyoto University, Huaguo Academy of Sciences University, are still treasures, and they cannot be obtained casually.

After seeing this slide, Professor Zhu's expression changed slightly, and he said immediately:

"Professor Dong, I'm just talking about the facts."