Chapter 338 Difficult and complicated diseases! (Please subscribe)
Zhou Cheng could not understand Zhang Zhengquan's happiness, and Zhang Zhengquan certainly could not understand Zhou Cheng's distress.
After saying goodbye, Zhou Cheng returned home first and continued to sort out the corresponding theories of basic anatomical structures. This matter will soon begin formal research and must be sorted out.
Moreover, Zhou Cheng also found arthroscopic joint-sparing surgeries and their applications for shoulder joints, knee joints and hip joints in previous documents, and sent them to Director Zhang Jin.
Of course, Zhou Cheng also added corresponding concepts of tumor treatment into this plan, which is a mixed application.
The concept of tumor treatment is relatively mature. Although it has not been carried out clinically, the trials are effective. Chu Hanbo has published the corresponding article in a journal, which can be used for further research and reference.
Zhou Cheng had been thinking about this matter for the past two days, and after making a good deal, he sent it to Zhang Jin.
Then, Zhou Chenggong continued to sort out the basic anatomy theory. This is a big thing. You can't rush it, but you have to rush it. It's quite tangled.
Moreover, this project is a long-term one. Zhou Cheng might as well spend two or even three years to complete it, which is considered very fast. The main thing is to see the specific progress in that time.
But this is the overall subject. If we only start from the perspective of orthopedics, it should take more than half a year to a year to complete the subject, and then coordinate the data and publish an article.
This is the first project that Zhou Cheng has carried out independently. He raises and controls the funds himself, instead of borrowing money from others like before.
Time was tight, and at 8:20, An Ruo sent another message.
Zhou Cheng also started chatting with An Ruo.
At 10:20, after An Ruo fell asleep, Zhou Cheng started his simulation again.
It's just that in the simulated world, Zhang Zhengquan, a bad guy, was played badly by Zhou Cheng, and he couldn't reach a very high level. Zhou Cheng could only sigh, wondering whether there was something wrong with his teaching theory, or...
Zhang Zhengquan's medical talent is really limited.
Ignore it for now and go to sleep first.
The next day!
This is a Friday. Except for yesterday's surgery day, today should be very leisurely.
However, Director Lu Bin said yesterday that Quan Zhuolin's group had a very complicated case that needed to be discussed in the department. The main reason was that he hoped that Zhou Cheng could give some advice. Therefore, Zhou Cheng did not leave early.
Today was supposed to be Director Quan Zhuolin’s surgery day. Monday and Friday were all Quan Zhuolin’s surgery days this month. Director Tong only had one surgery day, Wednesday.
After all three groups completed their rounds, Lu Bin and Tong Xun did not leave, but stayed in the department and participated in the discussion of the issues.
As soon as the doctor in charge reported the medical records, everyone frowned.
"Bed 2, a patient with septic arthritis, had previously undergone a cannulated nail internal fixation operation for a femoral neck fracture in a prefecture-level city hospital, and an infection occurred after the operation."
"Before the debridement surgery, I was suffering from multiple resistant bacterial infections, high blood pressure, and mild diabetes. My blood sugar level was well controlled before the surgery. On the second day after the surgery, my blood sugar level soared to 13.2mmol/L."
"Especially after dinner, the blood sugar level reached the highest level of 17.2mmol/L."
"Currently, there are no traces of pus from the wound, but the bacterial culture results of the recent drainage fluid are a bit confusing. It seems that the bacterial results obtained are different each time, and the sensitive antibiotics are also inconsistent."
"So the current antibacterial regimen has been changed from cefuroxime to piperacillin, and now polymyxin is used. However, the bacterial culture results taken two days ago showed that among the currently sensitive antibiotics, polymyxin
The sensitivity is average, but sensitive to vancomycin."
"Yesterday, I invited a consultation from the pharmacy department. The consultation opinion was to stop polymyxin, switch to vancomycin, add levofloxacin, and take oral rifampicin. The patient did not see tuberculosis bacteria. The doctor on duty yesterday
It’s not prescribed, and I don’t know if I should abide by the consultation opinion for the time being.” The doctor in charge of the bed explained his views on the consultation opinion while introducing it.
Of course, maybe he had a problem with the doctor on duty yesterday. This patient was obviously very difficult, but the doctor in charge ignored him and didn't prescribe the medicines he should have prescribed.
However, just after Xie Limin, the bedside doctor, said this, Quan Zhuolin began to popularize the science: "Rifampicin is not only used for Mycobacterium tuberculosis, it is also commonly used as an antibacterial treatment for Staphylococcus aureus. Oral rifampicin is very effective in joint infections.
It’s effective. It’s not just for fighting tuberculosis, it’s a broad-spectrum antibiotic.”
Quan Zhuolin probably saw Xie Jian casually commenting on the consultation opinions of the deputy chief physician of the pharmacy department, so he warned him in advance not to think too much.
Xie Limin immediately shut up obediently and wrote the corresponding medical instructions on the paper honestly, which he would need to follow later.
He really didn't know this unpopular knowledge.
Quan Zhuolin then asked: "Dr. Zhou, Director Lu, and Director Tong, what do you think of this patient?"
After hearing this, Lu Bin said: "The current anti-infection plan should be changed according to the consultation opinion of the pharmacy department. For patients with septic arthritis, if the bacteria have developed multiple resistance, then vancomycin will be more effective.
of."
"If the current drainage tube is smooth, just observe it for a few more days. If bacteria can still be cultured in the subsequent drainage tube, you may have to perform a debridement. However, the current bacterial species are variable and may not be the real focus of infection.
.”
Quan Zhuolin said: "Currently, patients have strong opinions, saying that our hospital has not even figured out the diagnosis. We have performed several operations in vain and wasted so much time and money. In fact, we have already
I tried my best, but it’s hard to explain this situation.”
Infection is a big taboo in surgery.
Lu Bin asked: "Quan Zhuolin, I just heard that this patient had surgery in another hospital. How did such a patient come in?"
"Why doesn't he go back to the previous hospital or Shashi?"
This patient was first seen in a hospital and was transferred here after he became infected. Then they were wiping the butt of others, which made Lu Bin a little unhappy.
They are all prefecture-level hospitals. Why don't you let them deal with such troublesome patients on their own? This is very troublesome and may lead to lawsuits.
The key is that the patient still doesn't understand and thinks that the disease cannot be cured after spending money, so he only comes to you, which is a thankless type.
Before Quan Zhuolin could say anything, Xie Limin said: "This patient was admitted by the head nurse. I don't know what the situation is. When I was on duty, I entered the hospital through a regular clinic."
Normally, the director admits patients, and then the doctor in charge takes over. Therefore, Xie Limin first shied away from his own responsibility.
Quan Zhuolin pondered for a moment, glanced at Xie Limin, and said proactively: "Director Lu, this patient was called by the head nurse. I didn't know the situation at first. The head nurse originally planned to take him to your place. But because of this
Yue’s situation is special.”
"So it's under my control for the time being. You should know about this." Quan Zhuolin's tone was somewhat meaningful.
Lu Bin's expression changed slightly, and he glanced at Zhou Cheng, who was sitting next to him. He found that Zhou Cheng's expression had not changed, so he knocked on the table: "The key to our discussion now is how to treat this patient in the future, and whether to do it or not."
It is recommended that the patient be transferred to a higher-level hospital and we will discuss other matters later."
Quan Zhuolin noticed that Lu Bin was looking bored, tilted his head, and then looked back seriously.
"Director Tong, what do you think?" Lu Bin asked.
Chief physician Tong Xunjin is relatively new and has the lowest qualifications at present. He said with a cheerful smile: "I think this kind of patient needs to be debrided several times and find sensitive antibiotics before we can make a final conclusion. Otherwise,
"It's not easy. It's very troublesome." Tong Xun kept shaking his head, saying it was as if he didn't say anything.
In fact, infection, to put it simply, is a bacterial infection, but it is very troublesome to treat. Laymen think that hospitals are just messing around, but people who really come into contact with this industry will find out.
As long as the infection is caused by surgery, dogs will shake their heads when looking at such patients.
Anyway, if the cure is not good, there is only one sentence: good medicines are not good products. This kind of person is very smart, smarter than people in the world, and regards medical practitioners all over the world as evil people.
He belongs to the level of a saint. As long as there are poor people in the world, they are inseparable from him!
Lu Bin turned around and asked, "Dr. Zhou, what do you think of this patient?"
"Debridement. At present, the drainage tube is clear, but no bacteria can be cultured, but the infection cannot be controlled. I think it is possible that the continuous irrigation and drainage now does not reach the place where the infection is concentrated. Debridement, and then during the operation,
Send for bacterial culture."
"Try to find the focus of infection."
"Extensive infection. From below the greater trochanter of the femur to above the ankle joint, a huge abscess cavity appeared, but there was no bone destruction. Moreover, the patient's blood sugar level was also fluctuating, so in this case, it was necessary to
It must be thoroughly debrided, otherwise, if it progresses, there may be a risk of amputation.”
"Director Quan, when will you arrange the debridement of this patient?" Zhou Cheng didn't say much before, but now, he still thinks this case is interesting.
It's very rare. Zhou Cheng has never seen such a strange case in the Ninth Hospital of Magic City.
"This afternoon, there is only one today. Doctor Zhou, don't you have a small lecture in the morning?" Quan Zhuolin said in a flattering manner.
Next month, Zhou Chengcheng will come to his place, and he can finally relax a little and introduce the biggest reassurance in the department to his own group.
Quan Zhuolin is still looking forward to it.
Zhou Chengcheng said: "Then let's go to the operating room to have a look later. I just think this case is very interesting. I wonder if it's convenient for you, Director Quan?"
To be honest, there are very few cases that Zhou Cheng can find very interesting so far. The two surgeries he performed before, one for osteotomy and orthopedics, and one for muscle necrosis, were both slightly interesting and not that kind of surgery.
A very interesting disease.
"It must be convenient. Dr. Zhou, you can come and take the stage in person, which we really hope for."
"Dr. Zhou, you have been exposed to a lot of infection cases before, right? By the way, Dr. Zhou, you are a trauma surgeon, how could you not have been exposed to such patients?" Quan Zhuolin laughed at himself as he asked and answered.
Trauma surgery covers a wide range, is the foundation of the entire orthopedics, and has a wide range of contacts.
Zhou Chengcheng said: "Director Quan, that's not true. I have no experience in treating similar diseases. That is to gain more knowledge and let's learn from each other."
The more in-depth he studies, Zhou Chengcheng will find that the current orthopedic diseases are more complicated and complicated. There are known diseases and unknown ones, which means that the level is not enough.
If you jump out a hundred years and look at the people a hundred years ago, people at that time were much healthier and had no disease or pain. Even those who lived sixty years old would be considered old.
Skip a thousand years, and there would be no concept of diabetes, high blood pressure, etc. At that time, sixty would be an ancient thing.
Skip a few hundred years and look back. At that time, it was still a disaster for women to have children, with a mortality rate of 20 to 30%. Even the doctors in the palace were helpless...
At that time, there was no such thing as cancer, no terminal illness, and no such thing as infection. It was all about wind, cold, and heat. Death from wind and cold meant bad luck.
Therefore, Zhou Cheng has always been in awe of medicine. He never denies that a certain medical concept can cure diseases, but at the same time, Zhou Cheng denies everything that he thinks is more reasonable.
Because only by constantly denying can we get closer and closer to the truth.
"Dr. Zhou, you are joking." Quan Zhuolin smiled and said nothing more.
In this case, the trouble spots and difficulties have been clearly explained. What is needed is time to explore. Just holding a meeting here to discuss it will definitely not have much effect on the condition.
Then, it was time for Zhou Cheng's lecture.
Everyone knew the content of Zhou Cheng's lecture, so Lu Bin and Tong Xun soon called in everyone in their respective groups.
Amputated limb transplantation, based on the concept of replantation of amputated limbs, is combined with amputation. It is very novel and very bold. However, it has its basic concepts and is not considered to be particularly forward-thinking.
But as Zhou Cheng explains, everyone will feel that it is Zhou Cheng who dares to be so brave and skilled in re-attaching the legs of an amputated patient.
During this process, I gained a lot, but most of these gains were just for gaining insights. If I really wanted to implement it in clinical practice, neither Lu Bin, Quan Zhuolin, nor Tong Xun would dare to do so.
Afraid of failure, and then the patient will look for trouble. Now the patient’s family members will look for trouble, and they will cost money or even their lives!
Zhou Cheng saw that everyone listened attentively, but after he finished speaking, except for Qin Ming who asked two questions, everyone else remained silent.
This is far from Zhou Cheng’s expected teaching idea.
However, teaching is like this. Only those who want to learn want to teach. Those who don’t want to learn will not be taught no matter how hard they try. We are all adults and independent individuals. Everyone only needs to be responsible for themselves.
.
At noon, everyone had a quick snack and a packed lunch together.
Then, everyone left the operating room.
Tong Xun and Lu Bin were also there, both hoping to see how Zhou Cheng performed basic operations such as debridement and whether he could perform any tricks.