This doctor has a system

Chapter 195 193. Crushing 1
Xinyin City has a permanent population of 616.6 million. As the leading local hospital, the number of patients in the respiratory department here is comparable to that of the provincial hospital.

The more the amount is, the more difficult patients will be.

Zhou Meini, female, 77 years old, was admitted to the hospital with fever and chest tightness as the main symptoms. She was hospitalized in the local county hospital for 10 days.The doctor at the county hospital was very afraid that the patient would come to him, so he quickly communicated with the family members and transferred them.

"The patient has a history of type 2 diabetes for more than 20 years, and he has been taking the hypoglycemic drug metformin orally, and his blood sugar control is average." A young doctor introduced to everyone, "I also had a chest CT, and the report was lung abscess, but antibiotics were used. It’s time for imipenem, but the patient’s condition still hasn’t improved.”

Everyone looked at the patient, and the old lady was listless and extremely emaciated.What made Gao Feng feel a little weird was that the patient was still wearing a brand new light blue top, which didn't match the environment of the ward.

"Why are you putting on the shroud?" The doctor in charge of the bed said to the family members a little dissatisfied, "You really are"

"The old lady wants to wear it herself." A family member at the side called out to Qu, "She's afraid that she won't be able to wear it when her body becomes hard."

Immediately, ten thousand mud horses flew through Gao Feng's mind.
"We haven't reached this point yet. Haven't you seen all the experts from the province come?" The doctor in charge smiled awkwardly at everyone, "This is the custom here, and the elderly are more concerned about this."

Gao Feng and Director Shen went up to check the body carefully. Professor Quan Shifan from the provincial hospital greeted Director Shen, and they met several times during the meeting.

When he came to the meeting room, the doctor in charge showed all the patient's examination results to everyone again, "Basically that's all, I kindly ask all the experts for guidance."

"Crush: Dragons don't sing, tigers don't howl, the little doctor is ridiculous! Please use your professional medical knowledge to let everyone understand the huge level gap between them and you! This task is a continuous task, and the current completion level is 0 /3. You can get 80 skill points after completing the task."

Gao Feng originally wanted to wait a while before speaking out, but when he saw the task released by the system, he immediately regained his energy. 0/3?Does it mean to crush everyone 3 times?Is it too much?The system is good or bad, I like it very much.

"Let me throw bricks to attract jade first." He couldn't wait.

"The diagnosis of lung abscess in this patient is correct. She should have a lung abscess caused by the highly virulent Klebsiella pneumoniae. I saw the description in the admission medical record that the patient coughed rust-colored sputum. This is incorrect. Strictly speaking It should be brick-red jelly-like sputum, which is a typical symptom of pneumonia Klebsiella pneumonia."

"The reason why the patient's condition worsens is mainly due to poor physical fitness and poor nutritional status, which leads to poor anti-infection effect."

"I suggest placing a chest drainage tube immediately to drain the pus inside in time, so that the patient can get better by combining anti-infection and nutritional support treatment."

As soon as his words fell, everyone started talking.

"Your words are a bit absolute, right?" Miao Zhusheng said, "We have done several times of sputum culture, but we didn't find Kleb pneumonia."

"And there are three abscess cavities on the patient's lung, one of which is near the heart, which one should be drained?"

"Of course, all three of them have been drained, and none of them should be missing." Gao Feng looked at him strangely, "I will continue to wash with salt water for a few days later."

When he said this, Miao Zhusheng laughed in his heart, who can say beautiful words!They also thought of closed thoracic drainage for this patient before, but two of the abscess cavities were small, and the larger one was close to the heart.

"Why don't Professor Gao do this thoracentesis for us? Everyone just happens to learn on the spot."

"Okay." Gao Feng stood up, it's not like a tiger eats a grasshopper -- it's not enough to fit between its teeth.

Liao Guangzan's heart was pounding, he glanced at Director Shen, meaning: why don't you go up?The latter gave him a calm look.

Gao Feng didn't let anyone from the color ultrasound room come over. The respiratory department itself has a bedside color ultrasound machine and a chest CT as a reference, which is too pediatric for him.

Seeing Gao Feng skillfully operating the bedside color Doppler ultrasound machine to mark the positioning point, Miao Zhusheng had an ominous premonition in his heart. The situation didn't look right, and this person seemed to be more than just talking.

Sure enough, after local anesthesia, Gao Feng pulled out brick-red jelly-like pus with one injection. He quickly inserted a guide wire, expanded the skin, and inserted a drainage tube.

This person's closed chest drainage is also very good!Professor Quan Shifan admired in his heart, he thought he would be fine, but he definitely couldn't do it so neatly.

It is obviously more difficult to puncture the abscess cavity next to the heart. The patient's physical condition is very poor, and he coughs from time to time. Who would dare to take this risk? If the heart is pierced, it will be troublesome!But Gao Feng's expression was very casual, and Miao Zhusheng even felt that the other party was a little careless. Seeing that the drainage tube was easily inserted, he was a little at a loss.

Are all the young doctors in the provincial capital so good now?

Miao Zhusheng glanced at his teacher, who was watching Gao Feng connect the drainage bag with great interest.

My good teacher, shouldn't you have a serious expression at this time?We were all 1:0 by others, what is your attitude!
"Follow-up, it needs to be washed regularly. Her pus is very viscous, which can easily lead to tube blockage. Pay attention to care." Gao Feng explained to the tube bed doctor.

Everyone also expressed some opinions on this patient. Professor Quan Shifan suggested that the antibiotic be changed to ceftazidime avibactam sodium. This drug has a good effect on the highly virulent Klebsiella pneumoniae, except that it is expensive.

Doctors from Liao Guangzan's group were in charge of the next patient.

A 75-year-old female patient had shortness of breath without any obvious cause before January, difficulty lying on her back at night, aggravated after activities, and relieved after rest, cough, white foamy sputum, occasional left chest pain, chest CT showed: both lungs Diffuse exudative lesions with consolidation lesions, mixed with multiple nodules and massive lesions, the possibility of multiple infections in both lungs is considered high.

The patient had heart valve disease 5 years ago and underwent "mitral valve replacement, tricuspid annuloplasty, and left atrial appendage plication" in Provincial People's Hospital. The discharge diagnosis at that time was atrial fibrillation after heart valve disease. Level, after discharge from the hospital has been oral warfarin 1.875mg qd anticoagulant therapy.

The patient has no fever at present, breathing 28 times/min, blood oxygen saturation 925, scattered moist rales can be heard in both lungs, and the rest is normal.

Meropenem + voriconazole + vancomycin were used for 2 weeks in the hospital, but the re-examination of chest CT showed that the infection did not improve.
The combined use of meropenem + voriconazole + vancomycin is called "big universal" in the hospital, which means that in terms of anti-infection, these three drugs are almost at the top, covering almost 99.9% of bacteria and bacteria, so it is There is a saying of "big omnipotent".

Among the three anti-infective drugs, Gao Fushuai can't do it together. It seems that this patient's condition is seriously problematic.Gao Feng also became interested. Today, he wanted to see what kind of alluring slut was acting as a demon.

Eat my boss!
After seeing the patient, Liao Guangzan looked directly at Gao Feng: Are you still going?

This is a direct point to me, Gao Feng thought to himself, but he was very happy, "How about I start by throwing bricks and attracting jade?"

Miao Zhu was in a hurry, he winked at the teacher crazily, hurry up, this kid is so imposing, don't you want to suppress him?

Professor Quan Shifan had a serious expression on his face. He just took a look at the patient's chest CT and felt something was wrong.He came from an infection background, and he has treated countless patients with lung infections since he entered the industry. This patient does not look like a bacterial infection, nor does it fit a viral infection!fungus?The signs don't match either!

Seeing Gao Feng standing up, he also became curious and pricked up his ears to hear what the other party had to say.

(End of this chapter)