Gou is practicing medicine in the clinic

Chapter 354: Use mud-like medication, shameless cryptococcus
"Dr. Li suspects cryptococcal infection?"

Director Rong's face changed slightly. Ordinary people may not feel much about this disease, but experienced doctors all know that this disease is extremely difficult to treat and the prognosis is often poor.

And the condition is prone to recurrence.

If Li Jingsheng didn't have a series of outstanding performances before, Director Rong would just think that he was farting.

No one dares to despise Li Jingsheng's suggestions now, because although Li Jingsheng doesn't speak much, he always has the right target.

"I'm just suspicious, I can't be sure. If it's really cryptococcal infection, I'm afraid it's meningoencephalitis type."

Li Jingsheng said that the work was not accurate, but he gave out the specific types.

Clinically, this disease is divided into four categories, namely meningitis type, meningoencephalitis type, granulomatous type and cystic type.

Neither one is easy to deal with.

Among them, the meningoencephalitis type is the most complex type, competing with the granulomatous type.

"Let the laboratory examine the pathological slides immediately. If anything is found, do a mycological examination immediately."

Rong Xuekai ordered his assistant.

Cryptococcal meningitis is difficult to detect in the early stages. The changes in sugar and chloride in cerebrospinal fluid are often not obvious in the early stages, and will only begin to decrease significantly in the middle and late stages.

The special sugar content will be significantly reduced, even to zero.

The routine examination of this child's cerebrospinal fluid showed that the sugar content was significantly reduced. In addition, many other symptoms are consistent with this disease, so it is likely to be this disease.

"Dr. Li just mentioned that the child may have cryptococcal infection, and it may be a very difficult type of meningoencephalitis. This reminds us that we must be prepared for the worst. Now it can basically be characterized as an acute virus. Encephalitis, the child's condition is still not under control, which is very dangerous. I think just symptomatic treatment is not enough. Can we discuss it and actively intervene?"

Rong Xuekai's eyes swept over everyone.

He was a barefoot doctor, and he had many similarities with Li Jingsheng, a doctor who opened a clinic.

In the early years, barefoot doctors treated people because their conditions were limited and their medical knowledge was not that advanced.At that time, fevers that were slightly difficult to treat were directly classified as epidemics as long as vomiting and diarrhea occurred.

What do you mean?
It means the same thing as the plague.

In order to save people's lives, the barefoot doctors don't care about black or white cats. Cats that can cure diseases are considered good cats.

They use a mixture of Chinese medicine prescriptions and techniques, Western medicine, and Western medical treatments.

And that era was dominated by traditional Chinese medicine and traditional Chinese medicine.

There was no way. In that era, the great powers blocked all aspects of technology and did not let us learn at all.

Another characteristic at that time was that because of poverty, many people did not dare to go to the hospital for medical treatment when they were sick.It was only in recent years that the practice of asking a doctor to come to see a doctor slowly began to disappear.

It is conceivable that barefoot doctors at that time were actually the main force in medical treatment.

Under the unfavorable conditions of crude equipment, backward medical knowledge, and lack of drugs, they have developed amazing potential.

He tried every means to save the patient's life and developed his strong prediction ability.

After receiving a diagnosis, they will have an accurate judgment in their minds about whether the patient can be saved and in which direction the patient is likely to progress.

To put it bluntly, it is crisis awareness.

Li Jingsheng's prediction in this regard is extremely keen.

Boss Zhao from Chengnan Old Street should also be very capable in this area.

Because the doctors in the compound have a big tree at their backs, they have a certain degree of dependence, and they like to work as a team when encountering difficulties.If something goes wrong, you'll have to eat from the big pot. The hospital will step in to take care of you.
Therefore, it is difficult to develop this keen ability to predict risks.

Rong Xuekai benefited from his early experience as a barefoot doctor and honed this ability, which made him a fish in water in the Department of Critical Care Medicine.

At this moment, after listening to Li Jingsheng's diagnosis, he became highly vigilant and began to take the initiative, trying to intervene proactively before the child's brain lesions progressed to the point where it was difficult to cure.

When a serious disease takes hold and reaches a later stage, it will be like a landslide or a tsunami, and any means will be of no avail in front of it.

The best way is to proactively intervene before a serious illness becomes serious, to prevent it from progressing to severe disease or even causing a host of complications.

When it gets to that point, even gods can’t save it.

"I very much agree with Director Rong's suggestion. It is much better for us to take the initiative than to watch the virus continue to destroy the child's body and worsen the condition."

"Ahem... Dr. Zhao needs to be more careful with his words. Until the source of the disease is found out, we don't know where to attack even if we come up with a strategy. Symptomatic treatment is actually an active intervention. It is by no means just watching and ignoring it as you said."

"Yes, yes, I didn't express it well enough."

Dr. Zhao is 35 years old. Being able to participate in this consultation shows that he is favored by superior doctors.

But speaking carelessly in front of family members is a stupid mistake.

This is the importance of internship and secondary training.

Many postgraduates and even Ph.D. students follow teachers to carry out practical work in hospitals. Some teachers are afraid to let go, which results in insufficient training for them.

Then after I actually entered the hospital and became a doctor, because of my high academic qualifications and the famous teacher, the skills I learned may not be bad. The only shortcoming is the lack of grassroots training.

Many people who want to study for a doctorate only go to the hospital for a few days and then get promoted to attending doctor.

In order to recruit such highly educated talents, hospitals are often willing to open doors and lower their requirements in all aspects.

This results in the type of Dr. Zhao who lacks grassroots experience and lacks high awareness when communicating with family members, which can easily lead to doctor-patient disputes.

Of course, this is not a big deal.

After a few beatings, he will naturally become smarter and smoother, and his words will no longer be so willful.

"Let's seize the time and continue discussing the child's medication!" Rong Xuekai brought the topic back on track, which also alleviated Dr. Zhao's embarrassment.

Give young people more opportunities to try and make mistakes. Many compounds have this fine tradition.

Because chief physicians also grew up in this way.

"There are many kinds of antiviral drugs. If you know the type of virus, you can use the medicine accordingly. If this child has adenovirus or herpes virus encephalitis, then I believe that taking vidarabine will have an immediate effect. The problem is that the type of virus has not yet been identified. , can we consider applying the medicine first?"

The so-called harmonious medication refers to the use of drugs that do not only target a certain virus.

For example, amoxicillin is the most commonly used broad-spectrum bacterium expansion drug in clinical practice.

It has powerful bacteriostatic and bactericidal effects and can be applied to a variety of diseases and scenarios.

It can be called a miracle medicine level existence.

Viruses are fragments of bacteria that are constantly evolving and adding new species every year.

There are also artificially developed and synthesized viruses.

Clinically, there are no specific drugs for many viruses.

The most beneficial weapon against viruses is not drugs, but the human body's immune system.

Many people only know that Komodo dragons, which love to eat carrion, and bats that love to eat mosquitoes have strong virus immunity.As everyone knows, our human body’s immune system is not weak either.

Li Jingsheng couldn't help but think of the name of an antiviral drug—ribavirin.

The real name of this drug is ribavirin.

It is widely used in the treatment of viral encephalitis, and the effect is not bad.

"Director Rong must have a good medication plan."

"The only thing I can think of for the moment is ribavirin as an antiviral drug, and at the same time, intravenous infusion of 100 million U of interferon to enhance the antiviral effect."

Director Rong gave his own medication suggestions.

As expected of a leader in the Department of Critical Care Medicine, the medication plan was more comprehensive than Li Jingsheng thought.

Interferon is commonly used in tumor treatment. Its antiviral effect is actually not bad, and it can be used in combination with a variety of drugs.

"It seems that my prescription needs to be upgraded by another liter. There is still a gap between me and these big guys!"

Li Jingsheng said silently.

Although the efficacy and pharmacodynamics of Dacheng level are already very strong, there is still a big gap between them and the experts.

Even if the same medicine is used, if the timing and dosage of the medicine are accurately grasped, the effect will be better.On the contrary, if the timing of medication is wrong, the desired effect may not be achieved.

If it is used too early, one person will not dare to use the medicine, and the other person will kill the chicken with a knife and let the patient bear the harm of the medicine.

If used too late, the efficacy of the medicine will be greatly reduced and the dosage will be increased a lot.

Three-drug.

The patient's body is already weak, and he has to endure the side effects of the medicine, which is quite a bit adding insult to injury.

The key point is that the doctor added it himself in the name of saving the patient.

Doctors face four difficulties in treating patients: diagnosis and medication. These are the two top problems.

"Dr. Li from the Second Hospital just mentioned that the child may not be infected by a virus, but by cryptococcus. We must pay attention to this. Otherwise, if we use antiviral drugs to deal with fungi, we may be able to kill mosquitoes with cannons. Wrong weapon used."

When saying this, Rong Xuekai glanced at Dr. Zhao intentionally or unintentionally.

This is a secret reminder to Dr. Zhao, boy, please don’t talk nonsense again in the future.

We haven’t found out whether the patient has a viral infection or a fungal infection. How do you recommend drug intervention?
Dr. Zhao lowered his head, slightly embarrassed. "Cryptococcus is extremely difficult to deal with, but it would be good if it could be identified early. It would be extremely beneficial for treatment. It shouldn't be difficult to do pathology in the laboratory. Cryptococcus microscopy should be able to produce preliminary results soon. Result?"

Lian Tao frowned and said.

The laboratory can take a small amount of cerebrospinal fluid sample from the child, place it on a glass slide, then add a little ink, mix well, and add a cover slip.

If it is Cryptococcus neoformans, round or oval double-layered thick-walled spores can be seen under the microscope at this time.They have a broad capsule on the outside with clear and complete edges, and a single bud can be seen inside the bacteria.

If it is a variant of Cryptococcus, the bacteria may be rod-shaped, needle-shaped, spindle-shaped, scoop-shaped, spherical, or budding.

If it is not detected in this way, it can also be reexamined by centrifugal sedimentation method.

The laboratory of the People's Hospital is very powerful, and it still has this capability.

This result is usually obtained very quickly.

After all, this child's condition is critical, and with so many directors waiting on site, it's impossible to queue up stupidly in the laboratory according to the procedures.

Will definitely make it a priority to check.

"Hey, Director Lian's mouth is really golden! The laboratory called."

Rong Xuekai answered the phone.

After chatting with the other party for a few words, he hung up with a touch of excitement that was hard to conceal on his face.

"Doctor Li, Doctor Li, what can I tell you about you? Do you specialize in god-level prophecies? You are right again!"

Rong Xuekai looked at Li Jingsheng with eyes full of appreciation and affection.

How wonderful it would be if this boy could be his assistant!

He must have devoted all his life to teaching him.

"Is it really cryptococcus?"

Lian Tao and other experts were excited, but also secretly called for good luck.

It was almost treated as acute viral encephalitis.

Who would have thought that this shameless Cryptococcus bacteria was pretending to be a virus and deliberately confusing them, the doctors.

Viruses are often dubbed the traitors of the germ world by doctors.

Because they are fragments of pathogens that have mutated and acquired the ability to replicate themselves.

Bacteria have the ability to survive on their own, but viruses purely rob the host of nutrients.

After the human body is infected with germs, there may be no major symptoms.

There are even a large number of bacteria in the human mouth and intestines.Even human digestion requires the help of these bacteria.

They are sometimes called probiotics.

Li Jingsheng still remembers taking a medical experiment class and seeing that his saliva was full of bacteria, and he couldn't eat for several days.

Just thinking about that scene makes me sick.

There is a difference between fungi and bacteria.

Its biggest feature is that it is difficult to eliminate.

Nearly all patients with fungal infections have been on continuous medication for at least fourteen days.

But common bacteria or viruses can probably be treated with medication in a day or two.

Cryptococcus is a notorious fungus. It is difficult to detect, highly destructive, and can spread everywhere.

For example, in this child, it directly entered the brain, and then developed acute encephalitis.

"Although it is only the result of the preliminary examination, I think we can start taking the medicine. It is considered an experimental medicine! If it has an effect, it will be seen soon."

Rong Xuekai said excitedly.

"We won't discuss how to deal with cryptococcus, right? All the directors are busy people, and we are all affected today. If the child is rescued, let Secretary Bei treat you to a feast."

Rong Xuekai was already an old man and he no longer cared about promotions or salary increases.

Other doctors were extremely fawning to the child's mother and spoke cautiously, but he seemed straightforward and casual.

"No problem, this is totally what it should be. Even if Director Rong doesn't mention it, I still want to treat everyone to a casual meal after my son is discharged from the hospital to express my gratitude. You are all my son's lifesavers."

Beiyan agreed readily.

"Dr. Li, thank you for taking time out of your busy schedule to come and save this child and help us consult together. You showed me how powerful the Second Hospital is. I will visit you often in the future and keep in touch. If you encounter a seriously ill patient, call me You can communicate with me at any time regarding the two major categories of heart failure and heart failure. However, I usually guide rescue and medication in the intensive care unit during working hours. I may not be able to answer the phone or reply to messages in time. I can only ask for your forgiveness."

Rong Xuekai walked up to Li Jingsheng and held his hand tightly.

"You're too kind. It's my duty to save lives and heal the wounded. I'll keep your phone number so that I can find an opportunity to ask you for advice if I encounter something I don't understand in the future."

Li Jingsheng also followed the stick and asked for his contact information.

Bosses of this level are often cautious in their words and deeds.

Director Rong had already taken the initiative to say that he wanted to visit him frequently, but it was unreasonable for him to put on an airs and not have the dignity to ask for his phone number.

"Give me your number! I'll just dial it. I'm getting older and I really can't remember the number."

Rong Xue said with a smile.

This kind of person is really a role model. He can't remember his phone number, but he can firmly remember his experience in diagnosing various diseases and medication.

Another crazy doctor similar to Lian Tao.

He is obsessed with medicine and is only interested in the diagnosis and treatment of diseases.

A medical veteran who is worth learning from.

The two parties exchanged phone numbers, and Li Jingsheng also said goodbye and left.

Before leaving, Beiyan and his wife held his hands tightly, but Lian Tao, on the other hand, joked with him informally and left quickly.

The friendship between the two is so deep that they really don't bother to be polite and keep it superficial.

Li Jingsheng looked at the time and saw that it took a total of 86 minutes. It would take another half an hour to rush back to the hospital.

What a miserable life. This consultation took him almost two hours.

As long as the child can be saved, it will be worth it.

After all, a life was saved.

When he returned to the Second Hospital, he was still the same low-key outpatient doctor.

The level of a few students was limited and they only dealt with eight simple patients with joint dislocations and fractures. They were not yet capable of handling them.

Moreover, complex dislocations and displacements of wrist joints, elbow joints, ankle joints, and knee joints cannot be dealt with either.

Manual bone setting is not that easy to learn.

Even if you learn it, it is not easy to operate it well.

It takes countless practice and accumulation to get better and better.

Li Jingsheng hopes that these students will grow up soon. Even Dr. Chen, who has mediocre talent, has not given up on him.

Instead, let Dr. Chen remember eight words: Diligence can make up for weakness, and stupid birds can fly first.

He was obviously the eldest brother among the five, but he was successively surpassed by Ye Hui, Yang Luqing and others.Dr. Chen must have been deeply affected.

Dr. Xu refused to teach him at first, but he actually had good intentions and was doing it for his own good.

Because the talent is too poor, it is difficult to learn and achieve success.

Instead of wasting time and energy on manual bone setting, it is better to develop into other medical fields.

It's a pity that Dr. Chen himself never thinks like this. He just wants to learn bone-setting techniques and learn it well.

Judging from his operation of resetting the patient's shoulder joint, he must have practiced frequently at home.

It’s just poor understanding and slow progress.

The patients waiting outside looked happy when they saw Li Jingsheng rushing back after a long journey.

Many fractures and injuries are not treated here and can only be operated on in other hospitals.

Drilling N holes in the bone, attaching a steel plate, and fixing it on the bone with screws, how can it compare to manual bone reduction?

Not only is it more expensive, surgery itself is harmful to the body.

After the bone is reset, steel nails or even steel plates are used for internal fixation, which is another kind of injury.

After it heals, you have to hurt it again to remove the splint.

I believe that no patient would be stupid enough to listen to the nurse's lies, saying that there is no harm in the operation and that he will recover later.They all have no choice but to choose surgical treatment.

(End of this chapter)