Those years when I hung up and upgraded in the hospital

Chapter 28 Ideas and Attempts (Please collect and read)
After Fang Yun had breakfast, when he came to the office in the department, he found that someone had arrived earlier than him.

It's Xu Dong.

Xu Dong was recording the examination results of all the patients in the group. When he saw Fang Yun coming, he turned sideways, tilted his head and greeted kindly: "Brother Yun. Good morning."

"You were earlier." Fang Yun replied, buttoning up his white coat at the same time.

Xu Dong has a medium build, wears glasses, and has small freckles on his face. Apart from that, there is nothing special about him. Possibly his only trait is his down-to-earth quality.

"Brother Yun, this is the photo of the wound that I took yesterday when I was changing the dressing. I planned to send it to you, but I found that you were not added as a friend. Now add one?" Xu Dong generously invited.

"Okay, you open the QR code and I'll scan it for you." Fang Yun also wanted to check the condition of the wound.

After adding friends and making notes, Xu Dong sent all five photos.

The stump after amputation looks like the mouth of a giant salamander, except that the mouth is strangled by sutures. It is milky white, slightly corroded, red and swollen, with exudate and dots of pus spots. Other than that, there is nothing unusual...

Fang Yun only has three beds. The 13th bed is the sixth day after the fracture operation. The X-ray film has been reviewed after the operation. There is nothing special. He is just waiting for the sutures to be removed and he is discharged.

Bed 14 is a delivery boy who suffered an open fracture after slipping while driving. On the third day after debridement, suturing and internal fixation of the fracture, the inflammation index is high. The inflammation is currently being treated, and there is nothing special. I am just waiting to be discharged from the hospital.

The only thing is this 9-bed, which is a headache.

Xu Dong sent the photo, and Fang Yun probably asked after reading it: "Brother Yun, what did you think about this patient's infection?"

Xu Dong actually asked the question in advance.

"It's hard to say. When I was in Jishi People's Hospital, I had Staphylococcus aureus infection and Escherichia coli infection. The sensitive antibiotics I was given when I was discharged last time were Suprosen, cefaclor, and piperacillin..."

"I think it would be better to use piperacillin and sulbactam at the moment." Fang Yun is not ready to make a plan directly. He may have to discuss it with Director Long Quan later.

Xu Dong said: "Supu Shen is actually quite good. Cefoperazone mainly inhibits the synthesis of bacterial cell walls. Although sulbactam has a weak antibacterial effect, when combined with cefoperazone, it can increase cefoperazone's resistance to various β- The ability of lactamase to degrade cefoperazone has a significant synergistic effect."

"If you add topical antibiotics, it might have good results."

After saying that, Xu Dong looked at Fang Yun.

Fang Yun glanced at Xu Dong: "The patient is an elderly woman who has undergone cholecystectomy. Although Shuproshen is mainly excreted through the kidneys, about 25% of the dose of cefoperazone and 84% of sulbactam are excreted in the urine, and the remaining Most of cefoperazone is excreted in the bile..."

"Although the contraindications do not state that it should be used with caution in patients after cholecystectomy, it may increase the burden on the kidneys. If the patient is an elderly woman and the bile excretion of cefoperazone is not smooth, it will inevitably increase the burden on both kidneys, which is not good."

"But piperacillin will have more adverse reactions. It seems to be excreted through bile." Xu Dong seemed to know what drug Fang Yun would choose.

"Both piperacillin and tazobactam are mainly excreted through the kidneys. At least 60.00%, and the remaining approximately 30% of piperacillin and tazobactam are bound to plasma proteins. And piperacillin and tazobactam are widely distributed in tissues and In body fluids. The drug concentration in tissues is about 50% to 100% of the plasma concentration."

“The better the distribution of drug concentration in tissues, the better the anti-inflammatory breadth.”

"This 9-bed wound has a pale and decayed appearance nearby. It may be that the local blood supply is damaged due to infection. If the drug only spreads through the blood, it will be difficult to reach the place of action."

"The effect of topical gentamicin will be very limited. This old man's infection is no longer localized on the surface, but in the subcutaneous location. Topical gentamicin only treats the symptoms but not the root cause." Fang Yun explained to Xu Dong.Xu Dong frowned when he heard this, looked at Fang Yun blankly, and frowned slightly.

"Brother Yun, have you checked the information too?" Xu Dong discovered that Fang Yun, the attending physician, was different from the attending physicians he had met before.

During his training period, he had some very useful ideas and theories, but when he got here, he felt that his knowledge was too limited.

"Well, I have checked some. I plan to let the patient take some anticoagulant drugs orally to see if it can unblock the blood supply in the remote area." Fang Yun also felt that Xu Dong was more reliable, so he also gave him such advice in advance. For a moment.

Xu Dong said no more.

……

The county hospital is not particularly big. Most of the patients are regular patients, and the more difficult ones are transferred to higher-level hospitals.

The Longquan director's team, which has only 9 beds, is currently very difficult.

If it was a normal idea, then she would have improved by the time she transferred to Xiang Provincial People's Hospital and Jishi People's Hospital, and it would be impossible for her to come to the county hospital again.

As soon as he came out of bed 9 after checking the room, Long Quan frowned.

"Luo Su, what do you think would be a better way to deal with this 9-bed hospital? Although she may be transferred to the Second Affiliated Hospital of Shonan University in the future, that is only a possibility after Dr. Ding, who is in charge of supporting her, comes to our hospital. "

"There are still a few months left, we can't let the patient lie like this forever." Long Quan asked Luo Su.

Luo Su is the veteran head coach in the group and has the same seniority as Qin Chaowen.

"The current treatment guideline for dealing with infection is to culture bacteria. After finding sensitive antibiotics, continue using them for a period of time before surgery, then thoroughly debridement. Finally, continue to reduce inflammation."

"However, this patient must have undergone such a plan more than once in Ji City and Provincial People's Hospital. I don't know what to do now." Luo Su frowned.

If the debridement is not thorough enough, then the level of the doctors at Jiji People's Hospital is not good enough, and the level of the professors at the Provincial People's Hospital cannot be doubted, right?
Luo Su just talked about the currently popular treatment ideas.

Longquan was also dissatisfied. With such a routine approach, Longxian People's Hospital would definitely not be able to compete with large hospitals. Although it was a standardized treatment process, it was useless, so it could only seek changes.

"What did Dr. Fang think about it?" Long Quan asked.

"Director, I'm considering using some aspirin for anticoagulation. Check the platelet decline rate." Fang Yun had already done some homework, so he was not polite.

Hearing this, Long Quan frowned slightly: "Tell me what you think."

Fang Yun said: "Director Long, this patient's bacterial culture, drug sensitivity, debridement, and intraoperative internal and external antibiotics have all been used more than once."

"Furthermore, Ji City People's Hospital and Provincial People's Hospital have done a good job in post-operative anticoagulation, etc., but the patient still appeared partially pale."

"This means that the patient's local thrombosis may not be caused by abnormal coagulation function."

(End of this chapter)