Come on, Dr. Wu

Chapter 376 Change
“This is the patient’s condition after surgery.”

As he spoke, Director Wang showed the patient's postoperative X-rays and blood indicators.

Everyone then realized that the patient had already completed the operation, except for this!
Hmm! It's infected!
Moreover, it is Mucor!

If someone were to look from the back, they would find that all the doctors in the conference room were sitting up straight and leaning forward subconsciously. This was the action they took when they were thinking with absolute concentration, and this was also the time when they were absolutely serious.

Postoperative infection is a permanent pain for surgeons.

There are only two situations for patients after surgery. One is that there is no infection after the operation, and everyone is happy. This is what modern medicine has been committed to researching. Sterile surgery, sterile operation, etc. are all for this purpose, in order to avoid all postoperative infections. Because once a postoperative infection occurs, the consequences are unbearable for both doctors and patients.

That is the second type, infection after surgery.

If an infection occurs after surgery, the mildest possibility is an incision infection. What will be the consequence?
At the beginning, the skin around the incision may become red and swollen, which is also the earliest indication of infection. At this time, you should change the dressing from every two days to every three days, and then change it directly to every other day, or even twice a day, because along with the redness and swelling, there will be exudation.

If these exudates are not treated in time, the infection will be further aggravated.

Wound ulceration and pus formation are further events that may occur. It is not uncommon for patients who develop skin infection after surgery to have the surrounding skin removed and undergo skin grafting. This is still a relatively good outcome for postoperative skin infection. The infection may extend inward, causing bone infection and organ infection, requiring surgical intervention, etc. This is not an isolated case.

Therefore, for surgeons, sterility is always something engraved in the deepest part of their minds. Every time they perform an operation or make daily rounds, they must prevent the occurrence of infection.

The patient in front of us is obviously not in a mild case, but in a relatively serious condition after the infection.

The incidence of serious opportunistic infections caused by Mucor is actually not high, and it is even more difficult to diagnose.

Most patients with Mucor infection have complications such as diabetes, malnutrition, large-area severe burns, traumatic surgery, leukemia, lymphoma, AIDS or other serious wasting diseases, or are using immunosuppressants, cytotoxic drugs, corticosteroids and other drugs. Most of them have a serious condition before surgery, and once Mucor infection occurs after surgery, the condition becomes even more serious and the mortality rate is higher.

So far, none of the patients Wu Xiaofu has treated have had this type of infection, and he hopes that it will never happen in the future.

Every time Wu Xiaofu led a team to make rounds, he would popularize the concept of sterility, to the point that others were fed up with it.

In the surgical ward, there is an operation that is frequently performed, and that is dressing change.

Nowadays, surgical dressing changes are all done with disposable dressing bags, which are absolutely sterile and equipped with disposable gloves. When surgeons change dressings, they must strictly follow the principle of sterility, perform surgical hand washing before changing the dressing, wear gloves, a hat, and a mask, and the operation must be strictly standardized.

Moreover, according to regulations, dressings should be changed in the operating room, because sterile processing and ultraviolet disinfection are required here every day, and the bacterial survival rate is the lowest.

However, surgical patients often have difficulty moving after surgery, and surgeons have a lot of work to do, so most of them skip this process and basically change the dressings at the bedside.

Changing the dressing in this way actually increases the risk of infection. What's more, many surgeons omit many steps in order to be more efficient.

Not washing hands, not wearing gloves, and not following standard dressing change procedures before changing dressings are common practices in almost every surgeon.

As for hats and the like, who would wear them if the premonition department didn’t check?

Most patients actually have decent immunity, so even with such irregularities, they will not be infected. However, not all patients have such strong resistance. For example, a large group of patients nowadays, diabetic patients, have a much higher chance of infection than other people even if they strictly follow the sterile rules, not to mention if they do not strictly follow the sterile rules.

Therefore, in the surgical ward, you can always see a few infected patients from time to time.

Wu Xiaofu has seen many such cases. A perfect operation was finally successful, but all efforts were ruined because of infection.

The same is true of the case that Director Wang is presenting now.

Fungal infection is one of the complications after liver transplantation, and its incidence and mortality rate are high. In addition, this patient has hepatitis B, liver failure, diabetes, and surgery, so all these susceptibility factors are stacked up.

The body's own resistance to infection is minimal, and once an infection occurs, it can only be treated with antibiotic coverage.

Well, that is to say, for this type of patient, after discovering Mucor, we must use all our firepower to attack, just like going to war. Mucor is not an ordinary infectious bacteria, it is a special forces unit of dozens of people. Generally, for safety reasons, a regiment should be sent out to carry out the attack, so that there is a possibility of winning.

But this is a normal situation. Under normal circumstances, the combat effectiveness of this regiment is still acceptable.

But the combat effectiveness of this regiment is not good enough now. No, the combat effectiveness of the entire army is not good enough. So if you want to win, you cannot be stingy with manpower and firepower. You must directly dispatch a division or an army, use tens of thousands of people to attack these dozens of people, and directly surround and kill them, to win this battle with absolute certainty.

Director Wang obviously did this.

Look, there are Tenon, Swo, Koses, ganciclovir, and immunoglobulin G. In addition, there is post-operative airway protection. But even so, the patient's lungs were still infected with Mucor. An army was killed by a special forces unit of dozens of people. Tell me, is that scary?

The screen continued to scroll, and the symptoms of fever, cough, sputum, chest tightness, and shortness of breath became more and more serious.

At this time, the only thing you can do is increase muscle mass and continue renal replacement therapy to prevent the infection from spreading further.

What follows is months of antibacterial treatment.

The antibacterial regimen was adjusted several times, and in the end, I didn’t know whether all the previous treatments worked together or whether the treatment based on posaconazole was indeed effective against fungal infections.

After several months, the infection was finally brought under control.

It took more than half a year of treatment. You have to know that this is a patient who had just undergone a liver transplant and had so many underlying diseases. His body was already in an extremely weak state. So many drugs were injected into him, and all of them are toxic. This is not just talk. When the war breaks out, can the land under their feet withstand their artillery shells?
The answer is definitely no.

After the infection is controlled, the final result is that the patient's survival period is shortened again and he dies soon after.

That's the horror of infection.

If it weren't for this infection, it is estimated that this patient would have had at least three to five years or even longer to survive.

"If we encounter a similar patient, what should we do? Can we ensure that the infection is nipped in the bud?" "Can we learn something from this incident? Can we eliminate the possibility of infection before it occurs?"

"Can we develop a mature infection prevention program to eliminate the infection at its root, especially for patients with poor immunity?"

“If a patient becomes infected, can we develop an effective anti-infection strategy for all possibilities?”

……

A series of questions appeared on the screen, causing everyone to fall into deep thought.

Preventive medicine has never been an empty talk in modern medicine. Every doctor keeps this concept in mind, and the department of preventive medicine is absolutely indispensable in every hospital. However, it is not known whether the preventive work needs to be further improved, or whether the development of pathogens is too rapid, and the endless stream of diseases still makes doctors run around in a hurry.

Now this concept is raised again.

The first few questions Director Wang asked were actually about whether it is possible to solve the problem of postoperative infection fundamentally. Don’t talk about treatment, just prevent it from happening.

However, including Wu Xiaofu, everyone could only remain silent when faced with this question.

Because they know it's too difficult.

The next question is whether it is possible to develop a set of guidelines so that people can have guided treatment the moment the infection occurs, so that they don’t have to be like headless flies, constantly trying, and in the process of trying, everything is too late. Once the disease spreads, it will be extremely difficult to treat the patients.

But it is not so easy to formulate guidelines.

Especially for surgeons like them, what they can provide is just their own experience. They are professional in performing surgeries, but these jobs are really not what they are good at.

Therefore, faced with these problems, they, who were usually able to talk eloquently about complex patients and complex operations, were now speechless.

"Director Wang, this is not a consultation. You are clearly trying to start a revolution."

Yu Shifu suddenly spoke, and everyone's meditation was broken. They all nodded. Yes, Director Wang was not just asking questions, he was having a consultation. It was obvious that he was going to start a revolution. However, they actually had some expectations in their hearts. If they could really accomplish this revolution, then the future of their surgery would undoubtedly be rewritten.

There will also be a brighter future.

Director Wang also laughed when he heard this. "If a reform can bring some changes to our surgery department and bring a brighter future, then why not a reform? Of course, this is not something I can decide on my own. This time I just put forward an idea. How to do it specifically still needs to be discussed by everyone."

As he spoke, Director Wang looked at Wu Xiaofu who was beside Yu Shifu.

"Director Wu, most of the people sitting here are actually old guys. You are the only young one. The thoughts of two generations are definitely different. I want to hear your thoughts first. I also hope that your remarks can give us old guys like you something thought-provoking."

Wu Xiaofu didn't expect that Director Wang would suddenly bring the topic to him.

At this moment, everyone's eyes were focused on him. There was suspicion, expectation, and confusion in these eyes. It was the first time that Wu Xiaofu saw so many things in so many eyes.

When he was mentioned, he felt a little uneasy, but after standing up, Wu Xiaofu felt calm instead.

“All of you teachers are my predecessors. I dare not say anything revolutionary, let alone make any thought-provoking remarks. However, since this is a consultation, I will first talk about my thoughts on this case.

Infection is a major problem in our surgical operations. Prevention and treatment have always been a headache for us. Among infections, fungal infection is the most troublesome. In fact, the treatment of this case is very worthy of our study and also provides us with some guidance. Posaconazole has a definite therapeutic effect on pulmonary mucormycosis, and its toxic side effects are significantly less than amphotericin B.

When we encounter similar cases in the future, we can be more decisive, carry out accurate bacterial culture and precise medication. If the fungus is just budding, this will be enough to eliminate it in the bud.

This is treatment. I also have some opinions on prevention. As far as this case is concerned, most Mucor infections do not originate from incisions, but from the respiratory tract, gastrointestinal tract, and other routes. So, can we start from prevention? After surgery, we can carry out comprehensive treatment based on CRRT and enteral nutrition, which can greatly reduce the possibility of infection.

Then there is the choice of intravenous and oral medications.

......"

Everyone listened to Wu Xiaofu's words and nodded from time to time. When Wu Xiaofu spoke later, everyone had already started the discussion, starting from one case and extending it step by step.

Those sitting here are all top experts in their field. They actually have all the knowledge and experience. It’s just that they have always felt that this is too difficult, so difficult that they subconsciously avoided the idea.

Until now, the more they discuss it, the more difficult it seems.

In the end, he even started shaking his head again. Director Wang felt helpless looking at this scene, because there had been several times before when the process had progressed to this stage, but once it reached this stage, it could not go on.

He knows it is difficult, but he always wants to do more.

Just looking at this, I'm afraid I can only stay here this time.

“In fact, it is not impossible to develop a set of prevention and treatment guidelines. However, it is not enough to rely solely on the strength of our hepatobiliary surgery department. After all, infection cannot be considered one-sidedly, because it is a problem that needs to be considered from the whole body. Focusing on one point will only block one end and let it escape from the other.

Therefore, if we really want to complete it, we may have to call together all relevant departments and experts, conduct analysis, and then proceed step by step. However, since we are already sitting here today, we might as well start with ourselves.

The reason why everyone finds it difficult is that every time we discuss, we find that we always reach blind spots and our knowledge blind spots, making it increasingly difficult. In this case, we should ignore the knowledge blind spots and sort out what we can consider and what we think is necessary.

For the rest, we can ask other departments and experts to fill in the gaps.

However, we must take this first step. I am afraid that we are not the only ones stuck at this step. Other professions will also hold similar consultation meetings. Will they also stay at this stage every time? As long as we set an example, will this matter be able to move forward? "

(End of this chapter)