Doctor’s Life Simulator

[Ding, consume 1 simulation point to start a single case simulation. 】

[At the invitation of Wu Youtu, You Daren and Zhong Chengfa, you participated in the patient's consultation. However, since the patient's condition is very rare, there is nothing you can do. Only routine debridement can be performed. 】

[On the second day, the laboratory found out: WBC20.23X106/L, N0.83, L0.14, globulin 36g/L, white ball ratio 1.1. Bacterial culture: Streptococcus faecalis, sensitive to penicillin. 】

[Due to the patient's untimely consultation and the rare etiology of the patient, there was no immediate targeted treatment, the lower abdominal wall had been involved in the local area except for the skin of the eagle, extensive skin necrosis led to septic shock, and multiple lesions in the lungs and kidneys. Organ failure, despite active debridement treatment, life support treatment such as ventilator and continuous bedside hemofiltration, died because the family members in critical condition gave up treatment]

[Afterwards, after reviewing the condition and inviting experts from Hangcheng, it was finally confirmed that the real cause of the patient was the rare Fornier's gangrene. 】

[Fornier's gangrene was first described in detail by Fornier in 1883, hence the name. It is a subcutaneous infectious disease with abrupt onset, rapid change, severe condition and strong explosiveness. It occurs in male eagle stems, eagles, eagles and abdominal walls. It is a rare type of acute necrotizing fasciitis. one type. 】

[After the incident, Wei Guoqiang also made a special summary, and it was also the second case of this case in Hecheng in recent years. Fornier's gangrene is mostly caused by local injury or infection, and factors leading to infection, including systemic factors. Such as diabetes, blood diseases, AIDS, long-term use of steroid drugs. 】

[This patient has a history of rheumatism for five years, and taking hormones for a long time has resulted in a low body immunity. may be the main cause of the disease. In view of the pathogenesis of Fornier's gangrene, early diagnosis and timely treatment are the keys. At the same time, comprehensive measures are needed, including debridement, early incision and drainage, decompression, thorough clearing of necrotic tissue and fascia, and systemic broad-spectrum antibiotics to control the spread of infection. and diffusion, if necessary, systemic rehydration therapy to support. 】

[Single case simulation is over, whether to retain the clinical experience of the case. 】

"It's such a rare form of Fornier's gangrene, no wonder it developed so quickly."

After Qin Lang knew the patient's condition, he was ready to rescue him immediately. After all, early rescue is very important. Once the best time is missed, the patient's fatality rate is very high.

After Wu Youtu left with Peng Yun, the conference room fell into silence, and Zhong Chengfa and You Daren were still at a loss.

"Everyone, I know what the patient's symptoms are. This is a very rare type of acute necrotizing fasciitis. We will go to Dr. Wu right now. Time is running out, everyone, let's talk as we go."

Qin Lang's tone was firm, and he mobilized vigorously.

"Qin Lang, you really found the cause, you can't talk nonsense!"

You Daren immediately got up and followed Qin Lang, still in disbelief.

Zhong Chengfa was a little surprised. Now that he has a direction, it is better than a headless fly.

The three immediately headed for the ward, and soon joined Wu Youtu.

The matter is urgent, Qin Lang is not hesitating, and directly takes over the command:

"Dr. Wu, I have found the cause of the patient. It is Fornier's gangrene, a very rare type of acute necrotizing fasciitis, which requires early rescue as soon as possible."

"Fornier's gangrene?"

Hearing the confirmed cause of Qin Lang, Wu Youtu looked unfamiliar. This patient is really rare, and the First City Hospital has not encountered a single case for so many years.

However, seeing Qin Lang's serious and determined state, he still chose to believe it.

"Qin Lang, now that you have found out the symptoms, what is the treatment plan? Can the treatment center handle it?"

Wu Youtu began to calculate and estimate in his heart, the feasibility of the surgical plan, and whether the treatment center could undertake this emergency treatment.

After all, Qin Lang was still young, and he didn't know anything about the disease he proposed. If he was misdiagnosed, it would be the difference between life and death for the patient.

The treatment center has just started its trial operation. If this is not the case, it will have an impact on the subsequent approval.

Whether it is from the safety of the patient's life or the prospect of the treatment center, choosing to transfer the patient to the First Hospital of Hangzhou Zijingang is the best choice.

Qin Lang certainly understood Wu Youtu's hesitation and thoughts.

"Doctor Wu, Fornier's gangrene necrosis is very fast, and now the only chance for the patient to survive is in your hands. Don't think about transferring to another hospital, it's too late."

"We must now start debridement and broad-spectrum antibiotics to treat systemic infections. Fornier's gangrene requires thorough removal of necrotic tissue and fascia. After debridement, there will be a large area of ​​tissue defects in the eagle area, so it is necessary to cooperate with skin grafting and local skin grafting. **** and free grafts to repair the defect.”

"For this patient, we need to immediately adjust the state of the whole body, and at the same time use the VAC system to prepare the wound in the early stage, and then use the direct suture of the local skin flap to repair the skin defect."

Wu Youtu looked at Qin Lang, and while he was still thinking about it, Peng Yun exclaimed again:

"Doctor Wu, the patient's condition has further deteriorated, and the whole person has a mental disorder!"

You Daren and Zhong Chengfa were sweating coldly behind their backs, and looked at Wu Youtu and Qin Lang.

Wu Youtu finally chose Qin Lang's suggestion:

"Qin Lang, since that's the case, I will treat you according to your plan. If there is any problem, I will bear all the consequences."

You Daren and Zhong Chengfa saw Wu Youtu agreeing to Qin Lang's plan, and they began to participate in the rescue together.

Ten minutes later, the medical staff and all the equipment were in place.

After the patient is under general anesthesia. Under the auspices of Qin Lang, the first step of wound debridement was started.

In order to buy time, Qin Lang did not give up to the others at all, and started the operation quickly. The whole action was a little faster than usual.

The scalps of the attending physicians who were watching were numb for a while.

"This Qin Gallery, at a critical moment, is still very able to go!"

Since the patient's affected area is in very bad condition, with all kinds of richness and ulcers, even at the level of Qin Lang's debridement, it still requires a long and continuous meticulous operation.

For two consecutive hours, Qin Lang finally completely removed the necrotic tissue, pollutants and infected exudates, and completely stopped the bleeding.

"...VAC Negative Pressure Therapy, Hydrophobic Polyurethane Foam Dressing, Gasket, Connecting Catheter, Effusion Tank..."

Qin Lang began to report unfamiliar and clear equipment and equipment.

I have to say that I really want to thank you for the first aid this time. The latest equipment purchased recently includes a most suitable new type of intelligent negative pressure therapy device.

"...adjust the pressure to -125mmHg..."

Time was pressing, Qin Lang did not explain too much to everyone, and after a series of orders were issued, everyone was methodically centered on Qin Lang, and turned at a high speed.

According to the size of the wound surface, the hydrophobic polyurethane foam dressing was cut, and it was fully filled into the wound surface and the sneak cavity, and the sealing pad covered the dressing and the wound surface.

At this point, the first step is finally completed.

The next step is to wait for the wound to be clean and free of necrotic tissue, contaminants and signs of infection. UUkanshu www.uukanshu.com The bacterial culture of the wound exudate is negative, and direct suture or local **** can be used to repair the wound.

Since the patient's condition was already very serious when he was admitted to the hospital, the defect area was greater than 50%, and the stem was involved, so the suture could not be drawn, and only local **** could be used for repair.

By this time, more than three hours had passed since entering the operating room.

...

Director Wei Guoqiang, who was far away in Hangzhou, just finished the report. After coming out of the conference room, he saw Wu Youtu's previous message to him and various physical examinations of the patient.

And the most recent one is Wu Youtu's message before entering the operating room:

"Director Wei, after my joint consultation with Dr. Qin, Dr. You, and Dr. Zhong, the matter was urgent, we chose to take a risk, and the decision was made by me, and I will bear all the consequences. The initial diagnosis of the patient is a rare Fornier gangrene. "

"It turned out to be Fournier's gangrene!"

After all, Wei Guoqiang is the chief physician of the burn center, and he really saw this disease at an academic conference in the Asia-Pacific region.

And he knew very well that Fournier's gangrene was so violent that it was too late for him to be transferred.

Is it really possible without the treatment center he sits in?

Wei Guoqiang was annoyed. Just when he was about to contact Wu Youtu, the other party sent another message along with a few pictures.

Wei Guoqiang clicked on the voice, listening to Wu Youtu's latest report, the whole person was amazed, and immediately clicked on a few photos to confirm.

Wei Guoqiang held his breath, and nervously zoomed in with his fingertips, looking at the details of the picture...