After Lu Cheng and Fang Nixin arrived on stage, they briefly discussed the medical history with the doctor on stage. Lu Cheng probed the middle of the right femur with his hand. Good guy, he could feel the fluctuations in the subcutaneous cavity through his gloves.

At any rate, you can feel the temperature rise without wearing gloves. But infection is certain.

Let’s look at the evaluation of this disease on the panel: After comminuted femur fracture with plate and screw internal fixation: infection, nonunion, chronic osteomyelitis, plate fracture! lv67! (Lord level monster, characteristics: scar hyperplasia, bone resorption

, Infection regeneration ability: +200%! Infection mutation rate: 20%. Mixed infection mutation rate: 15%! Multi-resistant infection mutation rate: 10%.)

612144/612144!

It’s another big monster, and the special effects are too scary, right?

Lu Cheng looked at it, licked his tongue and asked, "Teacher, has this patient had drug sensitivity culture done before surgery?"

"I did it. It was Staphylococcus aureus infection and I was allergic to doxycycline and cefoperazone and sulbactam sodium. I had been taking cefoperazone sodium and sulbactam sodium for three days before the operation. I also prepared two pills during the operation." Standing at Lu

Said the person opposite.

Then he said: "Don't call me teacher. You are all experts from the Second Xiangya Hospital. My surname is She. You can just call me Lao She or ask me to call me Brother Min."

Fang Nixin immediately said: "Brother She, we are not experts, we are all students of Teacher Li Dongshan."

"It may not be enough to prepare only one cefoperazone for this patient during the operation. Please call the ward to send at least four more. By the way, have you contacted copper sulfate in advance?"

She Min heard this and said: "We have tried loading antibiotics on copper sulfate before, but it still didn't work. The copper sulfate liquefied directly and almost burned the patient's skin. Then we took it out."

"But if you still need the cephalosporin, I'll call someone right away to deliver it."

Hearing this, Fang Nixin was silent for a moment and said: "Let's prepare four more. This patient had a positive result of bacterial culture before the operation. Antibiotics will definitely be given during the operation, but how to give them? I'll hear later."

It belongs to Teacher Li Dongshan."

While he was talking, Li Dongshan came into the operating room to get dressed and said, "Director Wang, how many sets of surgical instruments have you prepared for this operation? We will need to change at least one set later."

"We have prepared it. We must have prepared many sets. There are three sets in total. We are afraid of this patient. How dare we not prepare it? Moreover, in order to facilitate flushing, we also bought a pulse irrigation gun."

"I've also contacted you about copper sulfate and have it on standby. If you need it, Professor Li, I can call someone to come up and make it right away. I'm always on standby. In addition, if Professor Li wants other arrangements, such as external fixation, that's fine.

Call me anytime."

"For this operation, I basically made plans for everything I could think of." Wang Linfeng replied immediately.

Hearing what Wang Linfeng said, Li Dongshan's anger subsided a little. He originally planned to come down for complex fractures. Nonunion is one of the more difficult complications after fracture surgery, but when he arrived, he was called to do the cleaning.

Chuang, isn't this looking down on him?

Where did someone ask a professor from the Xiangya system to debridement? If he had known earlier, Li Dongshan would have scolded her on the phone.

"That's okay, let's start the operation." No matter how helpless Li Dongshan was, he could only be a tool man for once.

Although the consultation fees for debridement and fracture treatment are the same, the value is different. I, Li Dongshan, have to come to do debridement. You guys are really amazing.

Wang Linfeng finally breathed a sigh of relief. In fact, the first person he called was not Li Dongshan, but Professor Xiong from Xiangya Hospital. But when others heard that it was debridement, they immediately hung up the phone.

Although the money for debridement and fracture treatment is very profitable, others don't want to do it at all. This is the main reason why Wang Linfeng concealed the patient's specific condition. Before he came, he had thought that Li Dongshan would be angry, so of course he had to prepare everything he could.

Ready.

When he got on stage, Li Dongshan put on a double layer of gloves, and then used a round knife to break open the skin of the original incision. As soon as he made the cut, blood started to flow. There were too many blood vessels in the scar hyperplasia, so he could only use it immediately.

Electrocoagulation to stop bleeding.

Then use an electric knife to slowly peel it down.

Just when it reached the subcutaneous layer and had not completely penetrated the fat layer, as soon as a hole was opened, a large bag of yellow and sticky pus gurgled out. Although it was not a spurt, it was just a small hole, just like a long pus.

They popped up in bunches like mushrooms.

Lao She, who had quick eyesight and quick hands, quickly used a suction device to guard the door at the entrance.

"Cotton pad!" Li Dongshan quickly asked for gauze to surround the edges. The more the pus spreads, the more likely it is to become infected in other places, so you must be very careful to minimize its spread.

"Get the culture tube!"

"Put the suction device in!" After all the pus outside was sucked out, Li Dongshan immediately called She Min to put the suction device in and try to suck out as much pus as possible so that the next step could be continued.

He also said: "If this patient doesn't undergo surgery, it won't be long before a sinus tract develops, which will almost reach the fat layer. I guess the muscle tissue inside will not be very good."

After he finished speaking, when Li Dongshan opened the fat layer to expose the muscle layer, he saw that the muscle was the color of rotten flesh, red and white, and he didn't know if it was a sign of abscess or muscle necrosis.

"Retract the hook, pull the fat layer apart a little, and give me the suction device." Li Dongshan saw the large abscess cavity and immediately took the suction device and started suctioning himself inside.

Halfway through the suction, the pus was so thick that it clogged the suction device.

But the location of the blockage is where the bottle mouth is attracted.

So immediately call for patrol to start the operation.

At this time, Lu Chengcheng discovered that the blood volume of this big monster had been reduced to: "548947/612265!"

The upper limit of blood volume is increased due to skin cutting, but!

Its current blood volume has been reduced a lot.

But based on this blood volume estimate, this patient’s abscess cavity is a bit big!

Hey, hey, every time the suction device is inhaled, the blood volume will be reduced by about 200-600, and then the amount of damage will become smaller and smaller. However, compared with the huge astronomical figures of hundreds of thousands, this reduction in blood volume is not significant.

quick!

This is definitely a tough battle.

After Li Dongshan watched that almost all the abscess cavity that could be seen was absorbed, he reopened the muscle layer and began to go deep inside!

But at this moment, Lu Cheng saw a series of plus signs popping up again.

"+100!"

"+95!"

"+92!"

Astonishingly, it was the pus cavity that had flowed before. While increasing the health value, it also expanded the infection.

Infection, a surgeon’s nightmare...

Infection, so to speak, even the infectious surgery department, which relies on infection for its livelihood, regards it as a nightmare.

The specialty of infectious surgery specializes in this area, but recurrence of infection after surgery still gives many professors a headache. Infections of patients in other surgical specialties will bring a lot of trouble to every surgeon, at least

For subsequent surgeries on infected patients, a hundred or so hairs will be saved.

If you don't have enough hair, you might be so bald.

If you can avoid touching infected patients, you will never touch them. Even in the three hospitals of the Xiangya system, unless someone deliberately greets them, 99% of the infected patients transferred from lower-level hospitals will treat the patients as

He went back to the original place and called the patient he had operated on before to debridement.

The remaining one percent are special patients who can interest professors and will stay directly.

Taking over someone else's infected patient is like wiping someone else's butt, and it's hard work but not necessarily flattering. Who would be so stupid?

But now that the surgery has begun, it must be done well.

Li Dongshan is a trauma specialist and has been exposed to at least a thousand infected patients in his life. Therefore, he is very clear about the treatment principles for patients with surgical infections.

First, finding the infecting bacteria and finding sensitive antibiotics is the top priority, even more important than surgery.

Before finding the infectious bacteria and sensitive antibiotics, there was no need to mention the surgery. However, Li Dongshan had already found this during the process of looking at the medical records. Otherwise, there would be no need to discuss the rest of the matter.

Second, it is thorough debridement. It must be thorough debridement to eliminate the secondary infection to the greatest extent possible, and then complete debridement a second time until the infection is completely gone.

The third is to use and modify sufficient and appropriate amounts of antibiotics.

The principle of treatment for infected patients is that surgery only accounts for less than one-third, or even only 20%. The adjustment and use of antibiotics are the most important.

This is also the reason why Li Dongshan is willing to do infection treatment in his own department, but is not willing to do infection treatment in hospitals below. A professor's ability to treat infection is definitely not just because of his superb skills.

Then when Li Dongshan continued to expose the fracture end, he breathed a sigh of relief. Fortunately, there was a closed dead space in the medullary cavity. Otherwise, the infection would have migrated along the medullary cavity in large quantities. Tsk tsk.

The difficulty has been increased many times again.

Osteomyelitis is another difficult problem in trauma surgery. In addition, dogs are too lazy to chew on the hard bone of nonunion.

"Bring the culture tube over again, send it for a quick microscopy, look for pus cells, and send another tube for bacterial culture."

After confirming that the osteomyelitis was localized, Li Dongshan sent out the second tube of cultured pus.

This is also an extremely critical part of the treatment of infected patients.

Bacterial culture is taken before surgery, soft tissue and bone marrow cavity are taken for bacterial culture during surgery. If necessary, blood culture and bone culture are also required. However, the patient currently does not have fever, chills and other symptoms, and the bone marrow cavity is partially closed. Although he will be sent to a doctor

Although cultivation is better, it is not particularly meaningful.

In textbooks, it is written that blood culture should be taken when there is a fever.

Moreover, cultures must be collected and sent multiple times after surgery until no bacteria can be cultured, then the infection is truly under control. During this process, the use of antibiotics must be adjusted or reduced or increased several times based on the culture results.

This is the real treatment process for infected patients.

The culture tubes had been prepared a long time ago. After being taken out, they were sealed and sent out again by the circulating nurse.

This operation is not an ordinary operation, so two of them are assigned to the tour, ready to pick up and deliver things at any time.

At this time, another circulating nurse also came in and said: "Four tubes of cefoperazone and sulbactam have arrived. If necessary, you can come on stage at any time."
To be continued...