Everything was important, and Fang Nixin didn't worry about it anymore.

Lu Cheng is just a student now. Although he has obtained a medical qualification certificate and has first-level surgical authority, his ability has far exceeded his own junior professional title, so he can do it based on the strong recommendation of the provincial professional committee.

Go to the medical department and ask for more advanced hand speed permissions.

Qian Nixin has done this kind of thing in the past. Otherwise, she would not be able to perform arthroscopy, which is at least the third category of surgery. The authority to perform arthroscopy is only open to senior attending physicians and above.

It's just that Fang Nixin obtained such authorization after she graduated. Lu Cheng, on the other hand, obtained such authorization almost when ordinary people graduated from graduate school. Such speed is simply unimaginable.

It can almost catch up with Fang Nixin.

But Fang Nixin still thought in her heart, what's so great, am I not younger than you?

Then the group began to make rounds, and there were still not many patients, only four in total.

One is a patient with open trauma on his upper arm. After applying VAC, the current wound condition is very good. As long as there is no infection, he can be transferred to Professor Zhou Xuanqing's team in the first ward of the Department of Orthopedics for skin flap transplantation.

The patient and his family were very happy and enthusiastically invited Li Dongshan and others to eat fruit.

Now I'm doing ward rounds, and of course I was declined.

General surgery patients have been discharged.

The remaining three patients are those who need knee arthroscopy today (to prepare for suturing of the lateral meniscus of the right knee), and the other is a patient with a comminuted fracture of the tibial plateau.

The patient's preoperative examination has been completed and the patient is currently waiting for the swelling to subside. The patient has been given prophylactic anticoagulation.

The last one is the patient who suffered from post-surgery infection after damaging his lower limbs that everyone is having a headache about now.

When Li Dongshan stood still in front of the patient and their family members, the patients and their family members all looked at Li Dongshan eagerly, with their eyes shining. In their understanding, it seemed that the patient had almost recovered after he came out of the operating room unharmed.

Restored.

As one of the top hospitals in Hunan Province, the Second Xiangya Hospital has absolutely no complications.

Moreover, it is now possible to save the limb, and the family has collected enough money, and is waiting for Li Dongshan to announce that he can recover and be discharged from the hospital at any time.

Li Dongshan said very calmly: "Jiang Congyue, and you all, please listen carefully. What I am going to say next is not to intimidate you."

"You have also seen what the patient's wound looked like before the injury. The bones were exposed, most of the muscles were crushed, and the meridians were embolized. The best way at that time was amputation, and the possibility of limb salvage was very small."

"Simply, he was relatively lucky. We saved the leg initially. However, as I told you before, he has only passed the first hurdle of the Long March."

"Moreover, the last thing we want to happen now is that the wound is infected. And the infected bacteria are very scary, and they are multi-resistant bacteria."

"What are multi-resistant bacteria..."

The patient is not a doctor, so Li Dongshan explained the patient's basic situation in detail in a popular and easy-to-understand way.

I understood, but the patient was anxious at that time: "Doctor, how did I get infected? How could I get infected? You are here at the Second Xiangya Hospital. Can't you even prevent infection?"

This is very realistic and true.

But that's the truth.

Li Dongshan said: "I just said that this is a special type of bacterial infection. We have the term preventive infection in the surgery, but not all patients can be 100% free of infection after taking preventive medicine."

"Especially for patients like you whose soft tissue damage is particularly severe, the chance of infection is greater."

"I don't know if you have learned about it in private with other doctors or on the Internet. In a situation like yours, I have mentioned it before. Even if the bones, blood vessels and tendons are connected, infection will occur.

The chances are still very high.”

"We have also used drugs, but drugs are not omnipotent, and we doctors are not omnipotent. Bacteria are walking in the air and are everywhere. Even if we have tried our best to give you preventive medicine,

The best and highest-grade antibiotics are still unable to prevent today's infections."

"This is just like how even if there are traffic lights on the road, there is still no 100% guarantee that there will never be an accident."

Although you say this, the truth is easy to understand for others.

But when it happens to the patient himself, it is difficult for him to understand it.

Jiang Congyue's wife immediately stood up and asked: "Professor Li, do you mean that my husband's trauma will 100% lead to infection? No matter what medicine is used, it can't be cured?"

When she asked this question, her son and daughter both pulled her hands. In fact, they understood Li Dongshan's explanation, but she ignored it and didn't want to.

No one is willing to accept the fact that infection has happened to them right away.

"It's not 100%, or how many percent. If the infection occurs, it's 100%. If it doesn't happen, the chance is zero. It doesn't mean that if it happens to you, it won't happen next time. Or it's a 95% chance. Nine times before me

If there are no infections in fifteen patients, the next five patients I encounter will definitely develop infections."

"This is a very complex issue. Even in our current medical science, we do not have a complete theory to demonstrate which patients will become infected and which patients will not. We can only count how many people have become infected and how many have not.

"

"This is just a statistic, not an argument. It's like planting a thousand seeds, but you don't know which one of them will not germinate, right?"

When Li Dongshan saw that Jiang Congyue and his wife were still talking, he stretched out his hand and interrupted: "I can understand your anxiety, but you don't want to talk yet, listen to me first."

"Now that things have happened, it is no longer important to pursue the investigation and worry about the probability of this happening. Our main purpose and main difficulty now is to control the infection while also saving the legs.

.”

"This is a very difficult process, not only for you, but also for us doctors."

"It's not that there is no treatment now, there is some treatment, but the process will be very long and the recovery time will be long. This is already a fact, and it is also a fact that we anticipated before doing the limb salvage surgery."

"This is also the main reason why we originally recommended you to ampute your leg directly."

"After we told you about the multiple difficulties involved in limb salvage surgery, you still insisted on choosing limb salvage surgery. We doctors are also helpless. You patients have the right to informed consent and the right to choose."

"If you have any concerns about our treatment process, all our medical information is on record, and you can check our medication records at any time."

"No, Professor Li, we definitely still believe you." After hearing this, Jiang Congyue and his wife found it difficult to accept it, but they seemed to have no choice but to digest it. It is true that Li Dongshan had mentioned these situations, but their

There are still doubts in my heart, whether Li Dongshan made any mistakes during the treatment process, which led to the current infection.

But we cannot say this directly. What if Professor Li is offended?

So the two of them were extremely entangled.

Seeing that Jiang Congyue and Jiang Congyue had stopped talking, Li Dongshan said: "Professor Yu, do you have any opinions on the treatment of this patient?"

Yu Youlin said in a deep voice: "Professor Li, the patient's current situation is very complicated, and he is still infected by multiple resistant bacteria. It will definitely need to be debrided again or even multiple times. After the bacteria are completely controlled, we can discuss the follow-up issues.

.”

"Currently, the patient's blood vessels have been anastomotic, and infection has occurred, and sepsis is very easy to occur. Therefore, the intravenous antibiotics must be kept up and adjusted at any time, otherwise, his life is still in danger."

Yu Youlin is a general surgeon, so it is not easy for him to say so much.

Then Li Dongshan called Zou Qian and Fang Nixin to express their opinions respectively.

Zou Qian and Fang Nixin were obviously much more professional and put forward many suggestions. For example, after this infection, sensitive antibiotics could be loaded with copper sulfate and slowly released locally to inhibit bacterial reproduction.

For example, changing the irrigation and drainage, changing the VAC again to continue negative pressure suction after re-injury, etc.

Then Li Dongshan looked at Cao Xiaohe, who was trembling a little. Cao Xiaohe's eyes went directly to the ground. He obviously felt that the complexity of this patient far exceeded his knowledge reserve, and Fang Nixin and Zou Qian

Finished everything that needs to be said.

Li Dongshan looked at Cao Xiaohe's cowardice and cursed in his heart, then looked directly at Lu Cheng: "Xiao Lu? Do you have any opinions?"

Li Dongshan still attaches great importance to Lu Cheng. Even if Lu Cheng says something wrong, he can correct him in time.

Lu Cheng thought for a while and then said: "Master, just now Teacher Yu, Teacher Zou and Senior Sister Fang have finished explaining the general principles of treatment, so I won't elaborate on it for now."

"But I think patients have a bit of doubt now, and I don't know if that's right or not."

"The patient's current bacterial culture results and drug sensitivity results were from three days ago. At that time, multi-resistant bacterial infections were found in the specimens taken. So, when we adjust the medication now, should we consider it on the original basis?

A little more comprehensive.”

"The antibacterial spectrum of amikacin covers a variety of gram-negative bacteria and a small number of gram-positive bacteria, while the antibacterial spectrum of ciprofloxacin is also gram-negative bacteria. In this way, if the patient's infection site

If Gram-positive bacteria are present, the antibacterial effect may not be achieved.”

"Moreover, if amikacin and ciprofloxacin can really kill the current pathogenic bacteria, the injured part of the patient now has an immune disorder, which is easy for other bacteria to colonize and multiply. We must also be vigilant.

Staphylococcus aureus reawakens or colonizes again through the blood circulation."

"So, I recommend adding an extra broad-spectrum antibiotic, such as meropenem."

"I read some literature yesterday, and I also saw above that multi-resistant bacteria like this can easily mutate or be recolonized by other bacteria during the treatment process. It is more appropriate to choose at least two or even three combinations of drugs.

"

"Of course, for a more specific medication plan, you can ask the pharmacy department for further consultation, or you can wait for the drug sensitivity results to come out before adjusting the type of antibiotics used."

"In some very isolated cases, there have been reports of the use of quadruple antibiotics."

As soon as Lu Cheng said these words, Li Dongshan was a little stunned.

Is this still the same Lu Cheng?

Is this the same Lu Cheng who couldn't even speak during the ward rounds a few days ago? At that time, Lu Cheng was a very high-handed person but short-sighted.

Why are there so many theories now?

Have you even memorized the antibacterial spectrum of this uncommon antibacterial drug?

Fang Nixin raised her eyebrows, feeling that something was wrong with Lu Cheng. Could it be that he had read all the documents yesterday?
To be continued...