MTL - Doctor’s Life Simulator-Chapter 8 Qin Lang's inference was astonishing

Peng Yun frowned, but did not stop Qin Lang.

Several little doctors also looked forward to this handsome training doctor.

Qin Lang said indifferently: "I think the use of conventional debridement to treat open fractures contaminated by industrial wastewater will increase the infection rate of patients."

Qin Lang walked directly to Wang Qiang's hospital bed, took Peng Yun's position, and then pointed to the patient's wound.

"According to the patient's self-report, after his leg was smashed, the entire leg was soaked in industrial wastewater for more than 10 minutes before being rescued by the workers. Therefore, the contaminants spread along the affected muscle septum and tendon sheath to the entire muscle gap. Therefore, it is difficult to completely remove these contaminants during routine treatment, so I think extended debridement should be used!"

After Qin Lang finished speaking, Qian Liang and Peng Yun were both stunned. They had to say that Qin Lang's point of view was very possible.

However, Peng Yun's foundation is not generally solid, and he directly asked:

"Qin Lang, I agree with your point of view that there are merits. It is true that local debridement has its limitations for infection control, but have you ever thought about it? Expanded debridement can effectively remove pollutants, but it also increases tissue damage. increase the risk of infection.”

"So I think instead of taking a huge risk to perform extended debridement, it is better to follow the routine local debridement. And, you have to be clear, the biggest problem we face is unknown pathogenic bacteria, only waiting for medicine Sensitivity tests and bacterial cultures are needed to confirm it.”

"But it will take time, and with extended debridement as you said, the risk of aggravating the infection is too great for the patient until the causative organism is identified."

Regarding Peng Yun's answer, if she hadn't been tested in the simulator world, Qin Lang might have been persuaded by her, but in the clinical experience in the simulated world, Wei Guoqiang, director of the Department of Plastic Surgery and Burns of the First City Hospital, did it. Trial.

Supported by the treatment results of more than 400 cases, the use of extended debridement can effectively clear the infection, thereby reducing the infection rate, the infection rate is only 10.2%, while the conventional debridement is 51.2%, and the extended The resulting infection is also much less severe than local debridement.

Of course, Qin Lang couldn't tell the result of this test, but he could try to persuade Peng Yun and Qian Liang from another angle.

Under the blessing of clinical experience in the simulator world, Qin Lang's temperament is like that of a senior resident physician, who has passed all the examination materials from Peng Yun.

In the disbelief of Qian Liang and Peng Yun, they said a sentence:

"In addition to local debridement, another reason is that the pathogenic bacteria were wrongly judged in the previous treatment plan, and the wrong use of antibiotics was caused. As long as we can use antibiotics correctly, we can greatly reduce the infection of patients. The rate is also enough to support us to try to expand the debridement."

After Qin Lang's voice fell, Peng Yun and Qian Liang were a little unbelievable:

"You said that both us and the previous doctors in the lower-level hospital had misjudged the pathogenic bacteria and used the wrong medicine?"

Peng Yun is very familiar with antibacterial drugs and said directly:

"The previous treatment plan was strictly in accordance with the "Guidelines for the Clinical Application of Antibacterial Drugs in China", which stipulated antibiotic prophylaxis for open trauma to bone and joints, and selected antibacterial drugs against Staphylococcus aureus."

After all, he is a true scholar who graduated from Union Medical College Hospital. When discussing professionally, Peng Yun always cites and argues sharply.

Qian Liang on the side also gave a wry smile. As expected of Peng Xueba, in the previous discussion on the condition, their group of resident doctors had been crushed in various ways.

Peng Yun's two little doctors are also full of admiration in their eyes. They are indeed the most promising elite doctors in the city's first hospital.

Peng Yun's aura was full: "And when I was at Xiehe Hospital, I participated in one of my mentor's projects, and counted 1,337 open fractures contaminated with toxic fluids, and performed bacterial culture and analysis on more than 150 patients with deep infections. The drug susceptibility test was found to be Gram-positive bacteria, and 78% were sensitive to cephalosporins."

"So, based on the "Guidelines for the Clinical Application of Antibacterial Drugs in China" and my personal practice, I think there is nothing wrong with the previous use of antibiotics."

Taking into account both theory and practical experience, Peng Yun's inference is indeed impeccable.

Qian Liang on the side also nodded, which was also his judgment.

For this, Qin Lang chuckled lightly. Without the clinical experience of the simulator, he would really only be defeated, but he knew that the real pathogenic bacteria was Escherichia coli!

A hint of wisdom flashed in Qin Lang's eyes:

"What Dr. Peng said is right, there is no problem with cephalosporins in routine use, but you have overlooked a crucial issue. Staphylococcus aureus is aerobic bacteria, but the patient was in a chemical plant where the injury was soaked. The pool is for process needs, but it is a strict oxygen-free environment.”

Qin Lang looked at the patient Wang Qiang. Although the latter did not know the reasoning behind this heroic little doctor, he could confirm one thing:

"The little doctor is right. The pool where my work accident happened is an anaerobic environment created in strict accordance with the requirements."

Qin Lang followed Wang Qiang's words and looked at Peng Yun aggressively:

"So, the pathogenic bacteria infected by the patient are gram-negative bacilli, so they are not sensitive to cephalosporins. Since it is a gram-negative bacillus, combined with the environmental analysis of the chemical factory where the patient is located, it is very likely that Escherichia coli bacterial infection.”

"So, I suggest adjusting the antibiotics to quinolones, such as ciprofloxacin, moxifloxacin..."

After listening to Qin Lang's well-founded analysis, Peng Yun, a scholarly tyrant, was in a trance for a while. Although she couldn't believe it, her reason told her that it was very possible!

As for Qian Liang, he secretly gave Qin Lang a thumbs up. Although it has not been confirmed yet, at least this is the first time he has seen Peng Yun so shriveled.

But, it's not over yet.

In order to ensure that the subsequent treatment is foolproof, Qin Lang continued to analyze:

"However, simply expanding debridement does have some risks. Therefore, auxiliary drainage techniques need to be added."

For the first time, Peng Yun carefully looked at the training doctor selected by this young community hospital, and for the first time there was sincere advice in his tone:

"Dr. Qin, the conventional enlarged debridement-assisted drainage techniques include simple negative pressure drainage, continuous irrigation drainage and continuous closed negative pressure drainage. Which do you think should be used?"

Peng Yun obviously did not expect that this little doctor Qin thought so deeply and meticulously.

From the factory environment where the patient is located, it is too keen and too talented to deduce that the causative bacteria are Gram-negative bacilli.

This requires strong observation and solid basic skills. After she heard it, she suddenly realized.

Just when Qin Lang was about to discuss which drainage technique to use, there was a sound of footsteps outside the ward.

A little nurse ran over ahead of time:

"In view of the patient's condition in hospital bed 13, it will not be cured for a long time. It happened that the chief director was in the department today and asked if there was any special patient situation recently, so he planned to advance the director's rounds and discuss the patient's condition together. The rest of the resident physicians And this group of advanced doctors and regulations trainees also rushed over."