I can see the status bar

Chapter 599 Double Meanings

A question from Sun Li'en triggered a heated discussion among the entire medical team.Liu Tangchun looked at himself, the unpredictable student who was smiling, and was really shocked.There is nothing wrong with Sun Lien's deduction, and his question directly exposes the core doubts to everyone's eyes.

Liu Tangchun narrowed his eyes, but he was thinking backwards in his mind, thinking about when Sun Lien discovered that there was a problem with the direction of diagnosis—even Liu Tangchun himself had just seen all the patient's examination reports.Old Comrade Liu was very sure that Sun Li'en must have had his own ideas before he said such a thing at the meeting.

As for Sun Li'en... He still kept a polite smile on his face, but he kept muttering in his heart, "No way? No way?"

I just asked a random question along my own train of thought, you guys don't have to act like you've already seen through the answer, right?

As a doctor who just obtained a medical license, Sun Lien is used to treating all doctors' diagnoses as "correct" diagnoses.If the French doctor believed that the patient had meningococcal infection, he must have seen some strong evidence to support this judgment.Although tests proved that the French doctor had misdiagnosed.But that evidence is likely to be the core evidence that guides the entire diagnostic process.

As for the cultivation of fastidious bacteria and anaerobic bacteria, this is the experience and lessons Sun Lien has learned in the Fourth Hospital.For example, the infection of canine-biting capnocytophaga in Huang Maode has never been confirmed by bacterial culture.There will be no errors in the status bar. If it cannot be cultivated, there must be a problem during the cultivation or sampling.After investigating the literature, Sun Lien decided not to blame his roommate Shi Yan for his poor technique—most Capnocytophaga canis-biting infections are confirmed by mNGS examination.

Hypothetically, assuming that the situation of this female patient is really in line with the direction guessed by other doctors, then the real challenge for doctors will come—how to treat an unknown source of infection without knowing the type of infection in the patient? treat?
"If Dr. Sun's guess is correct, and if our inference is correct." The internist said after discussing with several doctors around, "then we can basically be sure that ceftriaxone is not effective for this infection. That is, the bacteria are resistant or resistant to beta-lactam antibiotics."

"I tend to be resistant to drugs." Liu Tangchun added, "The patient's condition develops too fast. If it is drug-resistant, there should be at least a process of gradually returning to the state before treatment and then deteriorating. Three days after admission, he was unconscious and There is also high intracranial pressure, which is more like being masked by ibuprofen."

"That is to say, there are two possibilities for the bacteria we need to deal with." The physician nodded and continued to analyze, "It may be able to secrete β-lactamase, which can hydrolyze antibiotics or have a containment mechanism to prevent antibiotics from entering The type of target site. As for the variation of PBPs target protein and the change of cell wall permeability, these two are mainly drug resistance rather than drug resistance."

"The next question is, what are the bacteria that can secrete β-lactamase, and which ones can pass through the brain-blood barrier and cause meningitis." Liu Tangchun nodded, and he called Sun Lien's name again, "Tell me, what do you think?"

This time, it was Sun Lien's turn to be blinded by the roll call, "I...I don't know." Sun Lien shook his head apologetically, "I just have such an idea now, the specific... depends on the inspection data." He Cautiously suggested, "However, even if you don't know what bacteria it is, you can try to cure it, right?"

In fact, based on Sun Lien's idea, it is basically impossible to determine the type of bacteria infected before this unknown bacteria that can secrete β-lactamase kills the patient.This is Africa, not a hospital that can do mNGS testing.Three days after admission, the patient's condition had worsened to the point of unconsciousness.If you are still obsessed with bacterial culture, then when the results come out, you can basically sign the death certificate for this patient.

Rather than dwelling on the specific species of bacteria, it is better to cast a wide net of treatment through the qualities it exhibits.Gram-negative bacteria are not sensitive to ceftriaxone, but at least there are aminoglycoside antibiotics, macrolide antibiotics and quinolone antibiotics to choose from, and even β-lactamase-resistant β-lactamase such as meropenem can be used. Lactam antibiotics.

"For example, use doxycycline and moxifloxacin in combination." Sun Lien proposed his own treatment plan, "Doxycycline has a wide range of antibacterial effects, and moxifloxacin, as a quinolone, can also pass through the brain well." The blood barrier binds to the brain tissue."

"It's a good idea, but it's not realistic." Liu Tangchun unceremoniously rejected Sun Lien's suggestion, "We don't have moxifloxacin in stock, and she is allergic to the levofloxacin we brought." He looked at the neurologist beside him, "The patient's current How is your liver function?"

"It's not very good, but it's not enough to worry about." Dr. Shennai took out his mobile phone and showed the screenshots of the patient's liver function test five hours ago to all the doctors present. "Alanine aminotransferase 84, several others have increased to varying degrees."

"Considering the patient's high fever, it's not a big problem to raise this point." Liu Tangchun looked at Sun Lien, "You and Dr. Hu have a look at this patient. The main thing is to learn how to use his medicine."

Liu Tangchun had no further opinions on Sun Lien's diagnosis and clinical thinking. Sun Lien's main shortcoming in these two areas was lack of experience.After a year of special training by Dean Wu Youqian, Sun Lien's ability is much stronger than before - at least he can get rid of the student habit of asking questions, and instead focus on solving patients' disease problems.Liu Tangchun even felt a little surprised by this.

Don't think it's a bad thing for a doctor's lack of dedication to getting to the bottom of a patient's condition.Being able to figure out when to be confused and when to be clear is a sign of a mature clinician.Yuan Ping'an was sent to the Fourth Hospital to study because his temperament of being a top student was too obvious—in order to find out the specific development process of a disease, he could go to the data for a day.This kind of character is bound to be a good player in academic research, but it cannot be done in clinical practice.There is no pause button in daily life. In the process of doctors seeking answers, patients' diseases are also constantly developing.A patient whose disease has reached the terminal stage, even if the condition cannot be reversed, does not need the late answer.

As for asking Sun Lien to study with Dr. Hu from Shennei of the medical team, Lao Liu actually had two meanings.First, I still hope that Sun Lien can gain some new experience in clinical treatment and medication by observing the work of doctors from other medical schools.After all, Sun Lien's current work experience is still relatively inexperienced, and most of the treatment plans he proposes come from medical textbooks and pharmacopoeias.From Liu Tangchun's point of view, there is more than enough security but not enough spirituality.

Another meaning... Liu Tangchun felt that this doctor from Song'an Provincial Brain Hospital was quite capable, and if he could be recruited to the Fourth Hospital, he would be able to accomplish a lot.

　This morning I drove from Lanzhou to Shangluo, and tomorrow I went directly to Yueyang from Shangluo.After driving for eight or nine hours, my energy is really low... The plot design is currently based on insurance and stability. When I go back, I will show you a wave.

　　
　
(End of this chapter)