I can see the status bar

Chapter 619 Thorough debridement (subscribe on July 7, 31nd)

The main reason why Sun Li was surprised was the duration of necrotizing fasciitis.

Necrotizing fasciitis is a disease that progresses very rapidly.If it occurs on a limb, necrotizing fasciitis generally spreads to the entire limb within about 24 hours.And when it occurs in the perianal or retroperitoneal wall, it can progress even faster than it occurs in the limbs.

But three hours... three hours will develop to this point?Sun Li'en looked at Dr. Wang's drainage operation in disbelief.A large amount of foul-smelling purple-red liquid continuously emerged from the wound under the flushing of normal saline and hydrogen peroxide.And there is a tendency to take more and more.

"It's necrotizing fasciitis." Dr. Wang continued with the operation, "Dr. Sun, you can direct the medical treatment. I don't have the energy to be distracted now."

It is no wonder that Dr. Wang has such a request. In order to make the flushing more thorough, he has made five incisions on the patient's right perianal area.After bluntly separating the fatty tissue and necrotic fascia in the incision with the hemostat, he still needs to operate the tissue forceps to pull out the necrotic fascia—there are many operations, but there is only one anesthesiologist in the dressing room now.

Simple incision and drainage of perianal abscess does not even require an anesthesiologist in principle, as long as lidocaine infiltration injection is used to complete local anesthesia, the operation can be performed.If it wasn't for the patient's strong request, Dr. Wang would not have asked an anesthesiologist to perform spinal anesthesia on him.

Although he could not understand Chinese, the Nigerian peacekeeper could guess that something was wrong with him just by listening to the sudden increase in the frequency of exchanges between doctors.The anesthetist soon noticed that his heart rate and blood pressure were rising rapidly.Verbal reassurance did not achieve the desired effect, and the anesthesiologist directly administered 5% glucose-diluted propofol to the patient for anesthesia after seeking the consent of the chief surgeon, Dr. Wang.

"Nurse Tian, ​​ask the operating room to prepare." Dr. Wang continued to operate, but his hand movements became faster and faster, "This operation has to be transferred to the other side - if it continues like this, there will be accidents." of."

Sun Lien gave the anti-infection treatment plan in internal medicine, "Penicillin G skin test, after confirming that there is no allergy, 200 million units of intravenous infusion, four times a day." He glanced at the patient's status column again, and confirmed that there was no Streptococcus pyogenes Judgment was maintained after triggering meningitis and endocarditis. "Doctor Wang, how big is the fasciitis?"

Dr. Wang finished the cleaning on one side, and then directly opened the knife to the patient's other side of the anus, "I'll probably know after this knife... Fuck." He swears, "Both sides?! "

On the other side, pus and purple-red liquid also spewed out from the perianal area.It's just that the amount is a little less than the other side.

"The superficial fascia of the gluteus maximus on both sides is completely necrotic." After three more debridements near the perianal area on the other side, Dr. Wang muttered, "The deep fascia has been affected, and the perineal fascia is probably enough... ..." He sighed deeply, "This is troublesome."

After five cuts, a total of more than 1000ml of liquefied necrotic tissue gushed out.The skin of the black soldiers is already very dark, and it is really not easy to see the redness and swelling of the skin.But it was obviously necrotizing fasciitis, but it was treated as a perianal abscess.This made Dr. Wang feel very humiliated now - especially when Sun Li'en was standing beside him.

Under the notification of Nurse Tian, ​​the operating room quickly completed comprehensive preparations.The Nigerian soldier, who had been stabbed five times in the butt and looked like he was going to get another five, was quickly transferred to the operating room.

"What's the situation?" Chen Tianyang also appeared in the operating room, and he was fully armed. "I just heard from your little nurse outside that something went wrong with the operation?"

Although his face was covered with a mask, Sun Li'en seemed to be able to feel the burning of Dr. Wang's face from a few meters away.Out of "humanitarian care" for his colleagues, he quickly explained, "The patient's condition progressed rapidly within a few hours. Dr. Wang only discovered that the perianal abscess had progressed into perianal necrotizing fasciitis when he operated on it."

In fact, according to the prompt in the status bar, this is the closest to the truth.The duration of the patient's necrotizing fasciitis was only more than three hours, and the progress to this point was impossible for everyone to predict in advance.And more than 50 hours ago, it was indeed Streptococcus pyogenes that caused the soldier to develop a perianal abscess.It can only be said that Dr. Wang is a little bit recited today.Spontaneously ruptured perianal abscesses progressing to necrotizing fasciitis within three hours rather than a more stable anal fistula is itself very rare.

"Oh, necrotizing fasciitis." Chen Tianyang nodded after listening to Sun Lien's explanation, "It's really progressing very quickly." He glanced at the nurse who was repositioned from the side lying position to the lithotomy position by the nurses The patient and those surgical wounds that looked rather hideous asked, "Do you want to help? I think you should be able to handle it yourself, Xiao Wang, right?"

Dr. Wang only now recognized that the short and fat doctor in front of him was Chen Tianyang, and he couldn't help being overjoyed, "Professor Chen, it's great that you're here." Dr. Wang pointed at the patient lying on the bed and said earnestly, " His necrotizing fasciitis involves a large area, and the condition is more complicated... Mainly, there are signs of infection in the deep fascia of the perineum and gluteus maximus. I am really not sure about this. Since you are here, it is just right Show us your hand?"

As if to make Chen Tianyang feel less worried when he did his work, he also specially emphasized, "The operation of the peacekeeping hospital is different from that of domestic hospitals. We don't have so many rules. As long as the lives of these soldiers can be saved. I am now Just go and report to your superiors, they will definitely agree to allow you to take over the stage for surgery."

Chen Tianyang blinked his eyes, but he couldn't think of a suitable reason to refuse for a long time.To be honest, Lao Chen is getting old after all, and he has not fully recovered from the fatigue of doing more than a dozen operations in the American camp before.But...he took another look at that...horrible butt on the stage.

The consequences of necrotizing fasciitis may be very serious. Even if it is rescued, it may be disabled due to muscle adhesion.After thorough debridement in the early stage, and then active negative pressure continuous suction (VSD), at least part of the fascia that has become necrotic and turned into liquid can swell back.At that time, the disability situation might be a little lighter.

Chen Tianyang sighed, stood in front of the operating table, and said to Dr. Wang beside him, "You can help me." He turned his head and looked at Sun Lien, "Don't even try to run away, you kid—you are the second Help, do you know?"

(End of this chapter)