When doctors have a simulated operating room

The patient was diagnosed with fasciitis.

"It's hard to say. If it's really fasciitis, it's hard for the patient to survive according to his current condition."

Zhang Yi told the truth.

Many diseases can be cured by surgery, but there are also many diseases that cannot be cured by surgery alone.

For example, for patients with this infection, once the infection spreads throughout the body, dialysis may not be able to cure it, let alone surgery.

If she had a tumor, Zhang Yi could cut it off without leaving any cancer cells.

But bacteria have entered the blood, and surgery really can't cure it.

We can only try dialysis plus drugs plus the patient's own immunity.

When Chen Fang heard this, he also sighed slightly.

"Hey, you can't tell... that's hanging."

If Zhang Yi is unsure, others are even more unsure.

"What antibiotics were used before?" Zhang Yi suddenly asked.

"I used piperacillin during the day, and I changed it to ceftriaxone before entering the operating room just now."

Zhang Yi nodded:

"Well, it is indeed possible to change the medicine. After the piperacillin infusion during the day, the infection still occurred at night, which means that piperacillin is ineffective.

If it is really fasciitis, ceftriaxone has a relatively wide antibacterial spectrum and is effective against both aerobic and anaerobic bacteria.

Let's do this. If the results come out later and confirm that it is fasciitis, we will use antibiotics in combination.

At this juncture, we can only use effective antibiotics in combination once more."

"Okay!"

Fasciitis is a multi-pathogenic bacterial infection.

It is also a mixed infection of anaerobic and aerobic bacteria.

Normal patients are relatively easy to treat, but the aunt in front of me is in a state of extremely low immunity.

After dialysis and medication, Zhang Yi didn't dare to guarantee that he could cure it.

Of course, we have to try.

We have to try our best.

In general, patients with fasciitis need combined antibiotic treatment, such as metronidazole, gentamicin, cefotaxime, ceftriaxone, ampicillin, etc.

Different antibiotics can restrain different pathogens.

For example, ampicillin is very sensitive to enterococci and anaerobic peptostreptococci.

Another example is that metronidazole is also highly effective against Bacteroides fragilis.

Another example is cefotaxime and ceftriaxone, which can effectively inhibit anaerobic and aerobic bacteria.

A single antibiotic cannot cure fasciitis.

It must be combined with medication.

Half an hour later, the dialysis machine stopped.

From the monitoring, the patient's blood pressure and heart rate have increased a lot.

The blood pressure rose to around 90, and the heart rate also exceeded 60.

But the cardiopulmonary function is still not very good.

Dialysis only has a filtering effect, and it may not completely eliminate all toxic substances in the body.

The remaining small number of pathogens may continue to multiply and flow throughout the body with the blood.

The patient is still in danger at that time.

Chen Fang looked at the patient and said:

"Has the laboratory not yet produced the results? Xiao He, go and call and ask."

"Okay!"

As soon as he finished speaking, someone came from the laboratory.

It was the male doctor who personally delivered the results.

When he handed it to Zhang Yi, he was still embarrassed:

"Zhang... Assistant Zhang, I... I'm sorry, I was really busy today, I'm really sorry."

Zhang Yi glanced at him and was too lazy to talk to him.

He looked at the test results in his hand.

Seeing that Zhang Yi ignored him, the male doctor took the initiative to mention:

"Assistant Zhang, you are right. The results show that it is indeed a multiple bacterial infection, including human Prevotella, Fusobacterium nucleatum, Escherichia coli, Streptococcus and Enterococcus."

When Chen Fang heard this, he immediately came over to take a look.

It is indeed a multiple infection.

Not only infection, but also electrolyte disorder. We must quickly replenish electrolytes, intestinal nutrition and vitamins.

Immediately, Chen Fang arranged new medical orders.

"I have given new medical orders. There are metronidazole, ampicillin and gentamicin, as well as diuretics and nutrients. You should quickly infuse them to the patient, and act quickly!"

After giving the medical orders, Chen Fang reminded the nurse.

"Okay, infuse it right away!"

After the doctor gave the new medical orders, they were displayed on the computer. The nurses had to check frequently to know which doctor had added which new medical orders.

Sometimes, more responsible doctors would worry that the nurses would miss the new medical orders, so they would directly remind the nurses.

Some doctors will not remind you.

Soon, the patient was given a new drug.

First, antibiotics were combined with electrolytes, and then the patient was given a new drug.

Maintain electrolyte balance in the body.

Then provide nutrients, diuretics, and kidney-protecting drugs.

After a busy circle, the doctor can only wait.

Medicine, examination, dialysis, basically everything that should be done has been done.

Next, it really depends on fate.

Let's see if the aunt can make it.

If she can make it, she will live, and if she can't, she will die.

Generally, if the patient's body is mostly infected with anaerobic bacteria, hyperbaric oxygen therapy can be used to treat the disease.

But this aunt is infected with anaerobic and aerobic bacteria at the same time, and the proportion is similar.

Hyperbaric oxygen therapy will not only restrain anaerobic bacteria, but also breed aerobic bacteria, increasing the reproduction of aerobic bacteria.

It is very likely to rob Peter to pay Paul.

Considering the patient's current condition, hyperbaric oxygen therapy is not considered for the time being.

The patient's chest was replaced with a new gauze. After the nurse treated the aunt, Zhang Yicai put on a pair of gloves to check the aunt's wound.

Looking at the wound after cleaning, Zhang Yi rolled his eyes speechlessly.

Who cleaned this wound?

Why is it so messy?

Chen Fang showed a trace of embarrassment on his face:

"What's wrong, Zhang Yi? Is the wound cleaning unqualified?"

"Ahem, nothing, not bad, but can be improved."

After that, Zhang Yi lowered his head to observe.

It is indeed fasciitis. Although it has not reached the point of necrosis, it is not ruled out that the patient will not develop to necrosis in the current state.

"Teacher Chen, you have to keep a close eye on this aunt tonight. I feel that this person... In short, it is not ruled out that there will be a large area of ​​necrosis on the wound surface."

Chen Fang sighed helplessly:

"Hey, big brother, please stop being a pessimist..."

"I don't have a pessimist, I just want to remind you."

Chen Fang didn't believe it, and walked closer to carefully observe the entire wound shortly after he cleaned it.

The fat layer and fascia under the right chest have been almost cleaned.

Only muscle tissue and some necessary blood vessels are left.

In addition to eroding fat and fascia, fasciitis is also prone to cause blood clots.

Therefore, as long as there is an infection, small blood vessels will be cleaned together to prevent blood clots.

"I cleaned it quite well. As long as she can survive tonight, she may be better tomorrow."

Chen Fang said after observing for a while.