Chapter 168 If there is no operating room, then perform surgery on the spot
The ICU was full immediately after the gas gangrene incident.
Four infected patients were admitted to intensive care, and some others were also infected, but their conditions were not as severe as theirs, and they could only temporarily receive special care in the general ward.
"Doctor Xu, save my mother, Doctor Xu!"
As soon as he stepped into the intensive care unit, Director Zhang rushed over anxiously.
He was also one of the people who used to be hostile to Xu Qiu, but now he has no temper towards Xu Qiu and is only grateful.
A doctor who is unadulterated and has a pure mind of treating illnesses and saving people deserves everyone's respect.
"Well, let me take a look first."
Xu Qiu put on protective clothing and entered the intensive care unit.
As soon as I opened the door, a strong smell hit my face.
Wang Ping, He Hai and others looked so pale that they almost vomited out.
Xu Qiu also felt very uncomfortable.
He endured the discomfort and got closer to inspect the wound.
Zhang Mu is a standard right subcostal incision for liver cancer resection.
Today, blood-colored pus continues to ooze from the surface of her wound.
There are already signs of blackening on the edges of the skin, and there is no doubt that it has been infected.
Xu Qiu unzipped Zhang's mother's trouser legs again.
There are spots on the right thigh.
This is a local manifestation of systemic bacteremia.
Also a desperate symptom!
Xu Qiu felt a little heavy.
Her symptoms are no less severe than the source of infection in bed 21. The only good news is that Zhang’s mother does not need amputation for the time being.
Her lesion was in the wound where liver cancer was removed. Even if it spreads, it won't be an amputation. Basically, the bacteria will flow through everything from the heart to the limbs, and surgery cannot save it.
"Dr. Xu, do we need to treat septic shock and septic shock?" Director Jiang asked.
Xu Qiu shook his head after thinking for a long time.
Sepsis caused by gas gangrene is different from ordinary septic shock and septic shock.
It often starts with heart damage and then spreads throughout the body.
Also because there are a large number of pathogenic bacteria in the blood, which has a great impact on the microcirculation, the condition is very critical——
If the rescue is carried out according to ordinary septic shock, the patient will definitely not survive the first round.
He glanced at the blood filter machine next to him.
He said: "Withdraw the hemofiltration, perform surgical intervention immediately, and start with thorough debridement."
Director Jiang was very embarrassed and said: "There is no way. There is no room in the operating room. I have contacted him many times but there is no way. I can only do hemofiltration first!"
Xu Qiu shook his head: "Hemofiltration should not be done. Even if it is sepsis, hemofiltration is not the first choice."
"But...for the patient in bed 21, you also chose hemofiltration and catheter placement!"
After Director Jiang finished speaking, he explained: "I used CVVH because it can quickly remove macromolecular substances and various inflammatory metabolites, and control the internal environment as quickly as possible. Judging from the current situation, the rescue effect is very good. "
Xu Qiu shook his head: "The situation is different. The patient already has signs of kidney failure and must rely on hemofiltration to replace the kidneys.
As for the rescue effect - this is just a temporary illusion.
Without thorough debridement, you are just using hemofiltration to cover up the body's weakness. When various values drop, it will be too late to save the patient. "
He considered for a moment and said: "There are only two most critical things now.
One, debridement.
Two, antibiotics!
Even though CCVH can remove inflammatory substances, this process will interfere with the effective concentration of antibiotics, causing more harm than good! "
Director Jiang's expression changed. Is it really what Xu Qiu said?
On the other side, Xu Qiu didn't give everyone time to think.
He gave the order directly, saying: "Since there is no operating room, let's do it on the spot! Prepare the instruments!"
Compared with the infection caused by the spread of gas gangrene, the less strict surgical environment is not so scary.
The trade-off is worth it.
So, Xu Qiu and others set up the operating table for the intensive care patient and immediately completed the debridement.
After the operation, Xu Qiu gave the antibiotic indication: "Penicillin 4 million, q4h, clindamycin 900mg, q8h."
…
After leaving Zhang Mu's ward, Xu Qiu and others went to wash their bodies carefully and perform strict sterilization.
This is to avoid cross-infection between patients.
Although they are both gas gangrene, the pathogenic bacteria are different between them.
Carrying germs from one person to another can have very serious consequences.
After completing the cleaning and putting on new protective clothing, Xu Qiu came to the ward of the old professor of Linhai University.
This old man would not be able to undergo extensive surgical debridement.
He himself had diabetes, and later developed purpura fulminans, which his body could not tolerate.
After Xu Qiu thought about it, he considered it to be a mixed infection caused by anaerobic bacteria and enterococci.
He made several small incisions in the diseased area, exposed the infected area as much as possible, and performed simple debridement.
After that, in addition to Zhang’s mother’s same antibiotics, cefotaxime and ornidazole were also added.
…
For the next few patients, Xu Qiu made quick judgments and gave them appropriate antibiotics.
Pan Fuyou followed, becoming more and more silent.
He originally worked in the emergency department, and after retiring to the second line, he switched to the field of hospital admissions.
Therefore, he can still see some clues.
If anything, other doctors' treatment plan for serious infections such as gas gangrene is fire coverage.
Whether the pathogen dies or the patient dies, it depends on whether the patient can survive it.
but,
Xu Qiu seemed to know what pathogens each patient had.
The use of medicine was like a divine soldier descending from the sky, striking accurately without harming innocent people.
The benefits of doing this are obvious - if the medicine is used correctly, the infection can be quickly controlled and the patient's damage is minimized.
But the disadvantages are equally fatal.
Once the medicine is used incorrectly, the patient will die!
Can such a desperate treatment method really succeed?
Pan Fuyou didn't care about this.
"If the medicine is used like this, the patient will die, and the main responsibility is also Xu Qiu..."
However, as soon as this idea came into his mind, Pan Fuyou suddenly fell silent again.
He looked at Xu Qiu who was enduring the stench not far away, concentrating on examining the patient, and constantly asking about his health. At this moment, Pan Fuyou suddenly felt extremely ashamed.
...
That night, it was more than ten o'clock in the evening.
Dean Wang Shengde finally rushed back to the hospital.
He happened to meet Xu Qiu and others who had returned after treating the patient.
"Xu Qiu, how is the situation!" Wang Shengde was impatient.
"For the time being, we have given targeted antibiotic treatment plans, and the results will be revealed tomorrow morning." Xu Qiu said.
"Good, great, if it can really be controlled, Xu Qiu, you have helped me a lot and saved Linhai First Hospital!" Wang Shengde held Xu Qiu's hand, extremely excited.
After Xu Qiu left, he called Pan Fuyou alone.
It is said that Wang Shengde, who rarely loses his temper, took Pan Fuyou to his office that night and scolded him all night.
Wang Shengde was a little short of oxygen in the middle.
After breathing oxygen for a while, he grabbed Fan Lei who was sleeping soundly and continued to scold him.
The next day, at about six o'clock in the morning, when the nurse came to the dean's office to report the infection situation, she was shocked by the scene in front of her.
