2339 Small wound, big trouble
“We still need a CT scan?” The patient was a little unhappy, but his opinion was no longer important. The patient’s family seemed to have noticed something, and they quickly agreed.
This time, Zhou Litao did not try to squeeze out the pus inside the skin of the patient’s wrist. Instead, he gently disinfected the surface and covered it with sterile gauze.
He went to get a CT scan form, and the patient and his family members went for a checkup.
As soon as they left, Zhou Litao immediately pulled Zheng Ren to the on-call room. He turned on the computer and called the CT room. He told them the patient’s name and instructed them to upload the video immediately after it was done.
“Boss Zheng, what do you suspect the patient’s illness is?”
“Sea bacteria?” Su Yun was not sure either, so she looked at Zheng Ren and asked in a questioning tone.
“Yes, it’s an infection caused by bacteria from the sea.”
Zhou Litao tried hard to recall the sea bacteria.
He was very familiar with the bacteria of divergence. Non-tuberculosis referred to all the other types of bacteria other than tuberculosis and mycodratis, also known as environmental bacteria. Non-tuberculosis mycobacterial diseases referred to the pathological changes in the relevant tissues or organs caused by human infection with related bacteria.
“Boss Zheng, how did you determine that it’s a sea bacteria?” Zhou Litao asked.
“In general, non-tuberculosis divergent bacteria can grow in a wide range of temperatures. The patient only has a problem with his wrist, so it is considered that the most likely growth temperature is between 28 and 30 degrees Celsius.” Zheng Ren said.
Although Zhou Litao understood the logical relationship, he couldn’t accept the fact that he could rule out other problems at a glance.
“It’s like this. First, the patient’s family members mentioned that the gauze needs to be changed six to seven times a day. ” Zheng Ren said,”this means that there is a lot of pus at the patient’s wound. About 20 ml of pus needs to be drawn out from the wrist every day, and there’s definitely more inside. I reckon that there’s already a Dou Dao in there. “
Zhou Litao listened quietly. The first point didn’t fully answer his question.
“Second, the patient has no history of external injuries, and the pus is limited to the left wrist with such a serious ‘injury’. At that time, I was thinking that the patient might have been injured in that area, but he didn’t notice it. “
“If that’s the case, the scope of our consideration will be much smaller.”
“But we can’t rule out the possibility of thin needles …” Zhou Litao was still a little puzzled.
“Stupid!” Su Yun had already thought it through. He looked at Zhou Li Tao in disdain.”What did the patient say before he came? Rheumato-rheumato-arthritis!”
“Ah?” Zhou Litao looked at Su Yun in confusion.
“What does this mean? Can a infection caused by Staphylococcus epictis be misdiagnosed as Rheumatology?” Su Yun’s mouth was already overflowing with ridicule.
“Oh, oh, oh.” Zhou Litao finally understood.
“Yes, so the patient’s left wrist was probably stabbed by some sea creature when he was playing in the sea. However, the wound was so small that he didn’t notice it at all. The sea bacteria stayed under the skin to breed, which eventually led to the current situation. “
Zhou Litao was silent. He still didn’t understand, but he didn’t ask.
“Director Zhou, you should also memorize the course of diagnosis.” Su Yun patted him on the shoulder and said,”it’s called the ‘bird’s nest’ mycobacteria. It can cause non-tuberculosis mycobacterial pneumonia.” The bird’s endocytoid mycobacteria complex and the mycotis bacteria can induce non-tuberculosis mycoticallatitis. “
“There are too many. It’s troublesome to say. Temperature is the main basis for the final judgment of sea divergent bacteria. It only appears under the skin without affecting the internal organs, so there is a high probability of it being sea divergent bacteria. “
Zhou Litao sighed slightly and glanced at the computer. I haven’t even finished writing my research paper, and I’m already looking at diagnoses?
The branches of modern medicine were huge and complicated. Was he really going to become a general practitioner like before? Even if her hair turned white, she probably wouldn’t be able to do this.
In the past, the general practitioner was very rough when he treated patients, and he was not as professional as he was now.
“No need,” Zheng Ren laughed.”It’s the emergency department. We still have to focus on resuscitation. For the others, we just need to do a proper diagnosis. For example, this patient, send him to the hand surgery department. They should be able to make a correct diagnosis. “
“You’re talking nonsense. ” Su Yun said in disdain.
“It’s not nonsense. There are very few people who can remember it after seeing it once. What if general manager Zhou reads the books according to what you said and delays the emergency treatment?” Zheng Ren said very seriously.
Zhou Litao’s face was covered in tears.
It turned out that boss Zheng didn’t use vulgarities when scolding people because he despised her for being stupid.
However, he quickly got out of his depressed mood and asked,”boss Zheng, what do you think of the patient’s condition?”
“It’s not optimistic. A CT scan can’t explain anything. I think we’ll need an MRI scan. The tendons and the like should be corroded soon. The hand Department is in big trouble this time. “
Zheng Ren said with a sigh.
It was so heavy? Zhou Litao was stunned.
However, before the scan came back, everything was just a guess. The few of them chatted casually for a while until Zhou Litao’s phone rang. The doctor in the CT room said that the scan had been uploaded.
Zheng Ren sat in front of the computer, searched for the patient’s name, and opened the CT scan.
There was a 3×4 cm abscess under the skin of the patient’s left wrist. The patient’s tendon had been eroded, and even the radial and ulnar were invaded.
It was indeed a big problem. Zhou Litao was once again convinced by boss Zheng’s diagnosis.
“We’ll go back first. You can explain to the patients when they come back later. ” Zheng Ren said,”send him to the hand Department and have them consult the Department of Infection first to control the inflammation …”
“Do I need you to tell me about the normal treatment process? Do you really think you’re the director of the hand surgery department?” Su Yun interrupted Zheng Ren’s words and said in disdain.
“True,” Zheng Ren smiled.
“Boss Zheng, do you think the patient will recover?” Zhou Litao asked.
“We’ll talk about it after four or five operations. The effect can only be seen after chronic ulcer repair, tendon repair, median nerve loosening, local flap repair, and negative pressure closed drainage. “
Er … An invisible wound could actually induce such a serious illness! Zhou Litao was a little stunned.
“That’s nothing. Do you know what’s the most common way of infection for the sea divergent bacteria?” Su Yun asked.
Zhou Litao shook his head.
“The kitchen cuts the vegetables and changes the water in the fish tank. The boss first asked if they kept fish at home, then asked if they had gone on a trip. ” Su Yun said.
“Then why don’t you cut the vegetables?” Zhou Litao was still immersed in the list of surgical methods that boss Zheng had mentioned and could not extricate himself, so he asked in a daze.
Then, he saw Su Yun’s gaze behind the black hair on her forehead and scolded himself in his heart. He had already said that there was no wound, so he had ruled out this infection route.
What’s wrong with me? I’m so absent-minded. Zhou Litao first did a self-reflection.
“Get him to go for surgery. The two most serious problems are amputation of the spine and skin cancer.” Zheng Ren stood up and left, leaving behind his last words.
Zhou Litao nodded his head repeatedly. These two points were extremely important and could not be delayed.