"Another CT scan?" The patient was unhappy, but his opinion did not matter now. The family seemed to sense something and agreed.
This time, Zhou Litao did not try to squeeze the pus out of the patient's wrist. Instead, he lightly disinfected the surface and covered it with sterile gauze.
After getting a CT scan, the patient and his family went for the examination.
As soon as they left, Zhou Litao immediately pulled him to the on-call room. He turned on the computer and called the CT room. He gave the patient's name and told them to upload the scan as soon as it was done.
"Boss Zheng, what do you suspect is the patient's illness?"
"Mycobacterium marinum?" Su Yun was not sure either. He looked at Zheng Ren and asked in a questioning tone.
"Yes, it's an infection caused by Mycobacterium marinum."
Zhou Litao tried to recall Mycobacterium marinum.
He was familiar with Mycobacterium diverticulum. Nontuberculous mycobacteria referred to all mycobacteria other than tuberculosis and leprosy, also known as environmental mycobacteria. Nontuberculous mycobacteriosis referred to human infection with related bacteria that caused pathological changes in related tissues or organs.
"Boss Zheng, how did you determine that it was Mycobacterium marinum?" Zhou Litao asked.
"Most nontuberculous mycobacteria grow at a wide range of temperatures. The patient only had a problem with his wrist, so the most likely possibility was Mycobacterium marinum growing at a temperature between 28 to 30 degrees Celsius," Zheng Ren said.
Although Zhou Litao understood the logic behind it, he could not accept that he could rule out other problems at a glance.
"First, the patient's family said that the gauze was changed six to seven times a day," Zheng Ren said. "This means that there is a lot of pus in the patient's wound. About 20 milliliters of pus are drained from the wrist every day, so there must be more inside. I'm guessing there is already a sinus. "
Zhou Litao listened quietly. The first point did not completely answer his doubts.
"Second, the patient had no history of trauma despite such a serious' injury ', and the pus cavity was limited to the left wrist. I thought that the patient had been injured in that area, but the patient did not notice.
"If that's the case, the scope of our consideration has been greatly reduced."
"But we can't rule out the possibility of fine needles …" Zhou Litao was still puzzled.
"Stupid!" Su Yun had already thought it through. He looked at Zhou Litao with disdain. "What did the patient say before he came? Rheumatoid arthritis! "
"Ah?" Zhou Litao looked at Su Yun blankly.
"What does this mean? How could a Staphylococcus aureus infection be misdiagnosed as rheumatism or rheumatoid arthritis? "The corner of Su Yun's mouth was overflowing with ridicule.
"Oh, oh, oh." Zhou Litao finally understood.
"Yes, so the patient was probably playing in the sea when he was stabbed in the left wrist by some kind of sea creature, but the wound was very small, so he didn't notice it at all. Mycobacterium marinum stays under the skin and breeds, finally causing this situation. "
Zhou Litao was silent. There were still things he didn't understand, but he didn't ask.
"Director Zhou, shouldn't you also memorize diagnostics?" Su Yun patted his shoulder and said, "Mycobacterium avium complex will cause non-tuberculous bacillus pneumonia. Mycobacterium avium complex and mycobacterium scrofulaceum can induce non-tuberculous divergent bacillus lymphadenitis. "
"There are too many. It's troublesome to talk about. Temperature is the main criterion to determine whether it's Salmonella. If it only appears under the skin and doesn't affect the internal organs, then it's most likely Salmonella. "
Zhou Litao sighed slightly and glanced at the computer. He hadn't even finished writing the thesis and he was already reading diagnostics?
The branches of modern medicine were huge and complicated. Did he really want to become the general practitioner of the past? He was afraid that even if his hair turned white, he wouldn't be able to do this.
In the past, general practitioners were so crude, how could they be as professional as they were now?
"There's no need." Zheng Ren smiled. "The emergency department still has to focus on resuscitation. The rest only needs to do a good job of triage. Like this patient, send him to the Hand Surgery Department. They should be able to correctly diagnose him. "
"You're talking nonsense," Su Yun said disdainfully.
"I'm not talking nonsense. There are still very few people who can remember it after reading it once. What if Director Zhou does as you say and delays the emergency treatment? "Zheng Ren said very seriously.
Zhou Litao's face was full of tears.
It turned out that Boss Zheng did not use vulgarities to scold people. This was because he despised himself for being stupid.
However, he quickly escaped from some kind of depressing mood and asked, "Boss Zheng, what do you think of the patient's condition?"
"It's not optimistic. A CT can't explain anything. I think we'll need to do an MRI. The tendons and the like should be almost corroded. The hand department is in big trouble this time, "Zheng Ren said with a sigh.
Zheng Ren sighed.
So heavy?! Zhou Litao was stunned.
However, before the scan was uploaded, it was all speculation. They 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 an abscess about 3 × 4 cm under the skin of the patient's left wrist. The tendon had been eroded, and even the ulna and radius had been affected.
It was indeed a big problem. Zhou Litao was once again convinced by Boss Zheng's diagnosis.
"We'll head back first. You can explain to the patients when they come back later," Zheng Ren said. "Send them to the hand department and consult the infectious diseases department to control the inflammation …"
"Do I need you to tell me about the normal diagnosis and treatment process? Do you really think you're the chief of the hand surgery department? "Su Yun interrupted him and said disdainfully.
That was 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 surgeries. Chronic ulcer repair, tendon anastomosis, median nerve release, local skin flap repair, negative pressure sealing and drainage will only be effective after that. "
Uh … an invisible wound could actually cause such a serious illness! Zhou Litao was shocked.
"That's nothing. Do you know the most common route of infection for Clostridium albicans?" Su Yun asked.
Zhou Litao shook his head.
"Chopping vegetables in the kitchen and changing the water in the fish tank. The boss first asked if there were any fish in the house, then asked if he had been traveling, "Su Yun said.
"Then why not chopping vegetables?" Zhou Litao asked absentmindedly, still immersed in Boss Zheng's list of surgical procedures.
Then, he saw Su Yun's gaze behind the black hair on his forehead and scolded himself in his heart. He had already said that there was no wound, so this route of infection was ruled out.
What's wrong with me? I'm absent-minded. Zhou Litao first did some self-reflection.
"Hurry up and get him to the surgery. There are two serious problems with this illness — amputation and skin cancer." Zheng Ren stood up and left, leaving behind one last sentence.
Zhou Litao nodded repeatedly. Both were extremely serious and could not be delayed.
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