Chapter 2340

"And CT?" The patient is a little unhappy, but his opinion is no longer important at this time. The patient's family seemed to notice something and promised.

Zhou Litao did not try to squeeze out the pus inside the patient's wrist skin this time, but gently disinfected the surface and covered it with sterile gauze.

To open a CT list, patients and their families to check.

As soon as they left, Zhou Litao immediately took Zheng Ren to the duty room. While turning on the computer, he called the CT room. Said the patient's name and told the side to upload it immediately after it was finished.

"Boss Zheng, what disease do you suspect the patient is?"

"Marine Mycobacterium?" Su Yun was also unsure. Looking at Zheng Ren, he said in a tone of inquiry.

"Well, it's the infection caused by Mycobacterium haiense."

Zhou Litao tried to recall Mycobacterium haiense.

He is very familiar with bifidobacteria. Non tuberculous mycobacteria refer to all mycobacteria except Mycobacterium tuberculosis and Mycobacterium leprae, also known as environmental mycobacteria. Non tuberculous mycobacterial disease refers to the lesions of related tissues or organs caused by human infection with related bacteria.

"Boss Zheng, how do you judge whether it is Mycobacterium tuberculosis?" Asked Zhou Litao.

"Generally, the growth temperature of non tuberculous Mycobacterium is relatively wide. Patients only have problems with their wrists. The most likely growth temperature is Mycobacterium haiense with a growth temperature of 28-30 degrees Celsius." Zheng Rendao.

Although Zhou Litao understood the logical relationship, he ruled out other problems at a glance, which Zhou Litao could not accept.

"Well, first of all, the patient's family members tell themselves that they have to change gauze six or seven times a day." Zheng Rendao said, "this means that there are a lot of pus at the wound position of the patient. The position of the wrist needs to draw out about 20ml of pus every day. There will certainly be more in it. It is estimated that there are already sinuses."

Zhou Litao listened quietly. The first point didn't completely answer his questions.

"Second, with such a serious' injury ', the patient had no history of trauma, and the purulent cavity was limited to the left wrist. My consideration at that time was that the position was injured, but the patient didn't pay attention."

"If so, the scope of our consideration will be much narrowed."

"But I don't rule out that it's a fine needle..." Zhou Litao was still puzzled.

"Stupid!" Su Yun had figured it out. He looked at Zhou Litao contemptuously: "what did the patient say before coming? Rheumatism and rheumatoid arthritis!"

"Ah?" Zhou Litao looked at Su Yun blankly.

"What does this mean? Staphylococcus aureus infection will be misdiagnosed as rheumatism and rheumatoid?" Su Yun's sarcasm has overflowed.

"Oh, oh, oh." Zhou Litao wanted to understand.

"Well, so it's estimated that the patient was stabbed on his left wrist by some marine creature while playing in the sea, but the wound was very subtle and he didn't notice it at all. Mycobacterium haiense grew under the skin and finally led to this situation."

Zhou Litao was silent. He still didn't understand, but he didn't ask questions.

"Mr. Zhou, do you have to recite diagnostics, too?" Su Yun patted him on the shoulder and said, "bird intracellular complex Mycobacterium will cause non tuberculous Mycobacterium pneumonia. Bird intracellular complex Mycobacterium and Mycobacterium tuberculosis will induce non tuberculous Mycobacterium lymphadenitis."

"It's too much. It's troublesome to say. Temperature is the main basis for the final determination of marine Bifidobacterium. It only appears under the skin without affecting the internal organs. The probability is marine Bifidobacterium."

Zhou Litao sighed slightly. He glanced at the computer. Before the paper is finished, do you have to look at diagnostics?

The branches of modern medicine are huge and complex. Do you really want to become a former general practitioner? I'm afraid I can't do this when my hair is white.

In the past, general practitioners were so rough to see doctors that they can't be professional now.

"No." Zheng Ren smiled. "In the emergency department, the main energy has to be put on rescue. Others just need to do a good job of triage. For example, this patient should be sent to hand surgery, and they should be able to make a correct diagnosis."

"You're bullshit." Su Yun said contemptuously.

"It's not bullshit. There are still few people who can read it and remember it. What if President Zhou makes an endorsement as you say and delays the emergency rescue?" Zheng Ren said very seriously.

Zhou Litao burst into tears.

It turned out that boss Zheng didn't use dirty words to curse others, which was disgusting that he was stupid.

But he quickly got out of some frustrating mood and asked, "boss Zheng, what do you think of the patient's condition?"

"Not optimistic. A CT doesn't mean anything. I guess I have to do an MRI. Tendons and so on should be corroded. The hand department is in big trouble this time."

Zheng Ren sighed.

So heavy?! Zhou Litao was stunned.

However, when the image didn't come back, everything was a guess. Several people chatted casually for a while until Zhou Litao's mobile phone rang and the doctor in the CT room said that the film had been uploaded.

Zheng Ren sat in front of the computer, searched the patient's name and opened the CT image.

The patient has a 3 under the skin of his left wrist × About 4cm abscess, tendon has been eroded, and even ulna and radius have been invaded.

Sure enough, it was a big trouble. Zhou Litao was convinced by boss Zheng's diagnosis again.

"Let's go back first. The patient will come back later. Explain to them." Zheng Rendao, "send it to the hand department. First consult with the infection department to control inflammation..."

"Normal diagnosis and treatment process? You really think you are the director of hand surgery." Su Yun interrupted Zheng Ren and said contemptuously.

Yes, Zheng Ren smiled.

"Boss Zheng, do you think the patient can be well?" Asked Zhou Litao.

"Let's talk about it after four or five operations. The effect can be seen only after chronic ulcer repair, tendon anastomosis, median nerve release, local flap repair and negative pressure sealing drainage."

Er... An invisible wound can induce such a serious disease! Zhou Litao was a little creepy.

"It's nothing. Do you know what is the most common route of infection of Mycobacterium tuberculosis?" Su Yun asked.

Zhou Litao shook his head.

"Cut vegetables in the kitchen, and then change the water for your fish tank. The boss first asked if you had fish at home, and then asked if you had traveled." Su yundao.

"Then why not cut vegetables?" Zhou Litao was still immersed in the pile of techniques that boss Zheng said. He couldn't extricate himself. He asked in a trance.

Then he saw Su Yun's eyes behind his black hair on his forehead and scolded himself. They all said there was no wound, so they directly ruled out this route of infection.

What's the matter with him? He was absent-minded. Zhou Litao first did self-examination.

"Let him hurry to have an operation. There are two most serious things about this disease - amputation and skin cancer." Zheng Ren stood up and left, leaving a word at last.

Zhou Litao nodded again and again. These two points are very serious and can't be delayed.