"Do we still need to do CT?" The patient was a little unhappy, but his opinion was no longer important at this time. The patient's family members seemed to have noticed something and agreed repeatedly.
Zhou Litao did not try to squeeze out all the pus from the patient's wrist skin this time. Instead, he gently disinfected the surface and covered it with sterile gauze.
I went to order a CT scan, and the patient and family members went for the examination.
As soon as they left, Zhou Litao immediately pulled Zheng Ren to the duty room, turned on the computer, and made a call to the CT room. He told the patient's name and told him to upload it immediately after finishing it.
"Boss Zheng, what disease do you suspect the patient has?"
"Mycobacterium marinum?" Su Yun was also unsure and looked at Zheng Ren and asked in a questioning tone.
"Well, it's an infection caused by Mycobacterium marinum."
Zhou Litao tried hard to recall Mycobacterium marinum.
He was very familiar with mycobacteria. Non-tuberculous mycobacteria refer to all mycobacteria except Mycobacterium tuberculosis and Mycobacterium leprae. They are also called 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 did you determine that it was Mycobacterium marinum?" Zhou Litao asked.
"General non-tuberculous mycobacteria grow in a wide range of temperatures. The patient only has problems with his wrist. The most likely possibility is Mycobacterium marinum that grows at a temperature between 28-30 degrees Celsius." Zheng Rendao.
Although Zhou Litao understood the logical relationship, he could rule out other problems at a glance, which Zhou Litao could not accept.
"That's right. First of all, the patient's family members reported that they had to change the gauze six or seven times a day." Zheng Ren said, "This means that there is a lot of pus in the patient's wound. About 20ml of pus has to be drawn out of the wrist every day, and there must be a lot of pus in it. There will be more, and it is estimated that sinus tracts have already appeared.”
Zhou Litao listened quietly, not fully answering his first question.
"Second, for such a serious 'injury', the patient had no history of trauma, and the suppurating cavity was limited to the left wrist. My thought at the time was that there was an injury at that location, but the patient did not pay attention."
“If that were the case, the scope of our considerations would be much narrower.”
"But it doesn't rule out that it's a fine needle..." Zhou Litao was still a little confused.
"Stupid!" Su Yun had already figured it out. He looked at Zhou Litao with disdain: "What did the patient say before he came? Rheumatism, rheumatoid arthritis!"
"Ah?" Zhou Litao looked at Su Yun blankly.
"What does this mean? Staphylococcus aureus infection can be misdiagnosed as rheumatism or rheumatoid arthritis?" Su Yun's lips were full of sarcasm.
"Oh oh oh." Zhou Litao finally wanted to understand.
"Well, so it is estimated that the patient was stabbed on his left wrist by some kind of marine creature while playing in the sea, but the wound was so subtle that he didn't notice it at all. Mycobacterium marinum stayed under the skin to breed, and finally led to the current situation Condition."
Zhou Litao was silent. He still didn't understand, but didn't ask any questions.
"Mr. Zhou, do you also need to memorize diagnostics?" Su Yun patted his shoulder and said, "Mycobacterium avium intracellular complex can cause non-tuberculous mycobacterial pneumonia. Mycobacteria, Mycobacterium scrofula, can induce nontuberculous mycobacterial lymphadenitis.”
"There are too many, and it's troublesome to talk about. Temperature is the main basis for the final determination of Mycobacterium marinum. If it only appears under the skin but does not affect the internal organs, it is most likely Mycobacterium marinum."
Zhou Litao sighed slightly and glanced at the computer. I haven't finished writing the thesis yet. Do I need to study diagnostics
The branches of modern medicine are huge and complex. Do we really want to become the general practitioner we once were? I'm afraid I won't be able to do this even if my hair is gray.
General practitioners used to be very rough in treating patients, but they are not as professional as they are now.
"No need." Zheng Ren smiled, "In the emergency department, the main focus has to be on rescue. For other things, we just need to do triage. For example, if this patient is sent to the hand surgery department, they should be able to diagnose it correctly."
"Just talk nonsense." Su Yun said contemptuously.
"It's not nonsense. There are still very few people who can remember it after reading it once. What if Mr. Zhou endorses it as you said and delays emergency rescue." Zheng Ren said seriously.
Zhou Litao burst into tears.
It turns out that Boss Zheng doesn’t use curse words when he curses people because he thinks he is stupid.
However, he quickly broke away from a certain depressing 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 guess we need an MRI. The tendons and the like are probably corroded. The hand department is in big trouble this time."
Zheng Ren said with a sigh.
So heavy? ! Zhou Litao was stunned.
But when the images didn't come back, everything was just speculation. The few of them chatted casually for a while until Zhou Litao's cell phone rang. The doctor in the CT room said that the film had been uploaded.
Zheng Ren sat in front of the computer, searched for the patient's name, and opened the CT image.
There was an abscess of about 3 × 4 cm under the skin of the patient's left wrist. The tendons had been eroded, and even the ulnar and radius bones had been violated.
It was indeed a big trouble. Zhou Litao was once again impressed by Boss Zheng's diagnosis.
"We are going back first. You can explain to the patients when they come back." Zheng Rendao, "Send him to the surgery department. First, consult the infectious disease department to control the inflammation..."
"Do you need to talk about normal diagnosis and treatment procedures? You really think you are the director of hand surgery." Su Yun interrupted Zheng Ren and said disdainfully.
Yes, Zheng Ren smiled.
"Boss Zheng, do you think the patient will recover?" Zhou Litao asked.
"Let's talk about it after four or five surgeries. Chronic ulcer repair, tendon anastomosis, median nerve release, local flap repair, and negative pressure sealing and drainage. Only then can we see the effect."
Uh... Invisible wounds can actually induce such a serious illness! Zhou Litao was a little horrified.
"This is nothing. Do you know what the most common infection route of Mycobacterium marinum is?" Su Yun asked.
Zhou Litao shook his head.
"Chopping vegetables in the kitchen, and then changing the water in the fish tank. The boss first asked if he kept fish at home, and then asked if he had ever traveled." Su Yundao.
"Then why not cut vegetables?" Zhou Litao asked in a daze, still immersed in the pile of techniques that Boss Zheng said.
Then, he saw Su Yun's eyes behind the black hair on his forehead and cursed himself in his heart. They said there were no wounds, so this route of infection was directly ruled out.
What was wrong with him? He was absent-minded. Zhou Litao first reflected on himself.
"Let him have an operation quickly. The two most serious diseases are amputation and skin cancer." Zheng Ren stood up and left, leaving the last words.
Zhou Litao nodded repeatedly. These two points were extremely important and could not be delayed.