In the department, there were Su Lin, He Tiancheng, Kamata, Li Wanqiu, me, and two nurses I didn't know, except for me who didn't wear work clothes, they all wore them, and the nurses also put on their masks.

Su Lin said: "For the patient Lin Hao's emergency, if it were not for the professional experience and literacy of the medical staff, we may have trouble in the emergency department, I would like to express my gratitude to every medical staff in the emergency department, without your timely help, in the current era when everyone is self-media, it may be a heavy blow to the reputation and reputation of our hospital. It is the duty of the doctor to treat every patient with heart, this is the awe of life, now let's analyze the death record discussion system, first of all, I will elaborate on pediatric meningitis, this is a class B infectious disease, speaking of infectious diseases, Li Wanqiu, you will answer, how many kinds of statutory class B infectious diseases, please give an example? ”

Li Wanqiu stood up and replied, and was asked to sit down by me.

"There are 26 kinds of Class B infectious diseases in China, including infectious atypical pneumonia, AIDS, viral hepatitis, human infection with highly pathogenic avian influenza, Japanese encephalitis, rabies, dengue fever, anthrax, tuberculosis, whooping cough, malaria, diphtheria, scarlet fever, and A H1N1. ”

Su Lin said: "The answer is very good, now we will discuss this Lin Hao's case for Japanese encephalitis." The early symptoms of pediatric meningitis are epidemially called triadics. The triad is headache, vomiting, and meningeal irritation, which is the earliest symptom of meningitis. If the child said, will say that he has a headache, vomiting, projectile vomiting is more typical, 0-2 years old children mostly can't speak, but body language and symptoms will respond, our hospital in the physical examination, will find that the child has a hard neck, and when the legs are bent, there may be pain, there are signs that the neck is raised at the same time, the medical term is Klinefelter's sign, when this symptom appears, meningitis should be highly suspected. Dr. Pu, do you have any insights?"

Kamata said: "That's the case, I regret Lin Hao's death due to meningitis, this child is very handsome, it's a pity, based on the situation of Lin Hao's family, I personally sponsor 5,000 yuan to show my heart." Just now Dr. Su said about the initial symptoms of meningitis, I will add about the treatment of meningitis, how, I am if, Lin Hao rescued, how to treat the symptoms? Treatment should first be based on maintaining blood pressure and correcting shock, and according to the characteristics of age and season, effective antibiotics that can easily penetrate the blood-cerebrospinal fluid barrier should be selected, and then antimicrobial drugs should be adjusted according to the results of bacterial culture and drug susceptibility tests. Penicillin has generally been susceptible to the three common pyogenic meningitis pathogens over the past few decades, but in recent years these bacteria have become less susceptible to penicillin, particularly influenza bacteria, which can produce lactamases resistant to ampicillin (ampicillin) and penicillin. There have also been isolated strains of pneumococcus and meningococcal that are relatively or highly resistant to penicillin. Fortunately, all three generations of cephalosporins have a significant effect on purulent meningitis caused by these pathogens. However, some highly resistant strains do not respond to cephalosporin therapy, and vancomycin is indicated. ”

He Tiancheng said: "I'm sorry, Doctor Pu, I'll interrupt, vancomycin is particularly damaging to the kidneys, Lin Hao's age is only six years old, and he is still growing his body, if you rashly use vancomycin, will it have an impact on the health of children, and it will lead to kidney failure in serious cases, I'm done, Dr. Pu, you continue, I'm also thinking about patients, don't care." ”

Su Lin hurriedly said: "Doctor He's a good question, we are a responsible hospital, we should fully consider the patient's health status in the use of medicine, of course, Dr. Pu is also very professional, Dr. Pu, you continue." ”

Kamata said: "I'm sorry, it's a bit out of date, in children and adults, the third generation of cephalosporin is the first choice for the treatment of three common purulent meningitis." Among them, cefttriazine, cefotaxime and cefuroxime have better effects, and chloramphenicol is more appropriate for patients with suspected Slight meningitis, and chloramphenicol is more appropriate for patients with severe allergy to penicillin and those who have previously used cephalosporins. In neonates, the causative organisms may be Streptococcus agalactiae, Escherichia coli, and Listeria monocytogenes, with ampicillin plus ceftriazine or cefotaxime preferred, or ampicillin plus aminoglycosan antibiotics, but there is alarm for hearing or vestibular impairment. In immunocompromised cases, after neurosurgery, or in cases of meningitis due to severe head injury, ceftazidime should be used because staphylococci or gram-negative bacilli, particularly Pseudomonas aeruginosa, are highly likely to cause disease, and these drugs are generally given intravenously. At the same time as antibiotics, dexamethasone 0.6 mg/kg.day should be given intravenously for three to five days in children, which can reduce the incidence of hearing loss and other neurological sequelae in children. Steroids should also be used in adults with fulminant infections who have intracranial hypertension, severe bacteremia, and acute adrenal insufficiency. Thank you"

Su Lin said: "Thank you Dr. Pu for your explanation, very professional, we have such a qualified and experienced doctor in the emergency department, it is a blessing for our emergency department, I will talk about the diagnosis of diseases, viral meningitis, tuberculous meningitis, fungal meningitis and spirochetal meningitis." Differences in cerebrospinal fluid (CSF) are the main basis for differential diagnosis. Elevated levels of lactate and lactate dehydrogenase in cerebrospinal fluid can be distinguished from viral meningitis, and persistently elevated levels of both indicate poor response or complications. ”

I wondered, "What are the complications of meningitis?"

"Oh, Director Feng, let me answer, purulent meningitis can have a variety of intracranial complications during the course of the disease. Subdural effusion, which is more common in infants under two years of age, is common in young adults and adults, usually with sinusitis or otogenic infection, and patients often have fever, seizures, and localized neurological signs. Hydrocephalus, brain abscess, venous sinus thrombosis, and cerebral infarction are rare. Systemic complications such as DIC, bacterial endocarditis, pneumonia, and septic arthritis can also occur. ”

I replied, "Be taught, learn from Dr. Su." ”

"There, there, Dr. He, can you summarize the pathogenesis of meningitis. ”

He Tiancheng said: "After the bacteria enter the subarachnoid space, the antigenic substances of the bacterial wall and some cytokines that mediate inflammation stimulate the vascular endothelial cells, adhere to and promote the neutrophil to enter the central nervous system, triggering the inflammatory process. The inflammatory process produces a large amount of purulent exudate that fills the subarachnoid space......"

This time the death record discussion system about meningitis, I was really very taught, I went back to the office and called Yan Musk, Yan Musk said nothing, this is not a big deal, the quality of the hospital must be controlled, the registration of various departments, if the law enforcement brigade investigates and stabilizes, I am not there these days, bothered.

In just a few words, there are not too many words, the implication is that I can handle it, she believes me, I have a headache myself, this matter has been dealt with, I don't know what will happen tomorrow.

Kiki made me a cup of coffee, she always showed up at the most appropriate time to give you that little warmth, how could such a girl not be liked.

"Brother, what's wrong with the hospital?" Kiki said worriedly.

"Handle it, don't worry, how did you learn from Nuolan?"

"She's so good, the computer is awesome, the kind that doesn't look at the keyboard when typing, and Sister Nuolan is also very good, and she is also very attentive to me, not the conservative kind. ”

"yes, it's been a long time since you got me a hand you learned, how about it?"

"That's fine, I'll show you what I've learned when I get home in the evening, the coffee is good. ”

"The taste is different, sweet and a little minty flavor. ”

"I made it at home, and I prepared it for you!"

"I really have a heart, after drinking your coffee, I feel instantly warmed up, and my mood is a lot better, learn computer with Nuolan, don't waste your knowledge of traditional Chinese medicine." ”

"Got it, brother!"

"Go to work, I'll pick you up after work. ”

"Okay. ”

......

Kim Boon Hui's office.

"Sister, Yan Musk Deer went on a business trip? "Left Secret Road.

"Japan, what does it mean to run so far!" Jin Wenhui said curiously.

"I don't know, Yan Musk is the chairman of the hospital, this hospital is now in her own hands, the hospital will always develop, I think, it should be to Japan to study or purchase advanced medical equipment, after all, Japan's medical treatment is very developed. ”

"Your analysis is very right, Zuo Mi, just these few days, find a way to deal with Xu Liang's five percent of the original shares, we can do anything conveniently, about our obstetrics and gynecology hospital and physical examination center, I think we can't lag behind, the introduction of advanced technology and equipment is necessary for the upgrading of the hospital." ”

"Sister, I fully support you, the strange thing is that Xu Liang hasn't been looking for me recently, he doesn't even have a WeChat, I don't know what is sold in the gourd, the more I think about it, the more I don't understand, I'm afraid that he plans to do something bad to me. ”

"Go find Chen Yong, let Chen Yong talk to him, ace to ace, you are too young, not the opponent of the old rascal, he is really unwilling to sell the five percent of the original shares, there is no way, there is definitely no dividend at the end of the year, I am not afraid of playing the company, I asked Zhao Lin, she is sure of this company. ”

"Okay, I'll go right away, I haven't seen Lawyer Zhao for a long time, is she still in Changsheng Law Firm?"

"Well, it's amazing, the gold medal lawyer didn't blow it out, so I asked her out to sing and clubhouse for a long time. ”

"Haha, will she come out, lawyers are generally more conservative!"

"What, the lawyer is also a person, call Chen Yong with the wind chime, there are many people. ”

"Okay, I'm going to Chen Yong's office. ”

"Well, pay attention to communication skills, and use wind chimes more when you talk, maybe it will work well, you know. ”

"I know sister, the wind chime is his brother, and he is the most stable to play the emotional card. ”