The patient's name is Qian Aiwu, 65 years old, 155 cm tall and 68 kg weight. He was admitted to the hospital for examination due to irregular bleeding from the lower body for two years. After CT and pathological examination, it was determined that it was grade III poorly differentiated squamous cell carcinoma, and it had involved the lower third of the vagina.

After the stage 3 and the classification has been confirmed, the next surgical treatment becomes the natural treatment process. Since the stage is in the middle and late stages, the scope of surgery is also relatively large. In addition to the uterine incision, the doctors removed both ovaries and appendages of Qian Aiwu at the same time, and dissected the lymph nodes in her abdominal cavity.

The procedure went smoothly and no signs of lymphatic metastases or peritoneal metastases were found during the abdominal surgery. After the two-hour operation, the chief surgeon, Feng Chujie, finished the treatment and was closed by the first assistant doctor.

"There was no problem with the process, and there was no problem with the post-operative check-up – at least we certainly didn't leave a piece of gauze or anything in the patient's body. Feng Chujie said to Sun Lien, "According to our inquiry, the patient had a history of high blood pressure before, and the oral medication was felodipine tablets. ”

Pushing open the door of the ward, Sun Lien saw Qian Aiwu lying on the bed.

Qian Aiwu, female, 65 years old, after hysterectomy (07.34.42), intestinal edema (05.11.24), thoracoabdominal and pelvic subcutaneous tissue and fascial edema (05.09.10), pelvic and abdominal pelvic subcutaneous tissue scattered pneumops (03.22.26). ”

This time, the status bar seems to have changed to that of a radiologist, and the status of the prompts is all diagnostic content from imaging.

"Did you do a CT?" Seeing so many obvious changes in imaging symptoms, Sun Lien's first reaction was to ask the patient about the results of the imaging examination. At least judging by the information on the status bar, this could be an infection involving both the thoraco-abdominal and pelvic cavities – a severe case just from the extent of the infection.

What's worse is that the patient has just undergone a rather traumatic organ removal operation, and the operation also involves lymphoid tissue - the so-called radical lymphatic dissection is actually the medical term for the removal of the entire lymph. In Qian Aiwu's abdominal cavity, in order to prevent lymphatic metastasis of cancer cells, lymph nodes, which are an important part of the immune system, were removed in large quantities.

If Qian Aiwu's thoraco-abdominal and pelvic cavities are infected at the same time, then the abdominal cavity and pelvic cavity that have just undergone surgery will definitely be the hardest hit area.

"I did it before the operation, but not after the operation. Feng Chujie frowned and replied, "She's not in a good situation now, and we want to avoid moving as much as possible." ”

Resting and recuperation after major surgery is a must. This is not only to allow the patient to recover as quickly as possible, but also to avoid the rupture of the wound due to exercise. In general, doctors don't take a patient who has just had an organ removal out of bed and take it to a CT room for another examination unless it's particularly necessary.

"Wait a minute, send it for a CT scan. Sun Lien put forward his opinion, "I'll ask the patient first." ”

Qian Aiwu had already woken up, she was lying on the bed, her face was pale and her expression was painful.

"Doctor, I hurt ......" she vaguely saw several white shadows flashing in front of her. Under the severe pain, she spoke a little weakly, "Help me......"

Sun Lien put on gloves and quickly palpated Qian Aiwu's abdomen. and let Xu Yourong listen to her lung sounds.

"The abdomen is distended, there is no tenderness, the abdominal muscles are tense, and the lower limbs are not swollen. After completing the examination, Sun Lien and Xu Yourong quickly exchanged the results of the examination, "There were no dry and wet rales in both lungs, and the patient was conscious, agitated, and short of breath. Heart rate 126 and no pathological murmur. ”

"The preliminary examination is like this, take blood and send it for testing and culture, and quickly send the person to the imaging department for a CT scan ......" Speaking of this, Sun Lien thought about it and added, "Do a liver function and check the markers of myocardial injury." Biochemistry and PCT are also re-done. He looked at Feng Chujie, who looked a little tired, again, "The patient's examination before admission is normal, and the liver and kidney functions are all good?"

"Yes. Feng Chujie replied very neatly, she glanced at the urine bag hanging next to the patient's bed, "The amount of urine is also normal now." ”

"Let's check the CT first. Sun Lien nodded, if Qian Aiwu had a thoraco-abdominal and pelvic infection as indicated in the status bar, then he would have to be more careful - with such a large-scale infection, there may be many organ failures. "Give her imipenem cilastatin sodium. ”

Imipenem cilastatin sodium is a broad-spectrum antibiotic, which is a "super broad-spectrum antibiotic" with a clinical effective rate of up to 93%. The clinical use of imipenem cilastatin sodium is generally used to combat very serious bacterial infections that have not yet completed culture and sensitivity tests.

It is also a "restricted" level of antibiotic. Doctors generally do not use this drug for anti-infective treatment when other options are available. If a doctor uses drugs such as imipenem cilastatin sodium too many times, he will even be criticized and even deducted by the pharmacy department and the medical department. The risk of bacterial infections has always been at a relatively high level, and our arsenal of ammunition to fight bacterial infections has not been updated for a long time. In order for existing antibiotics to be effective for a longer period of time without losing their effectiveness due to resistance, doctors must use antibiotics with caution.

"Good. Feng Chujie agreed to Sun Lien's request without hesitation, "Then what should I do with this patient?"

Qian Aiwu is now an inpatient admitted to the gynecology department, and if she is to be treated according to Sun Lien's doctor's instructions, then she should obviously be transferred out of the gynecology department and transferred to Sun Lien's department for treatment.

But Sun Lien is in the emergency department - there is no reason to transfer gynecology patients to the emergency department of his own hospital for treatment.

As soon as these words came out, Sun Lien also made a difficulty. He thought about it for a while and decided to throw this most troublesome problem to the leader to solve, "Give people the medicine first, and I'll ask Dean Liu for other questions—he handed this case into my hands." ”

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"Brother Luo, are you okay?" In the operation room of the CT room, Sun Lien looked at Luo Sanguan with a vegetable-looking face, and asked cautiously, "Why do I look at your face turning green?"

Brother Luo rolled his eyes with difficulty, "It's not for that ghost director to pour it." He rubbed his head and groaned, "I woke up this morning thinking my head was broken. ”

"It's okay, I've seen it. You're just getting the door in your head. Sun Lien smiled, "If you can't drink, just say it." If you can't drink with others, if you don't get drunk, you will have a ghost. Also, the surname is Wei. ”

"It doesn't matter what his last name is, if I drink with him again, I'll be an eggplant!" Brother Luo said indignantly, then covered his head again, and said apologetically, "Little grandson, brother, I will watch the film today and estimate the difficulty, don't worry, I will find someone else to come over to review the film later." ”

Sun Lien looked at the image displayed on the computer screen, and after a moment of silence, he slapped the screen with his mobile phone, "Then you call someone first, just let me ask Dean Liu how to accept this patient." ”