Sun Lien's question sparked a heated discussion among the entire medical team. Liu Tangchun looked at his unfathomable student who was smiling, and he was indeed a little shocked in his heart. There was nothing wrong with Sun Lien's reasoning, and his question directly exposed the core doubts in front of everyone's eyes.

Liu Tangchun narrowed his eyes, but he was working backwards in his heart, thinking about when Sun Lien discovered that there was a problem with the direction of diagnosis - even Liu Tangchun himself was all the examination reports of the patients he had just seen. Comrade Liu was extremely sure that Sun Lien must have had his own ideas first, and then he would say such things at the meeting.

As for Sun Lien...... He still had a polite smile on his face, but he kept muttering in his heart, "Won't it?

It's just a casual question along your own lines.,You guys don't have to make it look like they've seen through the answer, right?

As a doctor who has only obtained a medical license, Sun Lien is accustomed to treating all doctors' diagnoses as "correct" diagnoses. If a French doctor thinks that a patient has a meningococcal infection, he must have seen some strong evidence to support this judgment. Although the test proved that the French doctor misdiagnosed. But that evidence is likely to be the core evidence that guides the entire diagnostic process.

As for the cultivation of harsh and anaerobic bacteria, this is the lesson that Sun Lien learned in the Fourth Academy. For example, the yellow-haired canine bite carbon dioxide fibrophilus infection has never been identified by bacterial culture. There is no error in the status bar, if the culture does not come out, then there must be a problem during the culture or sampling. After researching the literature, Sun decided not to blame his roommate Shi Yan for being too skilled — most of the CBN fibrophilia infections were identified by mNGS testing.

Hypothetically, assuming that the situation of this female patient is really in line with the direction guessed by other doctors, then the real test of the doctor's problem is to come - how to treat an unknown source of infection without knowing the type of infection in the patient?

"If Dr. Sun's guess is not wrong, if our inference is correct. After discussing with several doctors around him, the internist said, "First of all, we can be sure that ceftriaxone is not very effective against this infection. In other words, the bacteria are resistant or resistant to β-lactam antibiotics. ”

"I'm inclined to be drug resistant. Liu Tangchun added, "The patient's condition progresses too fast, and if it is drug resistance, there should be at least a process of the disease gradually returning to the pre-treatment state and then deteriorating." Three days after admission, he was delirious and had high intracranial pressure, which was more like the condition was masked by ibuprofen. ”

"That said, there are two possibilities for this bacterium that we need to deal with. The internist nodded and continued, "It may be a type that can secrete β-lactamase, hydrolyze antibiotics, or have a containment mechanism that prevents antibiotics from entering the target site." Variations in PBPs target proteins and changes in cell wall permeability are not taken into account – these two are predominantly resistant rather than resistant. ”

"The next question is what bacteria can secrete β-lactamase, and which can cross the brain-blood barrier and cause meningitis. Liu Tangchun nodded, and he called Sun Lien's name again, "Tell me, what do you think?"

This time, it was Sun Lien's turn to catch the blind, "I...... I don't know. Sun Lien shook his head a little apologetically, "I just have such an idea now, specifically...... It still depends on the data of the inspection. He cautiously suggested, "But even if you don't know what kind of bacteria it is, you can try to cure it, right?"

In fact, according to Sun Lien's thoughts, it is basically impossible to determine the type of bacteria infected before this unknown bacteria that can secrete β-lactamase kill patients. This is Africa, not the four hospitals that can do mNGS testing. Three days after the patient was admitted to the hospital, his condition had worsened to the point of unconsciousness. If you are still obsessed with bacterial culture, then when the results come out, you will basically be able to sign a death certificate for this patient.

Rather than dwelling on the specific species of bacteria, it is better to use the characteristics it exhibits to treat it widely. Gram-negative bacteria are not susceptible to ceftriaxone, but at least aminoglycosides, macrolides, quinolones, and even anti-β β-lactamase antibiotics such as meropenem are available.

"For example, the combination of doxycycline and moxifloxacin. Sun Lien proposed his own treatment plan, "Doxycycline has a wide range of antibacterial effects, and moxifloxacin, as a quinolone, can also well cross the brain-blood barrier and combine with brain tissue." ”

"It's a good idea, but it's not realistic. Liu Tangchun unceremoniously rejected Sun Lien's suggestion, "We don't have moxifloxacin in stock, and she is allergic to levofloxacin." He looked at the physician on the side, "How is the patient's liver function now?"

"It's not too good, but it's not enough to worry about. Dr. Kaminai took out his phone and showed the doctors present a screenshot of the patient's liver function test five hours ago. "Alanine aminotransferase 84, several others have increased to varying degrees. ”

"Considering the patient's high fever, this rise is not a big problem. Liu Tangchun looked at Sun Lien, "This patient, you and Doctor Hu will take a look together." Mainly learn about other people's medication methods. ”

Liu Tangchun has no more opinions on Sun Lien's diagnosis and clinical thinking, and Sun Lien's main shortcoming in these two items is his lack of experience. Through Dean Wu Youqian's one-year special training, Sun Lien's ability is much stronger than before—at least he can get rid of the student habit of asking questions as if he was doing problems, and instead focus on solving patients' disease problems. This made Liu Tangchun even feel a little surprised.

Don't think it's a bad thing that doctors don't have the dedication to getting to the bottom of a patient's condition. Being able to figure out when it's okay to be confused and when it's important to be clear is a sign of maturity for a clinician. Yuan Ping'an was sent to study in the Fourth Academy because his scholarly temperament was too distinct - in order to understand the specific development process of a disease, he could consult the information for a day in a row. This kind of character is bound to be a good hand in academic research, but it can't be the same in clinical practice. There is no pause in daily life, and as doctors seek answers, patients' illnesses are constantly evolving. A patient whose disease has reached the end of its life and whose condition cannot be reversed does not need that late answer.

As for letting Sun Lien learn from Dr. Hu in the medical team, Lao Liu actually has two meanings. First, I still hope that Sun Lien can have some new experience in clinical treatment and medication by observing the work of doctors from other medical schools. After all, Sun Lien's work experience is still small, and most of the treatment plans he proposes come from medical textbooks and pharmacopoeia. From Liu Tangchun's point of view, there is more than enough safety but not enough spirituality.

Another meaning...... Liu Tangchun felt that this Shennai doctor from Song'an Provincial Brain Hospital was very good, and if he could dig up the Fourth Hospital, he would definitely be able to make a big difference.