I can see the status bar

Chapter 492 Drainage
The diagnosis of retroperitoneal necrotizing fasciitis should be divided into two parts, one part is "retroperitoneum" and the other part is "necrotizing fasciitis".

The retroperitoneum indicates where this disease occurs.This area refers to the area below the diaphragm, above the pelvic diaphragm—the levator ani muscle, the coccygeus muscle, and the superior and inferior fascia of the pelvic diaphragm covering both muscles—and between the peritoneum and the retroperitoneum A large area of ​​porosity.Due to the loose structure and special location of this area, many important organs, blood vessels and nerves pass through.

It is precisely because the structure of this area is loose and extensible, so once infection, bleeding, or tumor occurs here, the results will generally be more serious.The physical properties of human tissue itself help to stop bleeding and fight infection to a certain extent.

And necrotizing fasciitis shows how dangerous the disease is.As a critical and severe multi-bacterial mixed infection, necrotizing fasciitis can be fatal in any case.

Diagnosis of necrotizing fasciitis is relatively easy if it occurs in a superficial area.Patients will have more obvious pain, redness, swelling and heat of the skin on the body surface, or whitening and edema.Overall, features resembling diffuse cellulitis are present.

But then necrotizing fasciitis will develop rapidly. With the attack of germs and inflammatory substances, the patient's early severe pain will subside or even disappear completely due to the death of the nerve in the affected area, and will be replaced by numbness or paralysis.This is also one of the main features of necrotizing fasciitis.

As the blood vessels are destroyed and the blood vessels become clogged, the skin will gradually begin to turn purple and black, and blisters containing bloody fluid will appear.

As the germs erode the body further, the subcutaneous fat and fascia will eventually liquefy and die, exuding a foul-smelling exudate and producing subcutaneous gas.At this point, the patient will also have symptoms of systemic poisoning.That is sepsis.

According to the old man's analysis results, Qian Aiwu is now in the final step.Subcutaneous pneumatosis had already appeared on her CT examination, and she also had symptoms of sepsis.

"Yourong, contact the gastrointestinal surgery department immediately and ask them to prepare for the operation immediately." Sun Lien hung up the phone, his tone changed a little in a hurry, "Contact the infection department and the ICU to prepare for consultation..." He looked at Qian while talking Aiwu over there.Having just injected meperidine hydrochloride, Qian Aiwu, who was not very conscious, raised his eyelids and glanced at Sun Lien, then closed his eyes and passed out.

Sun Lien was in a hurry when he saw this, he turned his head and shouted towards the outside of the inpatient ward, "Push the gurney over here, call the operating ladder up, hurry up!"

Bruen was frightened by Sun Lien's fierce reaction, "What's wrong with this man?"

"This person is going to die!" Sun Li'en yelled out what was in his heart in a hurry, "She has retroperitoneal necrotizing fasciitis!"

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This was the first time that Sun Lien took the initiative to send a patient into the operating room.Because it was a sudden emergency operation, the entire operating room did not have the calm sense of step-by-step in the past.Every medical staff is running around like a race against death.The equipment nurses are urgently preparing surgical equipment, and the plasma urgently transferred from the blood bank is also being stuffed into the rewarmer.Sun Lien changed into his surgical gown and was nervously communicating with the surgeon beside him about the patient's condition.

"It's still hard to see on the CT." The chief surgeon looked at the CT image on the monitor and frowned. "Doctor Sun, are you sure it's retroperitoneal necrotizing fasciitis?"

Where can Sun Lien confirm it?At this moment, the old man's diagnosis is as secret as his own status bar.He could only explain, "I asked Dean Wu to find an expert to see the image and make a judgment. It is very reliable. And her symptoms are indeed consistent."

The surgeon thought for a while, and cautiously suggested, "Why don't I use a laparoscope first? If there are signs of fasciitis, then switch to laparotomy."

Sun Lien nodded, this is a safer method.It is very risky to perform laparotomy on a patient who has just had the uterus and appendages removed.It would be fine if we can be very sure that there is necrotizing fasciitis, but now it is a bit unreasonable to perform laparotomy on the patient based on only one CT image that neither the surgeon nor the radiologist of the hospital can confirm.

If it wasn't for knowing that Sun Lien's diagnosis was so scary, if it wasn't for knowing that Vice President Liu had specially handed over this patient to Sun Lien.The parenteral surgeon would not just agree to Sun Lien's request.

The laparoscope quickly passed through Qian Aiwu's flank and went deep into the retroperitoneum.Soon, her bowels, and the peritoneum behind them, were revealed on the screen in the operating room.

"There is obvious intestinal edema..." Before the chief surgeon finished speaking, a black fascia appeared on the screen.Even an emergency physician like Sun Lien can see that this is a very obvious and serious necrotic lesion.

"Switch to laparotomy." After operating the laparoscope silently for about 10 minutes, the chief surgeon decided to switch to laparotomy. "The infected area is too large."

For patients with this large area of ​​necrotizing fasciitis, active and adequate drainage and combination therapy with multiple antibiotics to deal with possible multiple bacterial mixed infections are very important treatment strategies.For the part of antibiotics, Sun Lien is going to discuss with the licensed pharmacists of the pharmacy department and the professional doctors of the infection department later. What he can do at present is to watch the operation complete first, and then give Qian Aiwu dialysis treatment—if there is any If necessary, plasma exchange may even be required.

There are treatment methods, but none of them can guarantee that Qian Aiwu will be able to survive.All the doctors can do is try to give her the most suitable treatment, and then see if she can resist it.

"Do as much drainage as possible." Seeing that there was nothing he could do here, Sun Lien exchanged a few words with the chief surgeon, then turned and left the operating room - Director Han arrived 5 minutes ago with a licensed pharmacist In the small conference room of the rescue room.If he didn't come to the scene quickly, it would be really unreasonable.

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"The culture results have not yet come out, and it is possible to continue the treatment with imipenem cilastatin sodium." The two licensed pharmacists who arrived with Director Han discussed with each other for a while, and then gave their own professional advice, " If you need to use hemodialysis or plasma replacement, the concentration of antibiotics in the blood will drop, and the specific drop ratio needs to be calculated separately according to the replacement amount. If Dr. Sun, you plan to use this kind of treatment, please let us know in advance, and we will do it as soon as possible Report to you the dosage of the drug that should be refilled."

A licensed pharmacist is actually a very useful auxiliary profession.If Sun Lien and the others are asked to calculate the supplementary dosage of antibiotics after dialysis or plasma exchange, they will either come to wrong conclusions after a long period of calculation, or they will not be able to calculate it at all. Perform dialysis and replacement, then re-supplement antibiotics.But this will inevitably lead to the fact that Qian Aiwu's infection cannot be suppressed by drugs during the few hours of dialysis.The risk caused by the drug will be replaced by the risk of infection.

Nodding his head, Sun Li'en began to ponder whether he should recruit two licensed pharmacists to the comprehensive diagnosis center.On the other hand, the Department of Infectious Diseases gave a more radical treatment plan.

"We recommend closed continuous irrigation and drainage for patients." The doctor from the infection department was obviously prepared, holding a thick stack of printed materials in his hand, "Although this treatment plan is mainly used for superficial necrosis fasciitis, but we think it can work in patients with retroperitoneal necrotizing fasciitis as well—the effect of large amounts of hydrogen peroxide and saline irrigation is even better than drainage alone."

(End of this chapter)