Doctor's Life Simulator

Chapter 106 The Extremely Rare Fornier's Gangrene, Qin Lang Makes Efforts to Turn the Tide (Subscribe)
[Ding, consume 1 simulation point to start a single case simulation. 】

【At the invitation of Wu Youtu, You Daren and Zhong Chengfa, you participated in the patient's consultation.However, since the patient's condition is very rare, there is nothing you can do.Only conventional debridement therapy can be performed. 】

[On the second day, the laboratory test showed: WBC 20.23X106/L, N 0.83, L 0.14, globulin 36g/L, white globulin ratio 1.1.Bacterial culture: Streptococcus faecalis (enterococci resistant to high concentrations of aminoglycosamines), sensitive to penicillin. 】

[Because the patient did not see a doctor in time, and the patient's etiology was rare, no targeted treatment was carried out at the first time. In addition to the skin of the perineum, the lower abdominal wall was involved locally, and extensive skin necrosis led to septic shock, as well as multiple lungs and kidneys. Organ failure, despite active debridement treatment, ventilator and continuous bedside hemofiltration and other life support treatment, died because the family members in critical condition gave up treatment]

[Afterwards, after reviewing the condition and inviting experts from Hangzhou, it was finally confirmed that the real cause of the patient was the rare Fornier's gangrene. 】

[Fornier's gangrene was first described in detail by Fornier in 1883, hence the name.It is a subcutaneous infectious disease with rapid onset, rapid change, serious condition, and strong explosiveness. It is prone to occur in male eagle stems, eagle capsules, eagles, and abdominal walls. It is rare in acute necrotizing fasciitis. one type. 】

[Afterwards, Wei Guoqiang also made a special summary. It is also the second case of this case in Hecheng in recent years. Fornier's gangrene is mostly caused by local injury or infection, and the factors leading to infection include systemic factors.Such as diabetes, blood disease, AIDS, long-term use of steroid drugs. 】

[This patient has a history of rheumatism for five years, and has taken hormones for a long time, resulting in low immunity.May be the main cause of the disease.In view of the characteristics of Fornier's gangrene, early diagnosis and timely treatment are the key. At the same time, comprehensive measures need to be taken, including debridement, early incision and drainage, decompression, complete removal of necrotic tissue and fascia, and systemic application of broad-spectrum antibiotics to control the spread of infection and diffusion, systemic rehydration therapy support if necessary. 】

[Single case simulation ends, whether to retain the clinical experience of this case. 】

"It turned out to be such a rare Fornier's gangrene, no wonder the onset is so fast."

After Qin Lang knew the patient's condition, he was ready to rescue him immediately. After all, early rescue is very critical. Once the best time is missed, the patient's fatality rate is very high.

After Wu Youtu left with Peng Yun, the conference room fell into silence, Zhong Chengfa and You Daren were still helpless.

"Everyone, I know what the patient's symptoms are. This is a very rare type of acute necrotizing fasciitis. Let's go to Dr. Wu immediately. Time is running out, everyone, let's talk as we walk."

Qin Lang's tone was firm, and he mobilized vigorously.

"Qin Lang, you really found the cause of the disease, you can't talk nonsense!"

You Daren immediately got up and followed Qin Lang, still a little unbelievable in his heart.

Zhong Chengfa was a little surprised. Now that he has a direction, it is better than a headless fly.

The three of them immediately headed towards the ward, and soon joined Wu Youtu.

The matter was urgent, and Qin Lang didn't even hesitate to take over the command directly:

"Doctor Wu, I have found out the cause of the patient, it is Fornier's gangrene, a very rare type of acute necrotizing fasciitis, and now we need early rescue as soon as possible."

"Fornier's gangrene?"

Hearing Qin Lang's confirmed cause, Wu Youtu looked strange. This patient is really rare, and the city's No. [-] Hospital has never encountered a case for so many years.

However, seeing Qin Lang's serious and determined state, he still chose to believe it.

"Qin Lang, now that you have identified the disease, what is the treatment plan? Can the treatment center handle it?"

Wu Youtu began to calculate and estimate in his mind, the feasibility of the operation plan, and whether the treatment center could undertake this emergency treatment.

After all, Qin Lang was still young, and he knew nothing about the disease he proposed. If he misdiagnosed it, it would be the difference between life and death for the patient.

The treatment center has just started its trial operation. If this incident is excluded, it will have an impact on the subsequent approval.

Regardless of the safety of the patient or the prospect of the treatment center, it is the best choice to transfer the patient to Hangzhou Zijingang No. [-] Hospital.

Of course Qin Lang understood Wu Youtu's hesitation and thoughts.

"Doctor Wu, the necrosis rate of Fornier's gangrene is very fast, and now the patient's only chance of survival is in your hands. Don't think about transferring to another hospital, it's too late."

"We must now start debridement and broad-spectrum antibiotics to treat systemic infections. Fornier's gangrene, gangrene requires thorough removal of necrotic tissue and fascia. After debridement, large areas of tissue defects will appear in the eagle area, so it is necessary to cooperate with skin grafting. Skin flaps and free grafts can be used to repair defects."

"For this patient, we now need to adjust the whole body state immediately, and at the same time use the VAC system to prepare the wound in the early stage, and then use direct suture and local skin flap to repair the skin defect."

Wu Youtu looked at Qin Lang, and while he was still thinking about it, Peng Yun on the side exclaimed again:

"Doctor Wu, the patient's condition has further deteriorated, and the whole person has mental disorders!"

You Daren and Zhong Chengfa were sweating coldly behind their backs, and looked at Wu Youtu and Qin Lang.

Wu Youtu finally chose Qin Lang's suggestion:

"Qin Lang, since that's the case, follow your plan for treatment. If there is any problem, I will bear all the consequences."

When You Daren and Zhong Chengfa saw that Wu Youtu agreed to Qin Lang's plan, they started to participate in the rescue together.

Ten minutes later, the medical staff and all the equipment were in place.

after general anesthesia on the patient.Under the auspices of Qin Lang, the first step of wound debridement began.

In order to buy time, Qin Lang did not give up to the others at all, and quickly started to operate. The whole action was a bit faster than usual.

The attending physicians on the side felt their scalps go numb for a while.

"This Qin corridor can be used. At the critical moment, it can really be used!"

Because the condition of the patient's affected area is very bad, with all kinds of thick and ulcers, even with Qin Lang's level of debridement, it still requires long-term continuous and meticulous operations.

After two hours in a row, Qin Lang finally completely removed the necrotic tissue, pollutants and infection exudate, and completely stopped the bleeding.

".VAC negative pressure therapy, hydrophobic polyurethane foam dressing, sealing gasket, connecting catheter, effusion tank."

Qin Lang began to report unfamiliar and clear equipment and equipment one by one.

I have to say that I am really grateful for the first aid this time. The latest equipment purchased recently contains a new type of intelligent negative pressure therapy device that is most suitable.

".Adjust the pressure to -125mmHg"

Time was running out, and Qin Lang didn't explain too much to everyone, and issued orders one after another, and everyone started to rotate at a high speed in an orderly manner with Qin Lang as the center.

According to the size of the wound, cut the hydrophobic polyurethane foam dressing, fully fill it with the wound and the hidden cavity, and seal the pad to cover the dressing and the wound.

Here, the first step is finally completed.

The next step is to wait until the wound surface is clean, free of necrotic tissue, pollutants, and signs of infection, and the bacterial culture of the wound exudate is negative, then direct sutures or partial skin flaps can be used to repair the wound surface.

Since the patient's condition was already very serious when he was admitted to the hospital, the defect of the eagle sac area was greater than 50%, and the eagle stem was involved, so it could not be closed and sutured, and only local skin flaps could be used for repair.

By this time, more than three hours had passed since entering the operating room.

Director Wei Guoqiang, who was far away in Hangzhou, just finished his report. After he came out of the meeting room, he saw the message Wu Youtu had left for him and the patient's various physical examinations.

And the most recent one is, Wu Youtu's message before entering the operating room:

"Director Wei, after my joint consultation with Dr. Qin, Dr. You, and Dr. Zhong, the matter was urgent. We chose to take a risk. The decision was made by me, and I will bear all the consequences. The initial diagnosis was the rare Fornier's gangrene. "

"It turned out to be Fournier's gangrene!"

After all, Wei Guoqiang is the chief physician of the burn center, and he actually saw this kind of disease at an academic conference in the Asia-Pacific region.

And he knew very well that Fournier's gangrene was so severe that it was too late to be transferred to another hospital.

A treatment center without him sitting in it, really?
Wei Guoqiang felt annoyed. Just as he was about to contact Wu Youtu, the other party sent another message with a few pictures.

Wei Guoqiang clicked on the voice, listening to Wu Youtu's latest report, he was completely surprised, and immediately clicked on a few photos to confirm.

Wei Guoqiang held his breath, nervously zoomed in with his fingertips, and looked at the details of the picture
(End of this chapter)