Chapter 2338 Small Wound, Big Trouble

"Do you still want to do CT?" The patient was a little upset, but his opinion was not important at this time. The family members of the patient seemed to have noticed something and agreed repeatedly.

This time Zhou Litao did not try to squeeze out all the pus inside the skin of the patient's wrist, but gently disinfected the surface and covered it with sterile gauze.

I went to order a CT order, and the patient and his family members went for the examination.

As soon as they left, Zhou Litao immediately dragged Zheng Ren into the duty room, turned on the computer, and made a call to the CT room. Said the patient's name, told that side to upload immediately after finishing.

"Boss Zheng, what disease do you suspect the patient is?"

"Mycobacterium marinum?" Su Yun was also uncertain, looking at Zheng Ren and asked in a questioning tone.

"Well, it's an infection caused by Mycobacterium marinum."

Zhou Litao tried his best to recall Mycobacterium marinum.

Mycobacteria is familiar to him. Nontuberculous mycobacteria refer to all mycobacteria other than Mycobacterium tuberculosis and Mycobacterium leprae, also known as environmental mycobacteria. Nontuberculous mycobacterial disease refers to the lesions of related tissues or organs caused by human infection with related bacteria.

"Boss Zheng, how did you determine that it was Mycobacterium marinum?" Zhou Litao asked.

"General non-tuberculous mycobacteria grow at a wide range of temperatures. The patient only has wrist problems. The most likely possibility is mycobacterium marinum that grows at a temperature between 28-30 degrees Celsius." Zheng Ren said.

Although Zhou Litao understood the logical relationship, he could rule out other problems at a glance, which Zhou Litao could not accept.

"It's like this. First of all, the patient's family members reported that the gauze needs to be changed six or seven times a day." Zheng Ren said, "This means that there is a lot of pus in the patient's wound. About 20ml of pus is drawn out from the wrist every day. There will be more, and it is estimated that sinus tracts have appeared."

Zhou Litao listened quietly, but did not fully answer his question on the first point.

"Second, the patient had no history of trauma for such a severe 'injury', and the purulent abscess was limited to the left wrist. I thought at the time that that location had been injured, but the patient didn't pay attention."

"If this is the case, the scope of our consideration will be narrowed down a lot."

"But it's not ruled out that it's a thin needle..." Zhou Litao was still a little puzzled.

"Stupid!" Su Yun had already figured everything out, and he looked at Zhou Litao with contempt: "What did the patient say before he came? Rheumatism, rheumatoid arthritis!"

"Huh?" Zhou Litao looked at Su Yun blankly.

"What does this mean? Staphylococcus aureus infection, will it be misdiagnosed as rheumatism or rheumatoid?" Su Yun's mouth was full of ridicule.

"Oh oh oh." Zhou Litao finally understood.

"Well, so it is estimated that the patient was stabbed on the left wrist by some kind of marine creature while playing in the sea, but the wound was so small that he didn't notice it at all. Mycobacterium marinum remained under the skin to breed, and finally led to the current condition. Condition."

Zhou Litao was silent. He still didn't understand, but he didn't ask any questions.

"Mr. Zhou, do you have to memorize diagnostics too?" Su Yun patted him on the shoulder and said, "Mycobacterium avium intracellular complex can cause non-tuberculous mycobacterium pneumonia. Mycobacterium, Mycobacterium scrofula can induce nontuberculous mycobacterial lymphadenitis."

"There are too many, it's troublesome to say. Temperature is the main basis for the final identification of Mycobacterium marinum. If it only appears under the skin but does not affect internal organs, it is most likely to be Mycobacterium marinum."

Zhou Litao sighed slightly, and he glanced at the computer. I haven't finished writing the thesis yet, do I have to read diagnostics on my side?

The branches of modern medicine are huge and complicated. Do we really want to become the general practitioners of the past? I'm afraid I can't do this even if my hair is white.

In the past, general practitioners were so rough in seeing a doctor, how could they be as professional as they are now.

"No need." Zheng Ren smiled, "Emergency department, the main focus has to be on rescue. Others just need to do a good job of triage. For example, if this patient is sent to the hand surgery department, they should be able to make a correct diagnosis."

"Just talk nonsense." Su Yun said contemptuously.

"It's not nonsense, there are still very few people who can read it once and remember it. If Mr. Zhou endorses the book as you said, what will happen if the emergency treatment is delayed." Zheng Ren said seriously.

Zhou Litao burst into tears.

It turns out that Boss Zheng doesn't use dirty words when swearing, because he dislikes himself for being stupid.

But he quickly broke away from some depressing mood and asked, "Boss Zheng, what do you think of the patient's condition?"

"Not optimistic. A CT can't explain anything. I guess an MRI is needed. The tendons and the like are almost corroded. The hand department is in big trouble this time."

Zheng Ren said with a sigh.

so heavy? ! Zhou Litao was stunned.

But when the video didn't come back, they were all guesses. They chatted casually for a while, until Zhou Litao's cell phone rang, and the doctor in the CT room said that the video had been uploaded.

Zheng Ren sat in front of the computer, searched for the patient's name, and opened the CT image.

The patient had a 3×4cm abscess under the skin of the left wrist, the tendon had been eroded, and even the radius and ulna had been violated.

Sure enough, it was a big trouble, and Zhou Litao was once again convinced by Boss Zheng's diagnosis.

"We're going back first, and you can explain to the patients when they come back later." Zheng Ren said, "Send it to the hand department, consult the infection department first, and control the inflammation..."

"Normal diagnosis and treatment process, do you still need to talk about it? You really think of yourself as the director of hand surgery." Su Yun interrupted Zheng Ren's words, and said contemptuously.

Yes, Zheng Ren smiled.

"Boss Zheng, do you think the patient will recover?" Zhou Litao asked.

"Let's talk about it after four or five operations. Chronic ulcer repair, tendon anastomosis, median nerve release, partial skin flap repair, negative pressure sealing drainage, and then we can see the effect."

Uh... an invisible wound can actually induce such a serious illness! Zhou Litao was a little terrified.

"It's nothing, do you know what is the most common infection route of Mycobacterium marinum?" Su Yun asked.

Zhou Litao shook his head.

"Cut vegetables in the kitchen, and then change the water for the fish tank. The boss first asked if he had fish at home, and then asked if he had traveled before." Su Yun said.

"Then why not chop vegetables?" Zhou Litao asked in a daze, still immersed in the bunch of spells Boss Zheng said.

Afterwards, he saw Su Yun's gaze behind the black hair on his forehead, and scolded himself in his heart. It is said that there is no wound, so this infection route is directly ruled out.

What's wrong with him, he was absent-minded, Zhou Litao first did self-reflection.

"Tell him to go for surgery as soon as possible. There are two most serious things in this disease—amputation and skin cancer." Zheng Ren stood up and left, leaving a last sentence.

Zhou Litao nodded again and again. These two points are very important, but there is no delay.